cryptography

Review
The Role of Blockchain in Medical Data Sharing
Hamed Taherdoost 1,2,3

1 Department of Arts, Communications and Social Sciences, University Canada West,

Vancouver, BC V6Z 0E5, Canada; [email protected] or [email protected];
Tel.: +1-236-889-5359
2 Research and Development Department, Hamta Group, Hamta Business Corporation,
Vancouver, BC V5Z 2C4, Canada
3 College of Technology and Engineering, Westcliff University, Irvine, CA 92614, USA

Abstract: As medical technology advances, there is an increasing need for healthcare providers all
over the world to securely share a growing volume of data. Blockchain is a powerful technology
that allows multiple parties to securely access and share data. Given the enormous challenge that
healthcare systems face in digitizing and sharing health records, it is not unexpected that many
are attempting to improve healthcare processes by utilizing blockchain technology. By systemat-
ically examining articles published from 2017 to 2022, this review addresses the existing gap by
methodically discussing the state, research trends, and challenges of blockchain in medical data
exchange. The number of articles on this issue has increased, reflecting the growing importance
and interest in blockchain research for medical data exchange. Recent blockchain-based medical
data sharing advances include safe healthcare management systems, health data architectures, smart
contract frameworks, and encryption approaches. The evaluation examines medical data encryption,
blockchain networks, and how the Internet of Things (IoT) improves hospital workflows. The findings
show that blockchain can improve patient care and healthcare services by securely sharing data.

Keywords: healthcare; data sharing; blockchain; encryption

1. Introduction
Everyone may benefit from healthcare data. It maintains a record of our bodily
characteristics. It is essential for the treatment and diagnosis of disorders [1]. With the fast
Citation: Taherdoost, H. The Role of growth of artificial intelligence (AI), health records have become a tremendous advantage.
Blockchain in Medical Data Sharing. It may assist in the development of AI diagnostic models and aid in the diagnosing process.
Cryptography 2023, 7, 36. https:// Even while the recording of medical data has moved from paper data to electronic medical
doi.org/10.3390/cryptography7030036 records (EMRs), which are more convenient for data storage and access, more attention
Academic Editor: William Puech needs to be placed on data privacy [2]. Several institutions and hospitals have curtailed
data transmission and exchange to prevent data privacy breaches, which has resulted in the
Received: 6 June 2023 establishment of data silos as medical information is dispersed among numerous healthcare
Revised: 6 July 2023
institutions [3].
Accepted: 10 July 2023
The sharing of medical data provides numerous benefits to diverse stakeholders.
Published: 12 July 2023
Sharing data among clinical organizations, hospitals, and healthcare providers, for example,
improves patient care coordination by providing comprehensive medical histories, allowing
for more informed decisions and preventing unnecessary testing [4]. In emergencies,
Copyright: © 2023 by the author.
data sharing between hospitals and emergency medical services can expedite care, as
Licensee MDPI, Basel, Switzerland. immediate access to vital patient information enables responders to administer appropriate
This article is an open access article treatment, thereby reducing delays and enhancing patient outcomes [5]. The integration
distributed under the terms and of medical data sharing with smart homes and Internet of Things (IoT) devices enables
conditions of the Creative Commons remote patient monitoring, which is advantageous for patients with chronic conditions
Attribution (CC BY) license (https:// and enables proactive healthcare delivery [6]. In addition, collaborative data sharing
creativecommons.org/licenses/by/ between institutions promotes medical research and scientific discoveries, facilitating the
4.0/). identification of patterns, risk factors, and the development of new treatments.

Cryptography 2023, 7, 36. https://doi.org/10.3390/cryptography7030036 https://www.mdpi.com/journal/cryptography

Cryptography 2023, 7, 36 2 of 20

Today’s data storage is accessible on the cloud rather than on paper in the era of
digitalization. At hospitals and medical institutes, information is stored using computerized
private databases [7]. As patients shift hospitals for personal reasons, these data disperse
among the many hospitals, and when a patient wants these data for investigations, they
lose all of their data and are unable to provide their medical history for the studies. Owing
to the absence of consistent data exchange and administration, interoperability across
hospitals becomes a challenge. The second difficulty comes when physicians are unable to
access prior-treatment records for patients to plan future diagnoses since the records are
held on the previous hospital’s proprietary database to protect hospital and patient privacy.
Consequently, data searching and sharing have become critical concerns [8,9].
Thus, more specialists and academics are beginning to investigate the issue of the
secure exchange of medical data. In the past, with the advent of cloud service [10], the
majority of medical institutions have selected a third-party cloud server as a data-sharing
platform [11,12]. Nonetheless, these cloud-based apps are often vulnerable to a variety of
assaults, such as identity theft, eavesdropping, and data tampering. Even though several
firms provide unmonitored cloud servers to safeguard the privacy of data sharing, this
centralized storage model is susceptible to single-point assaults.
Healthcare organizations, innovation trendsetters, and people from the healthcare
field as a whole are focusing on how to find what is now possible with blockchain and
what blockchain may enhance and moderate in the future [13]. Blockchain has the potential
to produce a monumental accomplishment in the medical biological system since it can
easily acquire explicit adjustments to the healthcare executives of the patient. With the
assistance of this invention, the power will return to the people, thereby indicating that
individuals will be responsible for maintaining their records, and thus acquiring control
over their information [14].
Several surveys, like those by Fang et al. [15], Westphal and Seitz [16], and Kuo et al. [17],
have explored the potential applications and benefits of blockchain in healthcare. They
cover topics like preserving patient data integrity, privacy, and interoperability, use cases in
healthcare management systems, and integrating blockchain with other technologies. Many
studies have summarized blockchain-based model implementations. Soltanisehat et al. [18]
evaluated many articles published from 2016 to 2020. This article focuses on healthcare sec-
tor scenarios rather than merely comparing and summarizing models. Abu-Elezz et al. [19]
undertook a model study from a novel angle, examining both the advantages and hazards
that technology presents to patients. Saha et al. [20] discuss many blockchain-based health-
care options; however, they do not compare their techniques. The published publications
were subjected to a statistical analysis by Hasselgren et al. [21]. Unfortunately, the strategies
were not summarized in this study. Jin et al. [22] examined the privacy-preserving exchange
of medical data using the blockchain model. The evaluation classifies blockchains as either
permissionless or permissioned. The authors then examined the merits and downsides of
each blockchain model. Dubovitskaya et al. [23] studied primarily the use of blockchain in
cancer medical data, including oncology data exchange and medication traceability. Their
research has limitations since it solely analyzes oncology data.
Concerning the existing gap, this review discusses the current state, research trends,
and challenges of blockchain in systematic medical data sharing. It examines a variety
of blockchain-based healthcare scenarios, compared various techniques, and assesses the
potential advantages and disadvantages. This work contributes to the current state of the
art in blockchain-based medical data sharing and provides insights for researchers and
practitioners in the field by providing a comprehensive overview.

2. Blockchain in Healthcare Overview

A blockchain may be seen as a distributed ledger that allows peers to exchange
data [24,25]. It was launched with Bitcoin and resolved a persistent issue: the double-
spend problem. With Bitcoin, this is accomplished by a majority consensus of so-called
mining nodes and the addition of legitimate transactions to the blockchain. Bitcoin was
Cryptography 2023, 7, 36 3 of 20

the first to use blockchain technology. Therefore, introducing a coin is not required to
utilize blockchain and develop decentralized apps [26]. This section explains the principles
of blockchain technology to facilitate a comprehension of the remainder of this article.
To aid the reader in comprehending the blockchain idea, its fundamental properties and
building blocks and also their subsequent importance in healthcare will be detailed in the
following sections.

2.1. Blockchain
A blockchain may be described as a sequence of time-stamped and cryptographically
connected blocks. These blocks are permanently and securely sealed [27]. Each new block
added to the end of the chain contains a reference to the content of the preceding block [28].
The shareholders, known as the blockchain’s nodes, are arranged in a peer-to-peer (P2P)
network. Each node in the network has two keys [29]: a private key used for decrypting
messages and allowing the node to read them, and a public key used for encrypting
messages transmitted to the node. Hence, the public key encryption process is employed to
assure the non-repudiation, irreversibility, and consistency of a blockchain [25]. Messages
encrypted with the accompanying public key can only be decrypted with the matching
private key. The term for this idea is asymmetric cryptography. While a comprehensive
explanation is beyond the scope of this study, more information may be obtained in [29].
The so-called hash, which is created using a cryptographic one-way hash function, is
used to connect every block on the blockchain. It also assures the block’s compactness,
anonymity, and immutability [30].
This leads us to the significance of network nodes. Because the blockchain system is
a P2P network, a node may be considered a peer when it begins to connect and interact
with other nodes in the network; hence, peer node is the correct term. A full node is, in
layman’s words, any computer that has the main blockchain client installed and runs a
complete copy of the whole blockchain ledger [25]. A user who wishes to interact with the
blockchain connects to the network through a node [31]. Miners are a subset of nodes since
each miner needs to also run a fully functional node. Each miner is thus a node, but not
every node is also a miner. This situation is known from a certain sort of public blockchain
using the proof-of-work (PoW) consensus algorithm. Some forms of blockchain networks
using different distributed consensus mechanisms, such as proof-of-stake (PoS), do not
need mining [32].
Depending on the level of involvement [33], blockchain may be classified into the
consortium, private, and public chain. As its name suggests, a public chain is entirely
public and open to anybody. Due to the immutability of the data on the chain, public
chains are regarded to be entirely decentralized. Participation in the consortium chain is
restricted to authorized members, and the write/read rights and participation accounting
permissions on the blockchain are constructed by the alliance’s norms. The private chain is
exclusive to private organizations, and the write and read rights on the blockchain, as well
as the permissions to participate in accounting, are constructed by the norms of the private
organization. Participating nodes are restricted in reference [34].

2.2. Smart Contracts

Computer protocols known as “smart contracts” allow for the informational distri-
bution, validation, and enforcement of contracts [35]. Smart contracts do not need the
verification of a third party, and successful transactions are irrevocable and traceable.
Computer software is used to create a legally binding contract that can be automatically
executed. A smart contract is a program placed on the blockchain that guarantees the safety
and security of transactions in the absence of third-party monitoring [36]. The process
of smart contracts is shown in Figure 1. In the smart contract code, predefined response
rules and trigger situations are encoded, triggering specific actions automatically when
predetermined conditions are met. This eliminates the need for intermediaries and im-
proves the contract execution process’s transparency, security, and efficiency. When trigger
Cryptography 2023, 7, x FOR PEER REVIEW 4 of 20

Cryptography 2023, 7, 36 and trigger situations are encoded, triggering specific actions automatically when prede- 4 of 20
termined conditions are met. This eliminates the need for intermediaries and improves
the contract execution process’s transparency, security, and efficiency. When trigger situ-
ations, suchsuch
situations, as specific dates,
as specific events,
dates, or conditions,
events, occur,occur,
or conditions, the smart contract
the smart implements
contract imple-
predefined
ments actions,
predefined such as
actions, transferring
such ownership,
as transferring releasing
ownership, funds,
releasing and updating
funds, rec-
and updating
ords. ByBy
records. incorporating
incorporatingblockchain
blockchain technology
technologyintointosmart
smartcontracts,
contracts,participants
participants gain
gain an
increased trust, lower costs, and reduced fraudfraud risks.
risks. Combining blockchain technology
smart-contract streamline
and smart-contract streamlineprocesses
processesoptimizes
optimizescontract
contractadministration
administrationandandprovides
provides a
a secureand
secure andtransparent
transparentsolution
solutionfor
foraavariety
varietyofofindustries.
industries.Table
Table11 displays
displays the highlights
of blockchain-enabled smart contracts.

Figure 1. Blockchain in a smart contract process.

blockchain-enabled smart
Table 1. Features of blockchain-enabled smart contracts.
contracts.

Features
Features Description
Description
Smart contracts cannot be changed after deployment. Like a contract, this cannot be
Smart contracts cannot be changed after deployment. Like a contract, this cannot be changed
Untamperable
Untamperable changed once signed.
once signed.
Smart
Smart contractsdo
contracts donot
not need
need aathird
thirdparty
partytoto enforce
enforce thethe
codecode
afterafter a violation;
a violation; thus,arethey
thus, they
Low
Lowcost
cost arecheaper
cheaper than
than regular
regular contracts.
contracts.
Openand
and transparent
transparent A smart contract will execute accordingtoto
A smart contract will execute according thethe design
design code
code and and be transparent
be transparent once de-
once deployed.
Open
ployed.
Decentralized Computers supervise and arbitrate smart contracts without third-party involvement.
Decentralized Computers supervise and arbitrate smart contracts without third-party involvement.

2.3. Importance of
2.3. Importance of Blockchain
Blockchain in
in Healthcare
Healthcare
Blockchain
Blockchain may provide an effective,
may provide an effective, efficient, safe, and
efficient, safe, and transparent
transparent method of data
method of data
and information communication for all stakeholders involved in the healthcare
and information communication for all stakeholders involved in the healthcare business busi-
ness [37]. tokenization
[37]. With With tokenization and contracts,
and smart smart contracts, it is possible
it is possible to decrease
to decrease or eliminate
or eliminate the pre-
the pre-authorization procedure in the healthcare industry [38]. While connecting with
authorization procedure in the healthcare industry [38]. While connecting with multiple
multiple parties, blockchain-based systems for health documentation protect the security
parties, blockchain-based systems for health documentation protect the security of an in-
of an individual’s data via the use of secure encryption methods [39]. Using the encryp-
dividual’s data via the use of secure encryption methods [39]. Using the encryption meth-
tion methods, smart contracts, and tokenization used in blockchain network transactions,
ods, smart contracts, and tokenization used in blockchain network transactions, the pre-
the pre-authorization method will be drastically streamlined, allowing patients to obtain
authorization method will be drastically streamlined, allowing patients to obtain essential
essential and informed treatment more quickly. This is a consequence of the healthcare
and informed treatment more quickly. This is a consequence of the healthcare provider’s
provider’s ability to immediately obtain pertinent information, whereas previously, they
ability to immediately obtain pertinent information, whereas previously, they had to rely
had to rely on the patient or on files physically delivered or emailed from many sources,
on the patient or on files physically delivered or emailed from many sources, such as local
such as local doctors, laboratories, etc. Not only may tokenization promote a more efficient
doctors, laboratories, etc. Not only may tokenization promote a more efficient contact and
contact and communication between insurance companies and healthcare practitioners,
communication between insurance companies and healthcare practitioners, but it can also
but it can also support and enhance patient–provider dialogue.
support
Theand enhance
expansion of patient–provider dialogue.business may be aided by blockchain tech-
the worldwide healthcare
nology, which can also save money and stimulate additional investment in vital resources.
With so much at risk, it is inconceivable that the current inefficient, excessively bureaucratic,
Cryptography 2023, 7, 36 5 of 20

and failing healthcare business can continue [40]. It is time for executives, practitioners,
and patients to embrace the available technological and system-based innovations.
The misuse of available information prevents healthcare organizations from providing
appropriate patient care and remarkably improved services. Even though these organi-
zations are economically competent, they are unable to meet the needs of patients. Here
are a few facts from Supporting Materials that illustrate this reality. Nowadays, healthcare
data breaches in organizations are estimated to cost around USD 380 per compromised
record. This amount is anticipated to increase with time. Several healthcare offices still use
antiquated frameworks for maintaining patient records. These frameworks are beneficial
for keeping patient information records close at hand. This might make it difficult for the
professional to analyze, which can be tiresome for both the specialist and the patients. As a
result, the cost of maintaining a patient-centered business increases substantially [41,42].
The majority of the present healthcare data infrastructure relies on reputable third parties.
In numerous instances, however, they cannot be relied upon. A potential answer to this
issue is the blockchain, which depends on consensus and does not need a central authority.

3. Methodology
This study continues by defining the used approach. The systematic study is confined
to the subject of medical data sharing.

3.1. Research Questions

The purpose of the study was to address the following research questions (RQs):
• RQ1: How established is blockchain in medical data sharing, and how has this evolved?
• RQ2: What are the latest developments in blockchain-based medical data-sharing research?
• RQ3: What are the issues of using blockchain to share medical data?

3.2. Databases
Included in the systematic review were the following databases:
• Scopus;
• Google Scholar;
• ScienceDirect.
Using the query string(s) listed below, a search for related articles was conducted.
Based on the study domain and the established RQs, the search strings were developed.
These keywords have been used in the search:
• “Blockchain” AND “Medical data sharing”;
OR
• “Blockchain” AND “Medical record sharing”;
OR
• “Blockchain” AND “Healthcare data sharing”;
OR
• “Blockchain” AND “Health data sharing”;
OR
• “Blockchain” AND “Health record sharing”;
OR
• “Blockchain” AND Medical data sharing;
OR
• “Blockchain” AND Medical record sharing;
OR
 OR
• “Blockchain” AND Medical data sharing;
OR
Cryptography 2023, 7, 36 6 of 20
• “Blockchain” AND Medical record sharing;
OR

•• “Blockchain” AND Healthcare data sharing;

“Blockchain” AND Healthcare data sharing;
OR
OR
• “Blockchain” AND Health data sharing;
• “Blockchain” AND Health data sharing;
OR
OR
• “Blockchain” AND Health record sharing.
• “Blockchain” ANDlibrary
The online digital Healthsearch
recordwas
sharing.
performed on 14 March 2023. The search query
was The online designed
purposely digital library
to besearch was performed
as comprehensive on 14 March
as feasible 2023. as
to evaluate The search
many query
results as
was purposely designed to be as comprehensive as feasible to evaluate as
possible that were relevant to the research topics given in this systematic review. By many results
as possiblein
searching that
thewere relevant
title of to the284
the articles, research topicswere
total items given in this systematic
discovered review.
via the main By
search.
searching in the atitle
Figure 2 shows of the articles,
summary 284 total
of the search anditems weretechnique
selection discovered viatothe
used mainthe
choose search.
arti-
Figure
cles. 2 shows a summary of the search and selection technique used to choose the articles.

Figure2.2.Process
Figure Processof
ofstudy
studyselection.
selection.

3.3.
3.3.Selection
SelectionofofStudies
Studies
Depending
Dependingon onthe
thecriteria,
criteria,articles
articleswere
wereeither included
either includedor or
excluded from
excluded thethe
from systematic
system-
review (Table 2). Fifty papers were ultimately included in the systematic review.
atic review (Table 2). Fifty papers were ultimately included in the systematic review. To ensure
To
that onlythat
ensure high-quality and relevant
only high-quality and research
relevantwas examined,
research the approach
was examined, the was rigorous.
approach was rig-
orous.
Table 2. Standards of inclusion and exclusion.

Inclusion Criteria Table 2. Standards of inclusion and exclusion.

Exclusion Criteria
Inclusion Criteria
1. Publication stage: Final Exclusion Criteria
1. Publication year: Out of the period 2017–2022
1.2. Publication stage:
Document type: Final
Article 1. Publication
2. Language:year:
Not Out of the period 2017–2022
in English
2.3. Document type: Article
Source type: Journal 2. Language: Not in English
3. Not focused on blockchain in medical data sharing
4. Article should contain and clearly outline research objectives 4. System design must not be defined properly

3.4. Limitations
One issue is due to the scope of attention; as systematic reviews have a confined focus.
Another restriction concerns the study selection, information loss on critical outcomes,
incorrect subgroup analysis, and inconsistency with the unique experimental results [43].
 4. System design must not be defined properly
objectives

3.4. Limitations
One issue is due to the scope of attention; as systematic reviews have a confined fo-
Cryptography 2023, 7, 36 cus. Another restriction concerns the study selection, information loss on critical7 ofout- 20
comes, incorrect subgroup analysis, and inconsistency with the unique experimental re-
sults [43]. Limited databases and the title search query are other limitations of this review.
The decision
Limited to use
databases and only
thearticle titles query
title search as theare
search
otherquery for thisofsystematic
limitations this review.review was
The deci-
motivated by the need to conduct a preliminary investigation of the topic within
sion to use only article titles as the search query for this systematic review was motivated by the lim-
itations
the need of
to time and aresources.
conduct preliminary Thisinvestigation
method has ofseveral limitations,
the topic including
within the the possibil-
limitations of time
ity of
and omitting This
resources. relevant
methodstudies, a reduced
has several precision including
limitations, in the study
theselection, and
possibility of the risk of
omitting
bias. studies, a reduced precision in the study selection, and the risk of bias.
relevant

4.4.Discussion
Discussion
RQ1:
RQ1:How
Howestablished
establishedisisblockchain
blockchainin
inmedical
medicaldata
datasharing,
sharing,and
andhow
howhas
hasthis
thisevolved?
evolved?
This
Thissystematic
systematicreview
review looked
looked forfor
articles published
articles published between
between20172017
and and
20222022
on the
onuse
the
of blockchain
use technology
of blockchain in theinexchange
technology of medical
the exchange data. Figure
of medical 3 provides
data. Figure a bibliometric
3 provides a biblio-
summary of the selected
metric summary articles. Only
of the selected twoOnly
articles. articles
twowere published
articles over the years
were published over 2017 and
the years
2018. In 2019, four papers were published. The years 2020 and 2021
2017 and 2018. In 2019, four papers were published. The years 2020 and 2021 each have each have nine items.
With
nine 24 papers
items. Withpublished
24 papers in 2022, the growth
published in 2022,rate
thehas risen.rate
growth It contains 48 percent
has risen. of all
It contains 48
papers
percentinofthis
all review.
papers inThis
thisdemonstrates that blockchain
review. This demonstrates research
that in medical
blockchain researchdata
insharing
medical
isdata
verysharing
important, and
is very expanding,
important, andand shows noand
expanding, indication
shows no of indication
slowing down. Blockchain
of slowing down.
enables enterprises to offer proper patient care and provide access to high-quality
Blockchain enables enterprises to offer proper patient care and provide access to high- healthcare
services. With this technology,
quality healthcare services. With health
this information exchange,
technology, health a substantial
information strain aowing
exchange, to
substan-
its repetitive nature and time-consuming nature, is swiftly alleviated.
tial strain owing to its repetitive nature and time-consuming nature, is swiftly alleviated.

30

25

20

15

24
10

5 9 9
4
2 2
0
2017 2018 2019 2020 2021 2022

Figure3.3.The
Figure Thetrend
trendofofpublishing
publishingarticles
articlesbetween
between2017
2017and
and2022.
2022.

Adoption
Adoptionand
andimplementation
implementationofofblockchain
blockchainininhealthcare
healthcaresystems
systemsand
andorganizations
organizations
for
forthe
thesharing
sharingof
ofmedical
medicaldata
datashould
shouldbe bethoroughly
thoroughlyevaluated.
evaluated.Various
Variousfactors,
factors,including
including
regulatory
regulatory frameworks, technological challenges, interoperability, data protection,and
frameworks, technological challenges, interoperability, data protection, and
stakeholder
stakeholderacceptance, need
acceptance, to beto
need considered. Several Several
be considered. research research
and development initiatives
and development
are investigating the potential of blockchain for medical data sharing, as its popularity
and importance have risen dramatically. Initially, research concentrated on the theoretical
foundations and viability of blockchain in this domain, resulting in the development of
frameworks, methods, and protocols tailored to address the unique challenges of medical
data sharing. As the technology advanced, efforts were made to improve the effectiveness
and functionality of blockchain in the sharing of medical data, including refining data
storage and retrieval, optimizing consensus processes, and exploring integration with other
cutting-edge technologies such as edge computing and IoT.
Despite growing interest and research in this area, blockchain technology for the
sharing of medical data is still in its infancy. Numerous proposed solutions are still in the
Cryptography 2023, 7, 36 8 of 20

experimental or proof-of-concept stages and require additional validation, standardization,

and integration with the current healthcare infrastructure. To accomplish a widespread
blockchain adoption in the healthcare industry, adoption, regulation, interoperability, and
scalability issues need to be resolved. These developments are required to ensure the
successful deployment of blockchain technology for the secure and efficient exchange of
medical data, which will benefit healthcare stakeholders and facilitate the improvement of
healthcare outcomes.
RQ2: What are the latest developments in blockchain-based medical data-sharing research?
There are several instances in which blockchain is utilized to share medical data.
Rajput et al. [44] propose a system for healthcare management that leverages blockchain
technology to create a tamper-protection application by taking into account secure rules.
In an emergency case, these regulations specify extendable access control, auditing, and
tamper resistance. Hu et al. [45] propose CrowdMed-II, a blockchain-based health data
management architecture that might solve the aforementioned issues with health data. In
their framework, they investigate the architecture of significant smart contracts and suggest
two smart contract structures. In addition, a unique search contract for searching patients
is introduced. They assess their efficacy based on Ethereum’s execution costs. The paper
by Hashim et al. [46] presents a transaction-based smart contract-triggering method for
inter-blockchain communication, allowing the exchange of electronic health records (EHRs)
across separate blockchains. They employ local and global smart contracts that will be
executed whenever a blockchain-based transaction is generated. Local smart contracts are
used to share EHRs inside a blockchain, while global smart contracts are used to share
EHRs across blockchains that are independent of one another. Using the Hyperledger
Fabric blockchain technology, the experimental setup is executed. In a health federation
arrangement, inter-blockchain communication between two separate fabric networks is
handled by a global smart contract using Hyperledger Cactus for EHR exchange.
Wu et al. [47] build a blockchain-enabled framework for dynamic access control
coupled with local differential privacy (LDP) techniques to offer attribute-based privacy
protection in transaction processing. In the framework, they develop four kinds of smart
contracts to suit the needs of anonymous transactions, dynamic access control, advan-
tageous matching decisions, and the assessment of disclosed data. To provide granular
privacy protection, they categorize critical EMR parameters into distinct tiers and ran-
domize them before data publication using differential privacy budgets. In addition, they
create a data quality function that illustrates the disruption caused by LDP-based privacy
preferences from the requester’s perspective, and they propose suitable many-to-many
matching selections among participants for advantageous transactions. Specifically in the
study by Kumar et al. [48], deep learning and permissioned blockchain uses a blockchain
system to register, verify (using zero-knowledge evidence), and validate communicating
entities by utilizing a consensus process based on smart contracts. The authenticated
data are then utilized to propose a unique DL strategy that combines a stacked sparse
variational autoencoder (SSVAE) with self-attention-based bidirectional long short-term
memory (SA-BiLSTM). In this system, SSVAE encodes or converts healthcare data to a new
format, while SA-BiLSTM detects and enhances the attack detection process.
Several blockchain implementations, encryption strategies, and IoT-based systems are
the three main categories of current system platforms for exchanging medical data. Table 3
outlines research proposing blockchain solutions for exchanging medical data.

4.1. Types of Blockchain

There are four primary forms of blockchain networks, including public blockchains,
private blockchains, consortium blockchains, and hybrid blockchains. Each of these systems
has advantages, disadvantages, and optimal applications. The paper by Zhang and Lin [49]
offers a blockchain-based safe and privacy-preserving protected health information (PHI)
sharing (BSPP) protocol for enhancing e-health system diagnostics. Initially, the data
architecture and consensus procedures for the two types of blockchains—private blockchain
Cryptography 2023, 7, 36 9 of 20

and consortium blockchain—need to be designed. The private blockchain is responsible for

storing PHI, while the consortium blockchain maintains the PHI’s safe indexes. To ensure
privacy preservation, access control, data security, and secure search, all data, including
PHI, keywords, and patient identities, are encrypted with a public key using keyword
search. Two kinds of blockchains, private and consortium blockchains, are developed in
another research by Shamshad et al. [50] by defining their consensus, data formats, and
procedures. A private blockchain is responsible for the maintenance of EHRs, while a
consortium blockchain keeps the safe indexes of EHRs. To achieve data security, secure
search, access management, and the protection of patient privacy, all EHRs are public-key
encrypted with an appropriate search phrase.

4.2. Encryption
Encryption of medical data facilitates electronic data transmission and the sharing of
clinical patient data and documentation. Regardless of location, patient medical data may
be exchanged within a health system or transmitted to permitted health systems. In the
study by Yang et al. [51], first, the encrypted medical data are saved in the cloud, and then
the storage address and medical-related information are entered into the blockchain, thus
ensuring efficient storage and eliminating the risk of irreversible data change. The proposed
approach combines attribute-based encryption (ABE) and attribute-based signature (ABS)
to enable the exchange of medical data in many-to-many interactions. The ABE provides
data privacy and fine-grained access control, while the ABS confirms the source of medical
data while safeguarding the signer’s identity. In addition, the majority of medical data
ciphertext decryption activities are outsourced by the data user to the cloud service provider
(CSP), which may significantly minimize the computing strain. In a separate investigation,
Sun et al. [52] conduct a hash computation on the EMR and record the resulting value on
the blockchain to assure the data’s integrity and validity. They encrypt the EMR and put
it in the distributed storage protocol interplanetary file system. The encrypted keyword
index information of EMRs was saved on Ethereum, and instead of relying on a centralized
third party, a smart contract implemented on Ethereum was utilized to perform keyword
searches. In addition, they use the ABE method to guarantee that only the access policy-
compliant qualities may decode the encrypted EMR. Zhang et al. [53] address these issues
by providing a distributed PHR-sharing mechanism based on blockchain and ciphertext
policy ABE (CP-ABE), which enables efficient encryption and decryption. In addition to
maintaining the data’s integrity and tracking its source, blockchain records all activities on
the data as transactions. In addition, the nodes of the blockchain serve as attribute authority
for the CP-ABE cryptosystem. Tracing cryptographic techniques enables the identification
of rogue blockchain nodes. Furthermore, the recovery of ciphertext is made fair via the
use of smart contracts. To circumvent the restricted storage capacity of blockchain, our
innovative solution employs both on-chain and off-chain storage options.
In the study by Zhang et al. [54], the deniably authenticated searchable encryption
scheme (DASES) utilizes blockchain to assure the integrity, immutability, and traceability
of image data, while circumventing the blockchain’s storage and processing limitations.
Not only can the DASES survive an inside keyword guessing attack (IKGA), but it can also
offer good privacy protection and validate the validity of medical picture data. Secondly,
they demonstrate that the DASES meets the ciphertext and trapdoor indistinguishability
conditions. Regrettably, the DASES is less efficient than other comparable systems in
the literature, but its largest asset is its capacity to provide an improved identity privacy
protection and enhanced security. The application created by Cheng et al. [55] enables the
physician to access the patient’s personal history EMRs with the patient’s permission to
comprehend the patient’s sickness history and build a new medical record for the patient.
The server calculates the ciphertext and adds it to the patient’s medical record to complete
the case update. Via hierarchically storing patient information, medical staff information,
and medical records, Yuan et al. [56] devise a three-chain paradigm. The combination
of interplanetary file system (IPFS) technology and the encryption algorithm guarantees
Cryptography 2023, 7, 36 10 of 20

the security and efficiency of data storage off-chain. Attributes are used to classify users,
and ABE technology is used for the secondary encryption of the key and ciphertext chan-
nel. However, hierarchical encryption drastically reduces the chance of a system assault.
Zhang et al. [57] provide a unique blockchain-based data sharing system (BDSS) with
fine-grained access control and permission revocation for the medical context. With this
concept, they divide the EMR into public and private sections. Next, they employ sym-
metric searchable encryption (SSE) technology to encrypt these two pieces independently,
and ABE technology to encrypt the symmetric keys used by SSE technology. Based on
CP-ABE, Tan et al. [58] present a blockchain-enabled security and privacy protection system
for COVID-19 medical records with traceable and direct revocation. With this system, all
public keys, revocation lists, etc., are maintained on a blockchain, and the blockchain is
used for consistent identity authentication. The system management server is responsible
for producing the system settings and publishing the COVID-19 medical practitioners’ and
users’ private keys. Using policy matching, the cloud server provider (CSP) maintains
the CEMRs and creates the intermediate decryption parameters. If the user has private
keys and intermediate decrypt parameters, he or she may compute the decryption key.
Chen et al. [59] offer BFHS, a blockchain-based method for the safe, granular exchange
of EHRs. On BFHS, they encrypt EHRs using ciphertext-policy ABE and upload them to
the IPFS for storage, whilst the matching index is encrypted with proxy re-encryption and
stored on a medical consortium blockchain. In addition, a credit evaluation system was
developed and included in the smart contract. The combination of smart contracts, proxy
re-encryption, a credit assessment system, and IPFS provides patients with a secure EHR
sharing environment and a dynamic access control interface.

4.3. Ciphertext
Ciphertext is the result of an encryption algorithm transforming plaintext into en-
crypted text. Ciphertext cannot be read until it has been decrypted (converted to plain-
text) using a key. Decryption cipher is a method that converts ciphertext to plaintext.
Yang et al. [60] propose a novel blockchain-based keyword search protocol with dual
authorization for the exchange of EHRs. The certificateless cryptosystem eliminates key
escrow and certificate administration. The development of the authorization matrix en-
ables the dual authorization of user identities and searchable departments. Moreover, the
matrix may manage user access privileges. The ciphertext index signal value enables an
authoritative control over the ciphertext index. The ciphertext MAC verification code kept
on the blockchain can check for the legality of ciphertext, and smart contracts are utilized
to guarantee fair transactions. Yang et al. [61] encrypt keywords using the certificateless
cryptosystem, which eliminates the certificate administration and key escrow issues. The
suggested approach also enables multi-user searches, and the user authorization table
may be utilized to adjust medical data users’ access rights. In addition, the root values of
the Merkle trees are recorded in the blockchain to assure the search results’ immutability,
integrity, and traceability. In addition, a smart contract facilitates a fair transaction between
a cloud service provider and customers of medical data without the need for trusted third
parties. They demonstrate that the suggested technique is safe against the random oracle
model’s keyword-guessing attack. Lai et al. [62] propose a secure medical data-sharing
system based on a traceable ring signature and blockchain as a solution to the issue of
medical institutions’ challenges in exchanging medical data. First, a certificateless traceable
ring signature mechanism based on distributed key generation is suggested to preserve
data integrity and privacy. The combination of a smart contract with access control and a
self-controlling object (SCO) enables the outsourcing of decryption and the sharing of data.
In addition, the suggested approach leverages the IPFS to store the seas of medical privacy
data and encrypts the hash index to store it, which increases data sharing efficiency. Using
the consensus process, they may choose the proxy node and upload the SCO package to
the blockchain node for data exchange after the blockchain has been incorporated.
Cryptography 2023, 7, 36 11 of 20

4.4. IoT-Based Systems

With healthcare mobility solutions, IoT may automate the workflow of patient care by
automating the workflow of patient care. Data transfer, machine-to-machine connectivity,
and interoperability have increased the productivity of healthcare sectors. Healthcare
professionals and patients may save time with IoT integration. Chen et al. [63] presented a
health IoT-based blockchain data-sharing system that protects privacy. To allow patients to
construct granular privacy protection, they devised a privacy-preserving mechanism based
on the content extraction signature system. They created a Byzantine fault-tolerant leader
election method that improves the Raft algorithm’s security and data-sharing efficiency. In
addition, they built a summary contract to facilitate the retrieval of data. Pang et al. [64]
propose a patient-controlled EHR-sharing system based on blockchain technology and
cloud computing. To prevent tampering, the medical abstract and access strategy are kept
on the blockchain. To accomplish fine-grained access control, they suggest encrypting
EHRs using ABE and multi-keyword encryption. In addition, they suggested a node-state-
checkable practical Byzantine fault tolerance consensus method to prevent Byzantine nodes
from gaining access to the consortium blockchain. Nie et al. [65] present a new blockchain-
based safe-sharing system with searchable encryption and a concealed data structure
through IoT devices. Data owners’ EHR ciphertexts are kept in the interplanetary file system
(IPFS). A user with the appropriate access rights may search for the needed data using the
data owner’s time-limited authorization and validate the search result’s legitimacy. With a
symmetric key, the data user may then obtain the appropriate EHR ciphertext from IPFS.
In IoT applications, the technique combines searchable encryption and smart contracts to
provide safe search, time management, verified keyword search, quick search, and forward
privacy. Wang et al. [66] present a consortium-based blockchain-based PHR management
and sharing system that is both security-conscious and privacy-preserving. The PHR
ciphertext of Internet of medical things (IoMT) is stored using the interplanetary file system
(IPFS). Hence, zero-knowledge proof may be used to validate keyword index authentication
on the blockchain. In addition, the system combines modified attribute-based cryptographic
primitives with custom-tailored smart contracts to offer safe search, privacy preservation,
and individualized access control in IoMT situations. Wu et al. [67] present a triple-subject
purpose-based access control (TS-PBAC) model that is compatible with a blockchain-
enabled reliable transaction network, and they design an individual-centric security and
privacy-preserving mechanism for access control with varying purposes and roles in IoMT
scenarios. Particularly, they develop a hierarchical purpose tree (HPT) and associated
regulations to ensure the legality of an external user who has several purposes. They
create a LDP-based policy and role-based access control mechanism in an edge computing
paradigm to award fine-grained permissions to authorized users to increase the privacy of
sensitive characteristics against an internal attacker.

Table 3. Summary of studies that propose blockchain systems in medical data sharing.

Blockchain Role Year Capability Smart Contract Reference

Trust-less medical data sharing 2017 Access control mechanism X [68]
Receive data from the shared pool once
Blockchain-based data sharing for
2017 identities and cryptographic keys have [69]
electronic medical records
been validated
The enhanced consensus technique
Efficient and secure medical data delivers EMR consensus without
2018 [70]
sharing significant network congestion or energy
consumption
Secure and privacy-preserving Session-based flexible healthcare data
2019 [71]
data sharing sharing
Cryptography 2023, 7, 36 12 of 20

Table 3. Cont.

Blockchain Role Year Capability Smart Contract Reference

Blockchain-based searchable
2019 Complete control over data access X [72]
encryption
Mutual authentication and the generation
Efficient healthcare data sharing 2019 [73]
of a session key
Fine-grained access control, keyword
Privacy-preserving data sharing 2019 [74]
search, and privacy protection
Using bilinear mapping and intractable
Secure and privacy-preserving
2020 issues, the authentication process’s [75]
data sharing
security danger may be neutralized.
Verification by zero-knowledge proof,
decryption using proxy re-encryption
Efficient and secure data sharing 2020 [76]
technology, and PBFT-based distributed
consensus
The data usage ontology and the
Privacy-preserving data sharing 2020 automatable discovery and access matrix X [77]
comprise the dynamic consent model
In the random oracle paradigm, keyword
Fine-grained access control and
2020 indistinguishability against adaptively [78]
privacy protection
selected keyword assaults
Couples with privacy-sensitive
information are stored on the consortium
Protected data sharing 2020 [79]
blockchain, while non-sensitive data are
shared on the public blockchain
Scheme for anonymously transmitting
Privacy-preserving medical data
2021 medical data based on proxy [80]
sharing
re-encryption algorithm and cloud servers
Secure data sharing 2021 Proxy re-encryption protocols [81]
Protected data sharing 2021 Searchable encryption and K-anonymity X [82]
Allowing data requesters to comply with
Consortium-based data sharing 2021 data access requirements and to build [83]
their standing within a consortium
Secure and privacy-preserving The outsourced business has no access to
2021 X [84]
data sharing the server or its data
Data ownership, data traceability, data
Secure and distributed data
2021 consistency, privacy protection, data [85]
sharing
security, and distributed storage
Certificateless public key cryptography
Secure data storage and sharing 2021 [86]
and elliptic curve cryptography (ECC)
Fine-grained access control, efficient
retrieval across encrypted PHRs with
Hierarchical data sharing with low-consumed hierarchical key
2022 [87]
access control distribution and key leakage resistance, as
well as efficient aggregative
authentication
Searchable encryption with access
2022 Algorithm for key-policy ABE X [88]
control
The condition is concealed inside the
Privacy-preserving data sharing 2022 re-encryption key so that the proxy cannot X [89]
discover it
Cryptography 2023, 7, 36 13 of 20

Table 3. Cont.

Blockchain Role Year Capability Smart Contract Reference

Storing encrypted medical data in
Protected and integrated data dispersed storage mode and integrating
2022 [90]
sharing patient data across offline institutions and
platforms
Patients’ personal information is held on
off-chain storage (IPFS), while other
Privacy-enhanced data storage
2022 information is saved on the blockchain X [91]
and exchange
ledger, which is available to all
participants
Feasibility of recovery of the encryption
Hybrid storage with access control 2022 X [92]
keys
Secure data sharing with access Immutability, fine-grained access control,
2022 X [93]
control and traceability

In the sphere of blockchain-based medical data sharing, there are common concepts
and tendencies. These papers highlight the use of blockchain technology to facilitate the
secure and trustless sharing of medical data, addressing issues of trust, security, and privacy.
These solutions seek to provide a tamper-resistant and transparent infrastructure for storing
and sharing sensitive medical information by leveraging the distributed and decentralized
nature of blockchain in conjunction with cryptographic techniques.
In these blockchain-based systems, privacy and data security are top priorities. Sev-
eral methods, including encryption techniques, access control mechanisms, and privacy-
preserving algorithms, are used to protect the privacy of patient information while allowing
authorized parties to access relevant data. In addition, attribute-based access control and
fine-grained access control mechanisms are frequently employed, enabling data owners
to define access policies based on particular attributes or duties. Frequently, consortium
or permissioned blockchains are utilized, allowing multiple trusted parties to collaborate
and administer the shared data. Moreover, interoperability, consent management, and com-
pliance with regulations such as the General Data Protection Regulation (GDPR) are also
essential considerations for these solutions. These trends highlight the growing interest in
utilizing blockchain technology to establish secure, privacy-preserving, and interoperable
medical data-sharing systems.
Various research studies are garnering interest in the application of blockchain tech-
nology to the exchange of medical data. Several approaches and frameworks have been
proposed by researchers to resolve the challenges associated with health data exchange.
These methods make use of blockchain characteristics such as tamper resistance, secure
rules, extendable access control, auditing, and counterfeit protection. They investigate the
architecture of smart contracts, devise methods for inter-blockchain communication, and
assess the efficacy of these systems by calculating execution costs. Integrating encryption
methods such as attribute-based encryption (ABE) and ciphertext-policy ABE (CP-ABE)
with blockchain ensures privacy protection, granular access control, and secure search.
Consideration is given to public, private, consortium, and hybrid blockchains for the secure
storage and management of medical data. Moreover, techniques such as hash computation,
deniably authenticated searchable encryption schemes (DASES), and smart contracts are
utilized to guarantee data integrity, validity, and traceability. By integrating blockchain
technology with encryption techniques, researchers hope to develop dependable systems
that improve data security, privacy, and the exchange of medical information.
RQ3: What are the issues of using blockchain to share medical data?
Using blockchain technology for sharing medical data presents several issues that
need to be addressed. Firstly, scalability is a major concern. Blockchain networks may
struggle to manage the large volumes of data involved in sharing EMRs among multiple
Cryptography 2023, 7, 36 14 of 20

stakeholders. Scaling the blockchain to accommodate these demands is essential for efficient
data sharing [69]. Ensuring the privacy and confidentiality of sensitive medical data is
paramount in healthcare systems. While blockchain offers immutability and transparency,
it presents challenges in protecting patient privacy and maintaining data confidentiality.
Innovative solutions must be developed to address these concerns and provide robust
privacy measures in blockchain-based medical data-sharing systems [70].
Another significant issue is the performance and efficiency of blockchain networks.
Public blockchains, in particular, can experience slow transaction-processing speeds and
high energy consumption. These limitations hinder the real-time access and responsiveness
required for sharing medical data effectively. Optimizing blockchain performance and
energy efficiency is crucial to ensure seamless data sharing [74]. Additionally, the interop-
erability of blockchain with the existing healthcare infrastructure is a challenge. Integrating
blockchain into diverse systems and ensuring compatibility with legacy systems is complex.
Achieving seamless interoperability among different healthcare providers and systems is
crucial for effective medical data sharing. Addressing this issue requires careful planning
and implementation strategies [75].
Regulatory and legal considerations play a significant role in blockchain-based medical
data sharing. Compliance with data protection laws, such as GDPR, is necessary. However,
the decentralized nature and immutability of blockchain can make it difficult to meet
certain regulatory obligations, such as data deletion and consent management. Developing
frameworks that align with regulatory requirements is vital to ensure compliance while
leveraging the benefits of blockchain technology [91]. Lastly, establishing a governance
framework and building trust among participating entities are critical aspects of blockchain-
based medical data sharing. The distributed nature of blockchain requires robust consensus
mechanisms and trust models to guarantee data integrity and reliability. Creating effective
governance structures that address the needs and concerns of all stakeholders is essential
for successful implementation [81].
The use of blockchain for sharing medical data poses several challenges. Scalability,
privacy and confidentiality, performance and efficiency, interoperability, regulatory com-
pliance, and governance and trust are among the key issues that need to be addressed.
Overcoming these challenges is crucial for the successful implementation of blockchain-
based solutions in healthcare, enabling secure, efficient, and privacy-preserving sharing of
medical data. Table 4 provides an overview of the various research papers pertaining to
blockchain-based medical data-sharing schemes.

Table 4. Challenges and possible solutions of blockchain-based medical data-sharing schemes.

Category Study Challenges Possible Solutions

Attribute-based access control,
Utilize attribute-based encryption, design access
[51] privacy preservation, data sharing
control policies, optimize data sharing efficiency
efficiency
Implement access control mechanisms with granular
Fine-grained access control, permissions, employ scalability solutions such as
[52]
scalability, data validation sharding or sidechains, ensure data validation through
Access Control and smart contracts
Privacy
Searchable encryption for medical Develop deniably authenticated searchable encryption
[54] images, deniable authentication, schemes, implement access control mechanisms,
access control ensure confidentiality of medical images
Design decentralized attribute-based sharing
Decentralized attribute-based sharing,
[53] mechanisms, address privacy concerns, implement
data privacy, attribute management
effective attribute management
Cryptography 2023, 7, 36 15 of 20

Table 4. Cont.

Category Study Challenges Possible Solutions

Implement privacy-preserving access control
Access control in IoT, privacy
[67] mechanisms, address IoT-specific challenges, enable
preservation, data publishing
secure data publishing
Integrate edge computing with blockchain for
Cross-domain data sharing, edge
[55] cross-domain sharing, ensure data integrity through
computing integration, data integrity
consensus mechanisms
Industrial healthcare systems, secure Utilize permissioned blockchain for secure sharing,
[48] data sharing, deep learning leverage deep learning techniques for efficient data
integration analysis
Data Sharing and Employ privacy-enhancing techniques, ensure secure
Privacy preservation, data security,
Integration [76] data storage and transmission, implement access
access control
control protocols
Leverage blockchain for secure data sharing, integrate
Edge-based IoMT, secure data
[88] with edge-based IoMT, employ privacy-preserving
sharing, privacy preservation
techniques
Fine-grained data sharing, privacy Design fine-grained data-sharing protocols, employ
[89]
preservation, secure storage privacy-preserving techniques, ensure secure storage
Design emergency-specific data sharing frameworks,
Emergency and Emergency data sharing, data privacy,
[44] address privacy concerns, ensure secure
Healthcare-Specific secure communication
communication through encryption
Design rehabilitation-specific data-sharing schemes,
Rehabilitation medical record sharing,
[85] address data privacy concerns, establish
data privacy, interoperability
interoperability standards
Develop anonymous data-sharing protocols, ensure
Anonymous data sharing, secure
[86] secure communication through blockchain, optimize
communication, scalability
scalability
Design privacy-preserving mechanisms using
Medical data privacy, consent
[80] blockchain, implement consent management
management, auditability
frameworks, provide auditing capabilities
Address trust and privacy through blockchain’s
Trust and privacy concerns, access
[75] transparent and immutable nature, implement access
control, data provenance
control mechanisms, track data provenance
Checkable-state PBFT consensus Implement checkable state PBFT consensus algorithm,
[64]
algorithm, data consistency, auditing ensure data consistency, provide auditing mechanisms
Utilize privacy-enhancing technologies, ensure data
Privacy preservation, data integrity,
[81] integrity through cryptographic mechanisms, design
secure sharing protocols
secure sharing protocols
Implement cryptographic mechanisms, standardize
Data integrity, interoperability,
Data Integrity and [70] data formats, design efficient access control
efficient access control
Consistency mechanisms
Utilize encryption techniques, implement access
[73] Data privacy, integrity, access control control mechanisms, ensure data integrity through
hashing or digital signatures
Use cryptographic techniques for integrity verification,
Data integrity verification, user
[74] implement user authentication protocols, employ
authentication, secure storage
secure storage mechanisms
Cryptography 2023, 7, 36 16 of 20

Table 4. Cont.

Category Study Challenges Possible Solutions

Trust and security issues in data
Use blockchain to create a trustless environment,
[68] sharing among multiple cloud
implement secure data sharing protocols
providers
Ensure GDPR compliance through blockchain,
GDPR compliance, data storage, data
[91] implement secure data storage mechanisms, enable
sharing
secure data sharing
Privacy preservation, secure sharing Employ privacy-preserving mechanisms, design
Governance and
[92] protocols, consortium blockchain secure sharing protocols, establish governance
Compliance
governance frameworks for consortium blockchains
Multi-hop permission delegation, Develop multi-hop permission delegation schemes,
[93] controllable delegation depth, access enable control over delegation depth, implement
control access control mechanisms
Implement data protection mechanisms, ensure
Data protection, transparency,
[83] transparency through blockchain, establish
consortium governance
governance frameworks for consortium blockchains

Using blockchain technology for sharing medical data presents several technical chal-
lenges that need to be addressed for successful implementation in healthcare systems.
Scalability is a major concern due to the large volumes of data involved, requiring the
blockchain networks to be scaled appropriately. The privacy and confidentiality of sensitive
medical data need to be ensured, necessitating the development of innovative solutions
such as attribute-based encryption and robust access control policies. Performance and effi-
ciency issues, including slow transaction-processing speeds and high energy consumption,
need to be optimized for real-time data access. Interoperability with existing healthcare
infrastructure requires careful integration and compatibility planning. Regulatory compli-
ance, particularly with data protection laws like GDPR, is crucial, and frameworks aligning
with these requirements need to be developed. Establishing a governance framework
and building trust among participants is essential, necessitating robust consensus mecha-
nisms and effective governance structures. Overcoming these challenges will enable the
secure, efficient, and privacy-preserving sharing of medical data, leading to improved
healthcare outcomes.

5. Conclusions
As medical technology progresses, there is a rising demand for healthcare professionals
throughout the globe to communicate an expanding number of data safely. Blockchain
is commonly used in the healthcare industry to provide a comprehensive knowledge
of patient information and monitor data-sharing permission. It is a robust technology
that enables numerous parties to view and exchange data securely. Considering the
huge difficulty that healthcare organizations confront in digitizing and exchanging health
information, it is not surprising that many are striving to enhance healthcare operations via
the use of blockchain. Using publications published between 2017 and 2022, this review
examines the present status, research trends, and problems of blockchain in medical data
exchange to address the existing gap.
To attain this purpose, RQs were formulated and a predetermined technique was used
to reduce the number of articles reviewed to 50. They were then studied further. Our results
show that blockchain technology development and its use in the exchange of medical data
are growing. Hence, most of blockchain’s potential remain untapped. Most of the studies
propose a unique framework, architecture, or methodology for medical data exchange by
utilizing blockchain technology. As there are a multitude of benefits in exchanging patient
data in a safe, decentralized manner, it is difficult to comprehend why the industry has
not determined and concluded on using this concept earlier. Nevertheless, as with many
Cryptography 2023, 7, 36 17 of 20

factors in the commercial sector, there are actual reasons as to why it is difficult to exchange
healthcare data. It seems that countless challenges must be addressed before blockchain
can become the dominant industrial technology.

Funding: This research received no external funding.

Data Availability Statement: Not applicable.
Conflicts of Interest: The author declares no conflict of interest.

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