=Paper=
{{Paper
|id=Vol-3302/paper5
|storemode=property
|title=The Structure of the Blockchain-Based Multi-Agent System for Secure Management of Medical Information
|pdfUrl=https://ceur-ws.org/Vol-3302/paper3.pdf
|volume=Vol-3302
|authors=Tetiana Hovorushchenko,Vitaliy Osyadlyi,Peter Popov,Tetiana Kysil
|dblpUrl=https://dblp.org/rec/conf/iddm/HovorushchenkoO22
}}
==The Structure of the Blockchain-Based Multi-Agent System for Secure Management of Medical Information==
https://ceur-ws.org/Vol-3302/paper3.pdf
The Structure of the Blockchain-Based Multi-Agent System for
Secure Management of Medical Information
Tetiana Hovorushchenkoa, Vitaliy Osyadlyia, Peter Popovb and Tetiana Kysila
a
Khmelnytskyi National University, Institutska str., 11, Khmelnytskyi, 29016, Ukraine
b
City University of London, Northampton Square, London, EC1V 0HB, United Kingdom
Abstract
The state-of-the-art on known blockchain-based systems for secure management of medical
information, conducted in this paper, showed that none of the analyzed solutions satisfies all
combined necessary criteria. Therefore, it is necessary to design and implement a blockchain-
based system for the secure management of medical information that would satisfy all the
necessary criteria at the same time, which is the goal of this study. Since the designed
blockchain-based system for secure management of medical information must perform four
separate functions, when performing them, information and data will be exchanged, that is,
there will be interaction, it was decided to develop the blockchain-based system for secure
management of medical information as a multi-agent system. So, the paper developed a
blockchain-based multi-agent system for secure management of medical information, which
evaluates the medical information’s sufficiency before recording it in the blockchain (the
agent for evaluating the medical information’s sufficiency), entering information into the
blockchain and obtaining information from the blockchain (the agent for entering information
into the blockchain and obtaining information from the blockchain), evaluating the reputation
of a health care institution as a blockchain miner (the agent for evaluating the reputation of a
health care institution). Thus, the developed system satisfies all specified necessary criteria in
a complex. The considered examples of the work of proposed blockchain-based multi-agent
system for secure management of medical information showed that the proposed system can
significantly increase the security of medical information management, medical information
storage and medical information exchange, increase the protection of confidentiality of
medical information, thereby increasing the trust of the medical community in medical
information technologies and in clinical decision support systems.
Keywords 1
Blockchain, medical information, the agent for evaluating the medical information's
sufficiency, the agent for entering the information in blockchain and obtaining the
information from blockchain, the agent for evaluating the reputation of a health care
institution.
1. Introduction
The field of medicine, both in the world and in Ukraine, has high risks and stakes, is characterized by the
high cost of medical errors and the high dynamics of the course of diseases, insufficient information for
doctors to make decisions under strict time constraints, therefore it needs constant changes through
informatization and automation of routine processes, support medical decision-making. Exactly information
technologies and clinical decision support systems will help minimize the likelihood of medical errors and
IDDM’2022: 5th International Conference on Informatics & Data-Driven Medicine, November 18–20, 2022, Lyon, France
EMAIL: tat_yana@ukr.net (T. Hovorushchenko); vitalik9865@gmail.com (V. Osyadlyi); p.t.popov@city.ac.uk (P. Popov);
kysil_tanya@ukr.net (T. Kysil)
ORCID: 0000-0002-7942-1857 (T. Hovorushchenko); 0000-0001-7861-4684 (V. Osyadlyi); 0000-0002-3434-5272 (P. Popov), 0000-0002-
1091-3327 (T. Kysil)
©️ 2022 Copyright for this paper by its authors.
Use permitted under Creative Commons License Attribution 4.0 International (CC BY 4.0).
CEUR Workshop Proceedings (CEUR-WS.org)
provide effective care regardless of the burden on doctors. Information technology and clinical decision
support systems are a key factor in the success of medical research and health care industry [1-5].
But when using medical information technologies and clinical decision support systems, the
security of medical information and medical data should be taken seriously. The exchange of medical
information and data, in accordance with the law on medical confidentiality, requires increased
security requirements from medical organizations. Information and data used by health information
technology and clinical decision support systems may be vulnerable to leakage and falsification
during transmission, storage, and exchange. If medical information is stolen, deleted or distorted, it
can pose a serious threat to the patient's life and health. Unauthorized access to patient medical
records lead to a patient privacy’s breach. Currently, in the used medical information technologies and
clinical decision support systems, there is often a lack of transparency and the ability to check
permission to access medical information, consent to make changes to medical information.
Therefore, the protection of the confidentiality of medical information and the safe medical data
storage are decisive factors for the choice of medical information technologies and clinical decision
support systems. It is blockchain technology that can help in the safe management of medical
information and data, in ensuring the trust of the medical community, scientists and pharmacists in
medical information technology and clinical decision support systems, as well as in improving the
quality of healthcare data management.
Blockchain is a chain of blocks, each of which contains certain information that can be viewed, but
cannot be changed by any user [6]. The new block refers to previous block, thus creating a chain –
each block is connected to previous and next block. The rigid connection of blocks excludes the
possibility of inserting any data between two other blocks and/or changing the block [7].
A series of events must occur before a block of new information is written to the chain. First of all
is verification. Unlike classic transactions, transactions in the blockchain are approved by a computer
network of thousands and even millions of machines around the world. Second, after verification, the
information is sent to block with the time, date, digital signature of both parties and amount. And,
finally, the block receives a unique identification code, as well as the hash of the previous added to
the chain packet. Only after such hashing block with new information can be added to blockchain [8].
In this way, the blockchain is protected from unauthorized changes, and this is one of its main
advantages – immutability. Since the possibility of hacking by attackers is eliminated, a reliable
transaction ledger is created that network participants can trust. The key to the security of the
technology is that all network users are notified of any changes [9].
By joining the blockchain network, the user can be sure that he will always receive reliable and
timely information, and that his private blockchain records are only accessible to the network
members he chooses. A transaction requires the agreement of all participants on the accuracy of the
data, and records about all verified transactions are immutable – no one, not even a system
administrator, can delete a transaction [10].
So, blockchain is changing the way of storage and share of medical information by decentralizing
medical information, increasing the security, efficiency and transparency of information sharing.
Ensuring secure management of medical information based on blockchain technologies is currently an
actual task for Ukraine.
2. State-of-the-Art
Let’s conduct the state-of-the-art on known blockchain-based systems for secure management of
medical information. We are interested in whether the known blockchain-based systems provide an
evaluation of the medical information's sufficiency (such as the presence of all the necessary
information elements for entering information into the blockchain) before its entering into the
blockchain – criterion 1, whether they perform the entering information into the blockchain –
criterion 2, or whether they perform the obtaining information from blockchain – criterion 3, whether
they allow to evaluate the reputation of a health care institution (as a blockchain miner) – criterion 4.
The results of the state-of-the-art on known blockchain-based systems for secure management of
medical information are presented in Table 1.
Table 1
Known blockchain-based systems for secure management of medical information
Known blockchain-based systems Criteria for the known blockchain-based systems
1 2 3 4
The cloud architecture of blockchain-based no yes yes no
intelligent agents based on convolutional neural
networks for increasing the indicators of medical
data [11]
A system in which the blockchain consortium is no yes no yes
the middleware and the medical facilities are the
nodes of the platform [12]
Three-level medical data management system no yes yes no
based on blockchain technologies [13]
Architecture of medical data access control no yes no no
based on blockchain [14]
Scheme for sharing electronic medical records no yes yes no
based on hybrid blockchain architecture [15]
DynamiChain network service for the healthcare no yes yes no
industry [16]
SPChain blockchain network for supporting the no yes yes no
patients and medical institutions [17]
Methodology and information technology of yes no no no
evaluating the sufficiency of information [18-20]
Ontology-based intelligent agent for yes no no no
determination of sufficiency of information
[21, 22]
HerBChain – a blockchain-based informative no yes yes no
platform for herbal products’ assurance and
control [23]
Blockchain-based auditable access control no yes yes no
system for IoT environments’ private data
security [24]
Blockchain-based medical prescription system no yes yes no
[25]
HapiChain: A Blockchain-based framework for no yes yes yes
patient-centric telemedicine [26]
MedBlock: blockchain-based information no yes yes no
management system for handling the patients'
information [27]
Blockchain-based distributed democratized no yes yes no
electronic medical record sharing platform [28]
Blockchain-supported architectural framework no yes yes no
for control of health personal data security [29]
Blockchain-based architecture for the no yes yes no
international health record exchange platform
[30]
Blockchain-based e-Health framework for no yes yes yes
processing the patient medical records [31]
HealthChain: secure blockchain-based system for no yes yes yes
healthcare data management [32]
MEXchange: a privacy-preserving framework for no yes yes no
exchange of health information using the
blockchain [33]
IoT-based and blockchain-based management no yes yes no
system for medication adherence [34]
ACTION-EHR: blockchain-based patient-centric no yes yes no
management system for electronic health record
data [35]
MedChain: system for management of medical no yes yes yes
records access and permissions using the
blokchain [36]
Blockchain-based FHIRChain architecture using no yes yes no
digital health identities to authenticate
participants [37]
eHealthChain: blockchain-based management no yes yes no
system for personal health information and
health data from medical IoT devices and its
applications [38]
Blockchain-based communication system for no yes yes no
healthcare domain using patient-centric
approach [39]
SmartMedChain: blockchain-based smart no yes yes yes
framework for healthcare domain [40]
Blockchain-based healthcare system using no yes yes no
artificial intelligence [41]
Blockchain-based counterfeit medicine no yes yes no
authentication system [42]
Blockchain-based methods of management of yes yes yes no
medical data [2]
Decision support system for medical field yes no no no
considering legal grounds [1, 3]
The state-of-the-art on analyzed blockchain-based systems for secure management of medical
information, conducted in this chapter, showed that none of the analyzed solutions satisfies all 4
combined necessary criteria. Therefore, the design and implementation of a blockchain-based system
for the secure management of medical information, which would satisfy all the necessary criteria at
the same time, is the goal of our study.
3. Structure of the Blockchain-Based Multi-Agent System for Secure
Management of Medical Information
For solving the complex problems, multi-agent systems are often used, which consist of a set of
agents that perform separate functions and interact with other agents.
Multi-agent system is a system formed by several interacting agents. Multi-agent systems are used
to solve problems that are difficult or impossible to solve with a single agent or a monolithic system.
Agents of a multi-agent system must have the following important characteristics: autonomy – agents,
at least partially, are independent; limited representation (view) - none of the agents has an idea about
the entire system, or the system is too complex for the knowledge about it to be of practical use to the
agent; decentralization – there are no agents managing the entire system. The agents of a multi-agent
system exchange the acquired knowledge, obeying the established rules of "communication"
(protocols) in the system.
The advantages of multi-agent systems are the relative simplicity of developing individual agents,
interoperability, which allows adding new agents to the system as needed (including those developed
by independent developers), high adaptability.
Since the designed blockchain-based system for secure management of medical information must
solve three independent problems (evaluating the medical information's sufficiency, entering the
information in blockchain and obtaining the information from blockchain, and evaluating the
reputation of the health care institution), which are difficult to solve with a monolithic system. When
solving them, information and data will be exchanged. That is, there will be interaction, it was
decided to develop the blockchain-based system for secure management of medical information as a
multi-agent system – agents of such system (for evaluating the medical information's sufficiency, for
entering the information in blockchain and obtaining the information from blockchain, and for
evaluating the reputation of the health care institution) are independent, autonomy and decentralized,
and have limited representation.
The structure of the blockchain-based multi-agent system for secure management of medical
information is presented in Fig. 1.
So, our blockchain-based multi-agent system for secure management of medical information
consists of 3 agents. The work begins with the fact that blocks of medical information, which consist
of records, each of which, in turn, consists of the 3 elements - "type of information" (analyses,
fingerprints, etc.), "time of information (when the information was obtained), quality of information
(the validity period and relevance of information) are entered into the cloud environment. Before
recording any medical information in the blockchain, the medical information must be assessed for its
sufficiency – for this purpose, it is submitted to the input of the agent for evaluating the medical
information's sufficiency. Such an agent analyzes each of the N records of each block for the presence
in each record of the elements "type of information", "time of information", "quality of information",
and also counts the number of available elements in the block. Based on the received data, the
calculation of the quantitative assessment of the medical information's sufficiency in the block is
performed – by dividing the number of available elements in the block by 3*N. If the medical
information's sufficiency assessment for the block is 1, then the information in the block is enough
and it can be entered into the appropriate blockchain block, otherwise, if the medical information's
sufficiency assessment for the block is less than 1, then the information in the block is not enough, so
it is necessary to add the medical information and repeat verification of its sufficiency.
If the information is enough and can be entered into the blockchain block, then the information is
transferred to the agent for entering the information in blockchain and obtaining the information from
blockchain. For entering information into the blockchain, it is anonymized and encrypted, keys are
sent, and a message about entering information is generated. If not all instances of the register match,
then a refusal to write information to the blockchain is generated, otherwise a decision is made about
the possibility of adding medical information to the blockchain, after which the information is
checked by validators, and a service transaction is generated. If not all information has passed the
verification, then a refusal to write information to the blockchain is generated, otherwise the
information is entered into the blockchain.
The agent for entering the information in blockchain and obtaining the information from
blockchain is also responsible for issuing the information. If it is necessary to obtain information from
the blockchain, then a request to the validators is generated, the request is added by the validators, and
the validators notify the custodians that the keys should be provided. If permission is received,
information is issued.
The third agent of the blockchain-based multi-agent system for secure management of medical
information is the agent for evaluating the reputation of the health care institution. Reputation is an
important indicator because blocks are recorded by verified validators who are moderators of the
system. Exactly for determining such validators the reputation is valuable, because the blockchain
chooses a validator, which will record the next block, based on exactly reputation (the better the
reputation, the greater the chance of creating the next block).
Figure 1: The structure of the blockchain-based multi-agent system for secure management of
medical information
So, the scientific novelty of this paper is the developed blockchain-based multi-agent system for
secure management of medical information, which evaluates the sufficiency of medical information
before recording it in the blockchain (the agent for evaluating the sufficiency of medical information),
entering the information in blockchain and obtaining the information from blockchain (the agent for
entering the information in blockchain and obtaining the information from blockchain), evaluating the
reputation of a health care institution as a blockchain miner (the agent for evaluating the reputation of
a health care institution). Thus, the developed system satisfies all 4 specified necessary criteria in a
complex.
4. Results & Discussion
Let's consider examples of the work of the proposed blockchain-based multi-agent system for
secure management of medical information.
To implement the blockchain-based multi-agent system for secure management of medical
information in the form of a web service, the PHP programming language and the Symfony
framework with the MVC architecture were used.
For the first example, medical cards of the outpatients of the medical clinic of Ozerna microdistrict
(Khmelnytskyi, Ukraine) were used. The medical information for the first example is divided into 10
blocks, each of which consists of 20 records. The work begins with the fact that blocks of medical
information are entered into the cloud environment. Before recording any medical information in the
blockchain, the medical information must be assessed for its sufficiency – for this purpose, it is
submitted to the input of the agent for evaluating the medical information's sufficiency. Such an agent
analyzed each of the 20 records of each of the 10 blocks for the presence in each record of the
elements "type of information", "time of information", "quality of information", and also counted the
number of available elements in the block (so, each block consists of 60 elements). The result of the
analysis and calculation performed by the agent is represented in Table 2 (rows 2 and 3).
Since the second, third, fourth, seventh, and ninth blocks have medical information's sufficiency
assessment is 1, the information in these blocks is enough and it can be entered into the corresponding
blocks of the blockchain. Since for the first, fifth, sixth, eighth, tenth blocks, the medical information's
sufficiency assessment is less than 1, the information in these blocks is not enough, so it is necessary
to add the medical information of these blocks and recheck its sufficiency.
After adding the corresponding five blocks with information, the information was again evaluated
for its sufficiency – for this purpose, it was again submitted to the input of the agent for evaluating the
medical information's sufficiency. The result of such analysis is represented in Table 2 too (rows 4
and 5). Since the medical information's sufficiency assessment is 1 for the first, fifth, sixth, and tenth
blocks, the information in these blocks is enough and it can be entered into the corresponding blocks
of the blockchain. Since the medical information's sufficiency assessment for the fifth block is still
less than 1, the information in this block is still enough, so it is necessary to add the medical
information in this block and recheck its sufficiency.
After adding the corresponding block with information, the information was again evaluated for its
sufficiency – for this purpose, it was again submitted to the input of the agent for evaluating the
medical information's sufficiency. The result of such analysis is represented in Table 2 too (rows 6
and 7). Since the assessment of the medical information's sufficiency for the eighth block is 1, the
information in this block is enough and can be entered into the corresponding block of the blockchain.
Table 2
The result of the analysis and calculation performed by the agent for evaluating the medical
information's sufficiency for Example 1
Block 1 Block Block Block Block Block Block Block Block Block
2 3 4 5 6 7 8 9 10
Quantity of 59 60 60 60 30 48 60 10 60 50
elements in
block (initial)
Assessments 0.98 1 1 1 0.5 0.8 1 0.17 1 0.83
of the
medical
information's
sufficiency
(initial)
Quantity of 60 60 60 60 60 60 60 35 60 60
elements in
block (after
adding)
Assessments 1 1 1 1 1 1 1 0.58 1 1
of the
medical
information's
sufficiency
(after
adding)
Quantity of 60 60 60 60 60 60 60 60 60 60
elements in
block (after
second
adding)
Assessments 1 1 1 1 1 1 1 1 1 1
of the
medical
information's
sufficiency
(after second
adding)
So, now all 10 blocks of medical information are ready to be entered into the blockchain. The
information is transferred to the agent for entering the information in blockchain and obtaining the
information from blockchain. For enter information into the blockchain, it is anonymized and
encrypted, keys are sent, and a message about entering information is generated. Since all instances of
the register match, a decision was made about the possibility of adding medical information to the
blockchain, after which the information was checked by validators, and a service transaction was
generated. Since all the information passed the check, the information was entered into the
blockchain.
For the second example, laboratory data of visitors to the laboratory of the medical clinic of Ozerna
microdistrict (Khmelnytskyi, Ukraine) were used. The medical information for the second example is
divided into 7 blocks, each of which consists of 12 records. The work begins with the fact that blocks of
medical information are entered into the cloud environment. Before recording any medical information
in the blockchain, the medical information must be assessed for its sufficiency – for this purpose, it is
submitted to the input of the agent for evaluating the medical information's sufficiency. Such an agent
analyzed each of the 12 records of each of the 7 blocks for the presence in each record of the elements
"type of information", "time of information", "quality of information", and also counted the number of
elements present in the block (so, each block consists of 36 elements). The result of the analysis and
calculation performed by the agent is represented in Table 3 (rows 2 and 3).
Since for all seven blocks the quantitative assessments of the medical information's sufficiency are
less than 1, the information in these blocks is not enough, so it is necessary to add the medical
information of these blocks and recheck its sufficiency.
After adding the blocks with information, the information was again evaluated for its sufficiency –
for this purpose, it was again submitted to the input of the agent for evaluating the medical
information's sufficiency. The result of such analysis is represented in Table 3 too (rows 4 and 5).
Since the assessment of the medical information's sufficiency is 1 for the fourth, fifth, sixth and
seventh blocks, the information in these blocks is enough and it can be entered into the corresponding
blocks of the blockchain. Since for the first, second and third blocks, the assessment of the medical
information's sufficiency is still less than 1, the information in these blocks is still enough, so it is
necessary to add the medical information in these blocks and recheck its sufficiency. However, the
health care institution, after analyzing the findings, decided to upload medical information to the
blockchain without further adding.
Table 3
The result of the analysis and calculation performed by the agent for evaluating the medical
information's sufficiency for Example 2
Block 1 Block 2 Block 3 Block 4 Block 5 Block 6 Block 7
Quantity of elements in 15 12 14 20 18 8 10
block (initial)
Assessments of the 0.42 0.33 0.39 0.56 0.5 0.22 0.28
medical information's
sufficiency (initial)
Quantity of elements in 35 32 34 36 36 36 36
block (after adding)
Assessments of the 0.97 0.89 0.94 1 1 1 1
medical information's
sufficiency (after adding)
So, all 7 blocks of medical information were transferred to the agent for entering the information
in blockchain and obtaining the information from blockchain. For entering information into the
blockchain, it is anonymized and encrypted, keys are sent, and a message about entering information
is generated. Since all instances of the register match, a decision was made about the possibility of
adding medical information to the blockchain. Further, the information was checked by validators,
and a service transaction was generated. Since not all information passed the verification, as a result, a
refusal to write information to the blockchain was generated.
The aim of the considered examples is demonstration of the functioning of the proposed
blockchain-based multi-agent system for secure management of medical information, and
demonstration of the advantages of the proposed system. Accordingly, the considered examples
showed that the proposed system can significantly increase the security of medical information
management, medical information storage and medical information exchange, increase the protection
of confidentiality of medical information, thereby increasing the trust of the medical community in
medical information technologies and in clinical decision support systems.
As conducted in Chapter2 analysis showed, none of the analyzed solutions satisfies all 4 combined
necessary criteria (evaluation of the medical information's sufficiency, entering information into the
blockchain, obtaining information from blockchain, evaluation of the reputation of a health care
institution (as a blockchain miner)). Instead we proposed solution, which satisfies all 4 specified
necessary criteria in a complex: as the examples confirmed our system evaluates the sufficiency of
medical information before recording it in the blockchain, entering the information in blockchain and
obtaining the information from blockchain, evaluating the reputation of a health care institution as a
blockchain miner.
5. Conclusions
Blockchain is changing the way of storage and share of medical information by increasing the
security, efficiency and transparency of medical information sharing, decentralizing the medical
information. Ensuring secure management of medical information on the basis of the blockchain
technologies is an actual and currently task for Ukraine.
The state-of-the-art on known blockchain-based systems for secure management of medical
information, conducted in this paper, showed that none of the analyzed solutions satisfies all 4
combined necessary criteria. Therefore, design and implementation of a blockchain-based system for
the secure management of medical information, which would satisfy all the necessary criteria at the
same time, is the goal of our study.
Since the designed blockchain-based system for secure management of medical information must
perform four separate functions, when performing them, information and data will be exchanged, that
is, there will be interaction, it was decided to develop the blockchain-based system for secure
management of medical information as a multi-agent system.
So, the scientific novelty of this paper is the developed blockchain-based multi-agent system for
secure management of medical information, which evaluates the sufficiency of medical information
before recording it in the blockchain (the agent for evaluating the sufficiency of medical information),
entering the information in blockchain and obtaining the information from blockchain (the agent for
entering the information in blockchain and obtaining the information from blockchain), evaluating the
reputation of a health care institution as a blockchain miner (the agent for evaluating the reputation of
a health care institution). Thus, the developed system satisfies all 4 specified necessary criteria in a
complex.
The considered examples of the work of proposed blockchain-based multi-agent system for secure
management of medical information showed that the proposed system can significantly increase the
security of medical information management, medical information storage and medical information
exchange, increase the protection of confidentiality of medical information, thereby increasing the
trust of the medical community in medical information technologies and in clinical decision support
systems.
6. References
[1] T. Hovorushchenko, A. Herts, Ye. Hnatchuk. Concept of Intelligent Decision Support System in
the Legal Regulation of the Surrogate Motherhood. CEUR-WS 2488 (2019) 57-68.
[2] T. Hovorushchenko, A. Moskalenko, V. Osyadlyi. Methods of Medical Data Management Based
on Blockchain Technologies. Journal of Reliable Intelligent Environments (2022). doi:
10.1007/s40860-022-00178-1.
[3] T. Hovorushchenko, Ye. Hnatchuk, A. Herts, O. Onyshko. Intelligent Information Technology
for Supporting the Medical Decision-Making Considering the Legal Basis. CEUR-WS 2853
(2021) 72-82.
[4] M. Bogdan. Clinical Decision Support Systems: Do They Enhance Care and Cut Costs?, 2020.
URL: https://kindgeek.com/blog/post/clinical-decision-support-systems-do-they-enhance-care-
and-cut-costs.
[5] S. Khairat, D. Marc, W. Crosby, A. Sanousi. Reasons for Physicians Not Adopting Clinical
Decision Support Systems: Critical Analysis. JMIR Medical Informatics 6 2 (2018) No e24. doi:
10.2196/medinform.8912.
[6] Z Xu., C. Zou. What can blockchain do and Cannot do? China Economic Journal 14 1 (2021), 4-
25. doi: 10.1080/17538963.2020.1748968.
[7] W. Li, M. He, H. Sang. An Overview of Blockchain Technology: Applications, Challenges and
Future Trends, in: Proceedings of 2021 IEEE 11th International Conference On Electronics
Information and Emergency Communication, ICEIEC-2021, Beijing, 2021, pp. 31-39. doi:
10.1109/ICEIEC51955.2021.9463842.
[8] L. Yang. The blockchain: State-of-the-art and research challenges. Journal of Industrial
Information Integration 15 (2019), 80-90. doi: 10.1016/j.jii.2019.04.002.
[9] X. Li, P. Jiang, T. Chen, X. Luo, Q. Wen. A survey on the security of blockchain systems. Future
Generation Computer Systems – The International Journal of EScience 107 (2017), 841-853. doi:
10.1016/j.future.2017.08.020.
[10] A. Sanka, R. Cheung. A systematic review of blockchain scalability: Issues, solutions, analysis
and future research. Journal of Network and Computer Applications 195 (2021) No 103232. doi:
10.1016/j.jnca.2021.103232.
[11] S. Kim, J. Huh. Artificial Neural Network Blockchain Techniques for Healthcare System:
Focusing on the Personal Health Records. Electronics 9 5 (2020) No 763. doi:
10.3390/electronics9050763.
[12] Y.Chen, L. Meng, H. Zhou, G. Xue. A Blockchain-Based Medical Data Sharing Mechanism with
Attribute-Based Access Control and Privacy Protection. Wireless Communications & Mobile
Computing 2021 (2021) No 6685762. doi: 10.1155/2021/6685762.
[13] L. Zhang, M. Peng, W. Wang, Y. Su, S. Cui, S. Kim. Secure and Efficient Data Storage and
Sharing Scheme Based on Double Blockchain. CMC-Computers Materials & Continua 66 1
(2021) 499-515. doi: 10.32604/cmc.2020.012205.
[14] F. Chen, J. Huang, C. Wang, Y. Tang, C. Huang, D. Xie, T. Wang, C. Zhao. Data Access Control
Based on Blockchain in Medical Cyber Physical Systems. Security and Communication
Networks 2021 (2021) No 3395537. doi: 10.1155/2021/3395537.
[15] Y. Cao, Y. Sun, J. Min. Hybrid blockchain-based privacy-preserving electronic medical records
sharing scheme across medical information control system. Measurement & Control 53 7-8
(2020) 1286-1299. doi: 10.1177/0020294020926636.
[16] T. Kim, S. Lee, D. Chang, J. Koo, T. Kim, K. Yoon, I. Choi. DynamiChain: Development of
Medical Blockchain Ecosystem Based on Dynamic Consent System. Applied Sciences-Basel 11
4 (2021) No 1612. doi: 10.3390/app11041612.
[17] R. Zou, X. Lv, J. Zhao. SPChain: Blockchain-based medical data sharing and privacy-preserving
eHealth system. Information Processing & Management 58 4 (2021) No 102604. doi:
10.1016/j.ipm.2021.102604.
[18] T. Hovorushchenko, O.Pomorova. Methodology of Evaluating the Sufficiency of Information on
Quality in the Software Requirements Specifications, in: Proceedings of 2018 IEEE 9th
International Conference on Dependable Systems, Services and Technologies, DeSSerT-2018,
2018, pp. 385-389. doi: 10.1109/DESSERT.2018.8409161.
[19] T. Hovorushchenko. Information Technology for Assurance of Veracity of Quality Information
in the Software Requirements Specification. Advances in Intelligent Systems and Computing 689
(2018) 166–185. doi: 10.1007/978-3-319-70581-1_12.
[20] T. Hovorushchenko, O. Pomorova. Evaluation of Mutual Influences of Software Quality
Characteristics Based ISO 25010:2011, in: Proceedings of 2016 IEEE International Scientific
and Technical Conference “Computer Science and Information Technologies”, СSIT-2016, Lviv,
2015, pp. 80-83. doi: 10.1109/STC-CSIT.2016.7589874.
[21] T. Hovorushchenko, O. Pavlova, D. Medzatyi. Ontology-Based Intelligent Agent for
Determination of Sufficiency of Metric Information in the Software Requirements. Advances in
Intelligent Systems and Computing 1020 (2020) 447-460. doi: 10.1007/978-3-030-26474-1_32.
[22] T. Hovorushchenko, O. Pavlova. Evaluating the Software Requirements Specifications Using
Ontology-Based Intelligent Agent, in: Proceedings of 2018 IEEE International Scientific and
Technical Conference “Computer Science and Information Technologies”, СSIT-2018, Lviv,
2018, vol.1, pp.215-218. doi: 10.1109/STC-CSIT.2018.8526730.
[23] M. Yik, V. Wong, T. Wong, P. Shaw. HerBChain, a blockchain-based informative platform for
quality assurance and quality control of herbal products. Journal of Traditional and
Complementary Medicine11 6 (2021) 598-600. doi: 10.1016/j.jtcme.2021.07.005.
[24] D. Han, Y. Zhu, D. Li, W. Liang, A. Souri, K. Li. A Blockchain-Based Auditable Access Control
System for Private Data in Service-Centric IoT Environments. IEEE Transactions on Industrial
Informatics 18 5 (2022) 3530-3540. doi: 10.1109/TII.2021.3114621.
[25] J. Li. A New Blockchain-based Electronic Medical Record Transferring System with Data
Privacy, in: Proceedings of 5th International Conference on Information Science, Computer
Technology and Transportation, ISCTT-2020, Shenyang, 2020, pp. 141-147. doi:
10.1109/ISCTT51595.2020.00032.
[26] H. Kordestani, K. Barkaoui, W. Zahran. HapiChain: A Blockchain-based Framework for Patient-
Centric Telemedicine, in: Proceedings of IEEE 8th International Conference on Serious Games
and Applications for Health, SeGAH-2020, Vancouver, 2020. doi:
10.1109/SeGAH49190.2020.9201726.
[27] K. Fan, S. Wang, Y. Ren, H. Li, Y. Yang. MedBlock: Efficient and Secure Medical Data Sharing
Via Blockchain. Journal of Medical Systems 42 8 (2018) No 136. doi: 10.1007/s10916-018-
0993-7.
[28] P. Patel, S. Majumder, S. Shevkar, H. Shalu. EMRs with blockchain: a distributed democratised
electronic medical record sharing platform. Lecture Notes in Computer Science 12991 (2022)
16-26. doi: 10.1007/978-3-030-96527-3_2.
[29] S. Amofa, E. Sifah, K. Agyekum, S. Abla, Q. Xia, J. Gee, J. Gao. A Blockchain-based
Architecture Framework for Secure Sharing of Personal Health Data, in: Proceedings of 20th
IEEE International Conference on e-Health Networking, Applications and Services,
HEALTHCOM-2018, Ostrava, 2018. doi: 10.1109/HealthCom.2018.8531160.
[30] H. Lee, H. Kung, J. Udayasankaran, B. Kijsanayotin, A. Marcelo, L. Chao, C. Fisu. An
Architecture and Management Platform for Blockchain-Based Personal Health Record
Exchange: Development and Usability Study. Journal of Medical Internet Research 22 6 (2020)
No e16748. doi: 10.2196/16748.
[31] C. Agbo, Q. Mahmoud. Design and Implementation of a Blockchain-Based E-Health Consent
Management Framework, in: Proceedings of IEEE International Conference on Systems, Man,
and Cybernetics, SMC-2020, Electr. Network, 2020, pp. 812-817. doi:
10.1109/SMC42975.2020.9283203.
[32] T. Rahoof, V. Deepthi. HealthChain: A Secure Scalable Health Care Data Management System
Using Blockchain. Lecture Notes in Computer Science 11969 (2020) 380-391. doi: 10.1007/978-
3-030-36987-3_25.
[33] D. Lee, M. Song. MEXchange: A Privacy-Preserving Blockchain-Based Framework for Health
Information Exchange Using Ring Signature and Stealth Address. IEEE Access 9 (2021)
158122-158139. doi: 10.1109/ACCESS.2021.3130552.
[34] P. Pawar, C. Park, I. Hwang, M. Singh. Architecture of an IoT and Blockchain Based Medication
Adherence Management System. Lecture Notes in Computer Science 12616 (2021) 208-216.
doi: 10.1007/978-3-030-68452-5_22.
[35] A. Dubovitskaya, F. Baig, Z. Xu, R. Shukla, P. Zambani, A. Swaminathan, M. Jahangir, K.
Chowdhry, R. Lachhani, N. Idnani, M. Schumacher, K. Aberer, S. Stoller, S. Ryu, F. Wang.
ACTION-EHR: patient-centric blockchain-based electronic health record data management for
cancer care. Journal of Medical Internet Research 22 8 (2020) No e13598. doi: 10.2196/13598.
[36] E. Daraghmi, Y. Daraghmi, S. Yuan. MedChain: A Design of Blockchain-Based System for
Medical Records Access and Permissions Management. IEEE Access 7 (2019) 164595-164613.
doi: 10.1109/ACCESS.2019.2952942.
[37] P. Zhang, J. White, D. Schmidt, G. Lenz, S. Rosenbloom. FHIRChain: Applying Blockchain to
Securely and Scalably Share Clinical Data. Computational and Structural Biotechnology Journal
16 (2018) 267-278. doi: 10.1016/j.csbj.2018.07.004.
[38] P. Pawar, N. Parolia, S. Shinde, T. Edoh, M. Singh. eHealthChain-a blockchain-based personal
health information management system 77 1-2 (2021) 33-45. doi: 10.1007/s12243-021-00868-6.
[39] V. Naresh, S. Reddi, V. Allavarpu. Blockchain-based patient centric health care communication
system. International Journal of Communication Systems 34 7 (2021) No e4749. doi:
10.1002/dac.4749.
[40] D. El Majdoubi, H. El Bakkali, S. Sadki. SmartMedChain: A Blockchain-Based Privacy-
Preserving Smart Healthcare Framework. Journal of Healthcare Engineering 2021 (2021) No
4145512. doi: 10.1155/2021/4145512.
[41] A. Ali, M. Pasha, O. Fang, J. Ali, M. AlZain, M. Masud. Blockchain-Based Healthcare System
Using Artificial Intelligence. CMC – Computers Materials & Continua 71 2 (2022) 2721-2738.
doi: 10.32604/cmc.2022.019880.
[42] N. Alam, M. Tanvir, S. Shanto, F. Israt, A. Rahman, S. Momotaj. Blockchain Based Counterfeit
Medicine Authentication System, in: Proceedings of 11th IEEE Symposium on Computer
Applications and Industrial Electronics, ISCAIE-2021, Malaysia, 2021, pp. 214-217. doi:
10.1109/ISCAIE51753.2021.9431789.