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Report for mini project. Blockchain technology used to solve issues of storing and using medical records
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A Mid-Phase Mini Project Report on
HEALTHDEMIC Submitted in partial fulfilment for the degree of Bachelor of Technology in Computer Science and Technology Submitted by Shruti Mishra (1812022) Satabdi Paul (1812033) Manjyot Gill (1812020) Under the guidance of Dr. Sanjay Pawar USHA MITTAL INSTITUTE OF TECHNOLOGY SNDT Women’s University, Juhu Tara Road, Santacruz West, Mumbai- 2020-
Approval Sheet This is to certify that Shruti Mishra, Satabdi Paul and Manjyot Gill have completed the Mid-Phase Mini Project Report on the topic “ Blockchain Solution to Health Care Record System” satisfactorily in partial fulfillment for the Bachelor’s Degree in Information Technology under the guidance of Dr. Sanjay Pawar during the year 2020-21 as prescribed by SNDT University. Guide Head Of Department Dr. Sanjay Pawar Dr. Sanjay Pawar Principal Dr. Sanjay Pawar Examiner 1 Examiner 2
The world's healthcare system is in disarray and needs to be repaired. Global health investment is forecast to rise to $18.28 trillion, according to the World Bank. Despite this, many people are unaware of how to stay safe and disease-free. Many developed countries lack even the rudimentary healthcare facilities and technology. Generic medicines, which are less expensive, do not always hit the people who need them the most. The times, however, are changing. Digital health technologies and preventive medicine are advancing at a rapid pace, and the average human lifespan is rising. Remote at-home testing and diagnostic devices are seeing rapid advances and will revolutionize convenient and accessible healthcare at home. We believe that lack of access to convenient personal healthcare services is a barrier to humans around the world, keeping them from having longer, healthier and happier lives. Beyond these challenges are opportunities. We are in a stage where large-scale incumbent healthcare providers, hospitals, technology firms and pharmaceutical companies are competing to control patients’ data in a centralized system for their own benefit. Naturally, this reduces the portability of data for patients and further entrenches the incumbents and solidifies their grip on patient data. Bowhead envisions a decentralized Blockchain-based health data repository controlled by the patient to ensure optimal security, portability and personal benefits. Healthdemic believes personalized, secure and high quality healthcare is possible for everyone.
Abstract i List of Tables iii List of Figures iv Nomenclature v 1 Introduction 1.1 Background................................. 1.2 Existing Systems............................. 1.3 Motivation...................................
1.4 Objectives of the Study......................... 2 1.5 Organization of the report....................... 2 2 Review of Literature 4 2.1 What is Blockchain............................ 4 2.2 Evolution of Blockchain......................... 5 2.3 Types of Blockchain........................... 6 2.4 Consensus algorithms........................... 8 2.5 Comparison between Hyperledger fabric and Ethereum 9 3 The Solution 10 3.1 Scenario:.................................... 10 3.2 Why blockchain and fabric?...................... 10 4 Methodology 12 4.1 Use cases..................................... 12 4.2 Architecture................................... 13 4.3 Activity diagram........ ........................ 15 4.4 Security Mechanisms............................ 16 5 Conclusion 5.1 Pros and Cons using Hyperledger.................. 5.2 Future Work................................... 5.3 Future Scope.................................. 5.4 Conclusion....................................
Table 2.1 Hyperledger fabric and Ethereum comparison............... 9
1.1 Background The health care services received from various hospitals and clinics have become prevalent, due to the predominant increase of specialty in the health care services and patient’s mobility. Doctors with information about the patient’s medical history can make precise decisions about the patient’s medical condition and treatment. A major problem that the health care services are facing now, is how to share the clinical data with various health care facilities while ensuring confidentiality, data integrity, and patient privacy. 1.2 Existing systems An EHR is an electronic version of a patient’s medical details. In current times, EHR is used to share patients’ medical records across various hospitals. EHR consists of health information of the patient in the form of Electronic Medical Record (EMR). EMR contains a patient’s medical diagnoses, allergies, history, treatment, and laboratory reports. The large amount of data in EHR can be used for machine learning and data analysis. The healthcare IT standards that are used in EHR are Fast Healthcare Interoperability Resources (FHIR) and Health Level 7 (HL7) to transfer clinical data between various applications that are used by different healthcare providers. The other models for interchange of medical data between healthcare providers are push, pull, and view.
when various participants want to access the same database. Thus, blockchain can minimize a lot of resources and costs to access the same database securely. HLF is a permissioned blockchain system that helps in preserving trust among participants in the network using CAs and MSPs. Medical data storing and sharing is an integral part of healthcare systems. However, sharing personal data among various participants through unsecured means can lead to leakage of critical information. Also, the lack of client control over their personal information leads to harmful consequences such as unauthorized identities can access/edit the personal medical details. And during sharing of the patient details can lead to even more risks. The critical issue in the electronic health/medical records (EHR/EMR) is maintaining interoperability among various involved identities. This issue may cause obstacles in the data transaction among each other. There is a lack of data management and sharing mechanism among the identities which leads to fragmentation of healthcare information. Apart from interoperability, data security and privacy are also challenges in the current ways of data storing and sharing data through EHR/EMR systems. Sharing and storing patient’s data has a lot of liabilities due to data leakage and potential shortcoming in security mechanisms. Blockchain for healthcare can ensure the security of the personal and medical information of the patients and can make sure that only authorized identities can access/edit the data using smart contracts which enables specific features among various identities in the system. Therefore, there is a clear need for a distributed way of sharing and store data where patients are more sure about their data security and privacy and in addition, all the involved identities can see the holistic view of overall transaction and interactions.
We aim to provide a digital solution to this problem so that next time when you visit your doctor, you don’t need to carry your medical file. We will be using Blockchain technology to store the patient records. This will ensure that the information remains secure while being decentralised across different peers. The basic idea is to use Blockchain for storing patient records. The workflow would be as follows: ● Anyone can register on the Blockchain network as a doctor or a patient. ● Whenever a patient visits a doctor, the doctor will have the required permissions to store the diagnosis and medical logs in the patient’s record which would be stored in distributed ledgers across the Blockchain network. ● The doctor would be required to sign in the transaction (which would be cryptographically encrypted with his private key) to create and modify the records of a patient (who would be uniquely identified by a patient ID). ● The medical records of a patient will be accessible from any hospital. 2
Blockchain is a decentralized, trustworthy distributed ledger on a peer to peer network that consists of a list of chronologically ordered blocks. Every block consists of a hash of a previous block and hence forming a chain. The first block in the blockchain is the genesis block and the block before a given block is called as its parent block. A block contains a header and body. The block header consists of
2.2 Evolution of blockchain
The mainstream internet usage at the turn of the century aided the introduction of digital currency as an expansion of electronic cash systems. The following is a timeline of blockchain’s growth. 2.2.1 1991 - Blockchain Invention Scott Stornetta and Stuart Haber invented Blockchain. They created a cryptographically protected chain of blocks which would prevent anyone from tampering with document timestamps [3]. 2.2.2 2008-2013 - Bitcoin Emergence Blockchain technology gained popularity due to Bitcoin in 2008, as it is the first application in the blockchain. Bitcoin was conceptualized by Satoshi Nakamoto. In 2009, Nakamoto published a white paper on Bitcoin. First Bitcoin was purchased for 10,000BTC in 2010. Bitcoin crossed $1 billion in 2013. 2.2.3 2013-2015 - Ethereum Development Ethereum was conceptualized by Vitalik Buterin. Ethereum has additional features like smart contracts compared to Bitcoin. The development of Ethereum has proven to be an important moment in the history of Blockchain. Ethereum is used for cryptocurrencies and in many other decentralized applications because of smartcontracts. 2.2.4 2015 - Hyperledger Hyperledger was developed by Linux Foundation in 2015. It allows development of open-source blockchain. The different Hyperledger frameworks are Hyperledger Fabric, Hyperledger Iroha, Hyperledger Sawtooth, and Hyperledger Burrow. 2.2.5 2015 - Future Many cryptocurrencies and applications have been developed after the emergence of Bitcoin and Ethereum. Nowadays, Blockchain technology is used by various companies and organizations. 5
fully centralized. It is used by organizations that need both public and private blockchain functionality. For example, Quorum and Hyperledger Fabric. 2.3.4 Hybrid Blockchain It is a mix of the private and public. In the blockchain, the peers determine who has access to which data. Some processes are kept private, while others are made public. On an open ledger, businesses can protect background transactions with business partners while still providing the product details to customers. For example, Dragonchain. 7
All the peers have equal authority, hence it is difficult to reach consensus. Before Bitcoin, a lot of decentralized currency systems failed because when it came to reaching a consensus, they were unable to resolve the most important problem, i.e., Byzantine Generals Problem.[22] 2.4.1 Byzantine generals problem The generals of various army battalions must choose whether to withdraw or assault. They must make a decision by sending messages by messengers and must reach an agreement. There’s a possibility that some of the messengers and/or generals are traitors. These traitorous generals can change the message and send a malicious response, causing the loyal generals’ plan to be disrupted. 2.4.2 Consensus mechanisms The following are the few consensus mechanisms that can be used to address the issue of the Byzantine generals problem: 2.4.2.1 Proof of Work Bitcoin uses PoW as the consensus mechanism. Miners “mine” a block to connect to the blockchain by solving cryptographic puzzles. This method requires a significant amount of energy and computation. The puzzles have been created in such a way that they are challenging and demanding on the system. When a miner completes the puzzle, they send their block for verification to the network. The method of determining whether a block belongs in the chain or not is extremely easy. A 51% attack is a possible attack in the blockchain, in which a miner or a group of miners with more than 51% of the computing power will prevent new blocks from being produced and establish false transaction records that benefit the attackers [22]. 2.4.2.2 Proof of State It is a more energy-efficient version of PoW. Nodes with the most stakes (for example, currency) are thought to be less likely to strike the network. The disadvantage here is the monopoly, when it comes to both technological and economic aspects of the scheme, the main stakeholder has full influence and authority. 2.4.2.3 RAFT RAFT is a distributed crash fault tolerance consensus algorithm that ensures that the system can make a decision and process client requests in the event of a failure [23]. It is a 8
To manage the medical records of patients, I need to map fabric components to requirements of the EHR systems. All hospitals act as organizations in the fabric network. Patient data has been treated as assets which are stored in the ledger. It is also possible to store the reference of the EHR data in the ledger but since application is not managed by real data and for that it will be necessary to maintain the separate database which will have patients data. This can be a good solution when it is integrated with production or real hospitals EHR data. For now patient records have few fields like personal and medical details like age, address, allergies, symptoms, treatment, followup, etc. When a doctor is medicating a patient, patient history data will be available which helps doctors to assign appropriate treatment. To improve the privacy of records, it is designed to provide extra steps in application for patients. Patient can decide to have permission to access his/her data from a particular doctor. Doctors can view limited fields of assent means patient data like all medical fields along with age and allergies. Whereas a patient can view all the fields but edit only personal fields. A similar application approach also available in [7] which motivated to this solution further
Blockchain has many advantages over many traditional database systems. One of the major advantages of blockchain is, it stores data cryptographically encrypted via distributed and decentralized way in peers which is nothing but a computing machine. This solves the availability of data within the network. It means for the outside world it is not possible to access data. The next benefit of blockchain is immutability. Since all the transactions are combined in a block and arranged in a chain as explained in Chapter 2. On top of the blockchain, hyperledger fabric provides some additional features which perfectly fit the current scenario. It is a permissioned and closed blockchain, no person can get added into the network unlike permissionless blockchains such as bitcoin, ethereum. This solves the confidentiality problem of patients’ data. The fabric has a concept of Certificate Authority for every organization or common CA called Fabric CA and MSP which provides identities and verifies when a transaction request is made. Moreover, all the components of the fabric network are scalable and pluggable. It means more organizations can be added connected 10
through channels, any number of peers for organizations. Like ethereum, the fabric also provides the concept of smart contracts, and when it is packaged and deployed it is called a chaincode. It is a business logic that is deployed on every endorsing peer. Initial organizations of the channel decide whether the new organizations should be added or not through Channel Configuration. It returns all the transaction information. All the components are explained further in the following section. 11
