A Framework for Data Sharing between Healthcare Providers
using Blockchain
Ahmed G. Alzahrani
1,2
, Ahmed Alenezi
1,3
, Hany F. Atlam
1
and Gary Wills
1
1
Electronic and Computer Science Dept., University of Southampton, University Road, SO17 1BJ, Southampton, U.K.
2
Department of Computer Science, Faculty of Computing and Information Technology,
King Abdulaziz University, Jeddah 21589, Saudi Arabia
3
Computer Science Dept., Faculty of Computing and Information Technology, Northern Border University, Arar, K.S.A.
Keywords: Blockchain, Healthcare Systems, Sharing Data, Privacy, Security, Kingdom of Saudi Arabia.
Abstract: The healthcare data are considered as a highly valuable source of information that can improve healthcare
systems to be more intelligent and improve the quality of the provided services. However, due to security and
privacy issues, sharing data between healthcare organisations is challenging. This has led to data shortage in
the healthcare sector which is considered as a significant issue not only in the Kingdom of Saudi Arabia
(KSA) but also worldwide. The primary objective of conducting this paper is to investigate the various factors
that enable secure sharing and exchange of healthcare information between different healthcare providers in
the KSA. It starts by discussing the current literature and frameworks for managing healthcare data
information and the challenges that health providers encounter, particularly when it comes to issues such as
data security, patient privacy, and healthcare information exchange. These challenges in managing healthcare
data have necessitated the need for implementing a solution that can allow medical providers to have access
to updated healthcare information. Attention in the healthcare sector has been drawn to blockchain technology
as a part of the solution, especially after the technology was successfully applied in the financial sector to
improve the security of financial transactions, particularly involving digital currencies such as Bitcoin.
Therefore, a framework based on the blockchain technology has been proposed to achieve the goals of the
present research.
1 INTRODUCTION
Advancements in Health Information Technology
(HIT) have resulted in improved delivery of
healthcare services to consumers as well as the
creation of new products and services in the
healthcare industry that were previously not
available. As such, HIT is increasingly being viewed
as one of the most promising ways in which to
improve healthcare operations including patient
safety, records management, the efficiency of
delivery systems and the overall quality of treatment.
Industry practitioners believe that consistent use of
technology in the healthcare sector leads to increased
healthcare efficiency, a reduction in costs, a decrease
in the paperwork involved, the extension of real-time
communication, and improvement of healthcare
quality (Chaudhry et al., 2006; Esposito, De Santis,
Tortora, Chang, & Choo, 2018; Ribitzky et al., 2018).
There have been many recent developments
within the healthcare industry that have helped pave
a way for blockchain technology in said industry. For
instance, there has been significant development in
the adoption of electronic gathering of health-related
data, cloud computing for data storage, enhanced
privacy protection regulations for patient data, and
the new opportunities that are continuously emerging
in the healthcare industry for data management, as
well as the convenience that is created from patients
being able to access and share their personal health
data (Chen, Ding, Xu, Zheng, & Yang, 2019).
Blockchain technology has been successfully
adopted and applied in the financial services industry
to improve the security of financial transactions, and
particularly those involving digital currencies such as
Bitcoin. The same concepts can be borrowed and
applied in the healthcare industry to help improve
security in terms of how health records and patient
information are stored, retrieved and shared among
different stakeholders. There have been many studies
in the health sector that have evaluated the potential of
blockchain technology in said sector (Cyran, 2018).
Alzahrani, A., Alenezi, A., Atlam, H. and Wills, G.
A Framework for Data Sharing between Healthcare Providers using Blockchain.
DOI: 10.5220/0009413403490358
In Proceedings of the 5th International Conference on Internet of Things, Big Data and Security (IoTBDS 2020), pages 349-358
ISBN: 978-989-758-426-8
Copyright
c
2020 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
349
This research proposes a framework based on the
blockchain technology to provide a secure
environment for data sharing between healthcare
providers in the Kingdom of Saudi Arabia (KSA). It
starts by providing analysis of the healthcare industry
with a particular focus on the context of the healthcare
sector in KSA. Consequently, the research review the
health systems currently in place and the general
culture of KSA as it relates to the use of technology
in the industry. The research also investigates the
potential of the blockchain technology in the health
sector and how to influence Healthcare Providers in
KSA to use it.
This paper is structured in six main sections. The
first part of the paper reviews the healthcare
information systems and blockchain. The second part
discusses how blockchain can address healthcare
challenges. Afterward, detailed analysis and
discussion of the related work are presented in the
fourth section. Whilst section five present the
proposed framework and its factors definitions.
Finally, the conclusion and future work section are
presented in section six.
2 BACKGROUND
In this section a review of healthcare information
systems, blockchain and the KSA context are
discussed.
2.1 Healthcare Information Systems
Healthcare practices generate extensive amounts of
data which can be seen as a data domain where it is
regularly accessed, created, or stored on a daily basis
(Esposito et al., 2018). Technology can play an
important role in boosting the quality of patients’
treatment and reducing the cost by using resources
such as practitioners and equipment (Esposito et al.,
2018). There are different kinds of healthcare
technology that are used to achieve different
objectives, with the ultimate focus on improving
patient outcomes and enhancing patient experience in
health facilities.
Healthcare data usually comprises information
which is very sensitive for its owners. For instance,
patients may be hesitant to share their data and have
it used for research purposes despite the positive
impact that such data can have on other patients in
similar conditions. This is because any inappropriate
disclosure of patient data or the identities of the
patients can have an impact on their health as well as
other social or financial implications concerning them
and their employers, and insurance companies among
other interested parties (Theodouli, Arakliotis,
Moschou, Votis, & Tzovaras, 2018).
The use of centralised data storage in health
institutions is considered the main limitation standing
in the way of interoperability, because it is considered
an issue for healthcare provider where they store all
the data/records in databank or one central database.
The issues that result from using a central storage
database are health data fragmentation, lack of quality
of data, low speed access to medical data, and
unavailability of system interoperability (Azaria,
Ekblaw, Vieira, & Lippman, 2016).
The medicinal services industry, specifically, has
been a noteworthy target for information theft, as
medical records oftentimes contain private data, e.g.
the names, social security numbers , and addresses of
patients (Dagher, Mohler, Milojkovic, & Marella,
2018).
In the US, no fewer than 112 million security
breaches were enumerated in the medical databases in
2016, with these breaches involving approximately
33% of the medical databases. In the last two decades,
an almost $30 billion loss has resulted from these
attacks on medical databases. Beside the financial
losses, said attacks are clearly a violation of the
patients’ privacy and their data (Zhang, Schmidt,
White, & Lenz, 2018). Thus, there is a need to
confront any future incidents, and healthcare data
decentralisation using blockchain is a possible way to
do so (Mwashuma, 2018).
2.1.1 Privacy in Healthcare
The concerns regarding protection of patients’
confidentiality and identity still exist despite the need
for data sharing (Terry, 2009). For example, the
interaction between medical systems might raise the
risk of health information and leakage due to the
electronic transmission of data without very secure
infrastructure, which may result in serious legal and
financial consequences (Downey & Olson, 2013).
Centralised institutions, as shown in Figure 1,
both private and public, gather enormous quantities
of sensitive and personal information. In terms of the
data on individuals which has been stored, these
individuals usually have little or no control over said
data and how it is used. (Zyskind & Nathan, 2015). In
general, both special category data and personal data
are vulnerable to attack and misuse, thus meaning
they should not be trusted in the hands of
intermediaries (Zyskind & Nathan, 2015).
With regard to recent attacks on clinical
information in cloud systems, different countries, such
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350
as the US (Glaser, 2017) and UK (O'Dowd, 2017) have
experienced significant data loss. Keeping patients’
personal data in the cloud without encryption will
allow the attackers to breach and steal private sensitive
data (Al Omar, Bhuiyan, Basu, Kiyomoto, & Rahman,
2019). Sensitive information should be protected and
kept safe from trespassers and eavesdroppers (Al
Omar, Rahman, Basu, & Kiyomoto, 2017). There have
been negative impacts, resulting from breaches, on the
overall perception of the healthcare sector, and these
impacts threaten to prevent future research which
could lead to more rigorous regulatory constraints
(Patil & Seshadri, 2014).
Figure 1: Centralisation vs Decentralisation.
2.1.2 Data Sharing
Currently, centralised data sharing is struggling to
fulfil the accessibility, scalability and security
requirements of the healthcare sector (Cyran, 2018).
In order to offer efficient collaborative treatment and
care decisions to the patients, it is essential to provide
scalable and secure data exchange. Patients visit
multiple and different clinical institutions during their
lifetime. The health providers need to keep their
patients’ conditions and data updated by being able to
exchange these patients’ information in a timely and
private manner (Zhang, White, Schmidt, Lenz, &
Rosenbloom, 2018).
Nowadays, almost all heath data is stored in
Electronic Medical Records (EMR) systems,
although the data mostly remains non-portable (Ivan,
2016). The difficulty in moving and sharing health
information in a secure way and in a timely manner
has a harmful impact on the care of the patient (Ivan,
2016). Some health entities take the advantage of
perceiving data management and use as a competition
like it appears in Figure 2. And to the mentioned kind
of entities sharing health records will allow the
patients to seek care services from different
institutions but owning health record by providers
mostly will make the patient keep come and stick to
same clinic. In addition, health providers consider
patients’ medical data to be their own property. This
is true with regard to the legal aspects, yet it
sometimes creates costly or unnecessary barriers for
patients who need or want to give their own medical
records to another institution (Ivan, 2016).
Figure 2: Lack of sharing data between hospitals.
Health providers sharing medical records between
one another reduces the waste and cost which may,
for instance, occur when there is duplicate testing
because the patients visit different clinics
(Engelhardt, 2017). However, entities are often
unwilling to share medical data either because of
certain privacy concerns, or just simply because they
are afraid this will give other institutions a
competitive advantage (Vest & Gamm, 2010).
2.1.3 Healthcare Systems in KSA
The level of adoption of Electronic Health Records
(EHR) systems in hospitals in the KSA is currently
poorly known. Furthermore, the determinants of the
adoption of HIT have not yet been quantified. In
addition, unlike most countries in the West, KSA
does not have any data protection laws (Aldosari,
2014). The existing Anti-Cyber Crime Law that was
issued and approved in 2007 is considered very
general and unclear (Commission, 2017).
The culture of KSA is another important factor
for consideration when evaluating the healthcare
systems in the country. This is because several studies
have indicated that local culture is one of the most
important barriers facing the adoption of new
technology and the use of online services in the
country (Hwang, Li, Shen, & Chu, 2004; Schneider,
2010). This can be attributed to the lack of awareness
and knowledge of existing technologies and how they
work. As a result, government organisations and
agencies in KSA encounter several problems related
to acceptance of new technologies (Khater & Rashed,
2017).
A Framework for Data Sharing between Healthcare Providers using Blockchain
351
2.1.4 Challenges of Healthcare Systems in
KSA
In the context of KSA, medical information is one of
the most targeted assets even more than personal data
in the healthcare domain. A recent survey conducted
by (Accenture, 2017) showed that a significant
majority of consumers have personally encountered a
breach of their medical data. The health data of 75%
of those surveyed was breached, while only 32%
claimed that it happened to their personal
information. This showed that the number of breaches
in KSA was nearly three times higher (35%)
compared to other surveyed countries. The most
common places for this to happen, as the above study
showed, were hospitals (43%), the office of the
physician (25%) and the pharmacy (24%).
Europe and Northern America have a set of laws
in place to ensure that personal data is secured and
protected, while KSA does not have any laws
regarding data protection, nor any information for
data security violations. Despite this, there is an Anti-
Cyber Crime law that was issued and approved in
2007, although it is considered a quite general and
unclear law (Commission, 2017).
Data Sharing is one of the most significant
challenges in KSA. Most hospitals and health
facilities in the country find it difficult to regularly
update patient records. Recent studies indicated that
only 16% of the hospitals in the country have
implemented EHR (Bah et al., 2011). Most public
hospitals still rely on paper-based systems for
managing patient records, with evidence suggesting
that the adoption of technology in these hospitals is
quite rare (Aljarullah, Crowder, & Wills, 2017).
2.2 Blockchain
Blockchain can be outlined as a distributed ledger that
is immutable and shared by peers in the network,
where records of transactions or events are appended
in a chronological order (Agbo, Mahmoud, & Eklund,
2019).
The blockchain technology is considered an
efficient enhancement tool for identity verification
and integrity of data, and thus it provides users with
consistent and trustworthy data in the cloud
environment (Liu, Yu, Chen, Xu, & Zhu, 2017). In
addition, blockchain is a robust instrument that boosts
governments’ information resource information
performance. The peer-to-peer (P2P) decentralised
data sharing system advances the efficiency of
sharing and decreases possible costs related to data
(Wang, Liu, & Han, 2017).
It facilitates engagement, smart contracts and
agreements, while also making the cyber security
feature more robust (Ahram, Sargolzaei, Sargolzaei,
Daniels, & Amaba, 2017). In addition, blockchain can
be defined as blocks that are timestamped and
chained together using hashing cryptography. These
blocks are sealed in immutable and secure manner
(Aste, Tasca, & Di Matteo, 2017; Roehrs, da Costa,
& da Rosa Righi, 2017).
2.2.1 Security in Blockchain
The technology environment continues to develop
and change, with the threats posed by hackers,
viruses, criminals and terrorists against information
security (IS) consistently increasing (ITGI, 2006).
Blockchain technology is showing some potential in
healthcare in terms of helping to overcome challenges
regarding data security, sharing, privacy and storage
(Engelhardt, 2017). One of the most important
requirements in the healthcare industry is
interoperability, which is the ability of multiple
parties, whether machine or human, to exchange
information or data consistently and in an efficient
way (Al Ridhawi, Aloqaily, Kantarci, Jararweh, &
Mouftah, 2018; Al Ridhawi, Aloqaily, Kotb, Al
Ridhawi, & Jararweh, 2018; Iroju, Soriyan, Gambo,
& Olaleke, 2013; Mead, 2006).
The blockchain infrastructure ensures that the data
stored on the network is immutable and has an
auditable history. This concept is vital in healthcare
because it would help preserve the integrity of patient
data by ensuring that no other person can access and
alter said data. All transactions involving the specific
set of data are traceable, which facilitates auditing of
the transition processes on the network (Mikula &
Jacobsen, 2018).
2.2.2 Blockchain in KSA
Blockchain is considered an emerging technology
and has not yet been adopted nor applied in the KSA
as far as we know. Based on the search result
regarding blockchain in KSA, there was only one
result that discussed VAT in the financial system. In
the mentioned study the author proposed a system
containing a transparent database for VAT
transactions to deduct the tax and store it on a peer-
to-peer network (Alkhodre et al., 2019). However, the
proposed solution has not been implemented in the
real world yet.
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352
3 HOW BLOCKCHAIN CAN
ADDRESS THE HEALTHCARE
SYSTEMS CHALLENGES
The existing systems that depend on a single authority
to store encrypted data will be vulnerable to attack,
and attackers can concentrate their effort on a single
target to perpetrate DoS attacks, inject malicious data,
and extort data through theft or blackmailing. The
management of medical data in a safe and accurate
way will lead to the development of digital health
(Ichikawa, Kashiyama, & Ueno, 2017).
Government entities can provide better services in
healthcare by keeping the medical records of patients,
which can then be shared with other service providers
(Alketbi, Nasir, & Talib, 2018).
In addition, there are some advantages when it
comes to the implementation of blockchain
technology in healthcare institutions. One of these is
the management of electronic medical records for
patients. Nowadays, patient data is stored in a secure
way in many places, yet scattered between many
organisations, clinics and insurance providers,
without full access to a shared database of patients
(Skiba, 2017).
The other benefits of applying blockchain in
healthcare institutions are: immutability and
verifiability for transactions, transparency, tamper
resistance, and integrity of distributed sensitive health
information. Basically this can be achieved by using
a consensus protocol and cryptographic mechanisms
such as digital signatures and hashing (Dubovitskaya,
Xu, Ryu, Schumacher, & Wang, 2017).
Blockchains are decentralised, meaning that they
do not need the authority or trust of individuals of the
network or the group. The reason that the system does
not require trust is because each node has a complete
copy of all the historic information available and just
by achieving the majority consensus more data will
be added to the chain of prior information. Therefore,
blockchain has the upper hand over the current
security measures (Taylor, Dargahi, Dehghantanha,
Parizi, & Choo, 2019).
The blockchain addresses many issues with
current health IT models, which include security, and
especially data integrity and privacy, and
immutability, which assures identities, thus creating a
very strong audit trail and subsequently improving
healthcare-related security either for patients or
providers (Brodersen et al., 2016).
It is foreseeable that blockchain technology will
benefit patients who interact with systems of
healthcare by avoiding routine registration processes
and decreasing their waiting time. Moreover, by
providing immutable and transparent personalised
medical records that can be accessed from anywhere
(universal EMR) it will decrease paperwork, cost and
overheads (Rabah, 2017).
4 RELATED WORK
In this section reviews of the related works on
healthcare systems that based on blockchain are
critically reviewed.
Gem Health Network (GHN) allows health
providers to share health information and data based
on blockchain technology. GHN was developed
based on Ethereum blockchain technology to create a
secure infrastructure in which there is a shared ledger
system where new transactions and records are
maintained, thus removing the challenges resulting
from centralised storage. This system gives patients
significant control of their data while also allowing
health providers access to all relevant information in
real time (Mettler, 2016).
In 2011, there was a collaboration between the
country of Estonia and Guardtime, the latter of which
uses blockchain technology to operate a healthcare
platform that now secures millions of records
(Vazirani, O'Donoghue, Brindley, & Meinert, 2019).
Thus, Estonia has shown that operating a complete
public health infrastructure using blockchain
technology is achievable (Mettler, 2016). Moreover,
in this system the patients own and control the access
to their healthcare data (Kim, Kuo, & Ohno-
Machado, 2017).
MedRec is a blockchain-based decentralized
record management system to handle EHR was
designed to manage issues such as authentication,
confidentiality, accountability and data sharing in
managing healthcare records and patient data. The
technology also provides an immutable log of all
transactions involving a patient's information is
created and provided to the patient (Ekblaw, Azaria,
Halamka, & Lippman, 2016). However, the MedRec
system does not store patients' health records. The
system uses blockchain technology to store the
record's signature. The signature provides an
assurance that the record’s unaltered copy is obtained
(Azaria et al., 2016; Ekblaw et al., 2016).
Medshare was introduced by Xia et al. (2017) to
address the issues of sharing medical data. This
system is built using blockchain technologywhich is
secured and safe for health data exchange between
untrusted entities. The aforementioned design uses
smart contracts and control mechanism to track the
A Framework for Data Sharing between Healthcare Providers using Blockchain
353
data behaviour in an effective manner and repeal the
access to the entities on detection of violation the
permissions on data. Healthbank offers users a
platform where they can store and manage their
medical information in a secure environment and also
make it available for medical research in exchange for
financial compensation. This company is working on
empowering patients to have full control of their data
by using blockchain technology for transaction
validation and verification.
Ancile is a framework built on Etherum
blockchain and uses smart contracts for EHR
management that gives the ownership and the control
of EMRs to the patients. It securely controls the
access to the documents and keeps tracking of how
records are used, transfer records in a secure way, and
reduce unauthorized parties' ability to obtain PHI.
Another permissioned blockchain framework
proposed by Dubovitskaya et al. (2017) for sharing
and managing cancer patients' medical records. In the
design to authenticate registered users a membership
service employed using a username/password
scheme. The patient identity was created by using a
combination of personally identifying information
encrypted for security including names, date of birth,
social security number and zip code. And for the
medical data, a secure cloud server used to upload
them with access managed by the logic of blockchain.
5 PROPOSED FRAMEWORK
This section investigate different framework factors
that influence the use of technology in healthcare.
While there have been many revolutionary
technologies in the past, not all of them have been
adopted with ease. New technologies, such as
blockchain, are continuously being studied in terms
of how they can help improve the health sector. The
targeted users, such as healthcare professionals and
administrators, must be convinced that the technology
will be useful in their line of work and that it will
enhance their operations in the health sector.
5.1 Framework Development
The research framework was constructed in three
stages, as shown in Figure 3. The first stage involved
a literature review, which was conducted in order to
collect the influences that affect people's use of
technology and sharing data between healthcare
providers. This can be beneficial in pointing out the
affecting factors that contribute to the use of
technology with respect to healthcare systems. The
second stage is to collect the relevant factors that are
related to data sharing from the previous stage. The
final stage is grouping the factors that affect the using
blockchain in healthcare systems according to the
practitioners in Saudi hospitals, into categories and
components.
Figure 3: The framework development stages.
5.2 Sharing Data between Healthcare
Providers Framework (SDHPF)
This framework is divided and organised into three
main categories, as illustrated in Figure 4, namely
healthcare systems, security, and blockchain.
Figure 4: The proposed SDHPF.
5.2.1 Factors Related to Healthcare Systems
In this section the factors that are related to healthcare
systems are defined.
Grouping
thefactors
into
categories
and
components
Stage3
Collectthe
relevant
factorsthat
arerelated
tosharing
datausing
theprevious
stage
Stage2
Reviewthe
litearture
andcollect
general
factorsthat
affect
people'suse
of
technology
Stage1
HealthcareSystems
Decentralisation
Cost
Efficiency
Culture
RiskPolicy
EaseofUse
Security
DataIntegrity
Privacy
Confidentiality
Transparency
Anonymity
Blockchain
Availability/
Robustness
Accuracy
Immutability
Tamper‐proofing
Interoperability
AccessControl
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354
Decentralisation: enables distributed
environment between the nodes, and the data can be
recorded stored and updated without relying on a
central authority anymore (Agbo et al., 2019;
Alhadhrami, Alghfeli, Alghfeli, Abedlla, & Shuaib,
2017; Hölbl, Kompara, Kamišalić, & Nemec
Zlatolas, 2018; Khezr, Moniruzzaman, Yassine, &
Benlamri, 2019; Macrinici, Cartofeanu, & Gao, 2018;
Mwashuma, 2018; Vazirani et al., 2019).
Cost: blockchain will help to reduce cost that
could result in the current systems by moving the
records between entities and reducing the
administrative cost by eliminating the third party
(Engelhardt, 2017; Khezr et al., 2019; Mwashuma,
2018; Rabah, 2017; Vazirani et al., 2019).
Efficiency: repeating tests and unavailability of
data could be dangerous because these factors might
delay the treatment for the patient as well as
increasing the cost. Moreover, sending data in
traditional ways, e.g. email, can cause security risks,
unlike blockchain, the latter of which has great
potential for reducing cost and the production of
repetitive registrations while also improving the
treatment outcomes (Engelhardt, 2017; Rabah, 2017;
Vazirani et al., 2019).
Culture: culture can be considered a huge
difficulty that might face the adoption and acceptance
of blockchain, and therefore explaining the benefits
of blockchain is necessary considering that most
people in KSA prefer to contact the government
through traditional methods (Abdullah, Rogerson,
Fairweather, & Prior, 2006; Hwang et al., 2004;
Khater & Rashed, 2017; Schneider, 2010).
Risk Policy: making the policy clear enough to the
patients and using smart contracts will help to make
the policy suitable for the patients, thus motivating
them to be more involved in blockchain technology
(Commission, 2017; Khezr et al., 2019).
Ease of Use: this involves showing the system in
a way that motivates practitioners such as doctors to
use to the technology instead of the basic method
(papers), so as to reduce the cost, waiting time, and
improve the treatment outcomes (Davis, Bagozzi, &
Warshaw, 1989; Venkatesh & Davis, 2000).
5.2.2 Factors Related to Security
The following introduce the factors that are related to
the security category in the framework.
Data Integrity: the immutable property of
blockchain will guarantee the integrity of the data
because, once the data is saved on blockchain, it
cannot be altered, corrupted, or even deleted
(Alhadhrami et al., 2017; Alketbi et al., 2018;
Engelhardt, 2017; Rabah, 2017; Vazirani et al.,
2019).
Privacy: blockchain will be more secured, since
all data on blockchain is encrypted, and using the
symmetric encryption will help to keep the identity of
the patient anonymous, thus protecting his/her
privacy (Agbo et al., 2019; Engelhardt, 2017;
Vazirani et al., 2019).
Confidentiality: confidentiality of the patient is
assured because the data is encrypted using the
symmetric technique by default, and this will
maintain the anonymity of patients and protect the
information from hacking. Using blockchain will
make data/records available, and this will decrease
the issues that result from storing the data of patients
locally in each hospital, such as repeating the tests
and basic paperwork (Alhadhrami et al., 2017; Rabah,
2017; Sankar, Sindhu, & Sethumadhavan, 2017).
Transparency: blockchain can improve
communication and data transparency between
clinics and the data will be updated and therefore
trusted and accessed from anywhere (Azaria et al.,
2016; Khezr et al., 2019; Linn & Koo, 2016;
Mwashuma, 2018).
Anonymity: eliminating the third party will
smooth communication and data transference
between nodes, while the identities of individuals
remain anonymous because of data encryption, which
makes the system secure and more reliable. In
addition, access is limited to only fully trusted nodes
when it comes to sensitive information about the
patient (Engelhardt, 2017; Hölbl et al., 2018;
Mwashuma, 2018).
5.2.3 Factors Related to Blockchain
The following define the factors that are related to the
blockchain category in the framework.
Availability/ Robustness: blockchain enables the
replication of data or records in multiple nodes, which
ensure that the records that have been stored on
blockchain are available; indeed, this makes the
system flexible against data hacking, data loss or data
corruption (Chowdhury, Colman, Kabir, Han, &
Sarda, 2018; Hölbl et al., 2018; Taylor et al., 2019).
Accuracy: the records will be accurate regarding
the consensus of nodes in blockchain, because it is
almost impossible for the data in the records added on
blockchain to be changed, tamper with or deleted
(Engelhardt, 2017; Vazirani et al., 2019).
Immutability: one of the most important
properties of blockchain is that the records will be
reserved forever after nodes majority consensus, and
it will become very difficult for anyone to tamper
A Framework for Data Sharing between Healthcare Providers using Blockchain
355
with or modify said records (Agbo et al., 2019;
Engelhardt, 2017; Mwashuma, 2018; Rabah, 2017;
Taylor et al., 2019; Vazirani et al., 2019).
Tamper-proofing: after data is added to the
blockchain, due to the encryption and digital
signature it cannot be changed, and if anything has
been modified or removed it will be easy to detect
(Dai, Shi, Meng, Wei, & Ye, 2017).
Interoperability: one of the potentials provided by
blockchain and needed most by healthcare systems is
to exchange patients’ data freely in a secure way and
thus ensure the decreasing cost, efficiency, and
privacy (Khezr et al., 2019; Mwashuma, 2018;
Vazirani et al., 2019).
Access Control: this will provide the ability to
track any action that has been carried out in the
system and identify which user carried it out, thus
limiting the access to completely trusted nodes to
handle critical (Abouelmehdi, Beni-Hssane,
Khaloufi, & Saadi, 2017; Vazirani et al., 2019).
6 CONCLUSIONS
In summary, the primary objective of this research
was to provide an overview of the potential of
blockchain technology in the healthcare industry. The
use of technology in providing healthcare services
comes with a lot of considerations that must be
analysed comprehensively to make the technologies
effective. New healthcare information technologies
focus on providing an avenue through which the
health sector can keep growing and improving while
at the same time maintaining the quality levels
through minimising the costs of accessing healthcare
and simultaneously improving patient experience in
healthcare facilities. The healthcare industry has been
suffering from inefficiencies in the handling of data.
Many patients and healthcare providers are frustrated
with the numerous hurdles when it comes to obtaining
current real-time patient information.
In conclusion, blockchain is a possible solution
through which to secure the health data of patients.
The question will be whether the technology is too
early in its infancy or if the cost to set up the
infrastructure is too high at this moment. The most
important hurdle of all is to implement this
technology within the parameters set forth by
regulators in the healthcare space. Therefore, the
primary target of this research is to investigate the
factors that influence healthcare providers to share
data using blockchain which has led to proposeing the
SDHPF. In terms of future work the next step is to
have the proposed framework reviewed by a number
of experts. Once the framework is reviewed by a
number of relevant experts, a survey will be
distributed to a number of practitioners in the field of
blockchain and healthcare systems to confirm the
framework which will be then used as a case study in
the real world.
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