MedBlock: Using Blockchain in Health
Healthcare Application based on Blockchain and Smart Contracts
Maria Inês da Fonseca Ribeiro and André Vasconcelos
INESC-ID, Instituto Superior Técnico, University of Lisbon, Lisbon, Portugal
Keywords: Healthcare, Interoperability, Blockchain, Smart Contracts, MedBlock, MedClick.
Abstract: Nowadays, healthcare data is generated every day from both medical institutions and individuals. Store and
share such large amounts of data is expensive, challenging as well as critical. This challenge leads to a scenario
of a lack of interoperability between health institutions and consequently to a patient's health data scattered
across numerous systems. Blockchain emerges as a solution to these problems. It consists of a distributed
database where records are saved with cryptographic encryption, making them immutable, transparent and
decentralized. There are multiple healthcare applications blockchain-based that are being actively developed
in order to solve the problem of interoperability between different health providers. The main objective of
this work is to analyse and survey the blockchain technology and to study the smart contracts development,
for the purpose of healthcare applications. Since this research is developed in the context of MedClick – a
web platform that has the goal to give patients the possibility to save their health data plus interact with all
the medical institutions they choose to, in one single site – an additional goal of this paper is to set the
architecture to MedBlock – the MedClick platform based on blockchain and smart contracts.
1 INTRODUCTION
In our society, healthcare is a domain where a large
amount of data is generated, accessed, and
disseminated on a regular basis. Storing and
distributing this large amount of data is crucial, as
well as significantly challenging, due to the sensitive
nature of data.
Furthermore, the healthcare interoperability
landscape is generally centered around business
entities, like hospitals and clinics. Each entity, creates
and maintains data with its own format and it is siloed
within the information system that creates it. Because
of this business centered scenario, a patient is also
obligated to fully trust his or her Electronic Health
Record (EHR), that contains highly sensitive and
critical data, to certain institutions. Besides, when
needed, the exchange of patients’ data between
different institutions can be technically challenging
and requires significant collaboration between the
entities involved (Gordon & Catalin, 2019).
The consequence of the lack of interoperability
between entities is that an individual patient's health
data may be scattered across numerous systems, and
no institution may have a complete picture. This
causes
a lack of patient centricity and can lead to a
compromised treatment (Medicalchain, 2018).
A technology that has been growing and
expanding is the blockchain technology. Succinctly,
this technology consists in a distributed database. Its
records are saved in blocks which makes it an
immutable, secure database. Being decentralized
allows its transactions to be transparent. This
emerging technology is being developed in many
different sectors, including healthcare.
Using blockchain, the problem of the lack of
interoperability between different health providers
can be solved, lowering operations costs and
coordination efforts. Besides, patients’ health records
integrity is ensured and allows them to own their
private health records.
Considering the need to come up with a solution to
develop healthcare applications capable of handling
healthcare information at an increasing scale, capable
of sharing patients health records between different
institutions, increasing interoperability, the main goal
of this work is to survey the state of the art of
blockchain technology, its principles and applications
and how smart contracts can complement it.
Furthermore, this paper aims to survey the state of the
art of healthcare applications based on blockchain.
Since this study is done in the context of MedClick
156
Ribeiro, M. and Vasconcelos, A.
MedBlock: Using Blockchain in Health Healthcare Application based on Blockchain and Smart Contracts.
DOI: 10.5220/0009417101560164
In Proceedings of the 22nd International Conference on Enterprise Information Systems (ICEIS 2020) - Volume 1, pages 156-164
ISBN: 978-989-758-423-7
Copyright
c
2020 by SCITEPRESS Science and Technology Publications, Lda. All rights reserved
(a web platform that aims to give patients the
possibility to schedule appointments, interact with all
health providers and manage healthcare information
in one single site), an additional goal of this work is
to implement MedBlock – the MedClick platform
based on blockchain and smart contracts.
The rest of this document is organized as follows.
In Section 2, the related work is presented, including
the background and state of the art of blockchain and
smart contracts, its application in healthcare and an
analysis of existing blockchain applications that focus
on healthcare. In Section 3, the proposed solution is
described, as well as its requirements and the work
already implemented. In Section 4, the evaluation
methodology to analyse the proposed solution is
defined. Finally, Section 5 concludes this document.
2 RELATED WORK
This section first describes how blockchain works and
its main components. Then, a few blockchain
platforms are analyzed. Next, the benefits of
blockchain in healthcare are explained. Lastly,
existing works that refer to healthcare platforms
based on blockchain are presented.
2.1 Blockchain Background
2.1.1 Distributed Ledger
A possible technology to solve the lack of
interoperability among health institutions and to solve
the lack of patient centricity is the distributed ledger.
A distributed ledger is an asset database that can
be shared across a network of multiple sites or
institutions. This network is composed by
participating nodes or peers, where each peer is a
computing device. All participants nodes can have
their own identical copy of the ledger. Besides
sharing assets, the participants nodes can have
resources allocated, that when functioning together
can make decisions on behalf of the network
(Leeming, Cunningham, Ainsworth, 2019). This
technology is highly efficient since changes made by
any participant with the permission are immediately
reflected in all copies of the ledger. (Gupta, 2018).
2.1.2 Blockchain Network
Blockchain is one form of a distributed ledger.
This specific shared ledger has records saved in
blocks that are linked together creating a chain. This
means the records saved have an order. In its turn,
each block consists of a group of transactions and a
hash that binds it to the preceding block (Li, Nelson,
Malin, Chen, 2019).
This type of distributed ledger is defined as an
immutable ledger for recording transactions, because
no participant node can tamper a transaction after it
has been recorded to the ledger. (Gupta, 2018).
Besides being a type of database, blockchain can
also set rules about a transaction and tied them to the
transaction itself. In contrast with conventional
databases where the rules are set at the database level,
not in the transaction (Walport, 2016).
An important aspect to mention is that, in
practice, blockchain may not be a suitable technology
to store large amounts of data due to the cost and
speed of writing data. A solution to this problem is to
store the actual data off-chain, in external data
sources, and store on-chain the pointers to that data as
hashes (Leeming, Cunningham, Ainsworth, 2019).
This design continues to guarantee the integrity of
data by comparing the hashes off and on-chain.
2.1.3 Smart Contract
Smart Contracts are computer programs written to
form agreements or establish a set of rules between
participants in a blockchain network. Using smart
contracts it is possible to ensure that the clauses of a
contract are accomplished and that breaching the
contract is expensive (Rosado, 2018).
Smart contracts are stored in the blockchain
network and are executed automatically as part of a
transaction, without relying on a third party (Gupta,
2018). This means that when a participant node
receives a transaction, the smart contract associated
with that transaction is invoked to ensure the validity
of the transaction and that the conditions stated in the
contract are met (Rosado, 2018). The result of the
transaction, if valid, is then recorded in the
blockchain. They cryptographically assure business
logic, provide controlled access to the blockchain and
allow that a transaction over an asset is made in a
transparent, conflict-free way while avoiding
transaction costs and the interference of a third party
(Swanson, 2015).
There is a variety of smart contract use cases that
can be applied to different application domains. They
can be used for banking transactions, for registering
any kind of ownership, or managing access control to
a specific asset. In each case, the smart contract
includes all the terms and conditions agreed by each
stakeholder available in the respective process.
The existence of smart contracts makes it possible
to create decentralized applications based on
MedBlock: Using Blockchain in Health Healthcare Application based on Blockchain and Smart Contracts
157
blockchain technology. Putting it simple: if the
blockchain is the database, then the smart contract is
the application layer that accesses it.
2.1.4 Permissioned and Permissionless
Blockchain
Blockchain networks can be permissioned or
permissionless.
Permissioned networks are private. This means
users need credentials – a unique identity – to connect
to the network and have restricted levels of access.
Within these networks there is a main identity
provider that manages access control (Li, Nelson,
Malin, Chen, 2019). These types of networks are
more suitable for organizations that want the ability
to constrain network participation. This leads to a lack
of transparency which is a disadvantage, but it
compensates assuring confidentiality.
On the other hand, permissionless networks are
public. This means they are accessible to every
Internet user and do not need credentials to add new
blocks to the distributed ledger. Any machine can
become a trusted node in the network, have an
identical copy of it and participate in it (Li, Nelson,
Malin, Chen, 2019). These types of networks
typically involve a native cryptocurrency
(Androulaki et al, 2018).
2.1.5 Consensus Mechanism
A consensus mechanism is the process in which a
majority of network participants come to an
agreement on the state of a ledger. It is a set of rules
and procedures that allows to add blocks to the
blockchain and maintain coherent a set of facts
between multiple participating nodes (Rosado, 2018).
There are several mechanisms that vary from
blockchain to blockchain. Table 1 presents a
description of the most used.
2.2 Blockchain Platforms
Blockchain emerged with the creation of the Bitcoin
blockchain in 2009. Bitcoin was developed as a peer-
to-peer electronic cash system and its goal was to
develop electronic payment system based on
cryptographic proof, allowing a transaction to happen
without trusting a third party (Nakamoto, 2008).
After that, there has been an increase interest on
the development of blockchain-based technologies
and blockchain capabilities started to be considered to
improve existing applications and to develop new
ones. This happen not only in financial sectors, but
also
in governments, supply services, insurances,
Table 1: Table with the most used consensus mechanisms.
Consensus Description
Proof of
Work –
PoW
Requires nodes to spend large amount of
computational power to solve intensive hashing
algorithms to add a new block. PoW gives
economic incentives to participating nodes so
they spend their computational power (Li,
Nelson, Malin, Chen, 2019)
Proof of
Stake –
PoS
Has miners that stake their cryptocurrency
tokens as a bet on which block they want to
include in the ledger. This proof makes it so that
any participant of the network has in its best
interest to be honest. This mechanism is less
wasteful than PoW (Costa, 2018)
Proof of
Authority
– PoA
The transactions are validated, aggregated into
blocks and put into the blockchain by approved
known nodes, which act like administrators.
This is a more centralized kind of consensus (Li,
Nelson, Malin, Chen, 2019)
Byzantine
Fault
Tolerance
– BFT
There are numerous BFT algorithms and they
require each node to know every other node in
the network so that consensus is reached. They
normally require a trusted central authority.
commercial services and healthcare.
Besides, blockchain platforms started to appear to
allow developers to develop blockchain applications
at ease. There are a variety of platforms for a diversity
of business needs that allow more companies to
implement their blockchain-based business.
At the moment, Ethereum and Hyperledger Fabric
are the most relevant blockchain platforms due to
their features (Kuo, Rojas, Ohno-Machado, 2019).
Considering network permission, consensus protocol,
smart contracts support and scripting language as
main features, it is possible to compare the two
platforms to choose the platform that can be used for
the proposed solution of this work.
Ethereum can be a permissioned or
permissionless blockchain, uses the Proof-of-Work
consensus and allows the development of smart
contracts in Solidity, a domain-specific language. It
has a public cryptocurrency that is used to mining,
that is, to add new blocks to the network. Hyperledger
Fabric is a permissioned blockchain, its consensus
algorithm is pluggable, depending on the domain it is
being used, and supports smart contracts in Java, Go
and Node.js. Also, Hyperledger Fabric does not have
cryptocurrency (Kuo, Rojas, Ohno-Machado, 2019).
When comparing these platforms in terms of their
technical features, Hyperledger Fabric is most
suitable for the purpose of this work. This is because
it supports smart contracts in popular languages that
most developers know, it has a modular and
pluggable architecture that makes it more versatile to
implement and does not have a cryptocurrency that
makes the consensus computationally expensive.
These features meet the requirements for the solution
that will be proposed below.
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2.3 Blockchain in Healthcare
Healthcare is one sector where blockchain technology
can make a difference and have an impact in patient’s
lives.
In this sector, all clinical data transactions have
verification costs associated. There is the cost of
securing data, along with the cost of maintaining a
primary source of truth (Gordon & Catalini, 2018).
Moreover, a result of the current healthcare being
centered around business entities is the use of highly
centralized information technology systems.
Blockchain is one possible technology that can
mitigate this problem. It is economical and efficient
and being a decentralized ledger, it eliminates
duplication of effort and reduces the need for
intermediaries (Gupta, 2018). Additionally, applying
blockchain to medical platforms may lower
operations costs and coordination efforts to reach
interoperability at scale (Gordon & Catalini, 2018).
This secure interoperability between health
providers is assisted by smart contracts, since once
set, a smart contract is immutable and can be trusted
to operate the same way, using trusted information
shared equally between all entities, indefinitely
(Kumar, Ahmad, Ramadi, Braeken, 2018).
By design, permissioned distributed ledger
systems are more compatible with healthcare systems
and therefore provide more utility to medical
institutions (Underwood, 2016). This is due to the
need of selective disclosure of private information
that rely on zero knowledge cryptography to provide
verification of transactions with a high degree of
privacy over the data (Gordon & Catalini, 2018).
2.4 Blockchain Implementations in
Healthcare
Regarding the development of blockchain in
healthcare, there are currently several papers and
implementations.
A relevant example is the Estonian Government
that implemented a blockchain solution in 2012
where each person in Estonia has an online e-Health
record that can be tracked. The KSI Blockchain
technology is used. Because only a hash of data is
stored on the blockchain, it can scale to provide im-
-mutability at high speed (Martinson, 2019).
Another example is the Ledger of Me platform
where the access of medical data and digital
interventions is combined. It is a system that allows
apps to interact with patients and their data. This
platform does not store EHR directly on the
blockchain, instead it stores hashes in it that will work
as pointers to the EHR stored off-chain (Leeming,
Cunningham, Ainsworth, 2019).
Similarly, the MediBchain paper proposes a
patient centric healthcare data management system by
using blockchain as storage to guarantee privacy.
Here the patient’s data is also shared and managed by
him (Omar, Rahman, Basu, Kiyomoto, 2017).
Likewise, CareChain is a consortium that
establishes a blockchain to which everyone can
connect but not be a computer node. It aims to create
interoperable health data blockchains and to give
individuals control over their own health information
(Carechain).
Another example of a system that is blockchain
based and will permit patients to easily and securely
share their medical records with providers is the
Coral Health platform. Its goal, using Ethereum, is to
create efficiencies in small but multiple parts of the
current health data landscape (Park et al, 2018).
Dovetail Lab is as well working on a healthcare
system to share patient’s data to improve the overall
healthcare system and healthcare services. The
system, based on Hyperledger Fabric, always informs
patients about data sharing and never do this without
the correct permissions (Dovetail, 2019).
MyMEDIS is also a blockchain-supported system
that, using both Fabric and Ethereum, aspires to give
control to patients over their existing medical records
and health related data, while making them instantly
available everywhere (Kovach & Ronai, 2018).
A blockchain infrastructure that implements its
own blockchain platform, that is, it does not use
blockchain platforms like Ethereum or Hyperledger
is Patientory. Its goal is to empower patients,
professionals, and healthcare providers to access,
store and transfer information safely, thus improving
care coordination while ensuring data security
(McFarlane, Beer, Brown, Prendergast, 2017).
Another identical proposal is the BlocHIE paper.
It suggests a blockchain-based platform for
healthcare information exchange between medical
institutions and individuals. It uses two loosely-
coupled blockchains
Electronic Medical Records
Chain that stores EMR for medical institutions and
Personal Healthcare Data Chain that stores PHD for
individuals (Jiang et al, 2018).
MedRec is also a proposal of a decentralized re-
cord management system to handle EHR and its
implementation is based on Ethereum. It has a
modular design that integrates with providers'
existing data storage solutions (Azaria, Ekblaw,
Vieira, Lippman, 2016).
One more example is the Medicalchain platform,
built on Hyperledger Fabric. This platform allows
MedBlock: Using Blockchain in Health Healthcare Application based on Blockchain and Smart Contracts
159
other digital health applications to develop on. It is
currently developing two applications: a telemedicine
to consult a doctor remotely and a marketplace of
health record to use in research. It uses two
blockchain structures – Hyperledger Fabric and
Ethereum (Medicalchain, 2018).
The majority of the solutions presented focus on
the benefit of blockchain to provide an audit of access
to data to allow the patient to manage consent and to
provide interoperability between several institutions.
Thus, this work is based on existing works, that is, it
is the combination of specific elements of each work
in order to develop a use case of a healthcare
application – MedBlock, the MedClick platform on
blockchain and smart contracts.
Table 2: Table comparing related work mentioned above.
Technology Consensus Cryptocurrency
Estonian
Government
KSI Block-
chain
Not specified No
Ledger of Me
Available to use
different
technologies
Not specified No
MediBchain
Own
Technology
Own protocol No
Carechain
Ethereum
without mining
Not specified Yes
Coral Health Ethereum PoW
Coral Health
Tokens
Dovetail Lab Fabric Practical BFT No
BlocHIE
EMR-Chain +
PHD-Chain
PoW with
FAIR-FIRST
+ TP&FAIR
No
MedRec Ethereum PoW No
Medical-chain
Fabric +
Ethereum
Practical BFT
+ PoW
MedTokens
MyMEDIS
Fabric +
Ethereum
Practical BFT
+ PoW
MediCoin
Patientory Ethereum PoW PTY/ DASH
3 PROPOSED SOLUTION
This section describes the proposed solution, its
requirements and architecture.
3.1 Requirements
In order to develop MedBlock, the healthcare
application proposed in this paper, it is necessary to
consider the requirements of MedClick.
MedClick is a one-stop platform that allows to
book an appointment across multiple medical service
providers, in a fast and user-friendly way. By having
a single platform for the patient to access multiple
healthcare providers, booking a medical consultation
becomes simpler and quicker. This allows the patient
to avoid the tedious and complicated process of
booking an appointment and always be dependent of
the electronic system provided by each health
provider. Figure 1 presents a UML Use Case diagram
with the most relevant use cases of the MedClick
platform that this work is expected to support.
Figure 1: Use Case diagram of the MedClick platform.
Figure 2: Business process for booking an appointment in
the MedClick platform.
Figure 3: Business process for browsing information in the
MedClick platform.
In Figure 2 and 3, it is represented the business
processes, in BPMN, regarding the most relevant
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functionalities for the purpose of this work – book
appointment and browse information.
3.2 Solution
Considering the distributed context of interaction
with medical institutions, involving several
healthcare providers, patients, and insurances, and the
current architecture of the MedClick platform, a
solution to help improve interoperability, security,
shareability and accessibility of health data is to
implement MedBlock – the MedClick platform based
on blockchain and smart contracts.
The main goal of this solution is to save
information in the blockchain regarding
appointments, patients’ most relevant information,
health professionals, health providers and insurances.
Additionally, all transactions about this
information are also stored in the blockchain so that
these become immutable and visible to all authorized
entities. In Figure 4, it is represented an Application
Usage Viewpoint in Archimate of the main features
of the MedBlock and the interaction of those
authorized entities with the blockchain. The Other
Ledgers mentioned can correspond to more
Healthcare Providers.
Concerning the patient’s health records, that differ
from the patient relevant information in terms of size
and quantity, they are saved outside the blockchain in
a non-distributed way. Moreover, a hash of each
health record, used as a pointer, is stored in the
blockchain. This design avoids the expensive
computational cost of storing large files in the
blockchain, while assuring that the data is not
changed without permission. This guarantee is made
through the comparison of hashes off and on
blockchain.
Considering the granular access control required
for sensitive health data, the most suitable blockchain
is a permissioned and private one. Here most of the
blockchain control is given to MedClick, that has
access to all data. This allows that each health
provider has only access to data from their patients.
This configuration ensures confidentiality of data.
In Figure 5, it is represented a UML sequence
diagram of how a generic interaction between a
patient and the MedBlock ClientApp is, using
Hyperledger Fabric. Note that the MedBlock
ClientApp includes the MedClick portal and the
Node.js server. This server invokes the smart contract
– chaincode – created for MedBlock, that in its turn
communicates with the ledgers.
Regarding the requirements of MedClick
mentioned
above,
this
proposal
supports
the
flow
of
Figure 4: Archimate Application Usage Viewpoint of the
proposed solution.
Figure 5: UML Sequence Diagram of a generic interaction
with MedBlock.
booking an appointment and browsing information
regarding health providers, health professionals,
health insurances, locations or specialties. The smart
contract, that in Figure 5 corresponds to
proposeTransaction, includes one function for the
book appointment and another for browsing
information.
Taking in consideration the characteristics of the
proposed solution, the supported flows and
considering the reference of multiple existing works
already presented, Hyperledger Fabric, with Practical
Byzantine Fault-Tolerant consensus algorithm, is the
most suitable blockchain platform to implement this
solution. This choice is due to the fact that Fabric
supports smart contracts in Node.js which is the
language used in MedClick, it has a modular and
MedBlock: Using Blockchain in Health Healthcare Application based on Blockchain and Smart Contracts
161
pluggable architecture that makes it more versatile to
implement and does not have a cryptocurrency that
makes the consensus computationally expensive.
In figure 6, it is shown a Technology Usage
Viewpoint in Archimate, which is an example of a set
of nodes for the MedBlock Network and for a
Healthcare Provider, using Hyperledger Fabric. The
number and the type of the peers in each network can
be specified. This is an example for only one
Healthcare Provider, though the architecture for
several Healthcare Providers is the same structure.
Figure 6: Archimate Technology Usage Viewpoint of the
proposed solution.
3.3 Implementation
Using Hyperledger Fabric, the main steps to
implement the proposed solution are:
Create a blockchain network, including the peers. It
must be specified where these peers are created – in
MedBlock and in each healthcare provider;
Create private channels between MedBlock and
healthcare providers – this allows confidentiality;
Create a Hyperledger Fabric ClientApp. This is the
connection between the end user and the MedBlock
blockchain network;
Integrate the MedClick website that already exists
with the ClientApp;
Write smart contracts – chaincode – that are called
from the ClientApp and submit transactions to the
blockchain network.
At the time of writing this paper, a few steps of the
implementation of the proposed solution have begun
to be developed after installing the prerequisites and
downloaded the necessary samples and images from
Hyperledger Fabric. The first step was the creation of
the MedBlock blockchain network, specifying the
number and the type of the peers. Afterwards, an
initial chaincode was written in Node.js, to initiate the
MedBlock blockchain with a set of patients, health
professionals, health providers and appointments, and
to request simple queries – for example to get all
health professionals or to get appointments by patient
email. Then, a preliminary version of an Hyperledger
Fabric ClientApp was developed as a Command Line
Interface, where the input from the command line was
parsed to invoke the chaincode previously created.
This initial implementation will be improved and
will be used as a base to continue to develop the
remaining steps of the planned solution.
4 WORK EVALUATION
METHODOLOGY
Blockchain technology has its strengths as well as its
weaknesses. To analyse the proposed solution in the
context of the MedClick using Hyperledger Fabric
and considering the trade-off between its
performance and its limits, an evaluation
methodology must be defined.
The performance of a blockchain platform can be
affected by many variables such as transaction size,
block size, ordering service, network size and
topology of nodes in the network, the hardware on
which nodes run, the number of nodes and channels,
and the network dynamics (Hyperledger Working
Group, 2018). To measure the performance of Fabric,
the Hyperledger community is currently developing a
draft set of measures along with a corresponding
implementation of a benchmarking framework called
Hyperledger Caliper (Hyperledger Fabric, 2019). It
allows to measure the performance of Fabric given a
set of use cases. This tool can produce reports
containing various performance metrics such as
execution time, latency, resource consumption,
scalability and throughput (Pongnumkul,
Thajchayapong, Siripanpornchana, 2017).
To measure the performance of MedBlock, the
Hyperledger Caliper will be apply to the use cases in
the context of MedClick regarding different types of
patients, appointments, health providers and health
professionals.
5 CONCLUSIONS
Nowadays, with the increasing number of medical
services providers and consequently the number of
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appointments, with the lack of interoperability and
the lack of patient centricity that is adjacent to it,
comes the need to find a solution with a secure and
viable way to store healthcare data and process
transactions in this sector. This solution must be
capable of mitigating these difficulties and improve
usability for the patients as well for the professionals.
This is where blockchain comes in. Being a
technology that ensures immutable and secure
transactions, it becomes a possible resolution for the
health sectors. Considering these two major factors,
after analysing the state of the art of blockchain
technology and of smart contracts, this work presents
a healthcare application blockchain-based –
MedBlock – as a solution to mitigate such problems.
To summarize, this research combines the
blockchain features that are beneficial for healthcare
with the smart contracts strengths, within the context
of the MedClick. This result in a healthcare
application based on blockchain and smart contracts
that gives patients the possibility to save their health
data plus interact with all the health providers and
professionals they choose to, in one single platform.
Besides, being implemented in Hyperledger Fabric, a
blockchain platform that has a modular architecture,
allows this work to take advantage of the blockchain
strengths in a business development context.
Currently the authors are finishing the
implementation of MedBlock and the evaluation of
results is planned.
ACKNOWLEDGEMENTS
This work was supported by national funds through
Fundação para a Ciência e a Tecnologia (FCT) with
reference UIDB/50021/2020 and by the European
Commission program H2020 under the grant
agreement 822404 (project QualiChain). The authors
would like to thank MedClick and Rui Cruz for the
opportunity to be a part of this project.
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