Volume 8, Issue 7, July 2023 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

The Blockchain-Based Solution and Applications

for EMR: Issues and Challenges
Sohaib Saleem1, *, Songfeng Lu2, Imdad Hussain3, Ubaid Ur Rahman3, Inam Ul Haq3, Asif Javed3
1
PhD Scholar, Hubei Engineering Research Center on Big Data Security, School of Cyber Science and Engineering, Huazhong
University of Science and Technology, Wuhan, 430074, China
2
Professor, School of Cyber Science and Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China
3
Department of Computer Science, University of Okara, Okara, Punjab, Pakistan

Abstract:- Electronic medical records (EMR) are the Internet of Things, government, education, and healthcare.
digital form of the most crucial, sensitive and private Blockchain technology combines diverse characteristics of
healthcare data. The EMR contains both medical and decentralization, immutability, robustness, security,
clinical data related to patients. The EMR data is stored transparency and trustless protocol. It has the potentials to
to access over the network for multiple stakeholders such eradicate the current problems of the healthcare sectors
as service providers, researchers, vendors, payers, [3][4][5].
pharmacies, and patients’ families, etc. The sharing of
EMR records is one of the significant and sensitive The current EMR system is not as efficient where the
portions of the healthcare system to improve the patient can share their medical data with confidence.
patient’s health. The current sharing method of the Because different hospitals and medical sectors are using
EMR system is in infancy or insufficient due to different programs and systems. Some hospitals are using
centralized storage or proprietorship. This arises the their EMR system and some are already developed ready-to-
issues and challenges of security, privacy, and use EMR systems [6]. It cannot be connected to access and
interoperability of EMR. The foundation of digital share the data during the treatment of the patient. In case, if
currencies like Bitcoin based on Blockchain is one of the a patient gets sick and traveled or referred to another
most cutting-edge technologies currently available. The hospital, then information from their EMR system of the
decentralized, immutable, shareable, transparent, and hospital could not be shared [7]. The patient wants to be in
secure record management system provided by charge of their personal information and share it with the
Blockchain technology may provide for allowing EMR specific authorized user as needed. But in the conventional
data to be distributed among various parties without system, the patient lacks confidence in the confidentiality
violating security and privacy. So, this paper reviews the and privacy of his or her personal information [7] [8].
blockchain-based solutions for managing and sharing the
EMR data. First, we highlight the major issues that are This systematic literature review examines how the
being met by different stakeholders in the healthcare blockchain-based EMR system can transform the current
sector. Secondly, we explore the features and healthcare (HC) setup. This study attempts to identify the
opportunities of this technology that can be used to benefits and opportunities to use the blockchain in an EMR
resolve these highlighted issues. Thirdly, the blockchain- environment for all healthcare players and to identify the
based applications need to be identified that have been developed blockchain-based EMR’s applications.
developed for the EMR healthcare sectors. The remainder of the paper is structured into five
Keywords:- EMR Issues, Blockchain, EMR Blockchain, sections. Section 1 presents the blockchain technology and
Systematic literature reviews, Information and Privacy its importance in electronic medical records. Section 2
Issues, Information Violations, Privacy Violations, Sharing explores the literature reviewed for this study and
of Information. blockchain features present the opportunities which might be
envisioned by using blockchain technology to revolutionize
I. INTRODUCTION the current EMR healthcare system. Section 3 describes the
methodology of research as well as sections characterized
Blockchain technology is a decentralized public ledger as; the need for conducting a systematic literature review,
or database that is distributed where every transaction is motivation and research questions, search strategy, inclusion
stored and verified anonymously by the nodes of the and exclusion criteria, classification criteria, data extraction.
network [1]. “Satoshi Nakamoto” an anonymous person, Section 4 discovers the result to answer the formulated
designed a peer-to-peer decentralized electronic cash system research questions. Section 5 describes the threats to the
without involving any third party. The first digital currency validity of this research. Finally, conclusion and future work
named as Bitcoin was introduced by this system in 2008 are documented.
[1][2].
II. BACKGROUND
The evolution of blockchain technology is not
restricted to cryptocurrency. Blockchain (BC), the newly This chapter consists of two parts. The first part
born technology, has gained a lot of attention and captivated defines major fundamentals and concept theories of
the rational attraction of domain experts and researchers in blockchain technology to understand the rest of the paper
several fields including banks, manufacturers, supply chain, based on the review studies about blockchain technology.

IJISRT23JUL2406 www.ijisrt.com 3268

Volume 8, Issue 7, July 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
The second part describes the use of EMR-based validated by the consensus of all nodes of the network.
blockchains in the healthcare sector and analyzed some Security, auditability, and anonymous transparency are all
blockchain implementations and the existing application of provided on all the network's permissioned nodes via this
blockchain in EMR healthcare. chain of blocks joined together using an irreversible hash
function [9] [11]. The distributed ledger and the consensus
A. Blockchain process are the two fundamental components of this
Blockchain technology works on a consensus algorithm distributed ledger technology. The distinction between
to replace the third-party. Blockchain manages and shares centralized and distributed ledgers is seen in Figure 1.
the records in the form of a distributed ledger. Blocks are

Fig. 1: Centralized vs. Distributed Ledger

B. Use of Blockchain in EMR Healthcare Xia et al. [15] used the permissioned blockchain for a
In the healthcare sector, EMR is the very important secure and scalable access control system called Blockchain-
aspect of patient care for diagnosis and treatment which based Data Sharing (BBDS). By utilizing cryptographic keys
needs to be circulated and shared among the different and digital signatures, this scalable and secure system safely
stakeholders e.g.; service providers, payers, pharmacies, allows data sharing while safeguarding the confidentiality of
researchers, patients’ families, etc. [10]. The EMR data can EMR data. The users/owners of the data can obtain their
be shared among different stakeholders when the patient is own EMR data from the shared pool after verifying and
moved or transferred from one hospital to another hospital. authenticating their cryptographic keys for security reasons
The patient can control his/her medical record and grant or in this permissioned blockchain-based data-sharing system.
revoke access to other parties on the network to achieve
security and privacy [9] [10]. Zhang et al. [16] Designed the blockchain-oriented
architecture for EMR called GAA-FQ (Granular Access
Healthcare stakeholders and experts may prefer the Authorization supporting Flexible Queries), which is used
blockchain to resolve the issues of security, privacy, data for the granularity of authorization of access control scheme
ownership and interoperability of healthcare sectors without for different stakeholder on the EMR system. To achieve a
the loss or delay of medical data. Blockchain technology can more flexible and accurate granularity for searches and
be proved as a game-changer when the multiple parties and access authorisation, a secure EMR system uses this design.
healthcare provider generate or share the information in a The access authorization method known as GAA-FQ has
trusted environment, where intermediaries are no longer been developed for secure EMR. It uses authorization,
required. This technological advantage improves the security encryption, and decryption algorithms and supports flexible
and privacy of patient data [12]. data queries.

The blockchain is using these days in the healthcare McFarlane et al. [7] Implemented a network storage
sector to overcomes all challenges and issues that are faced system for peer-to-peer EMR systems based on the
by the current EMR system [13]. In this perspective, blockchain for the Health information exchange (HIE) to
Dubovitskaya et al. [14] Purposed a framework for achieve interoperability and security. In this paper, the
maintaining the management of healthcare data and EMR author discovered the patient-provider system for achieving
data distribution between different healthcare providers privacy and security according to HIPPA rules and
based on the permissioned blockchain technology to regulations. With the help of this system, the current patient-
achieves security and privacy and can decrease the provider connection may do without the expenses associated
turnaround time for EMR sharing. This paper also presented with third parties. There are potentials in the system to
the different scenarios of using blockchain application in the upgrade the data integrity, reduced costs of transaction,
healthcare sector such as primary patient care to manage and decentralization, and trust. The patientory network [7], a
control the access his data, data aggregation for research patient-centered protocol supported by blockchain
purpose to participate in data sharing, connected different technology, is transforming how healthcare stakeholders
healthcare parities using the permissioned blockchain handle electronic medical data and effectively communicate
technology for patient care and cost management. with the clinical care team.

IJISRT23JUL2406 www.ijisrt.com 3269

Volume 8, Issue 7, July 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
C. Compared to Secondary Studies of its context and also compares to this study. The first
Blockchain appeared as the backbone of cryptocurrency attribute is Features and Benefits of BC, which shows that
when the first application bitcoin was launched in 2009. almost all these secondary studies incompletely describe the
Blockchain is the fastest growing technology that came in the feature of blockchain technology and as compared to this
healthcare sector in 2014. In the healthcare department, this study. The next attributes are EMR-related issues faced by
technology provides the facilities for the healthcare the patient, opportunities are offered by the blockchain to
stakeholders to manage the healthcare data, clinical trials, eradicate these issues and challenges, highlight the
electronic medical records (EMRs) and electronic health blockchain-based EMR applications in the healthcare sector.
records (EHRs) while upholding the regulatory compliance. These attributed did not address in these studies. So, our
major goal is to focus on these four attributes (EMR-related
There are only nine secondary studies were shortlisted issues are faced by the patient, opportunities are offered by
for comparison, we found that these studies discussed the the blockchain to eradicate these issues, blockchain-based
different attributes of this blockchain technology is the EMR applications.) as well as we explain the features of
healthcare sector. Table 1 shows the different attributes that blockchain technology.
have been studied by existing researchers for classifications

Table 1: Compared Secondary Studies

Reference Attributes
Features and EMR-related Opportunities are offered Identified
Research
Benefits of BC in issues faced by the blockchain to Blockchain-Based
Methodology
HC by the patient eradicate these issues? Applications
Rabah et al. [4], Incompletely Yes No No No No
Zhang et al. [5]. Incompletely Yes No No No No
Arsheen et al. [6] No No No Yes No
Boonstra et al. [12] No Yes No No Yes
Baysal et al. [13] Incompletely Yes No No Yes Yes
Yaqoob et al. [18] Yes No Yes Incompletely Yes No
Al Mamun et al. [19] Yes No No No Yes
Khatri, S. et al. [20] Incompletely Yes No NO Yes Yes
Reegu et al. [21] No No NO No Yes
This Study Yes Yes Yes Yes Yes

As earlier discussed, we identified that they only III. RESEARCH METHODOLOGY

highlight the blockchain technology for healthcare sectors
without focusing on the issues as well as the opportunities for The research methodology is the way or technique
Blockchain-based EMR systems did not address. No such that is used to solve a research problem(s) systematically.
study exists until the date that aims is to identify the The systematic literature review (SLR) is the type of
blockchain-based applications which comprehend the secondary study that uses any kind of research methodology
importance of the healthcare sector and its stakeholders in the to collect the data, finding and interprets the gap in the
to revolutionize the ecosystem. Additionally, the results of current research to answer the formulated research question.
previous investigations have been extracted using the Finding related literature in the field is the primary objective
qualitative research approach. As a result, we created a of a systematic literature review. There are many guidelines
quantitative research approach using a systematic literature are available for conducting the SLR. Following the
review as opposed to a non-structured review process. methodology suggested by Barbara Kitchenham [22] and
advised by [23] to seek the pertinent research for filling the
lacking gap, this SLR was carried out. Figure 2 shows all the
processing steps and their outcomes of Barbara Kitchenham
methodology which are implemented in this study.

Fig. 2: Implemented Processing Steps of Barbara Kitchenham Methodology

IJISRT23JUL2406 www.ijisrt.com 3270

Volume 8, Issue 7, July 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
A. Need of Conducting SLR goals of this study are to pinpoint the blockchain applications
After scrutinizing the existing secondary studies or that must be thoroughly examined in order to completely
literature related to EMR Healthcare, it is identified that transform the EMR record system. Last but not least,
some gaps are missing yet (Table I presents) and need to be compared to past non-structured review research, this
filled for further consequences. These existing studies only systematic literature review employs a broad and exact order
discussed the revolution of blockchain technology in the of activities to extract the outcomes. Table 1 present the
EMR system of the healthcare sector without focusing on the different attributes of secondary studies in accordance with
issues as well as the opportunities for Blockchain-based the scope of this study and tells us the gaps in the existing
EMR systems. No such study exists until the date that aims is studies that are not filled until now.
to highlight and discuss the applications of the EMR system
based on the blockchain distributed technology. B. Research Question and Motivation
The three research questions that guided our work and
Therefore, we are focusing on elaborating on the key helped us accomplish the objectives of the systematic
characteristics of blockchain technology and the problems literature review are presented in this section. The following
that the existing standard EMR system faces. The blockchain research questions are posed and addressed by this SLR.
provides opportunity to solve these problems and uncover the Table 2 present the research questions as well as the main
full potential in the EMR health records system. The primary motivation of research.

Table 2: Research Question and Motivation

Sr. # Research Question Motivation
What EMR-related issues are faced by To highlights and address the issues that are faced by the
1
the patient? patient in the current EMR system.
What opportunities are offered by the This research question seeks to explore the benefits and
2 blockchain to eradicate these issues? opportunities of this blockchain technology to resolve the
highlighted issues and challenges.
What Blockchain-Based applications To highlights the developed Blockchain-Based EMR
3
have been developed for EMR? applications that have been proposed in the scientific literature.

C. Search Strategy For inclusion purposes, after reading and analyzing the
The search strategy is an essential part of conducting a title and abstract of each study we concluded that only 26
systematic review. After ensuring the research questions, primary studies were considered for data gathering that is
keywords are formulated to find out the relevant existing relevant to our context i.e.: EMR Issues, Electronic Medical
research work by using the tag-based approach. We used Records issues, EMR Blockchain. Table 3 presents the
different digital libraries and web source for collecting the primary papers with corresponding Paper #, Authors,
primary studies as well as secondary studies. Some of the Publication year, Use cases, and Publication type/channel.
digital libraries that we used are; IEEE Xplore Digital Remaining studies were discarded because they were
Library, ACM Digital Library, ScienceDirect (Elsevier), irrelevant or out of context to our specified criteria or did not
Scopus, and Springer, etc. By using these digital libraries include our searched keywords in their title or abstract.
and databases, our purpose was to find and collect only peer-
reviewed studies that have been published in authentic and Shortlisted papers whose title are not matched to our
impact factor-based journals, conferences, books, and search strategy or research question was discarded. From
workshops. The search string; “EMR” AND (“issues*” OR them, some of the papers or studies were discarded that were
“blockchain*” OR “security and privacy*” OR “health*”) is not related to the EMR and blockchain technology in the
used to find out the relevant literature of our problem healthcare industry.
statement. Furthermore, we selected Google Scholar Web
sources to extend the research. All of the papers—regardless At last, by applying the following exclusion criteria, we
of quality or year of publication—were gathered and discarded the received set of results:
explored from multiple journals and conferences.  Papers are written in other languages than English.
 Master and doctoral dissertations.
D. Inclusion and Exclusion Criteria  Duplicated articles obtained from Google Scholar.
The next stage was to examine and screen the research  Studies that are not peer-reviewed, such as surveys,
papers for relevance after gathering papers from various interviews and press releases.
databases using our search strategy and search methodology.  Studies without full manuscript accessibility. Main
This step's first stage involved screening studies and emphasis are not correlated to our motivation such as
publications for inclusion based on their titles for relevancy. EMR and blockchain for EMR system.
Based on our research questions, all the primary studies
were collected and shortlisted that containing our targeted E. Classification Criteria
keywords especially; “EMR Issues, Electronic Medical The objective of this research is to discuss the issues of the
Records issues, EMR Blockchain, Electronic Medical current EMR health system and the potential of blockchain
Records blockchain, and EMR Privacy and Security”. technology for the EMR system, the blockchain-based EMR
applications. Nominated studies were classified according to
research questions. This step was planned to map the

IJISRT23JUL2406 www.ijisrt.com 3271

Volume 8, Issue 7, July 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
shortlisted research paper into the classification criteria. We keywords. Each nominated and included paper was read in
now provide the chosen paper's classification criteria. The depth after being grouped into distinct classes, and if the text
papers that were selected for shortlisting were grouped into or content of the paper is relevant to our context, then these
various classes or categories based on the search strategy and papers fulfill our classification criteria.

Table 3: Primary Papers with Corresponding Information

Paper Publication Publication
Authors Use Case
# Years Channel
1 Xia et al. [15] 2017 Journal Data Sharing
2 Yue et al. [41] 2016 Journal Privacy
3 Zhang et al. [16] 2018 Conferences Access Control
4 Dubovitskaya et al. [14] 2018 Journal Security and Sharing
5 Jiang et al. [52] 2018 Conference Healthcare Information Exchange
6 Liu et al. [8] 2018 Conference Privacy Sharing
7 McFarlane et al. [7] 2017 Journal Data Storage
8 Azaria et al. [9] 2016 Conference Data Access and Permission
9 Ahram et al. [48] 2017 Conference Managing and Access Control
10 Kim et al. [39] 2017 Journal Trusted Data Sharing
11 Xia et al. [34] 2017 Journal Data Sharing
12 Chen et al. [38] 2019 Journal Data Sharing
13 de Oliveira et al. [45] 2019 Conference Security
14 Fan et al. [50] 2018 Journal Secure Medical Data Sharing
15 Li et al. [36] 2018 Journal Data Preservation
16 Ito et al. [35] 2018 Conference Privacy
17 Rifi et al [42] 2017 Conference Data Access
18 Rouhani et al. [43] 2017 Conference Security
19 Ananth et al. [47] 2018 Journal Security
20 Xiao et al [40] 2018 Conference Sharing and Management
21 Zhang et al. [51] 2018 Journal Security
22 Chen et al. [56] 2021 Journal Security, Sharing, Storage
23 Zaabar et al. [53] 2021 Journal Security and Privacy
Secure Health Management
24 Sadeghi et al. [57] 2022 Journal
Information Systems
25 Karmakar et al. [54] 2023 Journal Data Storage, Integrity
26 Pawar, V., & Sachdeva [55] 2023 Journal Scalability

F. Data Extraction IV. RESULTS

After labeling the relevant studies, this phase is used for
extracting and recording the required information from the This chapter explains the research questions that are
selected studies that are used for answering the formulated defined in section 4. The first research question of this study
questions through this SLR paper. Data were extracted from is to highlights and addresses the issues that are faced by the
the literature primarily focusing on the EMR Issues, EMR patient in the current EMR system. The second research
Blockchain, and Electronic Medical Records Blockchain, question seeks to highlight the opportunities that are offered
EMR Privacy, and Security. Furthermore, we explored these by the BC for EMR. The next research question is to identify
studies to find the key benefits of blockchain technology in the Blockchain-Based applications that have been developed
the EMR environment. The following criteria are used to for electronic medical records.
extract the data from studies:
A. What EMR-related issues are faced by the patient?
 Primary information from shortlisted studies (i-e;
The healthcare sector consists of multiples players
publication title and authors)
creating the ecosystem i-e patients, providers, payers, supply
 Information associated with the study (main contribution,
chain bearers and research institutes, governments, that is
objective)
using the EMR records of patients without the permission or
 Results (issues that have been addressed, benefits of consent of the patient [17]. Each stakeholder creating
blockchain technology for EMR in HC) multiple issues while storing, sharing or management of data
The information data from the labeled research article in the area of concern. These records contain all the medical
were retrieved during this final stage of the systematic history of the patient throughout the medical system. So, the
literature review process in order to conduct a meta-analysis idea of centralizing all the medical records or information of
and respond to the established research question. EMR was revolutionized in the healthcare sectors. But the
control of the current centralized EMR system is in the hand
of third-party providers or players which creating numerous
issues and challenges [18] [24]. Existing literature was

IJISRT23JUL2406 www.ijisrt.com 3272

Volume 8, Issue 7, July 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
collected and analyzed to gather results is to rectify the issues of thousands of patients have been compromised on their
that are facing by the patient in the current EMR system. medical data because of the violation of security at hospitals,
These issues are discussed below: insurance companies, and different government healthcare
organizations. This EMR data is also vulnerable to misuse by
 Privacy and Confidentiality those people who are seeking to profit from these data by
The EMR data of the patient is the most sensitive, selling or buying doctor’s prescribing data to the research
private and confidential asset of patient care, thus the leakage organizations or pharmaceutical companies [25] [28].
of this data might hurt the patient reputation and money.
Because this data is scattered and stored among the multiple The storage or accessing of EMR data system facing
servers or computers over the network [25]. Secondly, the the issues [28] [31] these days are:
existing scenarios of EMR systems in the healthcare sectors  Alteration or modification of patient data and destroying
are developed on centralized architecture which is controlled the medical data without the involvement of patients
by a single authority that is more vulnerable to privacy and through the hacking.
confidentiality [26].  Misuse of EMR records by the unauthorized users of the
system, whose motive is to hurt or destroy the patient
Multiple healthcare stakeholders need to access or share reputation.
the medical information of patients without any modification.  Management of data takes extra time by the legacy EMR
The unauthorized users’ access might break the patient system which may lead to insecurity.
reputation and hurts the quality of care by using his/her data,  Government institution creates the disturbance of private
so the audit trail of data access may cause the breakage of
healthcare data.
confidentiality [6]. EMR data and access to medical data to
other parties on the network should be control by the patient During the treatment process of individuals, the patient,
to achieve privacy and confidentiality [27]. as well as physicians or doctors are uncertain about the
secure storage of EMR records [28] [32]. They are in stress
The medical data of any patient is vulnerable to misuse
about the data that may be unauthorized users access the
by those people who are taking profit from this data. For
private medical data of the patient which creates a serious
example, some pharmaceutical companies buying and selling
problem related to patient reputation and trust in the doctors.
the patient data to the research companies without the
acknowledgment of patient, which create privacy issues. The The security of the EMR’s data contains the integrity,
World privacy forum warns that electronic medical data is availability, and confidentiality of the information that needs
more sensitive and private to the patient, especially when this to ensure. So, to ensure the availability, confidentiality, and
data is stored on the central system [28]. integrity of private information is a very challenging task
[26].
The medical information always should be shared or
exchanged only with the permission of the patient. When the  Lack of interoperability or Data Sharing Limitation
patient is unable to shares their data, then the authorized One of the biggest and major issues of electronic
representatives or the guardians of the patient share the medical records is the lack of interoperability or data sharing
information [29]. The primary way to preserve limitations between similar or dissimilar kinds of systems.
confidentiality is to allow the only authorized users to access To check the medical’s history of the patient, the system
personal information. This may lead to privacy and must communicate efficiently or effectively with each other
confidentiality [30]. To achieve this goal, the United States during the treatment [28] [33].
Department of Health and Human Services (HHS) created
the rules and guidelines related to sharing and access control The medical records of EMR data are scattered or
of patient data. According to HHS, the patient has access and fragmented in silos form on the different systems, so the
control over their medical data. This may guarantee the communication among these systems is difficult because
privacy and confidentiality of patient health data [31]. these data are located on different sides. If the patient moved
or referred from one hospital or physician to another, then
The Health Insurance Portability and Accountability the patient needs to access their medical data from the
Act (HIPAA) privacy rules are used to define the restrictions previous hospital but the systems of EMR are not mutually
or guidelines to bound or restrict the companies or service connected for effective communication, so there are the
providers to fulfill the law related to the privacy of patient’s biggest issues is lack of interoperability. In another scenario,
data especially when they share the data between different some hospitals or providers don’t want to share data from
parties. This HIPAA rule classifies the four fundamental their system, even though the owner of this data is patient
parties that have access rights to access the medical and cannot share their data when they want [33].
information of patients i-e: health care providers, insurers,
health claims clearinghouses, and business associates [29] In healthcare sectors, another reason of the lack of
[31]. interoperability is that the healthcare organizations use their
independent different infrastructure (i.e.; protocols, OS,
 Data Security programming language, databases, software, etc.) to store
Electronic medical records are open to threats and the medical data, which arise the problems of
potential misuse due to a large amount of sensitive healthcare interoperability and availability of patient medical data
data stored in the central data center of the hospital which is among the different stakeholders [34].
vulnerable to security [28]. From the last few years, hundreds

IJISRT23JUL2406 www.ijisrt.com 3273

Volume 8, Issue 7, July 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Different providers of EMR use their EMR embedded with blockchain technology can exhibit healthcare
management tools or take the services of already developed intellect to plan better outcomes for patient care as it is the
EMR systems from the other vendors. Different vendors use sole purpose of the whole ecosystem to serve humanity [36].
different environments, tools, hardware software, protocols, Some EMR health blockchain opportunities are the highlight
procedures, operating system, so the interoperability for a specific demand of users to show the potentials of this
between a different kind of EMR hardware or software emergence.
cannot be user-friendly for the patient [6] [7].
These opportunities are grouped below by its uses:
So, non-interoperability can cause a lack of
coordination and communication among healthcare  Data Exchange
stakeholders in traditional systems. The poor or lack of Blockchain decentralized technology used to solve the
coordination or communication among the different medical issues of incompatible scattered and fragmented medical
stakeholder results in the lack of quality care of the patient records of a patient that are stored over the multiple locations
because patient themselves is not considered as data owner on the network [37] [39]. This technology has the potentials
for sharing their data among the different healthcare to resolve the issue of medical data sharing by using the
providers. distributed ledger and improved the patient quality of care
and coordination among the different parties of the EMR
 Interruption of the Physician-Patient Relationship systems [38] [40]. This coordinated and synchronized
The physician-patient relationship creates interaction structure of blockchain technology will improve real-time
problems during the medication or treatment of the patient communication for the diagnosis, treatment, information
[7]. According to literature, 92% of the physicians or doctors sharing, latest health notifications, as well as the history of
feel the disturbance or to avoid the use of the EMR system the patient [41].
when they communicate with their patients. The main reason
behind the problem of the physician-patient relationship is On the ledger of blockchain technology, all the nodes
that the physicians use the legacy system to store the data are connected in a decentralized manner, and when the
during the diagnosis of the patient which disturbs the patient wants to share the information from one point to
communication [31]. These legacy systems or computer for another, then-latest information is shared by giving the
EMR data storage is time-consuming especially when they authorization access [40] [36] to the particular physicians of
are using the computer during the diagnosis and maybe the the patient. Moreover, this technology help to avoiding the
physicians have limited computer skills [26]. These legacy single point of failure, because the multiple copies of patient
systems are less user-friendly or some physician has no data are available every time on different nodes [42]. So, the
computer skills for using the menus or system [12]. interoperability features of blockchain provide a more
suitable and reliable environment for the information sharing
 Lack of Availability of EMR data of the patient when they need to share the information [38]
The availability of EMR’s data depends upon the proper [16] [34].
coordination and communications between the system. The shared immutable ledger is used for the information
Because the system of the EMRs is primarily designed and sharing in which once the records are stored, after that the
developed for patient treatment and patient care [31]. information does not delete [39].

According to the survey that occurred in 2010, a 50%  Decentralization

EMR system is the physician's office-based that worked In the healthcare sector, the different distributed medical
including under the fully difficult and different level of stakeholders are located on the multiples site needs a
functionality [12]. So, the availability of patient medical data, decentralized management system for data storage [43].
prescriptions, history, treatment, and diagnosis data will be Decentralization feature is the backbone of the blockchain
valuable for the patient and doctors if the data is delivered technology [36] [34]. To highlight or resolved the issue of
and shares at the same time of needs. In the healthcare data management for healthcare, blockchain technology is
department, the main factors which create the problem of the the perfect solution for the decentralization management
availability of EMR data for the different healthcare system for all the stakeholders [16]. In this nature of
providers are the administrative decisions, legacy system, blockchain-based EMR healthcare systems, different
physical equipment, and technology [26]. providers, patients or other medical stakeholders can access
The availability, integrity, security, privacy of sensitive the same health records because the multiple copies of each
information are very challenging or serious issues while data lakes distributed over the multiples nodes of the network
sharing the information. [13].

B. What Opportunities are Offered by the Blockchain to So, health data management is the basic needs of every
Eradicate these Issues? healthcare sectors, which requires a lot of resources in terms
Blockchain has seemed a decade before in computing of human resources and technical or computer resources [44].
whereas it came within the healthcare sector in 2014 with the
start of the non-financial version of the technology. Therefore, this technology is based on decentralization,
Researchers are found eager to get aware of this distinctive which means there is no central or third party to store or
technology to grasp the potentials and challenges to extract manage the health data of the patient [41]. Decentralized data
the supreme benefits [35]. It is envisaged that EMR management can communicate the providers and patients
more efficiently and productively [35]. The same information

IJISRT23JUL2406 www.ijisrt.com 3274

Volume 8, Issue 7, July 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
or data can be shared and update the data in real-time, this the healthcare providers by the patient with the appropriate
feature can also increase the fraud detections and trace the access or permission for accessing the data [39] [43].
counterfeit drugs [40]. Moreover, this blockchain technology
for EMR management has the potential to transform the The secure patient-controlled access of data is sure by
current costly and expensive management system into an applying the consensus mechanism and cryptographic
easy and inexpensive system [37]. methods in blockchain distributed technology through the
only private key of the specific user can decrypt the data [9].
 Improved Data Security and Privacy The patient has the right and ability to grant and revoke
The security of patient medical data kept on the EMR access to other stakeholders (researchers, providers, and
system is generally improved by the immutability features of payers) in the EMR system.
blockchain technology. Because the blockchain ledger is an
immutable record of transactions, it is impossible to change  Availability and Robustness
the records once they have been put there. [35] Any Once the data is stored on the ledger of the blockchain
modifications made to block are irreversible and permanent. networks, it is shared and replicated to every other node that
Any modifications, whether significant or not, are exists on the network, so the availability of the health data of
permanently recorded in a new block [39]. EMR stored on the blockchain is certain [36] [41]. On the
blockchain network, there are multiple nodes present at the
With immutability, once the patient medical data or same time, if one node is down, at the same time the
information stored on the ledger of the blockchain, it cannot information should be accessible from other nodes means
be corrupted, altered or changed [37] [43]. If any malicious there is no single point of failure on the system of blockchain
user or attackers want to access or destroy the data then it is networks. Storage or existence of data at the same time on
impossible for them, because at the same time there are the multiples nodes must be guarantees that the availability of
multiple healthcare nodes are connected within the ledger the data from any of the nodes because the data is distributed
that contains the copy of data [41]. They immediately among every node on the network, so there is no chance of
received the notification if anyone wants to alter the data single point of failure on the system of EMR medical system
[34]. Because every information recorded on the blockchain [38] [45].
is time-stamped, encrypted, and added in chronological
order. So, the beauty of these features is, data is stored in an  Transparency and Trust
appended form, which means it cannot be altered or changed For the EMR environment, blockchain is an open and
[42] [45]. transparent technology that creates and ensures the trust even
with the untrusted parties over the system. The transparency
On the other hand, the patient data stored on blockchain and openness nature of blockchains provides a trustworthy
by using the cryptographic keys and digital signatures that EMR environment among the distributed healthcare
help to protect the identity and privacy of the patient. The applications [47]. This feature of blockchain technology
patient controls their medical data including the latest enables the applications of healthcare stakeholders accepted
information as well as the history of the data. If any medical in a different area. The blockchain-based system for the EMR
stakeholder wants to access the patient data, then he/she need environment enhanced the transparency of data with end to
to take the grants of the intended data from the patient [46] end details of data storage and data access [36] [47].
[47].
After embedded the transparency feature of blockchain
Therefore, immutability promotes the blockchain as in electronic medical records, the healthcare sector becomes
auditable and tamper-resistant. more transparent, efficient and removes the chances of fake
or fraudulent activities with the patient data. in the supply
 Health Data Ownership chain of the health EMR system, everything is transparent to
Patient medical data controlled by the central party in the all the parties over the network [49].
centralized environment of the traditional healthcare system.
[34]. But the patient needs to control their data, to control the The transparent system makes the system would be
access of their data [43], sharing or exchange their data. The accessible or approachable to every node or parties that are
patient needs to ensure that their medical records, as well as involved in the network, no matter which type of electronic
medical history, are not accessed or misused by unauthorized medical records they use [39]. So, this feature provides a
users or other medical stakeholders [45]. trustworthy environment as well as achieve high security and
transparency by using this system [16]. Also, the sharing of
By using the strong cryptographic encryption methods data among the nodes, origin of the data, history of the data,
and digital signature with BC which are defined by the smart location of the data, circulation of counterfeit drugs or fake
contract, the ownership of data is in the hand of the patient medicines recommended by providers to the patient on the
[36]. The smart contract is programmable computer code that network can be traceable and transparent to everyone.
is stored inside the blockchain and is activated and executed
automatically when the necessary conditions are met. It is Additionally, a blockchain based system's feature of
unnecessary to rely on a central authority or organization to data transparency can assist us in tracking down activities
carry out the contract when using a smart contract and the and stopping the distribution of fake drugs [38].
blockchain [9]. The execution of a contract between
untrusted parties is made possible by smart contracts built on
blockchain technology. The public key or private is signed to

IJISRT23JUL2406 www.ijisrt.com 3275

Volume 8, Issue 7, July 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
C. What Blockchain-Based Applications have been  DPS [36]
Developed for EMR? A blockchain-based data preservation system (DPS) also
Multiple applications of blockchain from the different implemented on the Ethereum platform for medical data,
areas have been proposed till the date in scientific studies. developed by [36]. The developed DPS system provides the
However, not all of these applications have been interpreted temper proof secure storage to guarantee the verifiability and
in the working environment. It is therefore important to primitiveness of stored data, maintain the validity and
address the real-world implementation of blockchain-based integrity of data, preserving the privacy of the patient. This
EMR healthcare applications from the literature. So, this system uses the proof of primitiveness of data with
research question helps to highlight the EMR applications blockchain that can detect the data tempering and can
and identify the areas where there are some research gap and validate whether the current data is similar to original data or
that missing gap need to shift research focus to those areas. not. On the other hand, DPS uses the cryptographic hashing
algorithm and storage mechanism to offer anonymity for the
 BPDS [8] protection of sensitive data from being leaked or stolen by
[8] Purposed a blockchain-based privacy-preserving data unauthorized parties.
sharing method for the EMR system, named BPDS that is
used for securely storing the EMR data on the cloud storage  HealthChain [48]
and indexed are created of this data using the tamper-proof The blockchain-based EMR application is HealthChain,
consortium blockchain. The patients can have complete which is implemented by permissioned and private
control over their EMRs or users for achieving security and blockchain on the IBM Bluemix platform using Hyperledger
privacy. By using the predefined access permission, sharing Fabric. The blockchain technology with the modular
of data can be secure through the smart contract of the architecture of Hyperledger enables the HealthChain to
blockchain. The CP-ABE-based access control mechanism achieves the confidentiality, security, and scalability of health
and the content extraction signature (CES) scheme in BPDS data. This application using the Practical Byzantine Fault
used to share the data selectively and protect the patient’s Tolerance (PBFT) consensus algorithm for the Protected
privacy during the sharing of data. Health Information PHI between healthcare network
providers and mobile devices within the network.
 MedRec [9] HealthChain also integrates the smart contracts to control the
[9] The purposed decentralized record management permissions and access rights on the blockchain network.
system of EMRs using blockchain technology for atheization
and data sharing among the multiples stakeholders, so-called  Ancile [49]
MedRec. This platform provides the immutable and easy Ancile is a blockchain-based framework proposed by
access approaches for patients to save their medical records Dagar et al. [49]. Ancile used the Ethereum blockchain's
and can also grant and revoke permissions to their data with smart contract in the aforementioned case to fully offer the
confidentiality and accountability as the records are not patient with access control, security, privacy, and
stored on the blockchain instead pointers to the data storage interoperability of electronic medical records. This
locations, logs and permissions are only stored in this framework using the six types of smart contract i-e;
blockchain. The medical stakeholder takes incentive as consensus protocols, services history, permissions contract,
rewards after participating on the network as a miner for classification, ownerships, and re-encryption. Using the smart
verifying and securing the network through the proof of work contract, patient checks and control the access permission of
on this platform. their private data. Furthermore, the beauty of this framework
is that patient transfer and grant or revoke the permission
 MedShare [34] from one node to another node using the cryptographic
MedShare is also a blockchain-based EMR application hashes of medical records and query links.
that offers the data provenance, access control and data
auditing of shared medical data in cloud repositories.  MedBlock [50]
MedShare monitors all activities of data sharing and MedBlock is another blockchain-based EMR application
transitions from one entity to another entity and recorded in a for secure information management to share the sensitive
tamper-proof manner. Moreover, this application tracks the electronic medical records among authorized users which are
data access by applying the smart contract and access control proposed by Fan et al. [50]. The basic purpose of MedBlock
mechanism in the subject to address the issues of medical is to handle the patient’s information to solve the problems of
data sharing. [34] proposed this application in a cloud data management and data sharing. The distributed ledger of
environment for the purpose to exchange the medical data MedBlock plays an important role for the authorized user to
among the different medical custodians such as research and access and retrieval of EMRs effectively and efficiently. The
medical institutions with minimal risk to data privacy. The ledger's retrieval system makes it simple for users to get
consensus nodes withing this system would be responsible involved and actively look for the information they need.
for processing the request of data exchange and then The EMR data's privacy and security are ensured by the
broadcasting the data in the form of blocks into the straightforward and efficient access control encryption
blockchain network without the violation of data privacy. technique, preventing the leakage of patients' sensitive
information. Besides, this system uses the access control
consensus protocol and cryptographic method to achieve
high information security and achieve the consensus of EMR
without much consumption of energy.

IJISRT23JUL2406 www.ijisrt.com 3276

Volume 8, Issue 7, July 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
 FHIRChain [51] ends reliance on a single authority. Data are dispersed among
The Health Level Seven International (HL7) group all full nodes in the blockchain; therefore, it can withstand
created the Fast Healthcare Interoperability Resources single points of failure. In the ChainSure system, network
framework, often known as FHIRchain [51], for transferring congestion has a significant impact on transaction speed; as a
clinical data to improve healthcare interoperability and result, the slower the rate, the more participants or nodes
efficiency. The Office of the National Coordinator for Health there are. Private keys owned by individuals may provide a
Information Technology's (ONC) roadmap's requirements for point of risk from a security standpoint in a decentralized
scalable and secure clinical data sharing, network node setup. Once created during the creation of a wallet, they
verification and authentication, and data source permissions permit access to all data that has been stored. If it is stolen, it
are all addressed by the blockchain-based application puts important data and digital currency at risk. Access to the
FHIRchain. A decentralized app (DApp) based on wallet is permanently lost if it is lost.
FHIRchain that employs digital health identities and keys to
authenticate and validate all participants and data access  ParallelChain [55]
authorizations is also designed and shown by the author A new system that balances energy economy and
Zhang et al. [51] of this study. Also, this DApp used to scalability for managing healthcare data. In terms of the
support the healthcare interoperability for the patient clinical quantity of messages sent and received as well as processing
records for efficient data sharing. efficiency, ParallelChain outperforms the consensus
algorithms of Bitcoin, Bitcoin-NG, and Algorand. Network
 BlocHIE [52] overhead, too. A more effective consensus technique is
BlocHIE is yet another blockchain-based healthcare utilized in place of the Bitcoin's energy-intensive PoW
information exchange (HIE) system that has been put up by consensus system. The ParallelChain is resistant to denial-of-
Shan et al. [52]. BlocHIE uses EMR-Chain and PHD-Chain service attacks, forks, and monopolistic issues. The quantity
to handle the difficulties of storing and exchanging electronic of data transfer, processing time, and the number of messages
medical records (EMRs) and personal healthcare data (PHD). exchanged were all greatly increased by changing the
Two loosely coupled blockchains, EMR-chain and PHD- consensus technique and the structure.
Chain, are utilized to store and manage the EMR and PHD
records separately on the network. The EMR chain maintains V. THREATS TO VALIDITY
the data produced by the hospital, and the PHD chain
provides the patient with access to that data. In order to meet Our major intention of conducting this SLR study is to
the needs of storing and exchanging medical data, various highlight the EMR applications that are developed on the
chains are utilized. blockchain network in the healthcare domain. After
analyzing the existing studies of blockchain-based EMR, we
 HealthBlock [53] tried to gather as many primary studies for the extraction of
HealthBlock is a blockchain-based platform for data. But this emerging field in his initial stages, researchers
decentralized healthcare management. The suggested are discovering its applications and very eagerly, so the threat
approach combines blockchain technology with IoT medical of this study is that, related studies may be published in the
devices to produce an efficient and secure RPM (Remote future which is not presented and added here in the process of
patient monitoring) and EHR (Electronic Health Record) publication.
management. Using the concept of decentralized storage and
a permissioned blockchain network as an access control As the purposed research was in the investigated stages,
system to manage patient vital signs data, the architecture of therefore no peer-reviewed literature was found in this area,
the recommended system was built. The proposed solution so might any type of work-related to this study to be
addresses security issues through resistance to a variety of published until the publication of this study. Our data
well-known cyberthreats, including spoofing attacks using extraction scenario based on the formulation of RQs so might
fabric certificates, tampering threats due to the usage of be possibilities that researcher or reader find some points that
cryptographic techniques, and repudiation threats using fabric we did not consider and can be helpful in the future. Also, the
digital signature. The decentralization approach, which threat is that no quality score is used for the collection or
consists of a decentralized blockchain network, a gathering of primary studies as well as secondary studies
decentralized Offchain database (OrbitDB with IPFS), and a which may consider the less quality result and synthesis.
decentralized Remote Patient Monitoring application, aims to VI. CONCLUSION
address centralized security issues.
Blockchain technology is an emerging technology that
 ChainSure [54] extended its applications from financial to non-financials
On an Ethereum test network, ChainSure, a proposed fields such as IoT, Governance, Education, Agriculture, and
conceptual insurance model based on smart contracts, has Healthcare, etc. In the traditional EMR healthcare system, the
been put to the test. We automate the entire operation by patient data is in the control of third-party or providers and
utilizing the potential of blockchain. Blockchain guarantees scattered or fragmented among the several repositories. This
the system's accuracy and security. Since data is situation has negatively affected on patient’s reputation and
unchangeable and visible, there are less opportunities for finance because of the leakage of his/her security and
cyberattacks on the ChainSure network. Data collecting and privacy. At the same time, interoperability among healthcare
administrative tasks are particularly difficult and time- stakeholders remains a serious challenge.
consuming in the traditional paradigm. The proposed system

IJISRT23JUL2406 www.ijisrt.com 3277

Volume 8, Issue 7, July 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
The features of blockchain technology such as [9.] Azaria, A., Ekblaw, A., Vieira, T., & Lippman, A.
decentralization, immutability, transparency, smart contract, (2016, August). Medrec: Using blockchain for
auditability is used with the EMR system to overcome the medical data access and permission management.
security, privacy and interoperability issues of patient data. In 2016 2nd International Conference on Open and
So, the EMR health system in healthcare sectors is Big Data (OBD; pp. 25-30). IEEE.
implemented in a more distributed and trustless way after the [10.] Kamau, G., Boore, C., Maina, E., & Njenga, S. (2018,
adoption of blockchain. May). Blockchain Technology: Is this the Solution to
EMR Interoperability and Security Issues in
In this research, we pay attention to collect all the Developing Countries? In 2018 IST-Africa Week
possible relevant primary literature to highlight the Conference (IST-Africa; pp. Page-1). IEEE.
blockchain-based EMR system in the healthcare area that [11.] Casino, F., Dasaklis, T. K., & Patsakis, C. (2018). A
enables the users or stakeholders to share, access or store the systematic literature review of blockchain-based
patient data in a secure, private and auditable way to applications: current status, classification and open
revolutionize the ecosystem. We got and investigated 28 issues. Telematics and Informatics.
primary studies from different scientific databases and web [12.] Boonstra, A., & Broekhuis, M. (2010). Barriers to the
sources. This paper also presented the issues of the current acceptance of electronic medical records by
EMR system after mapping the existing primary studies physicians from systematic review to taxonomy and
related to the EMR health system. Furthermore, we interventions. BMC health services research, 10(1),
identified the blockchain-based applications that have been 231.
developed for EMR records of the patient. As future work, [13.] Baysal, M. V., Özcan-Top, Ö., & Betin-Can, A.
we plan to extend this work by finding the challenges and (2023). Blockchain technology applications in the
limitations of blockchain technology that is being faced by health domain: a multivocal literature review. The
different healthcare stakeholders after the emergence of this Journal of supercomputing, 79(3), 3112-3156.
technology in the EMR system. [14.] Dubovitskaya, A., Xu, Z., Ryu, S., Schumacher, M.,
& Wang, F. (2017). Secure and trustable electronic
REFERENCES medical records sharing using blockchain. In AMIA
[1.] Nakamoto, S. (2008). Bitcoin: A peer-to-peer Annual Symposium Proceedings (Vol. 2017, p. 650).
electronic cash system. American Medical Informatics Association.
[2.] Zheng, Z., Xie, S., Dai, H., Chen, X., & Wang, H. [15.] Xia, Q., Sifah, E., Smahi, A., Amofa, S., & Zhang, X.
(2017, June). An overview of blockchain technology: (2017). BBDS: Blockchain-based data sharing for
Architecture, consensus, and future trends. In 2017 electronic medical records in cloud
IEEE International Congress on Big Data (BigData environments. Information, 8(2), 44.
Congress; pp. 557-564). IEEE. [16.] Zhang, X., & Poslad, S. (2018, May). Blockchain
[3.] Yaga, D., Mell, P., Roby, N., & Scarfone, K. (2019). support for flexible queries with granular access
Blockchain technology overview. arXiv preprint control to electronic medical records (EMR). In 2018
arXiv:1906.11078. IEEE International Conference on Communications
[4.] Rabah, K. (2017). Challenges & opportunities for (ICC; pp. 1-6). IEEE.
blockchain powered healthcare systems: A [17.] Tama, B. A., Kweka, B. J., Park, Y., & Rhee, K. H.
review. Mara Research Journal of Medicine and (2017, August). A critical review of blockchain and
Health Sciences, 1(1), 45-52. its current applications. In 2017 International
[5.] Zhang, P., Schmidt, D. C., White, J., & Lenz, G. Conference on Electrical Engineering and Computer
(2018). Blockchain technology use cases in Science (ICECOS; pp. 109-113). IEEE.
healthcare. In Advances in Computers (Vol. 111, pp. [18.] Yaqoob, I., Salah, K., Jayaraman, R., & Al-Hammadi,
1-41). Elsevier. Y. (2021). Blockchain for healthcare data
[6.] Arsheen, S., & Ahmad, K. (2021, November). SLR: management: opportunities, challenges, and future
A systematic literature review on blockchain recommendations. Neural Computing and
applications in healthcare. In 2021 International Applications, 1-16.
Conference on Information Science and [19.] Al Mamun, A., Azam, S., & Gritti, C. (2022).
Communications Technologies (ICISCT) (pp. 1-6). Blockchain-based electronic health records
IEEE. management: a comprehensive review and future
[7.] McFarlane, C., Beer, M., Brown, J., & Prendergast, research direction. IEEE Access, 10, 5768-5789.
N. (2017). Patientory: A Healthcare Peer-to-Peer [20.] Khatri, S., Alzahrani, F. A., Ansari, M. T. J.,
EMR Storage Network v1. Entrust Inc.: Addison, TX, Agrawal, A., Kumar, R., & Khan, R. A. (2021). A
USA. systematic analysis on blockchain integration with
[8.] Liu, J., Li, X., Ye, L., Zhang, H., Du, X., & Guizani, healthcare domain: scope and challenges. IEEE
M. (2018, December). Bpds: A blockchain based Access, 9, 84666-84687.
privacy-preserving data sharing for electronic medical [21.] Reegu, F. A., Abas, H., Jabbari, A., Akmam, R.,
records. In 2018 IEEE Global Communications Uddin, M., Wu, C. M., ... & Khalaf, O. I. (2022).
Conference (GLOBECOM; pp. 1-6). IEEE. Interoperability Requirements for Blockchain-
Enabled Electronic Health Records in Healthcare: A

IJISRT23JUL2406 www.ijisrt.com 3278

Volume 8, Issue 7, July 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Systematic Review and Open Research Challenges. personal health data. In 2018 9th International
Security and Communication Networks, 2022. Conference on Information Technology in Medicine
[22.] Kitchenham, B. (2004). Procedures for performing and Education (ITME; pp. 829-833). IEEE.
systematic reviews. Keele, UK, Keele [36.] Li, H., Zhu, L., Shen, M., Gao, F., Tao, X., & Liu, S.
University, 33(2004), 1-26. (2018). Blockchain-based data preservation system
[23.] Yaqoob, S., Khan, M. M., Talib, R., Butt, A. D., for medical data. Journal of medical systems, 42(8),
Saleem, S., Arif, F., & Nadeem, A. (2019). Use of 141.
blockchain in healthcare: a systematic literature [37.] Chen, Y., Ding, S., Xu, Z., Zheng, H., & Yang, S.
review. International journal of advanced computer (2019). Blockchain-based medical records secure
science and applications, 10(5). storage and medical service framework. Journal of
[24.] Lu, Y. (2018). Blockchain and the related issues: a medical systems, 43(1), 5.
review of current research topics. Journal of [38.] Chen, W., Mu, Y., Liang, X., & Gao, Y. (2019, July).
Management Analytics, 5(4), 231-255. Medical Data Sharing Model Based on Blockchain.
[25.] Anderson, J. G. (2000). Security of the distributed In Journal of Physics: Conference Series (Vol. 1267,
electronic patient record: a case-based approach to No. 1, p. 012014). IOP Publishing.
identifying policy issues. International Journal of [39.] Kim, K. J., & Hong, S. P. (2017). A trusted sharing
Medical Informatics, 60(2), 111-118. model for patient records based on permissioned
[26.] Bensefia, A., & Zarrad, A. (2014). A proposed Blockchain. J. Int. Comput. Service (JICS), 6, 75-84.
layered architecture to maintain privacy issues in [40.] Xiao, Z., Li, Z., Liu, Y., Feng, L., Zhang, W.,
electronic medical records. E-Health Lertwuthikarn, T., & Goh, R. S. M. (2018,
Telecommunication Systems and Networks, 3(04), December). EMRShare: A Cross-Organizational
43. Medical Data Sharing and Management Framework
[27.] Mashima, D., & Ahamad, M. (2012, January). Using Permissioned Blockchain. In 2018 IEEE 24th
Enhancing accountability of electronic health record International Conference on Parallel and Distributed
usage via patient-centric monitoring. In Proceedings Systems (ICPADS; pp. 998-1003). IEEE.
of the 2nd ACM SIGHIT International Health [41.] Yue, X., Wang, H., Jin, D., Li, M., & Jiang, W.
Informatics Symposium (pp. 409-418). ACM. (2016). Healthcare data gateways: found healthcare
[28.] Benaloh, J., Chase, M., Horvitz, E., & Lauter, K. intelligence on blockchain with novel privacy risk
(2009, November). Patient controlled encryption: control. Journal of medical systems, 40(10), 218.
ensuring privacy of electronic medical records. [42.] Rifi, N., Rachkidi, E., Agoulmine, N., & Taher, N. C.
In Proceedings of the 2009 ACM workshop on Cloud (2017, October). Towards using blockchain
computing security (pp. 103-114). ACM. technology for eHealth data access management.
[29.] Ozair, F. F., Jamshed, N., Sharma, A., & Aggarwal, In 2017 Fourth International Conference on Advances
P. (2015). Ethical issues in electronic health records: in Biomedical Engineering (ICABME; pp. 1-4).
A general overview. Perspectives in clinical IEEE.
research, 6(2), 73. [43.] Rouhani, S., Butterworth, L., Simmons, A. D.,
[30.] Zaghloul, E., Li, T., Mutka, M., & Ren, J. (2019). $ d Humphery, D. G., & Deters, R. (2018, July).
$-MABE: Distributed Multilevel Attribute-Based MediChain TM: A Secure Decentralized Medical
EMR Management and Applications. arXiv preprint Data Asset Management System. In 2018 IEEE
arXiv:1904.11432. International Conference on Internet of Things
[31.] Richards, M. M. (2009). Electronic medical records: (iThings) and IEEE Green Computing and
Confidentiality issues in the time of Communications (GreenCom) and IEEE Cyber,
HIPAA. Professional Psychology: Research and Physical and Social Computing (CPSCom) and IEEE
Practice, 40(6), 550. Smart Data (SmartData; pp. 1533-1538). IEEE.
[32.] Zaghloul, E., Li, T., Mutka, M., & Ren, J. (2019). $ d [44.] De Aguiar, Erikson Júlio, Bruno S. Faiçal, Bhaskar
$-MABE: Distributed Multilevel Attribute-Based Krishnamachari, and Jó Ueyama. "A Survey of
EMR Management and Applications. arXiv preprint Blockchain-Based Strategies for Healthcare." ACM
arXiv:1904.11432. Computing Surveys (CSUR) 53, no. 2 (2020): 1-27.
[33.] Schwarz, C., & Schwarz, A. (2014). To adopt or not [45.] de Oliveira, M. T., Reis, L. H., Carrano, R. C.,
to adopt: A perception-based model of the EMR Seixas, F. L., Saade, D. C., Albuquerque, C. V., ... &
technology adoption decision utilizing the Mattos, D. M. (2019, May). Towards a Blockchain-
technology-organization-environment Based Secure Electronic Medical Record for
framework. Journal of Organizational and End User Healthcare Applications. In ICC 2019-2019 IEEE
Computing (JOEUC), 26(4), 57-79. International Conference on Communications (ICC;
[34.] Xia, Q. I., Sifah, E. B., Asamoah, K. O., Gao, J., Du, pp. 1-6). IEEE.
X., & Guizani, M. (2017). MeDShare: Trust-less [46.] Yang, J., Onik, M. M. H., Lee, N. Y., Ahmed, M., &
medical data sharing among cloud service providers Kim, C. S. (2019). Proof-of-Familiarity: A Privacy-
via blockchain. IEEE Access, 5, 14757-14767. Preserved Blockchain Scheme for Collaborative
[35.] Ito, K., Tago, K., & Jin, Q. (2018, October). i- Medical Decision-Making. Applied Sciences, 9(7),
Blockchain: a Blockchain-empowered individual- 1370.
centric framework for privacy-preserved use of

IJISRT23JUL2406 www.ijisrt.com 3279

Volume 8, Issue 7, July 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
[47.] Ananth, C., Karthikeyan, M., & Mohananthini, N.
(2018). A secured healthcare system using private
blockchain technology. J. Eng. Technol, 6, 42-54.
[48.] Ahram, T.; Sargolzaei, A.; Sargolzaei, S.; Daniels, J.;
Amaba, B. Blockchain Technology Innovations.
In Proceedings of the 2017 IEEE Technology &
Engineering Management Conference (TEMSCON),
Santa Clara, CA, USA, 8–10 June 2017; pp. 137–141.
[49.] Dagher, G.G.; Mohler, J.; Milojkovic, M.; Marella,
P.B.; Marella, B. Ancile: Privacy-Preserving
Framework for Access Control and Interoperability of
Electronic Health Records Using Blockchain
Technology. Sustain. Cities Soc. 2018, 39, 283–297.
[50.] Fan, K., Wang, S., Ren, Y., Li, H., & Yang, Y.
(2018). Medblock: Efficient and secure medical data
sharing via blockchain. Journal of medical
systems, 42(8), 136.
[51.] Zhang, P.; White, J.; Schmidt, D.C.; Lenz, G.;
Rosenbloom, S.T. FHIRChain: Applying Blockchain
to Securely and Scalably Share Clinical Data.
Comput. Struct. Biotechnol. J. 2018, 16, 267–278
[52.] Jiang, Shan, Jiannong Cao, Hanqing Wu, Yanni
Yang, Mingyu Ma, and Jianfei He. "Blochie: a
blockchain-based platform for healthcare information
exchange." In 2018 ieee international conference on
smart computing (smartcomp), pp. 49-56. IEEE,
2018.
[53.] Zaabar, B., Cheikhrouhou, O., Jamil, F., Ammi, M.,
& Abid, M. (2021). HealthBlock: A secure
blockchain-based healthcare data management
system. Computer Networks, 200, 108500.
[54.] Karmakar, A., Ghosh, P., Banerjee, P. S., & De, D.
(2023). ChainSure: Agent Free Insurance System
using Blockchain for Healthcare 4.0. Intelligent
Systems with Applications, 200177.
[55.] Pawar, V., & Sachdeva, S. (2023). ParallelChain: a
scalable healthcare framework with low‐energy
consumption using blockchain. International
Transactions in Operational Research.
[56.] Chen, M., Malook, T., Rehman, A. U., Muhammad,
Y., Alshehri, M. D., Akbar, A., ... & Khan, M. A.
(2021). Blockchain-Enabled healthcare system for
detection of diabetes. Journal of Information Security
and Applications, 58, 102771.
[57.] Sadeghi R, J. K., Prybutok, V. R., & Sauser, B.
(2022). Theoretical and practical applications of
blockchain in healthcare information management.

IJISRT23JUL2406 www.ijisrt.com 3280