Journal of the

Nigerian Society
of Physical
J. Nig. Soc. Phys. Sci. 5 (2023) 992
Sciences

Secure Health Information System with Blockchain Technology

A. E. Ibora,∗, E. B. Edima , A. A. Ojugob
a Department of Computer Science, University of Calabar, Calabar, Nigeria
b Department of Computer Science, Federal University of Petroleum Resources, Effurun, Nigeria

Abstract
This paper focuses on highlighting the problems that are associated with the absence of privacy and security of medical records in a healthcare
system. It seeks to bridge the gap between the currently used security protocols in the management of health information, and encryption
algorithms that should be used. Extant health information systems have always been developed with conventional databases. With all the
privileges to read, write and execute assigned to the administrator, who has centralised control over all medical records, there is the likelihood of
the misuse, distortion and loss of such records in the event that the administrator becomes compromised or inadvertent system failure. To solve
this problem, the use of decentralised and distributed databases becomes paramount. Blockchain technology has recently received much attention
due to its ability to permit a peer-to-peer network with distributed databases that can be stored locally on each node in the network. Subsequently,
all updates on records in a database are communicated to all participating parties, hence addressing the problem of centralised control. In this
paper, we propose a health information system on a blockchain to create a trust-free system for both health personnel and patients. From the
results obtained, we achieved the decentralisation of the medical records’ database to enhance the security and privacy of data on the modeled
peer-to-peer network.

DOI:10.46481/jnsps.2023.992

Keywords: blockchain, health information system, distributed databases, encryption algorithms, medical records

Article History :
Received: 16 August 2022
Received in revised form: 06 November 2022
Accepted for publication: 06 November 2022
Published: 29 April 2023

© 2023 The Author(s). Published by the Nigerian Society of Physical Sciences under the terms of the Creative Commons Attribution 4.0 International license
(https://creativecommons.org/licenses/by/4.0). Further distribution of this work must maintain attribution to the author(s) and the published article’s title, journal citation, and DOI.
Communicated by: Tolulope Latunde (Ph.D.)

1. Introduction structures – from evidence-based medicine to e-medicine and

remote e-health services [1]. Similarly, the application and use
Computers have been employed in the delivery of health- of computer-based solutions in healthcare is witnessing new
care services and their usage has been helpful in enhancing dimensions, thus, giving room to novel security flaws. These
operational efficiency and clinical services. However, the emerging security flaws require effective defence mechanisms
current paradigm shift in the healthcare industry brings to light to contain likely unauthorised access, modification and distor-
the challenges of maintaining the integrity of medical records. tion of medical records.
With the advancement in information and communication
technology, healthcare delivery has come with new formats and The World Health Organisation defined a Health Infor-
mation System (HIS) as a system that is able to capture,
store, manage, and transmit health-related information. In this
∗ Corresponding author tel. no: +2348154213807
Email address: [email protected] (A. E. Ibor ) sense, achieving a functional HIS is paramount in enhancing
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the storage and retrieval of medical records. According to and other health personnel. In addition, patients’ past illnesses,
[2–4], a typical HIS must allow for the effective collection, which are recorded on the blockchain can be useful for the
processing, reporting, and use of health-related data across proper treatment of patients in contrast to systems that run on a
different health-based units. Current approaches to health centralised database with limited access and the possibility of
information systems rely mostly on centralised databases with central point of failure.
administrative control and policies, as well as authoritative
access. In this case, changes and updates are only effected by To address the problem of authoritative access and cen-
an administrator or super user, and any other person to which tralised control of the database of medical records, this paper
such rights and privileges are assigned. This nontransparent proposes a secure system for managing medical records using
transaction policy creates room for the possibility to distort the blockchain technology. The use of the blockchain provides
records and compromise the integrity of classified medical data. distributed access to the database of medical records to forestall
the problem of single pint of failure. In the same sense, it be-
In recent times, the emergence of disruptive technologies comes impossible to modify the stored medical records without
such as the blockchain provides the capacity of managing the consensus of the participating parties, thus making the stor-
distributed databases, which can be updated and locally age and transmission of medical records an entirely transparent
stored across all nodes in the network. According to [5], process. To implement the blockchain, we used Python, GO,
the blockchain is a distributed database of records (or public Docker Engine, interplanetary file system (IPFS), and other
ledger) of all transactions, which are executed and shared technologies with significant results obtained from rigorous ex-
among participating parties. Similarly, [6] argued that in a perimentation. The rest of the paper is organised as follows; the
blockchain, transparency is inherent, thus, permitting that review of the related literature is discussed in section 2. In sec-
updates on records are only possible when a majority of tion 3, the materials and method are discussed while the results
the participants reach a consensus. New insights into the and discussion are presented in section 4. Finally, the conclu-
expansion of HIS show that it has the potentials to increase sion with future research direction is given in section 5.
the accessibility to medical records [7–9]. However, the use of
conventional and centralised databases limit such possibilities 2. Review of Related Literature
as authentication credentials are granted from a central point.
In the event of a failure of the database, loss of records becomes A detailed analysis of the existing healthcare information
inevitable, in which case, the operations of the target system systems is provided in [12]. The authors argued that comput-
will be truncated in real time. These limitations necessitate the erisation is significant in realising an efficient HIS. Similarly,
need for a decentralised database that is difficult to compromise they investigated the security of medical records and were
in terms of data integrity, confidentiality and availability. able to give the design of a computerised system used by the
National Heath Management Information System (NHMIS).
Current implementations of the blockchain enable the use The implemented system was able to allow the safekeeping of
of a public ledger, which consists of the information of all the patients’ records with basic components of running an effective
participants and transactions on the blockchain [6–10]. The and productive hospital. This notwithstanding, the system ran
information captured as well as the digital transactions that on a local server database that served as the repository for all
have ever been executed on the blockchain can be recorded and medical data including queries and reports.
shared across the peer-to-peer blockchain network. Similarly,
[11] asserted that users can validate transactions, and also have In [4], the evolution of HIS is highlighted. Areas of interest
identical copies of these transactions on their local machines. include the migration from paper-based to computer-based pro-
In this way, health information can be securely stored, updated cessing and storage, the availability of global and regional HIS,
and transmitted without unauthorised modification. Further- the use of health-related data for effective healthcare planning,
more, it is easier to track all updates as the information stored and the deployment of technology for health monitoring. These
in the blockchain database is always complete and includes aspects of HISs have witnessed tremendous improvements
all records of transactions from the point of origin of the alongside an increase in health-related data. It is therefore
transactions. pertinent to have a robust mechanism through which the
escalating amount of medical records can be effectively stored,
Health information requires a high level of accuracy at all queried, reported and transmitted. Furthermore, [3] highlighted
times as minor changes in such data can lead to very unpleasant the design and implementation of a HIS, and discussed the
results with a plethora of consequences. With the blockchain possibilities of improving its structure through the use of a
network being able to perform periodic self-updates, it helps comprehensive, integrated and decentralised system.
to deliver a self-reviewing system that is computationally
infeasible and expensive to compromise. Transactions stored Similarly, [13] assert that the tendency to manually rec-
cannot be erased without the consensus of all participating oncile medical data among clinics, hospitals, laboratories,
parties. In this sense, it will be feasible to store and track pharmacies and insurance companies has not been a successful
medical records irrespective of the location of the Health process. This is due to the fact that no single list of the
Maintenance Organisation (HMO), patients, nurses, doctors, disparate locations housing patients’ data exists, and at the
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same time, it is difficult to ascertain the order of data entry

to determine the records, which predate the others. In other Consequently, the benefits of using blockchain for health-
words, determining the medications a patient is actually taking care are highlighted in [20]. Some of these include distributed
using antecedents of prescriptions may be unclear. In the same ledger, decentralised storage, authentication, security and
sense, every electronic health record uses different workflows immutability. The authors posited that the application of
to store data so that it becomes unclear who recorded what and blockchain in healthcare improves data sharing capabilities,
when. integrity, availability and authentication. In other words, the
blockchain will allow patients to have control and ownership
In [14], MedRec is proposed. MedRec is a decentralised of the sharing of their medical data in a secure environment.
record management systems using blockchain technology. The Besides, [21] identified electronic health records and personal
proposed system is able to give patients a log of their com- health records as the most targeted areas that rely on blockchain
prehensive, accessible and credible medical history. MedRec technology. They claimed that access control, interoperability,
allows participants to be informed of their medical history and data integrity are issues that the use of the blockchain in
including any form of modifications on these records. healthcare has helped to improve.

It is argued in [15] that the use of blockchain can be One significant feature of the blockchain remains that it
helpful to tackle the lagging in HIS, which runs on local server cannot be easily compromised [22]. When a block is cre-
databases. This is a fact as patients whose medical records ated, a one-time hash is generated. This hash is unique to the
are managed by HIS running on a local server database have blockchain and is generated using the values of the features of
limited privileges to such data. Consequently, the administrator each block. Changes to values in the block invalidate the hash
may alter these records or deny patients access to same. as well as the block making the blockchain unbreakable as il-
lustrated in Figure 1.
There are several attempts by malicious users to com-
promise the security of medical records. Cyberattacks such
as SQL injection [16], which targets the data aggregated on
the database over time are very common. To this effect, the
use of various disruptive technologies such as the blockchain,
artificial intelligence, and internet of things for protecting
medical records from human errors and cyberattacks is
discussed in [17]. The different application areas of these
technologies were also highlighted in this work including their
security-related concerns. Specifically, the authors identified
the use of blockchain-based trust models in the implementation Figure 1: An Illustration of the Blockchain
of data management in the healthcare sector to optimise the
process flow and reduce the operational costs. As shown in Figure 1, putting information in the blockchain
creates a block that contains the present and previous hashes.
The authors in [18] argued that the blockchain facilitates The first block is known as the genesis block, and has the
the use of a decentralised and distributed environment devoid present hash and previous hash. The second block is then
of a central authority. Since the transactions on a blockchain created and the hash of this block is linked with the genesis
are both secure and trustworthy, its use in healthcare for block, and so on.
realising patient-centric approach to healthcare systems and
maintaining accurate electronic healthcare records is cru- In this sense, [15] asserted that the use of blockchain inno-
cial. From their findings, the authors agreed that the use of vation allows a verified HIS to resolve certain issues, for ex-
blockchain technology in healthcare allows for the sharing of ample, moderate access to medical information, framework in-
data, the accurate management of health records, and access teroperability, improved quality of medical data, and trust-free
control. In the same sense, the use of lightweight blockchain transactions. In addition, the significant advantages of the usage
architecture for the management of healthcare data is proposed of blockchain in the security of medical records are highlighted
in [19]. The approach is able to reduce the computational and in [13, 22–25]. These include:
communication overhead of Bitcoin network using clusters, i. Distributed Database: Each patient on a blockchain can
where each copy of the ledger is maintained per cluster. access the entire database from its origin and be able to confirm
Each cluster consists of network participants that are able the records of his/her information or data straightforwardly,
to use canal for secure and confidential transactions. Their without a middle person.
approach was also targeted at eliminating the problems of ii. Peer-to-Peer Transmission: Communication happens le-
traditional client-server and cloud-based systems deployed in gitimately between nodes rather than through a focal hub. Ev-
managing healthcare data. Some of these problems include ery node stores and advances data to every other node.
single point of failure, centralised data control, inherent system iii. Transparency with Pseudonymity: Every transaction
vulnerabilities, and data privacy. and its related components are obvious to anybody with access
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to the blockchain. Every node, or client, on the blockchain has the block of information holding the medical record is changed.
a unique identifier of 30 or more alphanumeric code that dis-
tinguishes it. Clients can stay unknown or give confirmation of The blockchain network is a decentralised structure with
their identities to other people. All transactions happen between peer-to-peer nodes. These nodes inspect and authenticate the
blockchain addresses. validity of any new transaction such as a storage or retrieval re-
iv. Irreversibility of Records: Once a transaction is entered quest. This request is then fulfilled though distributed consen-
in the database and the records are refreshed, the records sus by different validating nodes. Moreover, no single validat-
cannot be adjusted, in light of the fact that they are connected ing node can have centralised control of the blockchain, making
to each record that preceded them (subsequently the expression it difficult for medical records to be corrupted, distorted, stolen
”chain”). Different computational algorithms and methodolo- or compromised. The architecture of the proposed system is
gies are used to guarantee that the chronicle on the database is shown in Figure 2.
lasting, sequentially ordered, and accessible to all others on the
system.

Other advantages of using blockchain technology include

the use of smart contracts for computational logic, scalability,
and the infeasibility of a single user compromising the entire
blockchain [26–30]. From the literature, the inherent problems
of centralised and authoritative databases can be addressed by
the use of the blockchain. Some of these problems include:
i. Standalone System: This requires authoritative access
and mostly not suitable for large scale networks.
ii. Cloud based Systems: It may be cheap to implement but
may not have the appropriate mechanism for allowing se-
cured transparent transactions. It can also lead to data
loss and theft in the event of espionage or system failure.

Therefore, it is envisaged that the use of blockchain will

help to resolve the highlighted issues since it is a peer-to-peer Figure 2: Architecture of a Secured HIS with blockchain technology
network where each participant has the database stored locally
in each of the nodes in the blockchain network. Changes to In the 3-tier architecture as shown in Figure 2, there is a
stored records are transparent to all participants and no partic- client side, application server and the blockchain database, in
ipant can authoritatively make a change without the consent of which the server-side procedures, data memory access, data
others. storage and user interface (UI) are created and kept up as
autonomous modules on isolated stages.
3. Materials and Method
The 3-tier design permits any of the three layers to be re-
In this section, the design of the proposed system is dis- designed or supplanted freely. The UI is actualised on a work-
cussed. The design highlights details of the functionality of the station and utilises a standard graphical user interface with vari-
system in terms of data storage, transmission, access and re- ous modules running on the application server. The three layers
trieval for all relevant parties. in the 3-tier architecture are as follows:
i. Client Side: This is the first tier and shows data identified
3.1. Method with services accessible on the desktop application. This
The blockchain is developed by creating a secure and layer speaks with different layers by sending results to
transparent environment for medical records. Using a 3-tier the peer-to-peer network and different layers in the sys-
architecture, the blockchain serves as the underlying database tem. It is a platform that enables the client to interact
for the storage and authentication of medical records. The with the system. The client side was built on Hyper-
client side of the 3-tier ensures the transmission of data to text Markup Language (HTML), Cascading Style Sheet
the blockchain’s network. These data is processed at the (CSS) and JavaScript.
logic layer, which interfaces with the blockchain to determine ii. Application Server: This is the second, which is addi-
the integrity or otherwise of the medical record using the tionally called the business logic or logic layer. This
hash code of each block. These hash codes are used to keep layer controls application usefulness by performing com-
the medical records safe in the blockchain. The hash codes prehensive processing. This layer was built on node.js,
are generated by mapping a variable length input such as composer, and Docker engine.
a patient record to a fixed length output. This fixed length iii. Blockchain Database: This is the last tier of the architec-
output is the hash value of the record, and will change when ture. This layer houses the database servers where data
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is stored and recovered. Information in this tier is kept i. HTML: is the standard markup language for creating web
free of application servers or business logic. This layer pages. It describes the structure and elements of a web
was built on ganache, yarn and truffle (Ethereum Hyper- page.
ledger Smart Contracts). ii. CSS: It is a style sheet language used for describing the
presentation of a document written in a markup language
3.2. Activity Diagram like HTML.
An activity diagram represents a series of actions or flow of iii. JavaScript: JavaScript, often abbreviated as JS, is a high-
control in a system similar to flowchart or a data flow diagram level, interpreted programming language that conforms
[31]. The activities modeled can be sequential and concurrent. to the ECMAScript specification.
Figure 3 shows the activities performed by each entity/class of iv. Python: Python is an interpreted, high-level, general-
the system and these activities are discussed thus: purpose programming language. Python has a design
i. The health personnel and patient attempt to login by philosophy that emphasises code readability, notably us-
entering their respective usernames and passwords, and ing significant whitespace. It provides constructs that en-
await authorisation from the blockchain database. If the able clear programming on both small and large scales.
username and password is invalid it aborts the operation v. GO: Go is a statically typed, compiled programming lan-
but if valid the users (health personnel and patient) gains guage that is syntactically similar to C, but with memory
access into the system and are assigned individual privi- safety, garbage collection, structural typing, and CSP-
leges. style concurrency.
ii. The health personnel views patients’ medical history, di- vi. Yarn (extension yarn.lock): In order to get consistent in-
agnose, run tests on the patient and then upload the med- stalls across machines, Yarn needs more information than
ical results into the system. The blockchain encrypts the the dependencies you configure in your package.json .
medical result and shares to multiple participants in the Yarn needs to store exactly which versions of each de-
network for consensus. pendency were installed. To do this Yarn uses a yarn.lock
iii. The patient views the medical result uploaded by the file in the root of your project.
heath personnel and can request for modification in bio- vii. Docker Engine: It is the underlying client-server technol-
data. The request is sent to the blockchain database and ogy that builds and runs containers using Docker’s com-
propagated across the network for subsequent approval ponents and services. Docker Engine supports the tasks
or decline of the request. If the request is approved the and workflows involved to build, ship and run container-
changes are effected otherwise the operation is aborted. based applications.
One participant cannot make changes without the cosen- viii. Electron.js: Formerly known as Atom Shell is an open-
sus of other participants in the network, otherwise the source framework developed and maintained by GitHub.
data is said to be compromised. Electron allows for the development of desktop GUI ap-
plications using front and back end components origi-
nally developed for web applications: Node.js runtime
4. Experimental Results and Discussion for the backend and Chromium for the frontend. Electron
An implementation of the architecture of the proposed sys- is the main GUI framework behind several notable open-
tems is given in this section. Several experiments were con- source projects including Atom, Visual Studio Code, and
ducted to test the developed application for realising distributed Light Table.
access to medical data based on the design of Figures 2 and 3. ix. InterPlanetary File System (IPFS): InterPlanetary File
The application used is built using existing technologies such System (IPFS) is a protocol and network designed to cre-
as node.js, truffle smart contract, inter-planetary. ate a content-addressable, peer-to-peer method of stor-
ing and sharing hypermedia in a distributed file system.
4.1. Testbed of the Experiments IPFS is a peer-to-peer distributed file system that seeks
The proposed system was implemented on a Windows ma- to connect all computing devices with the same sys-
chine running Windows 10 64-bit operating system, x64-based tem of files. IPFS could be seen as a single BitTorrent
processor with 4GB RAM and Intel ® Core i3 6100U CPU swarm, exchanging objects within one Git repository. In
@2.30 GHz 2.30GHz. other words, IPFS provides a high-throughput, content-
addressed block storage model, with content-addressed
4.2. Software Components hyperlinks.
An implementation of the architecture of the proposed sys-
tems is given in this section. The software used is built us-
4.3. Results and Discussion
ing existing technologies such as node.js, truffle smart contract,
inter-planetary file system, Docker engine. With the implemen- This section discusses the results of the experiments
tation of the blockchain, medical records were cryptographi- conducted to validate the efficacy of the proposed system.
cally stored on a peer to peer network. The components used in At the initial stage, a folder is created and populated with
building the software are as follows: any category of health records either for the health personnel
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Figure 3: The Activity Diagram of the Proposed System

Figure 4: Encrypted Folder of Health Personnel

Figure 6: Adding File to the Encrypted Folders

Figure 5: Encrypted Patient’s Folder

(doctor, nurse etc.) or the patient. This folder is then encrypted,

for which a hash value is generated. The generated hash value Figure 7: Importing Files with Hash Value
as shown in Figure 4 can be used to perform such operations
as the copying and sharing of the folder across the peer-to-peer
network. Both the health personnel such as the doctors and the shared folder. The folder at the same time can be opened in a
nurses, and the patients can participate in the viewing of the browser to view the records stored in it including the ability to
download it to a local machine.
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Figure 8: Activities on the Blockchain

Similarly, a patient’s folder undergoes the same process as

shown in Figure 5.

In the next stage, files are added to the created and en-
crypted folders for each entity participating in the blockchain.
The added files are encrypted and hash values assigned to
them to protect the integrity of their contents. This process is Figure 9: Used space and Peers Connected to the Blockchain network
depicted in Figure 6.

Files can then be imported across the network and stored

locally using the hash value earlier created for each file as 5. Conclusion
illustrated in Figure 7. In this way, health personnel and
The proposed system runs on a peer-to-peer network to
patients have access to the health records transparently, and
eradicate the actions of a middle man or administrator. Inter-
modifications to files are flagged when the hash values change.
action between the patient and health personnel, including hav-
ing access to medical records shapes a crucial piece of the fo-
All transactions (activities) in the blockchain by the differ-
cal activities underlying health information systems. The pro-
ent participating parties as well as the processes on data are
posed system was able to achieve the decentralisation of the
also transparent and available to all nodes in the blockchain.
medical records database to enhance the security and privacy
Sample transactions are depicted in Figure 8.
of data on the modeled peer-to-peer network. The encryp-
tion of patients’ data across the IPFS and the relevance of a
Furthermore, we can view the total amount of data stored
public/private key pair to share, upload and download data on
by multiple nodes participating in the network as well as
the blockchain network had an added advantage of the secu-
the number of nodes connected to the blockchain per unit
rity and privacy of medical records. The proposed system was
time. This number increases as more nodes participate in
designed to aid health management organisations in the stor-
the blockchain (see Figure 9). In this sense, it is possible
age and retrieval of medical records. The system is modeled
to maintain a transparent and distributed database of health
to tackle problems arising from data integrity, data security and
records, which are cryptographically secure and immutable
the manipulations of medical records, which have been the ma-
over time.
jor challenges in extant health information systems. Since the
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