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Secure and Trustable Electronic Medical Records Sharing using Blockchain
Alevtina Dubovitskaya, Zhigang Xu, Samuel Ryu, Michael Schumacher, Fusheng Wang
TL;DR
Sensitive EMRs must be shared across healthcare settings while preserving privacy, consent, and access to complete records. The paper proposes a permissioned-blockchain and cloud-storage framework for cancer care, implemented as a hospital-collaborative prototype. The prototype is designed to provide privacy, security, availability, and fine-grained patient-controlled access, while scalability and broader clinical testing remain future work.
Problem
Sensitive EMRs must be shared among multiple healthcare entities, but fragmented records, consent management, privacy risks, and centralized-system weaknesses complicate secure access.
Method
The paper combines a permissioned blockchain for metadata and access-control policies with encrypted cloud storage in a cancer-care framework and prototype.
Results
The prototype provides privacy, security, availability, and fine-grained access control through patient permissions, identity management, encryption, hashing, and digital signatures.
Takeaways & Limitations
The framework supports patient-controlled EMR sharing for oncology care and is intended to meet medical-practice requirements through collaboration with a hospital.
Takeaways & Limitations
System performance and scalability in clinical settings remain to be evaluated, and the authors plan testing with real patient data and extensions such as radiology images.
Abstract
from arXiv · showhide
Electronic medical records (EMRs) are critical, highly sensitive private information in healthcare, and need to be frequently shared among peers. Blockchain provides a shared, immutable and transparent history of all the transactions to build applications with trust, accountability and transparency. This provides a unique opportunity to develop a secure and trustable EMR data management and sharing system using blockchain. In this paper, we present our perspectives on blockchain based healthcare data management, in particular, for EMR data sharing between healthcare providers and for research studies. We propose a framework on managing and sharing EMR data for cancer patient care. In collaboration with Stony Brook University Hospital, we implemented our framework in a prototype that ensures privacy, security, availability, and fine-grained access control over EMR data. The proposed work can significantly reduce the turnaround time for EMR sharing, improve decision making for medical care, and reduce the overall cost
Introduction
EMR sharing is essential but difficult because sensitive records must move among many entities while preserving privacy, consent, and availability. The paper proposes a permissioned blockchain framework and prototype for secure, patient-controlled healthcare data sharing.
- Motivation: EMRs must be frequently shared among providers, insurers, pharmacies, researchers, patients, and families, making complete medical histories difficult to maintain.This is especially important for patients with serious conditions requiring long-term treatment and monitoring.
- Motivation: Patients control who may access their health information, but each transfer can require detailed consent specifying data, recipient, and access period.
- Motivation: Postal transfer is time consuming, while email transmission can expose healthcare records to security risks during transit.
- Motivation: Aggregating locally anonymized records from multiple institutions can enable patient de-identification and violate privacy.
- Motivation: Centralized storage and access control introduce a single point of failure, a bottleneck, and difficult choices between encrypted processing and trusted data access.
- Proposed framework: The proposed work combines a permissioned blockchain for metadata and access policies with cloud storage for encrypted patient data.
- Proposed framework: The paper proposes healthcare blockchain scenarios and presents a cancer-care data-sharing framework implemented as a hospital-collaborative prototype.
1 Background on Blockchain
The paper introduces blockchain as a distributed ledger and contrasts permissionless systems with identity-controlled permissioned systems. It describes Ethereum and Hyperledger, including their consensus, identity, ledger, and chaincode components.
- Blockchain models: Blockchain is a peer-to-peer distributed ledger, with permissioned systems controlling participant identities through an identity provider.
- Permissionless implementation: Ethereum is a permissionless programmable blockchain whose smart contracts encode state-transition functions executed on the Ethereum Virtual Machine.
- Permissionless implementation: Ethereum transactions require payment, and proof-of-work consensus finds a nonce whose resulting block hash satisfies a difficulty threshold.
- Permissionless implementation: Proof-of-work can consume substantial energy and supports throughput of no more than 60 transactions per second without significantly affecting security.
- Permissioned implementation: Permissioned systems restrict consensus participation to predefined users, enabling state-machine replication algorithms such as PBFT.
- Permissioned implementation: Hyperledger is a permissioned blockchain with modular consensus and membership, blockchain, and chaincode service categories.
- Permissioned implementation: Hyperledger membership services manage identity, privacy, and confidentiality, while transaction certificates can provide unlinkability.
- Permissioned implementation: Hyperledger chaincode combines transaction-execution logic with world state, while ledger hashes support efficient synchronization for temporarily offline nodes.
2 Potential Blockchain Applications in Healthcare
The paper outlines blockchain applications for primary care, research data aggregation, and connected health. These scenarios address fragmented records, consent and privacy challenges, and coordination among healthcare organizations.
- Applications: The three proposed healthcare scenarios are primary patient care, medical research, and connected health.
- Primary patient care: In primary care, disconnected hospitals can leave required information unavailable and force patients to repeat laboratory tests.
- Primary patient care: Primary-care data sharing remains cumbersome because sensitive records require efficient patient-controlled access policies and coordination among providers.
- Primary patient care: An institution-based approach lets trusted healthcare peers maintain a distributed ledger while patients access and manage data through any node storing their information.
- Medical research: For research, a shared distributed ledger can provide data traceability, authenticity, privacy, and transparency during aggregation by researchers, biobanks, and healthcare institutions.
- Connected health: Connected health uses a permission-based shared ledger among insurers, pharmacies, and other entities to support medication, cost, prescription, and treatment management.
- Implementation considerations: The scenarios require choosing between permissionless and permissioned blockchain implementations, with healthcare privacy and response requirements favoring permissioned systems.
3 Application in Radiation Oncology: Sharing Clinical Data between Healthcare Providers
The paper presents an oncology-specific prototype for sharing cancer patients’ clinical data among healthcare providers. Its blockchain-based design combines consent management, fine-grained permissions, off-chain encrypted storage, and role-based access.
- 3.1 Use Case Scenario: The prototype targets cancer patients receiving ionizing-radiation treatment and supports ongoing access to their clinical data during treatment and monitoring.
- 3.1 Use Case Scenario: Blockchain-based chaincode facilitates consent management, speeds data transfer, and lets patients impose fine-grained access policies for clinician sharing.
- 3.2 System Architecture: The framework combines membership services, off-chain hospital and cloud databases, consensus nodes, and role-based APIs for doctors and patients.
- 3.2 System Architecture: Patient data are encrypted off-chain, while chaincode and metadata manage pseudonymous patient identifiers, permissions, file pointers, hashes, and timestamps.
- 3.3 Data Structure and System Functionality: The prototype uses a four-node PBFT network supporting metadata creation, permission updates, data retrieval, clinician uploads, access, and research sharing.
- 3.3 Data Structure and System Functionality: Chaincode checks each clinician’s permission against the requested data category and timeframe, and requires patient agreement for research sharing.
4 Discussion
The discussion argues that the framework addresses privacy, security, and availability through permissioned blockchain mechanisms and encrypted cloud storage. Scalability remains a partially evaluated boundary, especially as the number of validating nodes grows.
- Privacy: Fine-grained permissions are enforced by chaincode, while permissioned identities and membership controls address unauthorized or malicious network behavior.
- Security: Patient-key encryption protects cloud-stored clinical data, and signed hashes and transactions support data integrity.
- Availability: Cloud storage supports shared-data availability through role-based APIs, and lost patient credentials can be used to recover access.
- Scalability: PBFT scalability has been verified only up to few tens of nodes, so the authors propose hierarchical BFT protocols and future clinical performance evaluation.
5 Related Work
Prior blockchain-healthcare proposals include unimplemented architectures and specialized authentication applications, while MedRec is described as the first functioning prototype. The authors distinguish their framework through permissioned blockchain and cloud-based storage choices.
- Yue et al. proposed a healthcare data gateway for secure medical-data control and sharing, but the system had not been implemented or tested.
- MedRec is described as the first and only functioning prototype, using Ethereum smart contracts and storing representations of medical records at network nodes.
- The authors’ prototype differs from MedRec by using permissioned blockchain rather than permissionless blockchain with proof-of-work, and cloud-based rather than local data storage.
Conclusion and Future Work
The paper proposes blockchain applications across healthcare settings and implements a permissioned-blockchain framework for radiation oncology data sharing. Future work includes expanding patient-record metadata, testing with real patient data, and applying additional scenarios in practice.
- The paper proposes blockchain applications for primary care, medical data research, and connected health.
- The framework uses an immutable, transparent ledger to track events across the healthcare network and facilitate medical-data management.
- A permissioned-blockchain architecture and prototype support privacy, security, availability, and fine-grained access control for radiation oncology data sharing.
- Future work will extend patient-record metadata, investigate radiology-image sharing, test the system with real patient data, and apply additional healthcare scenarios.