Integration of Blockchain and IoT for securing and exchanging health records Suela Maxhelaku1, Alda Kika1 and Ridvan Alimehmeti2 1 Tirana University, Faculty of Natural Sciences, Tirana, Albania 2 Neurosurgery University Service, Tirana, Albania Abstract In recent years, the healthcare industry has been on the forefront of adopting cutting-edge technologies in order to deal with data integrity, security of the information, interoperability and information sharing between patients and healthcare providers. This paper proposes a model to improve the Radiology Information System (RIS) by integrating blockchain technology and the Internet of Things (IoT). The integration of these technologies has the potential to improve patient care by ensuring real-time monitoring of patients, a secure and tamper-proof system, as well as secure management and exchange of patient data. In addition, this paper discusses the advantages of using blockchain technology and IoT in healthcare, as well as the ways in which these technologies can address the challenges that currently exist within healthcare systems. Keywords 1 Blockchain, IoT, Smart Contracts, Healthcare. 1. Introduction environment. However, despite these proposals, few blockchain-based projects have been implemented in the healthcare sector to date. [2] Health technologies have the potential to One of the most fundamental challenges that a enhance access to healthcare, address health modern healthcare management system must disparities and contribute to the overall health of overcome is the process of storing and the population [1] by ensuring that individuals transmitting data. In addition, several problems receive timely and appropriate medical care. exist with centralized EHR systems, such as According to the World Health Organization healthcare data breaching issues, a single point of (WHO), the majority of digital technology's failure, personal and sensitive personal potential uses for improving the health of information privacy concerns, and populations have not yet been explored and there interoperability issues with multiple systems and is a huge amount of potential for the data sources [3]. In addition, there are several implementation of digital health solutions, despite other challenges associated with healthcare the widespread use of digital technologies and the records, including access control, user trust, and fact that digital technology is the field where authentication.[4] [5] innovation is most evident. The adoption of digital health technologies has Meanwhile, blockchain technology has huge the potential to transform healthcare by enabling potential in the healthcare industry, especially in remote patient monitoring, improving patient health information exchange (HIE). According to outcomes, reducing healthcare costs, and securely many studies, blockchain-powered platforms can exchanging and storing health information. take the place of current HIE mechanisms because Meanwhile, IoT devices, including sensors and of their cost-effective, efficient, and secure Proceedings of RTA-CSIT 2023, April 26–27, 2023 Tirana, Albania EMAIL: suela.maxhelaku@fshn.edu.al; alda.kika@fshn.edu.al; ridvanalimehmeti@gmail.com; ORCID: 0000-0002-0695-4783 (S.M); 0000-0002-3598-7285 (A.K); ©️ 2020 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) wearables, have the potential to collect and a type of computer protocol that is executable via transmit real-time patient data, enabling the account. The deployment of smart contracts is healthcare providers to provide care that is both illustrated in Figure 1. [10] more individualized and more preventative with The policies and restrictions that are more information regarding the patient's current associated with privileges and services are state of health. However, implementing a client- outlined in the smart contract. Access control server architecture result in increased security policies are turned into smart contracts, and then risks, which can be mitigated by taking advantage the smart contracts are deployed on blockchain of blockchain technology, which implements a platforms, which offer a decentralized and distributed architecture. [6] tamper-proof network that ensures the contract is The use of blockchain technology has the executed in accordance with its rules. [11] potential to enhance the interoperability and security of healthcare data. Blockchain, which uses a decentralized and secure ledger system, can help ensure the privacy of patient data as well as the data's integrity, while also enabling the secure sharing of information. The findings indicate that blockchain technology has a wide variety of potential applications and uses within the healthcare industry.[7] The remainder of this study is organized as follows: In section 2, the principles of blockchain and IoT are discussed, as well as the significance of integrating IoT and Blockchain into healthcare. Figure 1: Smart contracts deploy and invoke process in Private Blockchain [10] Section 3 discusses the work related to the existing approaches for integration of Blockchain A blockchain network employs a consensus and IoT into healthcare. The proposed model algorithm to establish its level of trust and ensure based on the integration of blockchain, and IoT into the Radiological Information System is that transactions are recorded properly on blocks. In blockchain networks, some of the consensus proposed in Section 4. In addition, the conclusions algorithms that are used most frequently include as well as future work are presented in Section 5. Proof of Work (PoW), Proof of Stake (PoS), Delegated Proof of Stake (DPoS), and Practical 2. Background Byzantine Fault Tolerance (PBFT). [12] Decentralization, which represents the A blockchain is a digital ledger that serves as openness of blockchain technology as well as the a public, decentralized, and distributed database difficulty of avoiding being manipulated by that is managed by multiple participants across people, is an essential indicator of blockchain multiple nodes, where each node communicates technology. The Proof-of-Stake (PoS), and shares information through a peer-to-peer Distributed Proof-of-Stake (DPoS), and Casper (P2P) network.[8] The development of consensus algorithms are fully decentralized, blockchain technology as described in [9] whereas the Proof-of-Equity (PoET), and Raft describes the development of blockchain consensus algorithms are semi-decentralized. [13] technology, which includes the following stages: The Internet of Things (IoT) refers to a The first stage is Blockchain 1.0-Bitcoin, which collection of equipment, people, objects, and introduced the decentralization of virtual everything else that has the capacity to currency. The second stage is Blockchain 2.0— communicate and transfer data over a network Ethereum, which introduced smart contract without the intervention of any external agents. In authentication. The third stage is Blockchain the meantime, IoT presents users with a wide 3.0—IOTA, where IoT connectivity was variety of risks that endanger their privacy and established. security. Internet of Things vulnerabilities can In a private blockchain system, smart contracts lead to attacks on the integrity of data and are compiled using the Solidity programming equipment, as well as on users' privacy, network language, and each node represents a unique access, and service provisioning.[14] private blockchain account. The smart contract is 2.1 Importance of IoT and Blockchain Peer-to-peer network Network infrastructure security healthcare Smart Contracts Permissioned access to patient data The integration of blockchain with IoT Permissioned closed Data integrity applications in healthcare can help address some network of the key challenges related to trust, Shared real-time Collaboration confidentiality, integrity, and privacy of data.[15] updates to all members Their integration has the potential to bring Distributed, secure Patient health record significant changes to healthcare, such as better access outcomes for patients, lower costs, more Cryptography Protecting patient efficiency, better security, interoperability, and identity better coordination of care. IoT devices can be Disintermediation of Secure health data used to monitor patients in real time, and trust blockchain can ensure the integrity and privacy of Distributed framework Health information patient data. This can help reduce the risk of data exchange breaches and protect sensitive patient Disintermediation of Reduced transaction information. The decentralized architecture of transactions costs blockchain and a secure ledger system can help ensure the integrity and privacy of patient data. In addition, blockchain is used in integrating Blockchain technology has the potential to distributed health records in a unified, safe, and address some of the challenges facing the interoperable manner for use by health providers healthcare sector, as it can provide a secure and and patients, sharing of PHRs among health care tamper-proof environment [16] for storing and providers, with the possibility of knowledge and sharing sensitive healthcare data and ensure that consent of the patient [22]. patient health records are protected against In the current era of digital technologies, IoT unauthorized access and tampering through the has become an increasingly important component use of smart contracts. The use of smart contracts of smart healthcare, especially in light of the reduces the risk of tampering since their execution COVID-19 pandemic. Patients can benefit from is not dependent on any third party, nor can any the exceptional care made possible by the IoT, entity modify the rules defined in them.[17] which enables them to receive more targeted Additionally, blockchain technology can treatment [23]. facilitate interoperability among healthcare Figure 1 provides an overview of the general systems while offering patient-centered access architecture of EHR systems that are based on and allowing the users to exchange and share Blockchain technology and IoT [24]. health information in a standardized and secure manner, as the users can communicate with the blockchain only by using recognized interoperability standards such as FHIR, [18] as FHIR also improves the exchange of health care data as presented in our previous work in [19]. Blockchain offers numerous opportunities for usage in the healthcare sector, e.g., in public health management, user-oriented medical research based on personal patient data as well as drug counterfeiting [20]. Meanwhile, the advantages of using blockchain technology in healthcare are summarized in the following table [21]: Table 1 Blockchain Advantages in Healthcare [21] Figure 2: General EHR system architecture Blockchain Advantage in based on blockchain and IoT.[24] Feature Healthcare 3. Related works Gohar et.al proposed a Patient-Centric Healthcare Framework (PCH) using blockchain technology to protect health data sources, specifically by implementing a smart contract design on top of the Hyperledger blockchain platform on Amazon cloud to exploit smart contracts and blockchain access control capabilities for managing healthcare business and system integrity. Their study details the architectural design and implementation of data sharing design using Blockchain, Cloud, and IoT in healthcare systems [3]. Alam et.al proposed Blockchain based EHR framework that allows IoT device integration an can be upgraded to integrate with other healthcare facilities that need patient monitoring and personal health record integration. It consists of four layers as below [24] and presented in Figure Figure 3: General EHR system architecture 3: based on blockchain and IoT [24]. • EHR layer: Healthcare provider layer, healthcare providers share their records regardless of EHR storage type), 4. Proposed Model • Blockchain layer: An interface that translates records into a unified format In [26] we proposed a Radiology Information and uses IPFS storage to support System designed to assist physicians in managing interoperability. Smart contract, storage patient information. The system provides a user- policy, EHR manager, consensus friendly interface for storing and retrieving mechanism, and IPFS storage comprise relevant patient data, including techniques and the BC layer. results. In addition, the system is capable of • IoT-based patient monitoring layer: The displaying DICOM scan images of the patient, patient sensor layer to measures patient allowing for a comprehensive view of the patient's inputs medical history. • User Layer: Users interact with the In this paper, we propose to enhance the system. They can enter or view health system by incorporating blockchain technology information in a standard template and IoT. regardless of storage format. Blockchain technology can improve the security of the system by providing a Meanwhile in [25] is presented and the decentralized and tamper-proof record of all architecture of Blockchain-Assisted transactions and data exchanges. To ensure the Cybersecurity for the IoMT, which can overcome confidentiality of the information participants cybersecurity and privacy problems and share with one another, it is essential that they comprises of the following stages: authenticate one another using blockchain • Healthcare instrument state which is technology. Implementation of blockchain equipped with numerous IoMT healthcare technology can significantly enhance the level of instruments; trust and security associated with the exchange of • Blockchain state; information between parties. This step is essential • Edge network state; for ensuring the integrity and confidentiality of • Data synthesis state. the shared information. The use of smart contracts can guarantee that all participants with access to patient data are authenticated and authorized and granted access to the appropriate data and records. In addition, by integrating IoT devices, the [5] M. A. Sahi et al., “Privacy Preservation in patients can be monitored in real-time. This data e-Healthcare Environments: A Review,” can be transmitted in a secure manner to the RIS IEEE Access, 2017, doi: using blockchain technology. 10.1109/ACCESS.2017.2767561. [6] Azbeg K., Ouchetto O., Jai Andaloussi S. 5. Conclusion and Future work BlockMedCare: A healthcare system based on IoT, Blockchain and IPFS for data management security. This article presents a model that we proposed [7] Alhamzah F. Abbas, Naveed Akhtar with the intention of improving the Radiology Qureshi, Nohman Khan, Rabia Chandio, & Information System (RIS) by incorporating Javed Ali. (2022). The Blockchain blockchain technology and the Internet of Things Technologies in Healthcare: Prospects, (IoT). By integrating these technologies into the Obstacles, and Future Recommendations; system, we can guarantee real-time monitoring of Lessons Learned from Digitalization. patients, a secure and tamper-proof system, as International Journal of Online and well as the secure management and exchange of Biomedical Engineering (iJOE), 18(09), pp. patient data. 144–159. In our future work we will provide security https://doi.org/10.3991/ijoe.v18i09.32253 analysis of the proposed model. In addition, the [8] Odeh, A.; Keshta, I.; Al-Haija, Q.A. Analysis integration of Blockchain and IoT will require of Blockchain in the Healthcare Sector: further investigation in GDPR compliance, Application and Issues. Symmetry 2022, 14, resources constraints, bandwidth constraint, 1760. https://doi.org/10.3390/sym14091760 connectivity constraint and memory constraint [9] S. -J. Hsiao and W. -T. Sung, "Enhancing [24]. Cybersecurity Using Blockchain Technology Based on IoT Data Fusion," in IEEE Internet 6. 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