Chapter 1

Introduction

The integration of blockchain technology in the management of Electronic Health

Records (EHR) represents a pivotal advancement in the realm of healthcare
information systems. This project not only ensures robust security and data integrity
but also enhances the accessibility and trust in EHRs, potentially revolutionizing
patient care by addressing core issues of privacy and data security. The deployment of
blockchain could lead to significant reductions in operational costs, fostering a more
efficient and secure environment for managing health records that are critical for
modern healthcare services.

1.1 Overview

Electronic Health Records (EHR) are instrumental in modernizing healthcare by

consolidating patient data into digital records that are accessible across various
healthcare providers. This system enhances the quality of patient care by providing
immediate access to health information, which supports better medical
decision-making and coordination among healthcare professionals. Despite their
benefits, EHRs carry inherent risks related to the sensitive nature of health data,
posing challenges in data security and privacy. The global adoption of EHR systems
in countries like the United States, Canada, and Australia highlights their potential,
yet also underscores the critical need for enhanced security measures given the
sensitive nature of the data they handle.

1. 2 History

The inception of Electronic Health Records (EHR) traces back to the late 20th century
when healthcare began transitioning from paper-based record-keeping to digital
formats. This shift was initially driven by the desire to improve the efficiency of
healthcare delivery and enhance the accessibility of patient information. Over the

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decades, EHR systems have evolved significantly, influenced by technological
advancements, regulatory changes, and the increasing need for a more integrated
healthcare approach. In the early stages, EHR systems were simple databases used
primarily for storage.

Despite the rapid deployment and advancements, EHR systems have faced persistent
challenges related to data interoperability, security, and patient privacy. The
fragmented nature of healthcare information systems, varying standards, and
protocols across different platforms and regions have led to interoperability issues,
complicating the seamless exchange of vital health information. Furthermore, as the
digitization of health records increased, so did concerns about data breaches and cyber
threats, underscoring the need for improved security measures in EHR systems. As we
move forward, blockchain stands to be a cornerstone technology that could redefine
the future of EHRs, ensuring that the digital record-keeping system not only supports
the operational needs of healthcare providers but also upholds the highest standards of
patient data protection and privacy.

1. 3 Blockchain Technology as a Solution

Blockchain technology offers a robust framework for addressing the multifaceted

challenges that plague traditional Electronic Health Record (EHR) systems,
particularly in the realms of data security, privacy, and interoperability. At its core,
blockchain is a decentralized ledger that records all transactions across a network of
computers, making the data not only tamper-proof but also transparent to all parties
with permissioned access. This decentralized nature eliminates single points of
failure, which are common in centralized data management systems and represent a
significant risk in terms of data breaches and unauthorized access. By leveraging
blockchain, EHR systems can achieve a higher level of security, as each transaction
on the ledger—whether it's a new patient record entry, an update, or access by a
healthcare provider—is encrypted and recorded across multiple nodes. This ensures
that any attempt to alter the data would require consensus across all nodes, thereby
safeguarding the integrity of the records.

The privacy and confidentiality blockchain provides allows patients and providers
precise control over who can view and modify records, a critical feature in

2
maintaining patient privacy and adhering to strict regulatory standards like the Health
Insurance Portability and Accountability Act (HIPAA) in the United States.
Additionally, blockchain's inherent auditability features a transparent and immutable
history of all interactions with the data, providing a reliable audit trail for regulatory
compliance and medical reviews. This transparency, coupled with the system's
immutability, fosters trust among all stakeholders—patients, healthcare providers,
insurers, and regulators—by ensuring that the data has not been altered illicitly.

In the broader context of healthcare, blockchain's ability to facilitate seamless

interoperability between disparate EHR systems could revolutionize data sharing
among providers. Currently, the lack of standardization across different EHR systems
hampers efficient data exchange, which can delay patient care and lead to errors.
Blockchain offers a unified platform where information from various sources can be
accessed securely and reliably, without the typical barriers posed by differing systems.
This not only speeds up the process of medical decision-making but also enhances the
continuity of care by providing a comprehensive and up-to-date view of a patient's
health history.

1.4 Potential Impact

The integration of blockchain technology with Electronic Health Records (EHR) is

poised to have a transformative impact on the healthcare landscape. This innovation
not only promises to resolve existing issues but also opens up new possibilities for the
future of healthcare management and delivery. One of the most significant impacts of
blockchain technology is the enhancement of data provenance and auditability. By
creating an indelible record of all data transactions, blockchain ensures that every
piece of health information is traceable and verifiable, thereby reducing the risk of
errors and fraud in medical records. This aspect of blockchain is particularly critical in
clinical trials and research where ensuring data integrity is paramount.

Moreover, blockchain enables a new paradigm for patient-centered care by

empowering patients with control over their health data. Patients can manage access
permissions for their health records, deciding who can view or use their data. This
shift not only boosts patient engagement in their healthcare management but also
improves patient trust in EHR systems, a crucial factor given the privacy concerns

3
prevalent in today's digital age. Enhanced patient control aligns with global moves
towards personalized medicine, where treatments and medical interventions are
increasingly tailored to individual patients based on their specific health data.

Furthermore, the economic impact of blockchain on healthcare systems cannot be

overlooked. By automating many aspects of healthcare administration through smart
contracts, blockchain can significantly reduce overhead costs associated with data
management, billing, and compliance with healthcare regulations. These efficiencies
could lower healthcare costs for both providers and patients, making high-quality care
more accessible to a broader segment of the population.

Lastly, the potential for blockchain to integrate with other cutting-edge technologies
such as artificial intelligence (AI), the Internet of Medical Things (IoMT), and
predictive analytics further extends its impact. For example, blockchain can facilitate
the secure aggregation of vast amounts of health data from various sources, which can
be analyzed to uncover trends, improve disease prevention strategies, and even predict
outbreaks. This level of analytics can transform public health planning and emergency
response, making healthcare systems more proactive rather than reactive.

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 Chapter 2

Review of Literature
2.1 Literature Survey

The enhancement of Electronic Health Records (EHR) through blockchain technology

is a pivotal aspect of this research, which thoroughly explores existing literature to
understand the various challenges and implementations of EHR systems.

This survey highlights the critical issues related to data security, privacy, and
interoperability within the current healthcare data management systems. The focus
extends to examining the role of blockchain technology in healthcare, a promising
tool known for enhancing data integrity and enabling secure data exchanges. By
delving into these aspects, the review aims to establish a comprehensive foundation
that addresses the intricate challenges faced in healthcare data management, setting
the stage for the implementation of a more secure and efficient system.

2.2 Analysis

The literature review conducted in this research is documented in Table No. 2.1,
which synthesizes key findings from several influential studies on the implementation
of blockchain technology in EHR systems. This literature survey delves into existing
studies related to EHR systems, emphasizing critical aspects such as data security,
privacy, and interoperability. The table is organized to provide a systematic overview
of the scope, outcomes, and identified gaps in previous studies.

5
 Table 2.2.1: Literature Survey Table

Sr. Research Journal

Year Outcome Literature Gap
No. Paper Name Details

Using
Transactions on Meeting healthcare
Blockchain for
1. October the blockchain are regulations while
Electronic IEEE
2019 transparent and using blockchain
Health
auditable, can be challenging.
Records
improving trust.
Blockchain
and
AI-Empowere EHRs on the
d Healthcare blockchain can be
No universal
Insurance stored securely
standards exist for
Fraud IEEE July 2022 for the long term,
blockchain in
2. Detection: an ensuring
healthcare
Analysis, historical health
Architecture, data availability.
and Future
Prospects

Blockchain-Ba
sed Electronic
Health Access to Replicating data on
Records January anonymized a blockchain can
Management: IEEE patient data can
3. 2022 increase storage
A facilitate medical needs.
Comprehensiv research and
e Review and analytics.
Future

6
 Research
Direction

An efficient
privacy-preser Patients are more
Data can be
ving control engaged in their
permanently lost if
4. mechanism Science healthcare
July 2023 private keys are
based on direct decisions and can
lost or
blockchain for share data with
compromised.
E-health various providers
applications

Secure
Electronic
No single entity Mining and
Medical
has control, maintaining
Records Science
June 2020 reducing the risk blockchain
Storage and direct
5. of data networks consume
Sharing Using
monopolies. significant energy.
Blockchain
Technology

Ancile: Blockchain Blockchain

Privacy-preser technology technology
ving enhances the enhances the
framework for security of security of
access control electronic health electronic health
6.
and Science records by records by
May 2018
interoperability direct providing robust providing robust
of electronic encryption and encryption and
health records decentralized decentralized
using storage, reducing storage, reducing
blockchain the risk of data the risk of data
technology breaches and breaches and

7
 unauthorized unauthorized
access access

Blockchain
technology
Cloud-Assisted
ensures robust Staff and patients
Secure eHealth
7. encryption and may require
Systems for Science October
decentralized training to use
Tamper-Proofi Direct 2018
storage, making Blockchain-based
ng EHR via
EHRs highly EHRs effectively
Blockchain
secure against
breaches

A Taxonomic
Immutable ledger Healthcare
Review of the
ensures that EHR professionals may
use of IoT and Researc October
data cannot be struggle to adapt to
Blockchain in h Gate 2020
altered or blockchain
Healthcare
8. tampered with. technology.
applications

Blockchain have Challenges related

The benefits
several viable to security, privacy,
and threats of
characteristics scalability and
blockchain
9. Science October including interoperability are
technology in
Direct 2020 decentralization, still obvious
healthcare: A
immutability, vulnerabilities of
scoping
transparency and blockchain in
Review
traceability healthcare.

A Review on Existing EHR Integration

security security schemes challenges and the
schemes for showcase varied need for improved
IEEE July 2022
10. Electronic approaches to adaptability of
Health protect patient security measures
Records data effectively. to evolving cyber

8
 threats in
healthcare IT
systems.

Chapter 3

Research Gap, Problem Definition and

Objectives

3.1 Research Gap:

In the era of digital healthcare, Electronic Health Records (EHR) systems are
invaluable, yet they confront a critical research gap that hampers their efficacy.
Dagher et al.[1] emphasize the structural vulnerabilities of centralized Electronic
Health Records (EHR) systems, particularly regarding security and robustness.
Despite the widespread adoption of EHR systems, these vulnerabilities remain a
significant concern, indicating a gap in research focusing on enhancing the security
and robustness of EHR systems.

Azbeg et al.[2] discuss the limitations of traditional EHR systems in ensuring data
integrity and preventing unauthorized alterations. While these systems comply with
regulations and have proven reliable, they lack the robustness of newer technologies
like blockchain. This highlights a research gap in exploring how blockchain
technology can enhance the integrity and security of EHR systems.

Alonso et al.[3] propose the PBE-DA protocol to enhance privacy and security in
EHR systems through blockchain technology. Their focus on anonymous patient
access to sensitive data suggests a research gap in developing protocols that can
efficiently manage patient anonymity while ensuring secure data access in EHR
systems.

9
Abu-Elezz et al.[4] highlight the potential of blockchain technology in addressing
challenges within the healthcare industry, such as managing healthcare records and
improving data security. However, they also point out the complexity in technology
implementation and integration with existing systems, indicating a research gap in
developing strategies to overcome these challenges.

The literature survey suggests a research gap in exploring how blockchain technology
can enhance the security, privacy, and efficiency of EHR systems, as well as in
developing protocols and strategies to address the challenges associated with its
implementation and integration with existing healthcare IT infrastructures.

3.2 Problem Statement

The predominant problem with traditional EHR systems is rooted in the critical
vulnerabilities of current centralized architectures, which are susceptible to a
spectrum of security threats. Centralized data repositories present a lucrative target for
cyber-attacks, often resulting in unauthorized access to sensitive medical data and
significant breaches of patient privacy. This systemic weakness not only endangers
the integrity of medical records but also undermines the trust patients place in
healthcare providers to protect their personal health information. The result is a
healthcare infrastructure that is constantly at risk, despite the crucial role these
systems play in contemporary medical practice.

The move towards integrating blockchain technology within EHR systems has been
met with its own set of challenges. Although blockchain offers a more secure,
decentralized approach to data management, promising a transformative impact on the
integrity and trustworthiness of health records, its practical application within the
healthcare sector has been fraught with technical difficulties. Performance issues such
as increased latency, alongside the complexities of aligning blockchain's novel
infrastructure with existing healthcare IT ecosystems, pose significant barriers. Such
integration challenges exacerbate the difficulty of ensuring seamless operation and
user-friendly experience within these systems. The overarching problem, therefore, is
not only the security flaws of current EHR systems but also the impediments to the
adoption of blockchain technology, which, if overcome, could herald a new era of
secure and efficient health data management.

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3.3 Aim & Objective:

Aim:

The aim of the project is to develop an Electronic Health Records (EHR) system that
is both secure and efficient, leveraging the capabilities of blockchain technology. The
primary focus is to construct a system that not only fortifies the security of sensitive
patient data but also streamlines the process, making it more efficient for healthcare
providers and patients alike. The aim is to address the vulnerabilities of existing EHR
systems head-on by integrating the inherent security features of blockchain, such as
encryption and decentralization, to ensure that patient records are both impervious to
unauthorized access and easily verifiable for authenticity. Additionally, the system
aims to be scalable, capable of adapting to the ever-growing demands of the
healthcare industry, and ensuring that patient care is bolstered by reliable, secure
access to medical records. This project seeks to set a new standard for how health
information is stored, accessed, and utilized, with the ultimate goal of improving
patient outcomes and care delivery.

Objectives:

● To Strengthen Information Validation Protocols: Develop and implement a

robust framework within the EHR system that requires patient approval for
any updates or changes to their medical records by healthcare providers. This
measure will enhance the security of information and ensure that the patient's
health data is both accurate and consensually updated, preserving the integrity
of their medical history.
● To Augment Security with Blockchain: Leverage the advanced capabilities
of blockchain technology to bolster the EHR system's defense against data

11
 breaches and unauthorized access. By utilizing blockchain's decentralized
nature and cryptographic security measures, the system will protect sensitive
patient information and maintain high standards of data security.
● To Investigate the Potential of AI Integration: Explore the integration of
Artificial Intelligence (AI) within the EHR system to determine how AI can
enhance healthcare services. This objective focuses on harnessing AI's
potential to streamline data analysis, improve diagnostic accuracy, and
personalize patient care, all while maintaining strict compliance with privacy
regulations.
● To Ensure Data Consistency for third-party organizations: Utilize
blockchain technology to ensure the consistency and accuracy of medical
records across various platforms, making the data reliable for third-party
organizations, such as medical insurance providers. This consistent and
verifiable data will be instrumental in detecting and preventing medical fraud,
thereby safeguarding the financial aspects of healthcare management and
contributing to the overall trust in the healthcare system.

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 Chapter 4

Proposed System

The proposed EHR system encapsulates a robust framework engineered to enhance

security, patient care, and ensure data integrity through the innovative application of
blockchain technology. With a design that addresses the pressing challenges of
traditional EHR systems, this new framework aims to redefine how medical data is
stored, accessed, and shared across the healthcare landscape. The proposed system
introduces decentralized access control, utilizes smart contracts for patient-centric
updates, and exploits blockchain's immutable nature to preserve the sanctity of
medical data, setting the stage for a paradigm shift in health records management.
Figure 3.4 shows the general architectural framework of the proposed research work.

4.1. Proposed System/Framework

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 Figure 4.1.1: General Framework of the Proposed System

The architecture framework is centered around a blockchain-based approach that

enables secure and immutable EHR data storage. At its core, the framework involves
several key components:

● EHR Data Storage on Blockchain: Here, patient data is stored across a

network of blockchain nodes, ensuring decentralized and secure
record-keeping. Smart contracts are employed to automate the data
management process and to encode the rules of EHR data access and updates.
● Immutable Ledger and Audit Trails: This aspect of the framework is crucial
for auditing and compliance purposes. Every transaction on the blockchain is
logged in an immutable ledger, creating an audit trail that enhances
transparency and trust in the system.
● Interoperability Through APIs: The framework provides Application
Programming Interfaces (APIs) that ensure seamless interoperability between
different healthcare systems, enabling real-time data exchange and integration.
● Access Control and Privacy: A system of public and private keys, coupled
with encryption and decryption processes, enforces robust access control and
preserves patient privacy. Only authorized individuals with the correct private
keys can access or decrypt the sensitive EHR data.

14
Together, these elements form a cohesive and comprehensive architecture that not
only meets the contemporary demands of healthcare data security but also lays the
groundwork for advanced applications such as insurance fraud detection and seamless
third-party access.

4.2. System Design:

4.2.1. UML Diagrams:

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 Figure 4.2.1.1: UML Class Diagram

The UML class diagram above illustrates the structure and relationships within a
blockchain-based Electronic Health Record (EHR) system.

● Hospital (Admin): Represents the administrative authority within a healthcare

facility, capable of granting or revoking access rights to doctors and external
organizations.
● Doctor: A healthcare professional affiliated with a hospital, who can add or
update patient records and request patient approvals for changes to their
EHRs.
● Patient: An individual receiving medical care, who has control over their
EHR, including the ability to approve or deny changes to their medical
information.

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● Electronic Health Record (EHR): A digital record that stores comprehensive
medical data about a patient, which can be accessed and managed by
authorized doctors.
● Blockchain: The underlying secure structure that stores EHR data across a
network of computers, ensuring data integrity and decentralization through a
series of linked records or 'blocks'.

17
 Figure 4.2.1.2: UML Use case diagram

The UML use case diagram illustrates the following functionalities and interactions
within the EHR system using blockchain technology:

● Hospital (Admin) Use Case: The Hospital as an administrator can grant or

revoke access to both doctors and external organizations, controlling who can
view or modify the EHR. This showcases the administrative capabilities to
oversee and secure access to patient information.
● Doctor's Use Case: Doctors have the ability to read EHRs, add patient records,
and send requests for updating patient information. However, any update
requires patient approval, emphasizing a secure and patient-centric approach.
● Patient's Use Case: Patients can approve or deny requests to update their
records, manage access control permissions, and provide their medical history.
This represents patients' active role in their healthcare data management and
the safeguarding of their personal health information.
● Blockchain Use Case: The Blockchain acts as a secure foundation for the EHR
system, allowing the addition of new blocks (representing patient data) and the
verification of the integrity of existing data. This ensures a tamper-proof and
reliable ledger of EHRs, which is critical for maintaining data integrity and
security in the healthcare environment.

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 Figure 4.2.1.3: UML Component diagram

The Component diagram provided a high-level architecture of a blockchain-based

EHR system, detailing the components and their interactions

EHR Database: This is the central repository where Electronic Health Records are
stored. It is the core component that other parts of the system depend on for retrieving
and storing patient data.

Components: There are three main components shown:

● Patient Management: This component is responsible for handling

patient-related operations within the system.
● Hospital Management: It deals with administrative functions and the
management of hospital-specific data.
● Doctor Management: This component manages the activities and data related
to the doctors, such as credentials, patient assignments, and access to EHRs.

Blockchain Component: This critical component ensures the security and integrity of
the EHR system. It uses blockchain technology to create an immutable ledger for the
EHR data, thereby enabling secure transactions and storage.

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Interfaces:

● iPatient: Interface for patient interactions with the EHR system, likely for
viewing records or managing their information.
● iHospital: Interface for the hospital's administrative functions within the
system.
● iDoctor: Interface for doctors to access and manage patient records as per their
role and permissions.
● iEHR: The interface through which the system interacts with the EHR
database.
● iBlockchain: Interface that outlines the methods and protocols for interacting
with the blockchain component, such as adding new blocks or verifying the
chain's integrity.

4.2.2. Gantt Chart:

Figure 4.2.2.1: Gantt chart Semester 7

The Gantt chart for Semester 7 visually outline the timelines for the project, Semester
7's chart extends from July to December, covering critical phases such as researching
blockchain applications in healthcare, analyzing existing EHR systems, and
developing prototype components for a blockchain-based EHR system. Each task is
clearly delineated with defined start and end dates, facilitating a structured approach
through the research and initial development stages.

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 Figure 4.2.2.2: Gantt chart Semester 8

For Semester 8, the Gantt chart details the development and implementation stage of
the EHR project. It kicks off with the construction of the blockchain EHR system. A
pivotal segment is the pilot testing with simulated data, which is crucial for evaluating
system performance in a controlled environment. The project culminates in a
thorough system testing phase, ensuring reliability and efficiency, before proceeding
to the final documentation and project report submission.

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 Chapter 5

Experimental Setup

5.1 Details of Database/Dataset/Any input to the system

The project will rely on a secure and scalable database to manage the Electronic
Health Records (EHR) data. The database will include the following datasets and
elements:

● EHR Data: This dataset will encompass patient medical records, including
vital signs, diagnosis information, treatment history, medication records, and
other relevant healthcare data. The data will be structured and organized for
efficient storage and retrieval.
● Access Control Records: A separate dataset will store access control records,
including information about which doctors have access to specific patient
records and the associated permissions. These records will be managed
through smart contracts on the blockchain.

5.2 Performance evaluation parameters

5.2.1 Data Latency

Average time taken for a transaction (such as data entry, update, or retrieval) to
be recorded on the blockchain. Response time for data requests from the
system.

5.2.2 Transaction Throughput

Number of transactions the system can process per second. Performance

stability during peak transaction periods.

22
5.2.3 Scalability

The system's ability to handle increased data volume without performance

degradation. Evaluation of the blockchain network's capacity to add new
nodes (hospitals, clinics, etc.) seamlessly.

5.3. Software and Hardware Setup (For training and testing)

Hardware Requirements- Windows Intel i5, minimum 4GB RAM/linux

Software Requirements-

VS Code: An open-source, feature-rich code editor by Microsoft.

MetaMask: A cryptocurrency wallet and Ethereum dApp browser extension.

Ganache: A local Ethereum blockchain development and testing tool.

23
 Chapter 6

Result and Analysis

fig 6.1. Admin Portal

24
fig 6.2 Hospital tracking all appointments of patients and Doctor

fig 6.3 Hospital Adding a new doctor

25
fig 6.4 new doctor added successfully by hospital

fig 6.5 hospital viewing doctor info

26
 fig 6.6 Doctor dashboard

fig 6.7 Doctors scheduled appointments

27
 fig 6.8 Doctor consulting patient online

fig 6.9 Doctor fetching patients previous health records

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 fig 6.10 Patient Dashboard

Chapter 7

Conclusion

The project exploring the integration of blockchain technology with Electronic Health

Records (EHR) has demonstrated significant enhancements in security, privacy, and

data integrity, crucial for patient safety and trust. Blockchain’s decentralized and

cryptographic nature ensures that data is immutable and secure, enhancing privacy

through mechanisms that allow only authorized access via private keys, and

improving interoperability across various healthcare providers. While addressing

challenges like scalability, energy consumption, and initial implementation costs, the

29
project suggested mitigation strategies including permissioned blockchains and hybrid

models. It also considered regulatory compliance with standards such as HIPAA and

GDPR, recommending advanced consensus mechanisms and smart contracts to

streamline healthcare processes. Future research should focus on refining these

technologies and strategies through pilot programs and collaboration with tech

providers and regulatory bodies, emphasizing blockchain’s potential to revolutionize

healthcare data management with its robust security features and efficiency

improvements.

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Publications and Competitions

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Publications:

Paper titled ‘Enhancing Security of Electronic Health Records (EHR) Using

Blockchain’ was accepted in International Journal of Novel Research & Development
(IJNRD) ISSN:2456-4184

Paper titled ‘Enhancing Security of Electronic Health Records (EHR) Using

Blockchain’ was accepted in International Journal of Emerging Technologies and
Innovative Research (JETIR) ISSN :2349-5162

Competitions Participated

Participated in AAVISHKAR – The Mumbai University Project showcase

Competition at Inter College level in VESIT, Chembur on 14/12/2023.

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