Blockchain is a distributed, immutable ledger technology introduced as the enabling mechanism to support cryptocurrencies. Blockchain solutions are currently being proposed to address diverse problems in different domains. This paper presents a scoping review of the scientific literature to map the current research area of blockchain applications in the biomedical domain. The goal is to identify biomedical problems treated with blockchain technology, the level of maturity of respective approaches, types of biomedical data considered, blockchain features and functionalities exploited and blockchain technology frameworks used. The study follows the PRISMA-ScR methodology. Literature search was conducted on August 2018 and the systematic selection process identified 47 research articles for detailed study. Our findings show that the field is still in its infancy, with the majority of studies in the conceptual or architectural design phase; only one study reports real world demonstration and evaluation. Research is greatly focused on integration, integrity and access control of health records and related patient data. However, other diverse and interesting applications are emerging, addressing medical research, clinical trials, medicines supply chain, and medical insurance.

Blockchain Applications in the Biomedical Domain: A Scoping Review.

Primary care is challenged to provide high quality, accessible and affordable care for an increasingly ageing, complex, and multimorbid population. To counter these challenges, primary care professionals need to take up new and innovative practices, including eHealth. eHealth applications hold the promise to overcome some difficulties encountered in the care of people with complex medical and social needs in primary care. However, many unanswered questions regarding (cost) effectiveness, integration with healthcare, and acceptability to patients, caregivers, and professionals remain to be elucidated. What conditions need to be met? What challenges need to be overcome? What downsides must be dealt with? This first paper in a series on eHealth in primary care introduces basic concepts and examines opportunities for the uptake of eHealth in primary care. We illustrate that although the potential of eHealth in primary care is high, several conditions need to be met to ensure that safe and high-quality eHealth is developed for and implemented in primary care. eHealth research needs to be optimized; ensuring evidence-based eHealth is available. Blended care, i.e. combining face-to-face care with remote options, personalized to the individual patient should be considered. Stakeholders need to be involved in the development and implementation of eHealth via co-creation processes, and design should be mindful of vulnerable groups and eHealth illiteracy. Furthermore, a global perspective on eHealth should be adopted, and eHealth ethics, patients' safety and privacy considered.

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SERIES : eHealth in primary care. Part 1: Concepts, conditions and challenges

Towards a GDPR compliant way to secure European cross border Healthcare Industry 4.0

Recent advances in communication technologies and the Internet-of-Medical-Things (IOMT) have transformed smart healthcare enabled by artificial intelligence (AI). Traditionally, AI techniques require centralized data collection and processing that may be infeasible in realistic healthcare scenarios due to the high scalability of modern healthcare networks and growing data privacy concerns. Federated Learning (FL), as an emerging distributed collaborative AI paradigm, is particularly attractive for smart healthcare, by coordinating multiple clients (e.g., hospitals) to perform AI training without sharing raw data. Accordingly, we provide a comprehensive survey on the use of FL in smart healthcare. First, we present the recent advances in FL, the motivations, and the requirements of using FL in smart healthcare. The recent FL designs for smart healthcare are then discussed, ranging from resource-aware FL, secure and privacy-aware FL to incentive FL and personalized FL. Subsequently, we provide a state-of-the-art review on the emerging applications of FL in key healthcare domains, including health data management, remote health monitoring, medical imaging, and COVID-19 detection. Several recent FL-based smart healthcare projects are analyzed, and the key lessons learned from the survey are also highlighted. Finally, we discuss interesting research challenges and possible directions for future FL research in smart healthcare. 

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Federated Learning for Smart Healthcare: A Survey

On an EU level, the topic of electronic health data is a high priority. Many projects have been developed to realise a standard health data format to share information on a regional, national or EU level. All the projects favour and contribute to the development and improvement of the prerequisites for intra- and cross-border patient mobility. This work presents a new approach for the implementation of disruptive logging: an audit mechanism for cross-border exchange of eHealth data on OpenNCP, providing traceability and liability support within the OpenNCP infrastructure. Relevant parties could be legally obliged to keep a log of all privacy-critical operations performed by OpenNCP users.

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Blockchain-Based Logging for the Cross-Border Exchange of eHealth Data in Europe

An OpenNCP-based Solution for Secure eHealth Data Exchange

Allowing cross-border health-care data exchange by establishing a uniform QoS level of health-care systems across European states, represents one of the current main goals of the European Commission. For this purpose epSOS project was funded with the objective to overcome interoperability issues in patients health information exchange among European healthcare systems. A main achievement of the project was the OpenNCP platform. Settled over the results of the epSOS project, KONFIDO aims at increasing trust and security of eHealth data exchange by adopting a holistic approach, as well as at increasing awareness of security issues among the healthcare community. In this light, the paper describes the KONFIDO project’s approach and discusses its design and its representation as a system of interacting agents. It finally discusses the deployment of the provided platform.

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Luigi Castaldo

Papers

An OpenNCP-based Solution for Secure eHealth Data Exchange

KONFIDO: An OpenNCP-Based Secure eHealth Data Exchange System