Medical Blockchain-A literature review on challenges and Solutions Table of Contents Introduction What’s the Matter with the Blockchain

Medical Blockchain-A literature review on challenges and Solutions
Table of Contents
Introduction
What’s the Matter with the Blockchain?
How Will the Blockchain Affect Libraries?
Critical Evaluation
Literature Review
Conclusion
List of Figures
Frictions affecting business efficiency
The marketplace ecosystem consisting of the four parts: blockchain part, data storage, users and public instances.

Introduction
For centuries, Healthcare has been the single greatest area of research in human history and lack of technologies and increasing variety of health problems are the greatest obstacle to this area. Over the years, this area has overcome multiple sources of frictions (Figure 1) like information, innovation and interaction. Institutions and instruments of trust emerged to reduce risk in care, data and transactions. Technology innovations like cloud computing and big data helped overcome inefficiencies in information storage and sharing. Still, many transactions like privacy, fast data sharing and easy access of information etc. remain inefficient, expensive and vulnerable.

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Figure SEQ Figure * ARABIC 1:Frictions affecting business efficiency
Blockchain technology – which creates a permanent and transparent record of transactions – has the potential to obviate intractable inhibitors across industries. As frictions (Figure 1) fall, a new technology across the field emerges, and the way we structure our current solutions the future will be built upon that. With transparency as the norm, a robust foundation for trust using smart contracts and timestamp protocol can become the springboard for further healthcare evolution. Participants and assets once shut out of markets can join in, unleashing an accelerated flow of capital and unprecedented opportunities to create new applications and solutions.

What’s the Matter with the Blockchain?
The blockchain is not without its problems. The technical complexity of the cryptography and networking involved can make it difficult to understand. If we apply the blockchain to our current systems, this complexity may have negative consequences that far outweigh any benefits it delivers. Many patients have trouble navigating the health care system now; asking them to take on managing their own records in a complex blockchain setup is not likely to improve their care. Likewise, any use of the blockchain in the legal or education systems is going to require massive changes to industries that have a vested interest in keeping control of customers’ data. Another issue with current blockchain implementations is they are inefficient and environmentally unsustainable. The “proof-of-work” requirements in current versions of the blockchain require massive amounts of electricity; the energy cost of a single Bitcoin transaction could power 1.5 American homes for a day7. As the ledgers get longer, the math gets harder, and the amount of power being used increases. Thankfully, there are less computing-intensive versions of the blockchain in development. Possibly the biggest problem with the blockchain is there is a great deal of hype, uncertainty, and fraud surrounding it. Cryptocurrencies in general, and Bitcoin in particular, have an image problem and are regarded as something used for nefarious or criminal purposes. When hackers use ransomware to seize computer networks, they demand payment in Bitcoin.18 When people buy illicit drugs on the “dark web,” they pay in Bitcoin.6 When people see stories in the media mentioning cryptocurrencies being used to facilitate crime, it does not improve the image of the blockchain as a legitimate means of storing information or conducting business. Whether the blockchain can overcome this outlaw image and develop to its full potential as an information storage and verification system remains to be seen.

How Will the Blockchain Affect Libraries?
Basically, the blockchain is about storing information in a distributed, tamper-resistant setting. This fits well with the work librarians have always done, that is, gathering, preserving, and sharing authoritative information. The blockchain can help librarians achieve that work, especially in the world of scientific publication. One potential use for the blockchain is to create timestamped, verifiable versions of journal articles. Irving and Holden successfully tested the use of the Bitcoin blockchain “as a low cost, independently verifiable method that could be widely and readily used to audit and confirm the reliability of scientific studies.”. They did this by creating a cryptographic hash of the plaintext of a trial protocol document and using that hash to create a new private Bitcoin key. This creates a time-stamped record in the blockchain, which other researchers can quickly verify in the future. If the document has been changed, the hash of the new document will not match the one stored in the blockchain.

Critical Evaluation
RQ. What are the known issues and challenges about the medical data sharing using blockchain and their solutions?
Connecting Block Chain to AI:
Individuals can take control over their data and they can share it with companies, research institutions and other consumers. The blockchain based AI-mediated framework presented in the article provides a platform to access the value of time and combination value of personal data. This ecosystem can be a good marketplace where customer will be rewarded for sharing their data as well as well analysed and good collection of data can be used by doctors, pharmaceutical companies, food administration etc to improve the health of people1.
Blockchain based clinical/health information exchange:
The exchange of Personal Health Records and Health Information Exchange (HIE) data via the Integrating the Health care Enterprise (IHE) protocol is an important part of addressing the challenges of system interoperability and accessibility of medical records It addresses several existing pain points and enables a system that is more efficient, disintermediated, and secure7. There are architectures based on blockchain to enable patient to own, control and share their own data easily and securely without violating privacy, which provides a new potential way to improve the intelligence of healthcare systems while keeping patient data private, eg Healthcare Data Gateway2.

Literature Review
One of the major problem for healthcare is data exchange and ability to use data in research and commercial projects. At the same time, healthcare sector requires to maintain a high standard of data privacy and security. Data breaches in healthcare storage systems can be especially costly because of HIPAA fines and reputation losses. Blockchain solutions as described later could reduce data breach risks by utilizing threshold encryption of data (meaning that cooperation of multiple parties is required to decrypt data), together with public key infrastructure (i.e., the use of asymmetric cryptography to authenticate communication with system participants). Gained a substantial attention in recent years T, the blockchain technology gained substantial popularity in recent years primarily due to the popularity of the Bitcoin crypto currency, was previously has been proposed as a medium for health care data storage solutions 4, 5 and as a tool for to improving thee transparency in clinical trials 6. A blockchain-based system can dramatically simplify data acquisition process. They allow user to upload his data directly to the system and give his permission to use his data if it was bought through the system using transparent price formula determined by data value model. Also it would guarantee fair tracking of all data usage activity.
The promise of such solution is the opportunity for users to take ownership of their data and access priviledges and even allow them to sell their data directly to the consumers of data for the fair value of data. However, exchanging the data for currency may be problematic for many reasons including the need to perform a massive number of micro-transactions in multiple countries and among a large number of different types of the data market participants. Here we propose a new form of a utility crypto token called Life Pound, which can be generated or mined by putting the data on the blockchain-enabled marketplace to facilitate for transactions and enable the novel incentive schemes. The architecture of the proposed platform is described in Figure 2.
The clients of the marketplace and their goals are:
? users: to store and sell their biomedical data and to receive advanced health reports from the results of data analysis
? customers: to buy data from users and to provide results of data analysis for users
? data validators: to check the data received from users
? LifePound users: to use the cryptocurrency marketplace (possibly without any interaction with personal data).1
The Users are allowed to keep their data private and secured providing access to the data only for organizations whose paid for it and (optionally) staying as anonymous as possible. Customers intend to buy well-specified data samples which are aggregated from many users. To ensure the quality of the data provided by users, third party is needed – data validators, experts who are first buyers of the data. Data validators check the data quality and provide customers with a guarantee of user data validity. Interactions in the marketplace are registered on a blockchain in the form of transactions. Blockchain by itself does not contain any opened personal information. It contains hashes which could be used to timestamp and provide a reasonable level of non-repudiation for all actions at the marketplace. The former is achieved with the help of blockchain anchoring 2 and other accountable timestamping 9 techniques; the latter – with the help of digital signing and a blockchain-based PKI. Blockchain full nodes and cloud storage are the remaining two parts of the ecosystem. Cloud storage could be an existing cloud storage, for example, Amazon Web Services (AWS), which allows for building HIPAA compliant applications or Google Cloud Platform.
One of the major reasons for integrating cloud storage into the ecosystem is to provide an off-chain storage solution especially for large biomedical data files, such as CT scans or MRIs, where the size of one data file could reach 50 Mb. The cloud storage may require authentication for read and write access to data, which in a preferable setup would be based on the PKI established on the marketplace blockchain. To ensure security and privacy, the data uploaded by users to the cloud storage would be encrypted on the user side using a threshold encryption scheme 7-10. As the storage technology matures, it may be possible to replace cloud storage with the personal storage systems, where all the personal data would truly belong to the individual and also reside at the individual storage. The individuals also may be able to lend their data to the other parties for training purposes instead of selling the data. Blockchain full nodes should be responsible organizations with an access to all information in the blockchain. They are divided into three subtypes:
? (Blockchain) validators: commit new blocks with transactions to the blockchain
? Auditors: audit the marketplace
? Key keepers: keep key shares according to a certain threshold encryption scheme necessary to decrypt user data in the storage.

The precise protocol for key shares transmission and storage is out of the scope of this paper. In one possible setup, key keepers may have crypto identities backed by a blockchain-based PKI, which would allow them to establish authenticated communication channels with other participants of the described protocol for key share transmission. In this setup, the keepers might use ordinary security mechanisms to guarantee at-rest security for the shares.

Figure 2: The marketplace ecosystem consisting of the four parts: blockchain part, data storage, users and public instances.

Basically, the blockchain is about storing information in a distributed, tamper-resistant setting. This fits well with the work librarians have always done, that is, gathering, preserving, and sharing authoritative information. The blockchain can help librarians achieve that work, especially in the world of scientific publication. One potential use for the blockchain is to create timestamped, verifiable versions of journal articles. Irving and Holden successfully tested the use of the Bitcoin blockchain “as a low cost, independently verifiable method that could be widely and readily used to audit and confirm the reliability of scientific studies.”. They did this by creating a cryptographic hash of the plaintext of a trial protocol document and using that hash to create a new private Bitcoin key. This creates a time-stamped record in the blockchain, which other researchers can quickly verify in the future. If the document has been changed, the hash of the new document will not match the one stored in the blockchain. Another potential use for the blockchain in libraries is as a digital rights management (DRM) tool. Digital resources are inherently reproducible, and this creates issues for libraries and publishers. Publishers have imposed draconian, often unworkable DRM tools on libraries and consumers in order to prevent copying of their materials. Because the blockchain creates a unique, verifiable record that can be accessed by anyone, it could be tied to digital materials and used as a method to show “proveable scarcity” of that resource. This would allow digital materials to be uniquely identified, controlled, and transferred.

Publishers could be reassured no copies were being made, but whether prices would decrease accordingly is debatable. The blockchain also has implications for education in general. Just as a blockchain medical record would place control of data in patient’s hands, a blockchain education record could allow students to have a verifiable history of their academic achievements that they control. At least one company is actively pursuing such a system. Early in 2016, Sony announced plans to build a blockchain for the “open and secure sharing of academic proficiency and progress records.

Conclusion
The blockchain ledger system was created as a component of cryptocurrency technology, but it has many other potential uses. In the near future, everything from medical records to library checkouts could be tied to a blockchain ledger containing verifiable time-stamped records of creation and ownership. These systems could also be used to transfer value between users, detect changes in documents, or prevent data tampering. Librarians and others working in the health care field should consider the systems and processes they currently use, and explore whether moving them to the blockchain could be beneficial. This study aims to provide a comprehensive review of the of blockchain and its usage in healthcare as well as challenges and prospective solution in this path. from four different electronic databases. After this review we can say that there were many challenges that has been resolved with technological solutions but there are still few which are yet to look after. These are:
Risk of less valuable and low-quality information to be put on blockchain, this will be there and harm the trust of user and reputation of blockchain.

What if the private key of user is lost.
What if decentralization of blockchain is broken by any organization by acquiring most of servers.

What if quantum computing or any other method can be able to break the encryption.

Apart from that there are other constraints as well to slow down the progress and success of blockchain use in healthcare like immature technology, insufficient skills, regulatory constraints and insufficient business cases.
Reference
1 Mamoshina, P. , Ojomoko, L. , Yanovich, Y. , Ostrovski, A. , Botezatu, A. , Prikhodko, P., Izumchenko, E. , Aliper, A. , Romantsov, K. , Zhebrak, A. , Ogu, I. O. & Zhavoronkov, A. 2018 ‘Converging blockchain and next-generation artificial intelligence technologies to decentralize and accelerate biomedical research and healthcare’, impact journals, vol. 9(5), pp. 5665-5690.

2 Hoy, M. B. 2017 ‘An Introduction to the Blockchain and Its Implications for Libraries and Medicine’, Medical Reference Services Quarterly, Vol. 36(3), pp. 273-279.

3Estopace, E. 2017 ,’Study on use of blockchain for health data exchange underway’, ProQuest Document
4 ‘Honeypotz – Cybersecurity platform built on KSI Blockchain offering realtime protection ‘2016 ,M2 Presswire.

5 Nakamoto, S. 2009, ‘Bitcoin: A Peer-to-Peer Electronic Cash System’, www.bitcoin.org,.

6 Ravindranath, M. 2017. ,’HHS Wants More Blockchain In Health Records-Eventually, Nextgov.com (Online)’ , Washington.

7 Scott, M. 2016 ,’The Future of Medical Records: Two Blockchain Experts’.

8 Thorpe, J. H., Smith, L. C. , Gray, E. , Kona, M. , Mongeon, M. & Rosenbaum, S. 2017 ,’Who Owns Medical Records: 50 State Comparison, A project of the George Washington University’s Hirsh Health Law and Policy Program and the Robert Wood Johnson Foundation’.

9 Zyskind, G. , Nathan, O. ; Pentland, A. 2015 ,’Decentralizing Privacy: Using Blockchain to Protect Personal Data , Security and Privacy Workshops (SPW)’, IEEE, pp. 180 – 184
10 ‘veb and the novgorod region authorities announce the launch of a pilot blockchain project for tracking medication procurement adequacy’2016 , States News Service

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