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Secure and Trustable Electronic Medical Records Sharing using Blockchain
TL;DR: In this paper, a framework for managing and sharing electronic medical records (EMRs) for cancer patient care is proposed, which can significantly reduce the turnaround time for EMR sharing, improve decision making for medical care, and reduce the overall cost.
Abstract: Electronic medical records (EMRs) are critical, highly sensitive private information in healthcare, and need to be frequently shared among peers. Blockchain provides a shared, immutable and transparent history of all the transactions to build applications with trust, accountability and transparency. This provides a unique opportunity to develop a secure and trustable EMR data management and sharing system using blockchain. In this paper, we present our perspectives on blockchain based healthcare data management, in particular, for EMR data sharing between healthcare providers and for research studies. We propose a framework on managing and sharing EMR data for cancer patient care. In collaboration with Stony Brook University Hospital, we implemented our framework in a prototype that ensures privacy, security, availability, and fine-grained access control over EMR data. The proposed work can significantly reduce the turnaround time for EMR sharing, improve decision making for medical care, and reduce the overall cost
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TL;DR: This work created a system where sensors communicate with a smart device that calls smart contracts and writes records of all events on the blockchain, which would support real-time patient monitoring and medical interventions and automate the delivery of notifications to all involved parties in a HIPAA compliant manner.
Abstract: As Internet of Things (IoT) devices and other remote patient monitoring systems increase in popularity, security concerns about the transfer and logging of data transactions arise. In order to handle the protected health information (PHI) generated by these devices, we propose utilizing blockchain-based smart contracts to facilitate secure analysis and management of medical sensors. Using a private blockchain based on the Ethereum protocol, we created a system where the sensors communicate with a smart device that calls smart contracts and writes records of all events on the blockchain. This smart contract system would support real-time patient monitoring and medical interventions by sending notifications to patients and medical professionals, while also maintaining a secure record of who has initiated these activities. This would resolve many security vulnerabilities associated with remote patient monitoring and automate the delivery of notifications to all involved parties in a HIPAA compliant manner.
620 citations
TL;DR: There is a need for more research to better understand, characterize and evaluate the utility of blockchain in healthcare, and the state-of-the-art in the development of blockchain applications for healthcare, their limitations and the areas for future research are highlighted.
526 citations
TL;DR: A comprehensive survey on the literature involving blockchain technology applied to smart cities, from the perspectives of smart citizen, smart healthcare, smart grid, smart transportation, supply chain management, and others is provided.
Abstract: In recent years, the rapid urbanization of world’s population causes many economic, social, and environmental problems, which affect people’s living conditions and quality of life significantly. The concept of “smart city” brings opportunities to solve these urban problems. The objectives of smart cities are to make the best use of public resources, provide high-quality services to the citizens, and improve the people’s quality of life. Information and communication technology plays an important role in the implementation of smart cities. Blockchain as an emerging technology has many good features, such as trust-free, transparency, pseudonymity, democracy, automation, decentralization, and security. These features of blockchain are helpful to improve smart city services and promote the development of smart cities. In this paper, we provide a comprehensive survey on the literature involving blockchain technology applied to smart cities. First, the related works and background knowledge are introduced. Then, we review how blockchain technology is applied in the realm of smart cities, from the perspectives of smart citizen, smart healthcare, smart grid, smart transportation, supply chain management, and others. Finally, some challenges and broader perspectives are discussed.
472 citations
TL;DR: FHIRChain is a blockchain-based architecture designed to meet ONC requirements by encapsulating the HL7 Fast Healthcare Interoperability Resources (FHIR) standard for shared clinical data and a FHIR chain-based decentralized app using digital health identities to authenticate participants in a case study of collaborative decision making for remote cancer care.
Abstract: Secure and scalable data sharing is essential for collaborative clinical decision making. Conventional clinical data efforts are often siloed, however, which creates barriers to efficient information exchange and impedes effective treatment decision made for patients. This paper provides four contributions to the study of applying blockchain technology to clinical data sharing in the context of technical requirements defined in the "Shared Nationwide Interoperability Roadmap" from the Office of the National Coordinator for Health Information Technology (ONC). First, we analyze the ONC requirements and their implications for blockchain-based systems. Second, we present FHIRChain, which is a blockchain-based architecture designed to meet ONC requirements by encapsulating the HL7 Fast Healthcare Interoperability Resources (FHIR) standard for shared clinical data. Third, we demonstrate a FHIRChain-based decentralized app using digital health identities to authenticate participants in a case study of collaborative decision making for remote cancer care. Fourth, we highlight key lessons learned from our case study.
455 citations
01 Jun 2018
TL;DR: It remains to be seen whether blockchain can facilitate the transition from institution-centric to patient-centric data sharing, as this paper looks at barriers to blockchain-enabled patient-driven interoperability.
Abstract: Interoperability in healthcare has traditionally been focused around data exchange between business entities, for example, different hospital systems. However, there has been a recent push towards patient-driven interoperability, in which health data exchange is patient-mediated and patient-driven. Patient-centered interoperability, however, brings with it new challenges and requirements around security and privacy, technology, incentives, and governance that must be addressed for this type of data sharing to succeed at scale. In this paper, we look at how blockchain technology might facilitate this transition through five mechanisms: (1) digital access rules, (2) data aggregation, (3) data liquidity, (4) patient identity, and (5) data immutability. We then look at barriers to blockchain-enabled patient-driven interoperability, specifically clinical data transaction volume, privacy and security, patient engagement, and incentives. We conclude by noting that while patient-driving interoperability is an exciting trend in healthcare, given these challenges, it remains to be seen whether blockchain can facilitate the transition from institution-centric to patient-centric data sharing.
336 citations
References
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TL;DR: A new replication algorithm, BFT, is described that can be used to build highly available systems that tolerate Byzantine faults and is used to implement the first Byzantine-fault-tolerant NFS file system, BFS.
Abstract: Our growing reliance on online services accessible on the Internet demands highly available systems that provide correct service without interruptions. Software bugs, operator mistakes, and malicious attacks are a major cause of service interruptions and they can cause arbitrary behavior, that is, Byzantine faults. This article describes a new replication algorithm, BFT, that can be used to build highly available systems that tolerate Byzantine faults. BFT can be used in practice to implement real services: it performs well, it is safe in asynchronous environments such as the Internet, it incorporates mechanisms to defend against Byzantine-faulty clients, and it recovers replicas proactively. The recovery mechanism allows the algorithm to tolerate any number of faults over the lifetime of the system provided fewer than 1/3 of the replicas become faulty within a small window of vulnerability. BFT has been implemented as a generic program library with a simple interface. We used the library to implement the first Byzantine-fault-tolerant NFS file system, BFS. The BFT library and BFS perform well because the library incorporates several important optimizations, the most important of which is the use of symmetric cryptography to authenticate messages. The performance results show that BFS performs 2p faster to 24p slower than production implementations of the NFS protocol that are not replicated. This supports our claim that the BFT library can be used to build practical systems that tolerate Byzantine faults.
2,190 citations
TL;DR: Performance measurements of the experimental file system demonstrate the usefulness of proxy re-encryption as a method of adding access control to a secure file system and present new re-Encryption schemes that realize a stronger notion of security.
Abstract: In 1998, Blaze, Bleumer, and Strauss (BBS) proposed an application called atomic proxy re-encryption, in which a semitrusted proxy converts a ciphertext for Alice into a ciphertext for Bob without seeing the underlying plaintext. We predict that fast and secure re-encryption will become increasingly popular as a method for managing encrypted file systems. Although efficiently computable, the wide-spread adoption of BBS re-encryption has been hindered by considerable security risks. Following recent work of Dodis and Ivan, we present new re-encryption schemes that realize a stronger notion of security and demonstrate the usefulness of proxy re-encryption as a method of adding access control to a secure file system. Performance measurements of our experimental file system demonstrate that proxy re-encryption can work effectively in practice.
1,598 citations
01 Aug 2016
TL;DR: This paper proposes MedRec: a novel, decentralized record management system to handle EMRs, using blockchain technology, and incentivizes medical stakeholders to participate in the network as blockchain “miners”, enabling the emergence of data economics.
Abstract: Years of heavy regulation and bureaucratic inefficiency have slowed innovation for electronic medical records (EMRs). We now face a critical need for such innovation, as personalization and data science prompt patients to engage in the details of their healthcare and restore agency over their medical data. In this paper, we propose MedRec: a novel, decentralized record management system to handle EMRs, using blockchain technology. Our system gives patients a comprehensive, immutable log and easy access to their medical information across providers and treatment sites. Leveraging unique blockchain properties, MedRec manages authentication, confidentiality, accountability and data sharing -- crucial considerations when handling sensitive information. A modular design integrates with providers' existing, local data storage solutions, facilitating interoperability and making our system convenient and adaptable. We incentivize medical stakeholders (researchers, public health authorities, etc.) to participate in the network as blockchain "miners". This provides them with access to aggregate, anonymized data as mining rewards, in return for sustaining and securing the network via Proof of Work. MedRec thus enables the emergence of data economics, supplying big data to empower researchers while engaging patients and providers in the choice to release metadata. The purpose of this short paper is to expose, prior to field tests, a working prototype through which we analyze and discuss our approach.
1,578 citations
24 Oct 2016
TL;DR: This paper introduces a novel quantitative framework to analyse the security and performance implications of various consensus and network parameters of PoW blockchains and devise optimal adversarial strategies for double-spending and selfish mining while taking into account real world constraints.
Abstract: Proof of Work (PoW) powered blockchains currently account for more than 90% of the total market capitalization of existing digital cryptocurrencies. Although the security provisions of Bitcoin have been thoroughly analysed, the security guarantees of variant (forked) PoW blockchains (which were instantiated with different parameters) have not received much attention in the literature. This opens the question whether existing security analysis of Bitcoin's PoW applies to other implementations which have been instantiated with different consensus and/or network parameters. In this paper, we introduce a novel quantitative framework to analyse the security and performance implications of various consensus and network parameters of PoW blockchains. Based on our framework, we devise optimal adversarial strategies for double-spending and selfish mining while taking into account real world constraints such as network propagation, different block sizes, block generation intervals, information propagation mechanism, and the impact of eclipse attacks. Our framework therefore allows us to capture existing PoW-based deployments as well as PoW blockchain variants that are instantiated with different parameters, and to objectively compare the tradeoffs between their performance and security provisions.
1,258 citations
IBM1
TL;DR: In the early days of Bitcoin, the performance of its probabilistic proof-of-work (PoW) based consensus fabric, also known as blockchain, was not a major issue, and Bitcoin became a success story, despite its consensus latencies on the order of an hour and the theoretical peak throughput of only up to 7 transactions per second.
Abstract: Bitcoin cryptocurrency demonstrated the utility of global consensus across thousands of nodes, changing the world of digital transactions forever. In the early days of Bitcoin, the performance of its probabilistic proof-of-work (PoW) based consensus fabric, also known as blockchain, was not a major issue. Bitcoin became a success story, despite its consensus latencies on the order of an hour and the theoretical peak throughput of only up to 7 transactions per second.
956 citations