The Journal of Community Health Management 2024;11(2):71–87

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The Journal of Community Health Management

Journal homepage: https://www.jchm.in/

Review Article
Block chain technology for e-health

Mohammed Sanusi Sadiq 1, I. P. Singh 2, N. Karunakaran 3 *, M. M. Ahmad 4,

B. Maryam 5
1 Dept. of Agricultural Economics and Extension, FUD,, Dutse, Jigawa, Nigeria
2 Dept. of Agricultural Economics, SKRAU, Bikaner, Rajasthan, India
3 People Institute of Management Studies (PIMS), Kasaragod, Kerala, India
4 Dept. of Agricultural Economics and Extension, BUK, Kano, Nigeria
5 MCA-Google Apps, Suresh Gyan Vihar University, Jaipur, Rajasthan, India

ARTICLE INFO ABSTRACT

Article history: There is a dearth of interoperability between apps, data streams, and predictability in the healthcare industry
Received 29-05-2024 for a significant amount of the data generated by multiple digital ecosystems. Real-time data streams can
Accepted 03-06-2024 be derived as meaningful and scalable enough to enable real-time healthcare predictive analytics thanks to
Available online 20-07-2024 the new technology approach in distributed messaging and Blockchain, which has become a fundamental
component of many healthcare technology stacks. Additionally, absorbing data streams from multiple
sources from patterns of data can enhance models that are hampered by complex and lengthy analyses
Keywords:
by raising the level of prediction and accuracy. Improved responses, lowered availability requirements,
Information and communication and unified predictive modeling will speed up healthcare interoperability and, in turn, improve diagnosis
technology (ICT accuracy, move evidence-based medicine (EBM) in the right direction, and produce other positive effects
Evidence-based medicine (EBM)
on healthcare that improve best results and quality.
e-health systems (EHS)
This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons
Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon
the work non-commercially, as long as appropriate credit is given and the new creations are licensed under
the identical terms.
For reprints contact: [email protected]

1. Introduction more prevalent and claim a great number of lives. 2 The

well-being of patients is regularly monitored and observed
The provision of health services is one of the most
by a sizable number of medical professionals, therapists,
important fundamental human rights. In order to provide
nurses, and other employees. 3 Chronically ill patients are
medical services to people, a variety of health institutions,
routinely watched over and evaluated. Various healthcare
including hospitals, clinics, and pharmacies, are well-
monitoring systems have been developed over the past
equipped. Information and communication technology
few years and are now being used to gather, process, and
(ICT) development has paved the path for the integration
evaluate data obtained from sensing devices. 4
of wearable sensors with physical equipment. 1 The efficient
One of the best uses of smart technology and networks
and effective collecting, processing, and creation of data
like the Internet of Things (IoT) is e-health systems
over a vast network is made possible by the employment of
(EHS), which offer individuals vital, permanently altering
software and technological devices. Even though there are
services. 5 People are feeling the effects of these services
numerous medical facilities, fatal illnesses, including heart
not just in developed urban areas, but also in rural and,
disease, cancer, the flu, and pneumonia, have become much
notably, in developing nations. According to statistics,
* Corresponding author. the worldwide e-health market increased tenfold between
E-mail address: [email protected] (N. Karunakaran). 2013 and 2018, with patients increasing from roughly 0.35

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2394-272X/© 2024 Author(s), Published by Innovative Publication. 71
72 Sadiq et al. / The Journal of Community Health Management 2024;11(2):71–87

million to 7 million, linked devices & services increasing will directly benefit from this because all service locations,
in value from 440.6 million to 4.5 billion, and a compound regardless of who owns them, will have easy access to
annual growth rate of 30.8%. 6 By 2025, there will likely be their medical information. With secure and automated data
75.44 billion IoT devices in use worldwide. To cut expenses analysis, blockchain helps build a system that creates and
and boost the standard of care, medical professionals are manages content blocks called ledgers. 10 The safe recording
increasingly using remote communications and monitoring and analysis of all health-related data will provide fast
technology. 7 The World Health Organization reports that updates for medical professionals, healthcare workers, and
87% of nations have already started to implement e-health payers. Incorporating AI algorithms into the blockchain, is
efforts, and it is anticipated that upcoming 5G technology advanced. 11 AI has started to learn and think like a clinician
will further boost this number. The necessity for automated, in order to understand health trends and patterns. It collects
effective, and unified e-health systems is highlighted by the unstructured data from a variety of sources, including the
fact that the skilled workforce (physicians) is not growing at patient, the radiologist, and the pictures (Figure 2).
such a rate (Figure 1).

Figure 1: Globalization of blockchain with IoHT

Due to their quick uptake and implementation, Internet

of Medical Things (IoMT) devices and networks play Figure 2: Blockchain applications in healthcare
a significant role in e-health systems. 8 The majority of
the time, healthcare professionals utilize them to monitor Building an e-health ecosystem at the national level is
patients remotely. IoMT includes body area and body fraught with two primary obstacles. 12 The first focuses on
sensor networks, which are made up of diverse devices the integration and interoperability of current independent
that produce multidimensional data. A person often uses healthcare service providers (i.e., hospitals, diagnostic
2-3 IoT devices in addition to IoMT devices, such as centers, primary health facilities, IoMT applications,
a smartphone with several sensors, a smartwatch, and insurance providers, etc.). The second relates to the first
possibly a smart fitness wearable. 8 Therefore, every patient service provider’s system’s many internal and external
who uses the EHS makes use of a significant number components having secure access to patient digital
of IoMT devices, some of which may have been created records. 12 The unified access control measures are made
by different manufacturers and may not adhere to any more difficult by the high size and amount of this data.
particular data storage standard. Because of this, the data The major goal of the entire national healthcare ecosystem
produced is highly heterogeneous and is typically stored in is to make it possible for different service providers to
Relational Databases (RDB) that support Structured Query exchange medical data, while keeping the technological and
Language (SQL) on a central server. Additionally, because administrative specifics of each process and treatment. 13
there are several independent e-health service providers in Furthermore, a gradual transition towards interoperability
real-world circumstances, a patient’s common history is is the only viable option rather than completely replacing
recorded on numerous different servers, which violates the the current systems. The format of digital assets, the
atomicity of data. 9 The information systems of these health structure of stored data, the application interfaces of
service providers must be consolidated or linked in order information management systems, the types of users, and
to create a national-level (or comparable) health service centralized/distributed networks, to name a few, are just
that can offer superior medical facilities. Data gathering a few of the concerns that must be taken into account
and analysis for illness prediction and prevention on a during the unification and integration at the national level
bigger scale will be improved by doing this since it keeps or even corporate level. 14 In the event that such unification
atomicity while also eliminating data redundancy. Patients takes place in a situation where a centralized system
 Sadiq et al. / The Journal of Community Health Management 2024;11(2):71–87 73

links various EHS and permits the exchange of patient on the principle of message dissemination. Simply said,
records (digital assets) among them, asset security and a transaction is a single operation performed across a
privacy become crucial. All users (such as patients and single node, and since nodes can communicate with one
doctors) might register on a separate system, and the role- another and move data from one node to another over a
based access control (RBAC) method could be used to network, this is possible. 21 Each node serves as a central
set access control policies. 14 However, under a unified hub during the transmission process and has the ability to
system, the same patient might go to another hospital whose create and digitally sign the transaction. In a peer-to-peer
doctor might not be known to the first service provider. network, each node must independently verify incoming
Access control consequently becomes quite challenging transactions for their legitimacy, compliance, and conflicts
in such circumstances. Similar to this, various users may with peers. All of them must be digitally signed and tested
have varied access privileges to data. For instance, a in order for the transactions that made it through the
doctor may have full access while a nurse may only verification procedure to enter the memory pool, a local
be able to view information on prescribed medications. 15 list of the nodes that are still tentatively designated as
Additionally, the incorporation of unaffiliated IoMT unconfirmed transactions. They are thereafter passed on
devices, like smartwatches and health monitors, uploads to their classmates. The orphan pool, which serves as a
the data to each server’s server. Passive privacy attacks temporary holding area, is where all rejected transactions
can compromise patient information in a number of ways, are put.
starting with device-level permissions, wireless access, and Cryptographic hashing is another principle that ensures
server interaction with the ecosystem. 16 The centralized a successful data transport or transaction. 22 The header of
structure of this approach will also always result in a single each data block must be cryptographically hashed using the
point of failure and scalability problems for massive data SHA-256 cryptographic hash technique. The parent block’s
and storage/access. hash is also included in the header. Each block contains
the hash of its parent to complete the linear list of blocks
2. Block Chain Principles and construct a sequence, forming a chain that goes all
the way back to the first block ever made. The genesis
Recent advancements in technology have made blockchain block refers to the first block in the chronology. The parent
(BC) a contender for systems that can offer unmatched (prior) block of information, including the timestamp (date-
security characteristics. 17 The history of Blockchain time), origin, and originator, is linked to each block in the
technology is attempted to be explained simply by a number blockchain. Figure 3 shows a condensed representation of
of definitions. A distributed system (distributed ledger) the blockchain.
organized into blocks and connected by nodes is one of
the most often used definitions of a blockchain. In order
to distribute encrypted data safely and instantly across the
chain of blocks in the blockchain, mathematical models are
used. 18 Therefore, in order to comprehend the definition
of blockchain, it is first necessary to take into account the
following fundamental concepts.
The phrase "distributed system" has been around for a
while in computer jargon and refers to an earlier notion
of a computer network where each computer operates
independently and is dispersed across a region. 19 Messages
are passed between computers (referred to as "nodes") in
a system of numerous autonomous processes, which is
used a lot more frequently today. Decentralized refers to
the absence of a central organization or point of control
for transactions, identities, and data storage. The Block
merely symbolizes a file; it could be a text file (such
as a book chapter), a picture, a sample of a movie, a
spreadsheet, or any other type of structured data that
contains records that are storable and machine-readable. Figure 3: A condensed representation of blockchain
Information transmission is controlled through a chain-
like procedure created by the blocks’ connections to nodes Blockchain has mainly been used for cryptocurrency,
(hubs). 20 but it can also be used in other fields, including IoT, asset
Information, or data transmission that refers to one monitoring, access control, and corporate operations. 23
block is what transactions are in reality. They operate Additionally, the qualities of its immutability of ledger,
74 Sadiq et al. / The Journal of Community Health Management 2024;11(2):71–87

user anonymization, support for encryption, and validation point of worry in the application of this new technology is
through multi-peer consensus can be incredibly helpful the question of private versus public blockchain. Critique
for e-health systems. 24 A consensus process is used in on top of vulnerability is the first of them. Someone will
the peer-to-peer decentralized networking system known as eventually identify a flaw in the smart contract’s coding
blockchain to authorize any type of transaction. Between loop. In June 2016, this already occurred. 29 If a majority
two system users, a transaction might be the exchange of validators abide by the rules and establish a stronger
of information/data, digital assets, or cryptocurrencies. (also less expensive) immutability, such as one produced
Through a vote procedure among network peers, consensus by using the private blockchain, this or something like that
is the mechanism used to validate and legitimize a should be overridden. Additionally, the general public will
transaction so that it can be included in an immutable have more access to using a private blockchain. It will be
block. A pre-established smart contract (also known as helpful and acceptable as long as both or one achieves
chaincode) among the users who are transacting serves the fundamental requirements of data immutability, smart
as the foundation for the validation. The block in which contracts vulnerability preservation, and the preservation of
transactional data is stored is connected to the block before anonymous information during transactions by agreement
it in a chain structure by the hash value. 25 A single point with authentication. 30
of failure is removed by storing this structure in the ledger,
where every peer retains the same data. The potential for 4. E-Health and the Block Chain
malicious change after commit is also removed by the fact
that the data contained in blocks is both encrypted and A distributed database using state machine replication,
immutable. The majority of blockchain systems currently in the blockchain ensures the integrity and tamper-resistance
use are designed for cryptocurrency exchange or payments; of the transaction log through hash linkages between
as a result, they are unsuitable for tracking or exchanging blocks. 1 Atomic database changes, known as transactions,
digital assets. For complicated commercial applications that are grouped into blocks. In the context of decentralized
require business logic to be included in smart contracts, electronic currency, the blockchain concept was first
Ethereum and Hyperledger Projects (Fabric, Sawtooth, introduced for Bitcoin. Because of the success of Bitcoin,
Iroha) are more viable alternatives. In the blockchain, blockchain technology can be leveraged to provide secure
the ability to create transactions has an impact on access and reliable transactions across an unreliable network
control. The permissions of the participants to transactions without the need for a third party. On the fundamental
are determined by the smart contract in this predominantly building components of the blockchain, there have been
role-based system. 26 numerous reports. Blockchain is a logical collection
of blocks that each contain a list of accurate and
comprehensive transaction data. A chain is formed by
3. Block Chain: Private vs. Public
the blocks’ relationships (hash values) to one another. 31
Blockchain is a shared ledger: blockchain can be either The initial block is known as the block of genesis, and
a public or a private network from the perspective of the block that comes before a specific block is known
the authority because there are numerous parties involved as its block header. 15 Blockchain technology has become
in transactions exchanging the data that is headed by extremely popular and advanced to distribute safe and stable
cryptographic keys. 27 Depending on the technology you monitoring of medical records due to a growing interest in a
require, there is a significant difference. Additionally, it variety of applications, ranging from data storage, financial
depends on the guiding principle of not allowing anyone markets, computer protection, IoT, and nutritional science to
to make changes to your blockchain or those of a well- the healthcare industry and brain studies. By combining and
known and thoroughly vetted participant. The initial one, showing all real-time clinical records of a patient’s welfare
referred to as "public," refers to the connotation that people in a modern, secure healthcare setting, it might be a tool
frequently ascribe to the blockchain when they discuss it. 28 that, in theory, helps with individualized, trustworthy, and
This essentially means that anyone can read or write data safe treatment. 32
without specific authorization from a third party. This one The proposed solution assesses the patient’s general
is also referred to as a blockchain with no permissions. state, diagnosis, and recovery system using a blockchain
Despite the ease with which permission to use blockchain platform that focuses on concurrent execution and artificial
may be regulated, there is a larger chance that security will intelligence in healthcare networks. 33 Additionally, it
be compromised. The second, and undoubtedly most well- explores the pertinent surgical interventions by concurrent
known, is the private blockchain. It is a blockchain with operations and computational clinical decision-making
known participants that operate under permissions. In their studies to evaluate the standard of care for patients and
industrial group, for instance, they are trusted; therefore, the viability of diagnosis. The suggested technique has
many of the permission methods are not required. Legal been assessed in real-world and simulated healthcare
contracts are occasionally used to replace them. Another systems. Tagde et al. (2021) reported that Singh and Kim
 Sadiq et al. / The Journal of Community Health Management 2024;11(2):71–87 75

Figure 4: Health record management through blockchain technology

(2018) developed CHIE, a particular blockchain-oriented 5. The E-Health Solutions

healthcare knowledge-sharing network. The proposed
platform assesses the requirements for the exchange of 5.1. E-health security measures that are customary
health care data, particularly for personal health data
and electronic medical reports, and discusses a variety The majority of contributions focus on effective security
of other data types by integrating blockchains within and privacy assurance by incorporating additional processes
different sources. To ensure that the application met good into the current centralized architecture because it processes
criteria for validity and privacy, they coupled it with on- everything at a single location in the centralized architecture
chain and off-chain authentication mechanisms. The use (Sultanaet al., 2020). A three-factor authentication
of blockchain technology to exchange medical records technique employing both asymmetric and symmetric
and provide clinical staff, healthcare organizations, and crypto-systems was proposed as a way to meet most
patients with anonymity and protection can be considerably security requirements. The majority of these contributions
increased. 34 An analogous technique adopted by Cryan are key-based access control solutions (public/private
suggested a methodical and inventive architecture utilizing keys, biometric keys, etc.). The limits of three-factor key
blockchain technologies to secure private patient records, authentication-which is vulnerable to insider attacks-are
address fundamental data protection issues, and launch a discussed, and a novel three-factor system based on the
blockchain software framework for use across hospitals. discrete logarithm issue for elliptic curves is suggested. To
Blockchain technology has also shown enormous promise in propose a new system, which is more expensive than the
the medicinal and therapeutic fields. Even prior to starting previous one, the authors also included other discoveries
a clinical study or test, it may be able to store all clinical such as meaningless user identification, no session key,
approvals, schedules, and protocols on a blockchain through no mutual authentication, and impersonation assaults. One
the practical implementation of blockchain technologies. 35 person serves as both the data owner and the data retriever
This will improve the accuracy, security, timeliness, and in the system that Jeetand Kang (2020) presented, taking
transparency of crucial clinical trial-related information user-centric security concerns into consideration. To access
(Figure 4). or submit transactions, this scheme employs authentication
key agreement mechanisms. Numerous service providers
in an EHS frequently have access to the patient’s data. In
light of the problem, Ghazalet al.(2022) present multi-user
Searchable Encryption Schemes (SES), which are capable
of preventing data leaking. The strict consideration of data
76 Sadiq et al. / The Journal of Community Health Management 2024;11(2):71–87

encryption or storage security is not given, despite the Motwani (2022) proposes a BC-based continuous patient
authors’ main focus being on multi-user access control monitoring & data management. Core integration issues,
on cloud-based servers. The authors of (Abdellatifet al., digital asset management, access control to digital assets,
2021) suggest a SES-based EHS that supports encryption, and transaction/block size restrictions are not taken into
reoccurring data storage on the cloud, and multi-user account in these works (such as 1MB in Bitcoin).
access keys. Additionally, it is asserted that the monitoring
of distant patients and support for interoperability in 5.3. Access control with blockchain
intra-EHS services. Abdellatifet al.(2020) addresses
the difficulties that such centralized e-health systems Access control has been provided in a variety of domains
encounter. Interoperability makes it possible for EHSs to to some extent using BC. Meisami et al. (2021) describe
interchange data in a flexible manner, but it also raises a distributed key management architecture based on BC
issues with privacy leaks. The authors of (Velliyangiri et for cross-domain access that satisfies IoT access control
al., 2022) provide a hash-based dynamic privacy protection and fine-grained auditability. It suggests a key management
technique for biometric authentication. All transactional security access manager that is comparable to the peer
and authentication data are kept anonymous, yet they are of a general blockchain. The authors of Meisami et al.
all kept on a single server. The cloud-based access control (2021) provide a decentralized design for IoT application
system that is immune to inference attacks is discussed by access control, and BC is utilized for decentralization
the authors (Kondepogu and Andrew, 2022). For precise security. They make use of a delegation of permissions
access control, they provide a two-layer encryption system, system, in which a set of permissions is assigned to IoT
and to assure anonymity, they suggest a blind data retrieving users or devices and continually verified. Only permission
protocol. A smart card and password-authentication based delegation services based on the smart contract of the device
system has been presented in (Radjenovic, 2020) to owner are used by BC. However, because there may be
mitigate the denial of service (DoS) attack. Due to millions of IoT devices with various access requirements,
centralized storage, it tackles DoS difficulties; however, a making a smart contract for everyone would be expensive
multi-user authentication-based approach is not feasible. and inefficient.
The single point of failure and interoperability with various
EHS remain problems for all of the key-based security 5.4. Access control in EHS using blockchain technology
and privacy solutions mentioned here for a centralized
e-health system. E-health solutions built on the blockchain:
Certain specialized studies have concentrated on using BC
Research on the subject of blockchain and e-health has
to provide access control in EHS. Kadam and Motwani
been conducted, mainly with the goal of enhancing security
(2022) put forth a BC-based electronic health record
capabilities inside centralized e-health systems. The
(EHR) system that, by utilizing a collective authority,
research in (Kondepogu and Andrew, 2022) suggests a
enables interoperability and integrity of data records. The
pairing technique for data sharing in EHS utilizing BC,
abrupt changes in permits (and hence the use of smart
but it does not outline the whole architecture for IoMT
contracts), many EHS for the same patient, and massive
integration or unification at the federal level. Similar to
amounts of medical picture data are not taken into account.
Kayasthaet al. (2021), Chelladurai and Pandian(2022) give
Additionally, a private or consortium blockchain does
ideas about HoT devices and BC integration while Kadam
not require the usage of incentives for block creation.
and Motwani(2022) propose a BC-based continuous patient
For safe access to patient medical histories, authors in
monitoring & data management. Core integration issues,
Mukherjee et al. (2021) use BC. It demonstrates how
digital asset management, access control to digital assets,
doctors can access patient information and perform mutual
and transaction/block size restrictions are not taken into
authentication among patients with common conditions.
account in these works (such as 1MB in Bitcoin.
Using a keyword search & encrypted answer-based access
control mechanism, Mukherjee et al. (2021) proposes a BC
5.2. E-health solutions built on the blockchain based privacy-preserving EHR sharing protocol. But each of
Research on the subject of the blockchain and e-health these answers only deals with a single problem and offers a
has been conducted, mainly with the goal of enhancing fairly straightforward solution.
security capabilities inside centralized e-health systems.
The research in (Kondepogu and Andrew, 2022) suggests a 6. E-Health Block Chain Use Cases in Healthcare
pairing technique for data sharing in EHS utilizing BC, but it
6.1. Transparency in the supply chain
does not outline the whole architecture for IoMT integration
or unification at the federal level. Similar to Kayastha et Healthcare, like many other industries, places a premium
al. (2021), Chelladurai and Pandian (2022) gives ideas on the guarantee of medicinal commodities’ origins to
about HoT devices and BC integration while Kadam and establish their legitimacy. 36 Using a blockchain-based
 Sadiq et al. / The Journal of Community Health Management 2024;11(2):71–87 77

system, consumers can monitor products from the point 6.3. Electronic health records that focus on the patient
of manufacture to every stage of the supply chain,
providing them with complete visibility and transparency Healthcare experts, hospitals, and healthcare equipment
over the items they are purchasing. 36 This is a major have been the primary drivers of the need for a sharp
issue for the sector, particularly in developing nations increase in digital technology of medical health data
where fake prescription pharmaceuticals result in tens of over the past few years. 39 This is because digital
thousands of fatalities each year. Additionally, as more technology of this knowledge enables more accessible
telehealth monitoring is installed, its importance for medical communication and control and serves as the basis for
equipment is increasing quickly, piqued the curiosity of better and quicker decision-making. Electronic medical
dishonest actors. A well-known blockchain platform called records currently use blockchain technology in healthcare
MediLedger enables companies in the prescription drug in the highest numbers. 40 However, individuals leave their
supply chain to verify the legitimacy of medications, as well data fragmented across multiple institutions when life
as their expiration dates and other important details. circumstances isolate them from the data of one provider
through another, and as a result, they lose simple access to
historical data. Electronic health records (EHRs) are never
6.2. Smart contracts generated between numerous organizations to maintain
everlasting information. Since there is a critical need for
a novel approach to handling EHRs that enables patients
To preserve transparency across all phases of a medical
to share their current and traditional health data, several
study, smart contracts may also be used, repeated, and
researchers have raised the issue of blockchain application
then enforced. A blockchain, in the traditional sense, is
verification to protect the EHRs. A "MedRec" prototype
used to process a smart contract, which is a script. 19 It
makes use of unique blockchain benefits to handle security,
was found that malignant cells can be found and managed
honesty, and quick data sharing. It offers patients a full,
via a blockchain-based telemonitoring healthcare system
permanent background and works on a decentralized basis
for far-off patients. The proposed approach includes smart
to retain data and claims. It also gives patients quick and
contracts and blockchains, which are commonly utilized
simple access to their own clinical records across numerous
to ensure the confidentiality and authenticity of patient
providers and care facilities. 1 Medical papers would not be
data in highly developed hospitals and outpatient facilities.
preserved by "MedRec" or cause an adaptation period to
In a different study, a blockchain-based system called
start. It notifies the patient who is responsible for where the
Dermonet was offered as a way for patients to receive
form will go and stores a record label on a blockchain.
online dermatological consultations and teledermatology
monitoring. 37 Inadequate control over data, data provenance,
monitoring, and safety monitoring of medical information
On the other hand, a blockchain-based network called throughout the deployment of EHR are just a few of the
proactive aging encourages older individuals to lead serious problems associated with medical data exchange
active lives. Recall that chronic diseases (like cancer), during the implementation of EHR. MeD Share has
surgical operations, and aging may all benefit from the been made available as a safe blockchain framework for
use of blockchain technology as an effective and well- exchanging medical data between unreliable parties while
suited solution. Additionally, it might be possible for keeping in mind some restrictions. MeD Share can be used
pharmaceutical businesses, medication manufacturers, and by cloud service providers, doctors, and healthcare research
biomedical researchers to employ DNA knowledge stored organizations to share medical data and keep electronic
on blockchains to undertake enhanced global analysis at health records with high information authenticity, tailored
the genomic level. The blockchain should incorporate smart audit authority, and minimal possible dangers to data
contracts to make transactions between various parties protection and privacy. EHR typically contains extremely
considerably faster and more effective. 8 The concept private and crucial patient information that is shared for
was first presented by Nick Szabo in 1994. 1 In his effective diagnosis and treatment by doctors, neurosurgeons,
proposal, he defined a smart contract as "a process that healthcare providers, and scientists. 7 The majority of
enables computers to communicate and implement the professionals with the patient seem to notice things right
terms of a contract" and suggested converting contract away when a hospital visit starts. Without the requirement
clauses into code to eliminate the need for counterparties for laborious forms of pharmacological compromise,
to coordinate amongst groups. A smart contract has a medication errors, hypersensitivities, and medication
destination identification on a blockchain, as reported by solutions may be reasonably readily accommodated across
Tagde et al. (2021). By providing the blockchain address, blockchain records by useful patient-caring algorithms.
a smart contract can be rapidly generated for use in trade. Therefore, the application of blockchain innovation would
Depending on the information in the transaction, it is support better patient access to care, oversight of medical
manually executed on each network node separately. 38 records, faster validation of clinical knowledge, improved
78 Sadiq et al. / The Journal of Community Health Management 2024;11(2):71–87

surveillance, and more efficient care organization. manipulation to produce false results. It is equally important
that the supporting systems are extremely resilient to attacks
6.4. Verifying the credentials of medical staff that disrupt service in some scenarios where a connected
device may be relied upon in an emergency, such as warning
Similar to how they can be used to trace the origins an old person’s career that they have fallen or had a heart
of a medical good, cryptographic method can be used attack. In the field, IoT devices could be more securely
to track the experience of medical personnel. Credentials monitored with the help of blockchain technology because:
of staff members can be logged by reputable medical
facilities and healthcare organizations, which streamline
1. Using a unique hash function, personal information
the employment procedure for those organizations. Using
is preserved on the blockchain, and blockchain
the R3 Corda blockchain protocol, ProCredEx, a company
cryptography ensures that only people with the proper
based in the USA, has developed a system for verifying
permissions can access it. Any modification to the
medical credentials. 1 According to Tagde et al. (2021), the
source data will result in a new hash function, which
blockchain system has the following primary benefits:
can only be decoded into the original data by a user
1. Healthcare firms will be able to obtain credentials who is in possession of a specified set of cryptographic
more rapidly during the hiring procedure. keys.
2. A possibility for healthcare organizations, insurers, 2. Because doing so would require having access to all
and medical institutions to make money off of the stored copies, altering patient data once it has been
credentials information they already have on former recorded on the blockchain ledger (as a hash function)
and present personnel. is practically impossible.
3. Openness and guarantee for partners, such as
businesses that subcontract locum tenens or those 6.6. Tracking drugs and clinical trials
involved in developing virtual health care models, to
1. A medical strategy used to identify and prevent disease
inform patients of the qualifications of medical staff.
is clinical trials. To prevent and identify diseases,
The gathering, distribution, and dissemination of this highly numerous systems have been developed in recent
personal patient information to several entities could have years. 17 Data integrity, record-sharing, data privacy,
an impact on the patient’s care and carry serious dangers and patient enrollment are some of the weaknesses
to the patient’s welfare and background information. 8 Due in existing systems, which blockchain technology can
to a lengthy history of pre- and post-treatment, obey, address. The clinical healthcare systems listed below
and recovery, the incidence of such hazards may rise in offer data integrity and privacy. Healthcare is a token-
patients with chronic illnesses (such as leukemia and HIV). based system for tracking data on, among other things,
Maintaining a current medical background has, therefore, insurance providers, hospital staff, physicians, and
been very important. When Estonia pioneered the idea of health plans. Using smart contracts, the FHIRChain
keeping millions of medical records private while making smart health system enables the interchange of clinical
them accessible to insurance companies and medical healthcare data.
professionals at the same time in 2016, it established itself 2. The blockchain-based record-sharing tool Connecting
as the world leader in blockchain technology. 1 The express Care is similar and is available in numerous English
promise that patients can use this technology to create their cities. 1 Connecting Care is used in a diverse
own records may be the reason for the growth of blockchain healthcare organization to safeguard information about
technology in medicine globally. Any attempt at access hospitals and other medical record data. In order
or modification may be clearly identified and remembered to guarantee that only those with permission can
in the blockchain. This protects patient confidentiality and use the clinical system, it offers an access control
reveals any criminal activity, such as large-scale fraud or list. The implementation of blockchain smart contract
record tampering. functionality uses an Ethereum-based framework. The
Healthcare system uses an enrolling approach to sign
up a patient. The patient can enter their personal
6.5. Remote monitoring with IoT security
information into the system and the authorities have
One of the biggest advancements in digital health is the access to their medical records. 23 Blockchain-based
usage of remote monitoring technologies, in which all clinical settings will surely create new scientific
types of sensors detecting patients’ vital signs are used to potential for the advancement of medical research. On
help give healthcare practitioners improved visibility into the other hand, the dependable, secure, and scalable
patients’ health, enabling more proactive and preventative gathering, storing, and retrieval of these medical
care. 20 Health IoT security is a key worry, though, as it must studies in applications for precision medicine can
be kept secure and private while also guarding against data help create attractive potential for the diagnosis and
 Sadiq et al. / The Journal of Community Health Management 2024;11(2):71–87 79

treatment of illnesses. An online database could be

used for cognitive systems. Blockchain technology
may be used to process a digitized brain, and
neurotechnologies are still in the experimental phase.
Few companies have even announced a position for
blockchain technology.

7. Block Chain for the Healthcare Sector

Although the technology has been in use since 2009 and
is one of the key elements utilized to exchange the digital
currency Bitcoin, blockchain was a big topic in 2016. 24 The
system receives significant funding and attention from the Figure 5: Blockchain solution for interacting with drugs
National Health Information Technology Manager due to its
potential to solve numerous fundamental healthcare issues.
With the constantly evolving technological landscape, it to a chain. Each block includes information and data. 1
would be possible to govern and transfer electronic health Last but not the least, the chain is secured by encryption
records while maintaining confidentiality, interoperability, techniques, making it impossible to alter or modify. Due
a standardized shared infrastructure, and international to the decentralized nature of blockchain technology and
standards. 27 IT executives understand that their objective the several copies that exist on various servers, no one is
is to implement the right health IT trends and technologies able to change transaction data. Cybercrime is a threat to
as healthcare continues to advance relentlessly. To avoid data resources kept on centralized systems. As opposed
becoming early adopters of cutting-edge technology that to this, blockchain stores data in decentralized locations
jeopardizes a patient’s health, health IT administrators to guarantee its security and anonymity. 41 Blockchain
must exercise caution. One of the global industries with technology’s market worth significantly expanded during
the quickest growth is the pharmaceutical sector. It is the last few years. In comparison to all previous record-
a key factor in patient outcomes and helps get cutting- keeping methods, blockchain technology is more reliable
edge, possibly helpful therapies to market. It upholds the and secure. All nodes in the network share the same
standard and effectiveness of medical products sold under documents in this distributed ledger. By using blockchain
prescription to the general population. 32 Additionally, it technology to automate the conventional procedure, it is
facilitates the diagnosis and processing of sterile drugs, also used to boost efficiency and speed. Because it does
hastening the recuperation of patients. The majority of the not necessitate the purchase and sale of goods through
time, drug manufacturers struggle to quickly monitor their intermediaries, it also lowers expenses.
products, which may offer serious hazards by encouraging
counterfeit goods to undermine manufacturing or penetrate
the system for counterfeit pharmaceuticals. Its manufacture 7.1. Immutability
and dissemination, as a result, pose a serious threat to global The time stamping of a ledger, its connection to other
health, particularly in industrialized nations. For testing, ledgers, and its access to earlier documents form the
monitoring, and ensuring the manufacturing procedures of foundation of the blockchain data structure. Due to its
possible medications during their manufacture and research decentralized nature, the blockchain can be used to store any
and development (R&D), blockchain technology may be type of record in industries where legitimacy, authenticity,
the ideal option. 34 In this context, a long-term option for and auditability are crucial, including healthcare, banking,
preventing illicit substances could be an automated drug and supply chains. 42
management system (DDCS). Sanofi, Pfizer, and Amgen,
three major pharmaceutical corporations, launched a joint
7.2. Decentralized agreement
pilot initiative to examine and evaluate investigational drugs
utilizing a blockchain-based DDCS (Figure 5). 1 A blockchain’s resilience comes from its decentralization.
Blockchain, which may be configured to record online The two factors that prevent the blockchain from being
financial transactions in a safe and unchangeable manner, tampered with are encryption and immutability. However,
is essentially a distributed ledger (database). 33 Each it is a decentralized agreement that puts it into action. This
transaction on the blockchain is digitally signed by company will alter a blockchain where all networks are
participants to guarantee its security and legitimacy. controlled by a single entity or company. Just the blockchain
Consensus rules the distributed ledger’s operation (smart nodes who want to approve the activity are required. 43
contracts). Each transaction will be recorded in a block and Due to the fact that several parties with conflicting motives
validated by both parties in the ledger before being added must agree by means of decentralized consensus as to what
80 Sadiq et al. / The Journal of Community Health Management 2024;11(2):71–87

counts as a legal transaction, it is far more difficult to system for multi-party organizations. Recently, researchers
undermine the consistency of the blockchain. Because it is have looked into the potential of blockchain to create
highly unlikely that far more than 50 percent of the nodes a reliable, decentralized network for data sharing. To
would knowingly agree to corrupt the blockchain data in this encourage clients to keep their medical information up to
situation, numerous businesses running a few nodes each is date, a solution for doing so using a private blockchain
the most effective strategy. and the launch of the Healthcare Data Gateway (HDG)
Integrated incentives has been found. Individual healthcare information system
An individual member of the network must perform was proposed by Casado-Vara et al. (2018) as cited by
specific tasks, such as preserving data and validating Tagde et al. (2021) to be integrated into the distributed
transactions, in order for a blockchain to transform networks digital blockchain, where patient records are authenticated
into markets at a high level. The node is a distributed and stored openly. However, there are several drawbacks
ledger system that offers a secure, decentralized, distributed to blockchain technology in terms of where blockchain
information repository that is tamper-proofed, and it data is stored. 47 So far, there haven’t been many
generates some profit in proportion to the effort done attempts to leverage blockchain as a catalyst for reliable
to make up for that task. A community of untrusting healthcare networks. They employed digital currency and
people can work together and conduct business without blockchain to support the processing or governance of
the involvement of outside parties, thanks to the trustless the knowledge but rejected blockchain as a data layer.
method provided by blockchain. Additionally, it offers Monitoring and managing encrypted off-chain data was
a shared data archive in place of hierarchical records to be done using blockchain-based decentralized user
management for transaction processing, allowing each peer authentication. In the absence of precise clinical data in the
in the network to have a copy of mirrored data. Any blockchain, FHIRChain is a healthcare utilization paradigm,
consensus process is handled by the network for data and a health data-sharing mechanism managed through
replication, exchange, and synchronization between peers. a smart contract. Scalability, limited interoperability, a
The digital currency is built on a set of communication lack of blockchain developers, inadequate standards, high
protocols that allow for the shared management of energy consumption, and a lack of regulatory certainty
transactions among numerous computing devices that are are some of the issues the technology faces that have
spread out geographically. 44 delayed development. 13 Along with the difficulties in
Since its introduction in 2000, the term "blockchain e- using blockchain technology that have been described as
health" has become widely used in the healthcare sector follows, there are fundamental priorities in installing secure
to refer to information and communication technologies blockchain-based EHR systems. Adoption of blockchain
(ICT). Through the Internet and related technologies, it is facing difficulties, and deploying safe blockchain-based
can provide innovative solutions for the medical industry, EHR systems is a top priority (Figure 6).
including those for applications like medical informatics,
patient healthcare, healthcare practitioners, healthcare staff,
medicine, etc., related to clinical insurance and health
information. Patients can obtain their medical history and
information about care if knowledge or data are easily
accessible through increased software, applications, and
mobile devices. 45

8. Data Efficiency and E-Health System Security

To maintain the integrity, confidentiality, and dependability
of health records and health reports that include all wearable
sensor results and patient treatment records from service
facilities, the storage and management of medical details
require a uniform notion of access control, validation,
and immutability of data. 46 Role-based permission should
be required for data upload and processing due to the
sensitivity of the data and the privacy and confidentiality
involved in maintaining medical records. The requests can Figure 6: Security risks in conventional cloud-based electronic
medical records
be recorded and documented, and access can be gained to
the tracked data, using auditing mechanisms. Blockchain
provides an effective framework for creating a private/public
network with a secure information access management
 Sadiq et al. / The Journal of Community Health Management 2024;11(2):71–87 81

8.1. Security challenge 4. However, a rival party might utilize the privacy
protection system to carry out a criminal transaction.
8.1.1. System bugs The security of blockchain transactions in healthcare
1. Security weaknesses can be exploited by malicious applications may be restricted from the perspectives
software to build decentralized applications based on of legal traceability and accountability, ensuring the
the established blockchain. authority’s reliability.
2. In order to facilitate other crimes like identity theft and 5. The best way to keep track of a specific user and
data theft, these malicious assaults take advantage of gather all of his messages while maintaining the
security holes in the implementation of smart contracts. user’s sensitive information’s privacy is something that
researchers should investigate.
8.1.2. Secure blockchain deployment’s top priorities 6. From a development perspective, one interesting
The following three objectives must be met: research issue is how to increase privacy in a
blockchain with unreliable underlying assumptions
1. Privacy: The data is only accessible to authorized and cheap processing costs.
users. 7. A potential method for permitting an unreliable third
2. Dignity: Information must be accurate while in transit party to compute on patient data without violating their
and cannot be altered by an unauthorized organization. privacy is secure multiparty computing.
3. Accessibility: Services and information are not
unjustly withheld from legitimate users.
9.1. Scalability challenge
8.2. Confidentiality challenge 9.1.1. System bugs
1. Another issue with IoMT devices is their increased
8.2.1. System bugs overhead or processing resources due to their lack of
Presenting a framework for data privacy and integrity on scalability.
a blockchain-based EHR that makes use of cryptographic 2. This difficulty could lead to an increase in the overall
techniques is the key difficulty in ensuring patient data processing demands on the blockchain infrastructure.
privacy. 3. The issue becomes even more difficult when there
are many smart devices or sensors present because
1. By using his current account number, it is impossible
their computing power is inferior to that of a standard
to identify a specific patient thanks to this function. The
computer.
shortcomings in the safeguarding of patient data in any
4. Data latency and high processing power are caused
system like that should be fixed.
by the computationally intensive and high overhead
2. Since using blockchain-based frameworks within
bandwidth IoT devices in the blockchain network.
EHR requires a lot of computing power and takes a
5. These devices might not have the processing power
while to complete each task, patients ought to first be
necessary to use blockchain features, requiring them to
able to interchange their data with ease.
operate at subpar or even excessive speeds, preventing
3. Second, new patients must add a new node to the
them from running both their original software and
blockchain network, which calls for a number of steps
blockchain software at once.
to confirm the patient’s reliability.
9.1.2. A secure blockchain deployment’s top priorities
9. A Secure Block Chain Deployment’s Top Priorities
Studies are being conducted on the scalability of blockchain
For public blockchain privacy protection in healthcare in healthcare applications as the volume of medical data
applications, the following conditions must be satisfied: increases.

1. No links between transactions should be visible or 9.2. Interoperability challenge

accessible.
2. Only the parties involved in the transactions should be 9.2.1. System bugs
given access to their information. To meet the criteria 1. Blockchain interoperability is the ability to send data,
for data security, a healthcare application built on a conduct analyses, and handle allocations across several
private or consortium blockchain can put up an access blockchain networks without the use of a middleman
control policy. or central authority. The lack of interoperability may
3. In a public blockchain environment, the privacy make mass adoption all but impossible.
protection of transactions is a "double-edged sword." 2. Blockchain technology is decentralized and cloud-
On the one hand, a well-behaved patient wants to based, in contrast to the centralized local databases and
maintain the privacy of his identity and behavior. offline architecture used by current EHR solutions.
82 Sadiq et al. / The Journal of Community Health Management 2024;11(2):71–87

3. The creation of an efficient EHR system capable verified in one hour, even though five or six
of creating linkages and interoperability across both additional blocks must be included in the chain before
medical and scientific communities will be required confirmation. However, the majority of conventional
in order to move healthcare systems in this path and database systems only need a short while to confirm
include blockchain technology. a transaction.

9.2.2. Secure blockchain deployment’s top priorities 9.4.2. Secure blockchain deployment’s top priorities
1. Interoperability efforts to close the gap between 1. Less latency has been associated with blockchain-
various blockchains have increased, according to based Internet of Things devices, but it can also be used
researchers. Numerous them attempt to connect in other blockchain applications.
private networks to public blockchains or the other 2. A network with delay is necessary for the IoT network
way around. Prior strategies that focused on open since many devices are communicating with one
blockchains and cryptocurrency-related tools were another simultaneously.
ultimately less beneficial to corporate executives. 3. The consensus mechanism certifies each block’s
transaction, greatly reducing delays that would
9.3. Anonymity challenge otherwise negatively impact the performance of the
application.
9.3.1. System bugs
1. Bitcoin blockchain and Ethereum, which function 10. The Difficulties of Unifying Block Chain and
as public ledgers, need that all transactions be
E-Health
automatically available.
The application server, database, password protection, and
9.3.2. Secure blockchain deployment’s top priorities certification authority are all located in one location due
1. Rather than using usernames or passwords, the to the centralized architecture of existing independent e-
Ethereum network offers pseudo-anonymity. For health systems, which leads to a single point of failure. 24
instance, transactions are linked to addresses that are They are typically found on the same subnet, which is
public keys that are generated from user-held private vulnerable to attack, even though they are different physical
keys. devices. A solitary point of data leaking results from this
2. A user can verify a transaction using General as well. Transferring information is another crucial element
Ethereum, also called as zk-SNARKS (zero- because a patient can eventually visit several different care
knowledge succinct non-interactive proof of providers. The previous medical records are frequently
knowledge), without seeing the transaction’s unavailable since there is no direct linkage between the
underlying data or conversing with the user who various EHS. The cooperation between EHSs must take
aired it. place at a higher level of management and may be impeded
3. Zk-SNARKs, in the setting of a blockchain, enable by procedural and administrative concerns, despite the fact
participants to keep their payments confidential while that this activity can be automated. Last, but not least, all
still validating them in accordance with the network’s users have the same access to information because it is
consensus process. defined as a system component and not controlled by the
4. Once implemented, companies will be able to conduct patient. Although this is not a disadvantage, the patient
business on the same network as their rivals in should have full control over their information since they
complete secrecy while gaining access to the public are the owner of it. A blockchain-based e-health system can
Ethereum blockchain’s security. be built to address these problems. However, this movement
faces a number of difficulties, which are outlined below:
9.4. Latency challenge
1. Design: Resolving network type disparities since
9.4.1. System bugs different networks differ in their nature and
1. Blockchain integration into medical applications that architecture, such as whether they are centralized
demand real-time responses to situations and data may or decentralized.
be problematic because it will take time for consensus 2. Synchronization of transactions: While centralized
to form and transactions to be confirmed. Transaction systems handle transactions synchronously, several
latency is the amount of time it takes a blockchain to peers in the BC network handle huge concurrent
process a transaction. transactions.
2. For instance, the network must wait 10 minutes 3. Data atomicity: It can be difficult to maintain the
for each transaction to be confirmed on the bitcoin atomicity of earlier data. Medical information about a
blockchain. It is advised that each transaction be single patient is stored on numerous separate servers
 Sadiq et al. / The Journal of Community Health Management 2024;11(2):71–87 83

in various ways, with or without timestamps, and this review patient records and provide prompt medical
data may contain contradicting information. assistance. This clever e-health service makes it possible
4. Data migration: It is not possible to directly migrate for medical professionals to remotely monitor patients by
all old record to the BC system. Previous records with providing ambulatory care while at home, which not only
outdated timestamps cannot be accepted by BC ledger. streamlines the delivery of healthcare but also helps patients
Each new transaction must include a timestamp that is financially. 49 Additionally, the availability of full EHRs
up to date. in the cloud aids in tracking patient health and provides
5. Data types: Due to capacity restrictions, which include appropriate medical services throughout the diagnosis and
1MB for Bitcoin and 8MB for HDAc, adoption of treatment stages. Despite all these wonderful benefits, the
medical photos and documents in the BC block is trend toward storing EHRs in the cloud also presents
not possible. 26 However, with an e-health system, security issues that make it difficult to install e-health
substantial medical photos and documentation are apps there. 38 Secure EHR exchange between healthcare
always included in the data. Additionally, data can be providers and patients in mobile cloud environments is one
produced by various devices at various rates, such as of these security concerns. Without patients’ permission,
an IoMT sensor as opposed to an MRI. unauthorized parties may get harmful access to EHRs,
6. User types: Different user types have different needs which has a negative effect on the confidentiality, security,
for access management. A patient receives services and integrity of cloud-based e-health systems. Additionally,
from a variety of service providers, including doctors, patients can find it challenging to track and manage the
diagnostic facilities, nurses, and others, and each one cloud-based health records that are shared among healthcare
may have a different set of access requirements. providers. Therefore, it is vital to suggest effective access
7. Access limitation: It’s crucial to restrict a patient’s control measures for systems that share mobile cloud EHRs
access to their current provider. A patient may request (Figure 7).
that the previous doctor not access new information,
and this request may change regularly. Similar to that,
anonymization may be necessary before releasing the
data. As a result, capabilities for transaction generation
must be coupled with role-based access control.

11. IOT Data Sharing, Safeguarding, and

Confidentiality E-Health Records Using Block Chain
The use of blockchain technology to advance healthcare and
e-health services has recently attracted increasing interest. 27
With its decentralized and reliable nature, blockchain
has proven to have enormous potential in a number
of e-health industries, including the secure exchange of
Electronic Health Records (EHRs) and the management
of data access among numerous medical institutions. 42
Consequently, the implementation of blockchain technology Figure 7: Cloud-based architecture to implement electronic health
can offer potential solutions to simplify healthcare delivery record (EHR) system
and radically alter the healthcare sector. Electronic health
records (EHRs) are increasingly being stored in mobile A patient’s medical information is preserved in digital
cloud environments, which merge mobile technology with form as a medical health record (MHR). Electronic
cloud computing to make it easier for patients and healthcare records are becoming increasingly important
healthcare professionals to share medical data. With the in the modern world of data and technology in the
help of this cutting-edge strategy, healthcare services are medical industry. 37 However, there are issues with patient
made available along with EHRs and minimal operational medical health reports’ confidentiality and privacy. By using
costs. 36 The introduction of cutting-edge technologies like Ethereum blockchains and cloud-based technologies, which
Mobile Cloud Computing (MCC) and the Internet of connect patients and doctors everywhere in the globe,
Medical Things (IoMT) has significantly altered how e- we can see that many people are striving to solve these
health operations are conducted in the healthcare sector. 48 problems. It gives patients complete control over their data
Patients can now gather their own personal health data access and allows them to authorize others to examine their
at home using mobile devices (such as smartphones and data. Today, we use our mobile devices to store our photos,
wearable sensors) and share it in cloud environments, videos, emails, and even financial services, but we remain
which healthcare professionals can instantly access to unable to keep our medical information safe because the
84 Sadiq et al. / The Journal of Community Health Management 2024;11(2):71–87

healthcare ecosystem is becoming more complex due to changing as technology advances. New opportunities are
the involvement of stakeholders in challenging and crucial also opening up for the management of health data.
data interactions. Privacy, data security, and operational Additionally, it is practical for patients to consult their
effectiveness may all suffer as a result. Because of this, medical records. Blockchain is a brand-new, revolutionary
the problem of information-related health interoperability technology that may be able to address the issue of digitized
is still open. When Nakamoto wrote a piece on Bitcoin data’ authenticity. Blockchain, however, is an expensive
in 2008, he first mentioned blockchain technology. It is a data storage technology, especially for large amounts of
network of peer-to-peer nodes that communicate with one information and digital content. For storing substantial
another. 40 Decentralized networks, distributed databases, volumes of data and content, we advise adopting an IPFS
enhanced security, and peer-to-peer transactions that can be system files. It is clear from a comparison of HTTP to IPFS
verified are some of blockchain’s key characteristics. As a that HTTP has many drawbacks, including centralization,
result, blockchain technology has the capability to safeguard inefficiency, and a lack of historical versioning. Thus,
patient information in the healthcare system. Blockchain is IPFS overcomes HTTP’s drawbacks. There are issues
an advanced data framework in which expanding records like inefficiency and bad system adaption since the
are kept in blocks, each of which has four components: numerous health record platforms are not created to meet the
information, the current block hash, the preceding block demands and requirements of patients. Additionally, they
hash, and the timestamp. As a result, each new block that contend that the usage of EHRs has had a negative impact
is added to the blockchain is linked to the one before it. This on how information is processed. Due to these problems,
ensures that the information integrity is maintained across it makes sense to look for a platform, such as blockchain,
the endpoints without the need for human intervention that may help transform the healthcare industry into one
by using a hash value that renders it immutable, time- that is patient-focused. 10 A platform that delivers integrity
stamping all workflow recordings to give them an identity, of data to the patients’ health records and is open, secure,
and distributing replicas to each network node that is a and reliable (Figure 8).
player. The InterPlanetary File System (IPFS) is a peer-to-
peer (P2P) bit torrent-like distributed storage technique that
intends to connect all digital devices to a single file system
of files, making it possible to store enormous amounts of
medical records. Just the hash address of the information
has to be kept in the blockchain network rather than the
patient’s medical records. 3 High-integrity digital content
that is accessible to everyone is stored using IPFS. There
is no one point of failure with IPFS because it is distributed.
For maximum bandwidth, IPFS also supports a content-
addressed block storage approach. The Internet of Things
(IoT) has been growing in popularity in recent years,
particularly in the healthcare industry. 6 The development of
IoT and wearable devices in the medical industry along with
the advancement of technology has enhanced the standard
of healthcare. Wearable technology collects patient health
information and gives it to hospitals or physicians. Critical
and sensitive medical data are produced by wearable IoT Figure 8: Secure and trustable electronic medical records sharing
devices. Because it is closely tied to a patient’s life, this using blockchain
information must be secured with great care. Blockchain is
a fantastic way to protect the medical data that these IoT The information is kept in a cloud with third-party
devices produce. reliance in the earlier EHR models. To secure medical
data, a key management system is used. A secret key is
Blockchain technologies were first used in Bitcoin, used to transfer the data between peers. However, most
where each block uses a hash value to link to earlier people just utilize one key to exchange data. Data can,
blocks. It denotes the transactions are unchangeable once therefore, be hacked or altered if the opponent knows the
they are created. Researchers and scientists are paying close key. Every workflow in the blockchain is given a time
attention to blockchains in the present era for a number stamp, an identity, and copies that are shared throughout
of reasons, including wireless network decentralization, all of the network’s nodes. Although blockchain has many
access control, data security, and privacy. With the benefits, it also has a few limitations that pose some
expansion of electronic health data and the regulation of domain-specific difficulties. Scalability, storage, anonymity,
patient data privacy, the healthcare environment is quickly customization, and legislation are the four primary problems
 Sadiq et al. / The Journal of Community Health Management 2024;11(2):71–87 85

and security issues, as does the logging of data transfers

(Figure 9). Blockchain technology has the potential to be
the answer for data privacy and security for health data; each
block comprises a Block Header, a Transaction, a Counter,
and a Transaction.

12. Conclusion
The cornerstone for digitalization that can touch millions
of lives will be blockchain-based technologies. Blockchain
enters the communication industry and digital healthcare
as a player thanks to its fundamental decentralized
information collection and decentralized database, and yet
communicating and dispensing information across networks
by certified users with the option to add and at the
same period avoiding data alteration. From the early
hype surrounding healthcare, it has recently emerged as
a viable technology that can enter the story of healthcare
interoperability. There are many aspirations and visions
Figure 9: Architecture of patient record sharing about how and what exactly this unique technology can
do for the interoperability of healthcare data. Our society’s
nervous system will be an innovative fusion of blockchain,
that blockchain systems must overcome. Here are a few smart contracts, and artificial intelligence, enabling us to
answers to the issues mentioned above: Instead of storing live longer, healthier lives. Although it has the potential to
personal information on the blockchain, IPFS can be close the interoperability gap, blockchain cannot yet do so.
used to store data, and the hash from IPFS will be kept In order to be technologically fit, hospitals around the world
on the blockchain. It keeps a pseudonymous record of need to modernize their infrastructure and add additional
personal information. The data is kept in the mentioned healthcare personnel. They won’t be able to converse in the
local database. Classical databases can be used to store same language or be functional unless they have that.
data, but since a single authority is in charge of large
volumes of information, one cannot be sure that the 13. Source of Funding
data is confidential, authentic, and trustworthy. A growing
None.
number of technological building blocks are connected
by cryptographic algorithms to form the blockchain. No
14. Conflict of Interest
centralized data repositories exist in this distributed ledger.
Ledger technology, which may be used to create distributed None.
smart contracts, eliminates the need for a middleman by
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Record and Share Patient Health Information: An Exemplary Case I. P. Singh, Professor https://orcid.org/0000-0002-1886-5956
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B. Maryam, Research scholar https://orcid.org/0009-0004-4782-4032

Author biography
Cite this article: Sadiq MS, Singh IP, Karunakaran N, Ahmad MM,
Maryam B. Block chain technology for e-health. J Community Health
Mohammed Sanusi Sadiq, Professor https://orcid.org/0000-0003- Manag 2024;11(2):71-87.
4336-5723