A Decentralized Privacy Preserving Healthcare Blockchain for IoT, Challenges, and Solutions

Introduction

There are many potential benefits in the digitization of the healthcare administrative system. In this way, the digital healthcare system encompasses many items of interest – for example, prescription service, records of individual consultation with a medical practitioner, clinical examination reports (e.g., X-ray, blood test, and other pathological assessments), and patient's personal information (e.g., name, date of birth, age, height, weight, sexual orientation). All this information medical staff put in a digital database, commonly known as electronic healthcare record (EHR). It also stores patients' medical history; this way, the healthcare record keeps track of medications advice and appropriate preventative step by step guidance given. In addition, the advantage of digital healthcare systems providing benefits to the current coronavirus (i.e., COVID-19) pandemic, where remote patient monitoring and other healthcare deliveries are increasing used to contain the spreading of the virus in the community (Chamola et al., 2020).

The EHRs are a digital edition of a patient's paper-based medical records and charts that ensure that information is available instantly and securely to healthcare practitioners (e.g., doctors, nurses, pharmacists). They contain the medical and treatment histories of patients. They can also store information beyond standard clinical data collected in a healthcare provider's service.

The Internet of Things (IoT) technology has been adapted to collect and process the high volume of data generated in healthcare services. This way, IoT covers various healthcare applications for information gathering and processing purposes. For example, the IoT links individuals, objects, and goods to give the ability to collect data from sophisticated sensors and actuators, each transmitting data to centralized storage (e.g., cloud servers). In addition, the IoT analytics tools exploit IoT data to turn them into ideas and practices to influence healthcare business services.

Moreover, healthcare providers (e.g., doctor surgery, hospital, care home) commonly use EHR systems to monitor the individual patient medication data using a client-server architecture (Grant et al., 2006). Academics and practitioners have created different service-oriented computing (SOC) architectures (Bahga & Madisetti, 2013) to provide a system to monitor patient-specific medical data from different organizations for smooth healthcare regular operations. These SOC based EHR systems become complex, assessing the importance of data security and privacy-related issues (Azaria & Ekblaw, 2016).

Although, research initiatives of effective ways to share healthcare data among clinics and hospitals started in the early 1960s (Kim et al., 2019). Flowed by decades of research efforts and experimental results, research prototypes using different methods and technologies have been consolidated. World standardization organizations started to make interoperable services to exchange healthcare data; and healthcare data is isolated in silos (Reisman, 2017). In addition, the EHR systems have become complex, assessing the importance of data security and privacy-related issues (Azaria & Ekblaw, 2016).

The EHR system needs to ensure the confidentiality of the stored data and information. At the same time, the availability and integrity of stored data are also essential to regular healthcare operations. It must also have appropriate end-user authorization facilities for healthcare staff (e.g., nurses and doctors). Medical practitioners must access individual patients' data to provide correct diagnoses and pass medication prescriptions to the pharmacy.

This way, the EHR data often need to cross-organization boundary, and there is an initiative by healthcare practitioners and related industries to improve the automated systems in healthcare to share information by integrating the healthcare enterprise (IHE, 2019). It is worth noting that the research community has invested a substantial number of resources in finding a solution for the IHE initiative in recent years. Besides, academics and practitioners are promoting the advantages of establishing standards to address specific clinical requirements to support effective patient care.