A global world with frequent travels requires a patient-centric and movable PHR. The here suggested GPOC concept can be further investigated in the Sandbox. The technical requirements with decentralised blockchains, clouds, adaptable UX/UI and homomorphic encryption have been used.5 The chosen solutions for the GPOC Sandbox are discussed below.
Blockchains play a crucial role in the GPOC framework by allowing the permanent recording of encrypted data, rendering access nearly impossible without the requisite encryption codes. Within a peer-to-peer network-driven system, users collaboratively solve complex cryptographic nonce-based hashes, creating fingerprints that serve to prove the authenticity of transactions. The trust-less nature of this interaction is key, certifying the origin of transactions without the need for a central party. This security is further reinforced by consensus algorithms operating on game theory, ensuring the addition of blocks is a rigorous and secure process.25
Blockchain solutions, particularly those emphasizing zero-knowledge proof and decentralization, have been strategically chosen for the GPOC Sandbox. The GPOC concept, with its emphasis on patient co-ownership and secure global healthcare communication, demands robust and trustless transactions facilitated by blockchain technology. The unique requirements of GPOC, such as patient co-ownership and participation in global medical research, have directly influenced the technical design of the sandbox, aligning the chosen blockchain technologies with the GPOC vision of democratizing healthcare.
A blockchain is a linear transaction ledger, which is duplicated and distributed across an entire network of peer-to-peer computers. Each user stores one ledger copy and all user computers are nodes. Validation of the encrypted data creates durability and transparency, giving traceability from the genesis block.
Regulations may require keeping information not longer than necessary. Blockchain solutions for healthcare try to address this with off-chain interaction processing.15
For healthcare, the decentralised and transparent blockchain technology is strategic for solving issues and providing complication. PHRs require both privacy protection but also accessibility in the event of apt healthcare actions. This is accentuated in a GPOC.
Blockchain-based Zero-Knowledge Proof (BZKP) is an internet-of-things (IoT) model. It is patient-centric and aims to protect sensitive PHR data.11 Its scalability, robustness and immutability are suitable to GPOC.11 Blockchains accumulate loads of data and BZKP reduces storage.
As discussed earlier, the prominence of blockchain-based PHRs in healthcare reflects their widespread adoption. Their popularity is attributed to the heightened security and patient empowerment they afford, aligning seamlessly with the goals of GPOC. For instance, MyHealthData permits downloads from multiple institutions via mobiles and a blockchain relay server. It is designed for PHR interoperability.16 The recently published Blockchain-Based Deep Learning as-a-Service (BinDaaS) is a combination of blockchain and a deep-learning platform with inbuilt clinical predictions. It provides superior performance, accuracy, end-to-end latency and mining time compared to other models.17
For the usage of outsourced PHR clouds, key features of a secure health cloud have been presented in a case study of blockchain-assisted PHRs.18 A hybrid-blockchain solution addresses some security issues with sharing. Analysis with the blockchain benchmark tool Hyperledger Caliper, exhibits high performance.19 For GPOC Hyperledger Besu was used.14
Most blockchain-based PHR solutions have focused on single chains. The latest leakage mitigations require multi-chains. Hence, Relay-Chain as a Service (RaaS) and a cross-blockchain PHR solution may be suitable for patients visiting many hospitals.18 This was deemed relevant to GPOC and can be further explored in the Sandbox.
Moreover, the unique requirements of GPOC, such as patient participation in global medical research, have been considered in the technical design of the sandbox. The chosen blockchain technologies align with the GPOC vision of democratizing healthcare and contributing to the dissemination of artificial intelligence within the medical domain.
In the GPOC framework, understanding the nuances of cloud infrastructure becomes pivotal. Clouds, whether decentralized with globally distributed storage or centralized under singular control, directly impact the co-ownership and security aspects of GPOC. As we navigate through the intricacies of PHR data encryption, a crucial facet in GPOC's commitment to secure health data management, we encounter challenges such as time consumption and escalating costs, particularly with an increasing number of access policy attributes. Recognizing the need for enhanced performance, GPOC introduces Fine-Grained Access Control with User Revocation (FGUR). This not only addresses performance concerns but also aligns with GPOC's overarching goal of empowering patients in managing their health data. A strategic combination of Broadcast Ciphertext-Policy Attribute-Based Encryption (BCP-ABE) and attribute hierarchies of Comparison-Based Encryption (CBE) further reinforces the GPOC commitment to robust security measures.20
Centralised clouds mean storage and transfer by trusted third parties (like Amazon, Google, Microsoft). Here there are weaknesses that can harm data. Hitherto, most PHR solutions are centralised. However, the Diagonal Digital Signature Algorithm (DDSA) using Merkle Patricia Hash Trie (MPHT) algorithm is a PHR sharing solution with blockchain.21
In the context of centralized clouds, considerations align closely with GPOC. The challenges associated with centralized clouds directly impact GPOC's mission of co-ownership and secure health data management. The GPOC Sandbox addresses these challenges by adopting a decentralized approach, ensuring trustless transactions and empowering users in co-managing their health data securely.
A main issue with centralised clouds is the loss of privacy and security of sensitive PHRs.22 Therefore, we argue that outsourcing solutions for PHRs have critical such issues.23
To solve this issue, decentralised blockchains ensure trustless transactions. Each network member possesses an identical copy of data in a distributed ledger; any alteration is rejected by the other users. For instance, Ethereum, a decentralised and open-source blockchain, incorporates smart contract functionality. Serving as the native cryptocurrency of the platform, Ethereum empowers the development of applications on its blockchain.24,25,26 Hence, this is the chosen solution for the GPOC Sandbox.
Hyperledger, a platform for collaborative, permissioned private blockchains, aligns with GPOC's focus on secure and co-owned health data. Its support for emerging architecture design, including hybrid infrastructures that unify permissioned and public networks, underscores its suitability for GPOC. 27
Diverse ecosystems, like Directed Acyclic Graph (DAG)-based (e.g., Hedera Hashgraph, Holochain) and blockchain-like systems (e.g., Nano, IOTA, Obyte), demonstrate unique designs for efficiency and privacy.28,29,30,31 Layer 2 protocols (e.g., Cellar, Loom, Ark, Cosmos, Tesseract) facilitate scalability and privacy through state transfer channels.30 In healthcare, GPOC should support state change propagation and reversibility.32,33 Proposals for scalability, like sharding and block-size modifications, contrast with the limitations of slow and expensive layer 1 networks.31 Emerging healthcare chains, such as HealthChain, are also under consideration.32
Even though, blockchain implementation may be expensive, user costs may be lower and energy consumption higher. Moreover, lost key generation may be impossible, storages may exceed hard disc capacities. The security issue with social engineering remains. Though, there are capable software relying on decentralised or token-based distributed ledgers with effective cryptographics. Figure 1 illustrates some applications of blockchains relevant for the GPOC.
Illustrates some applications of blockchains relevant for the GPOC technical solution. Note that tokens have both virtual and real-world values, i.e., there are also disadvantages with blockchains, which are elaborated below.
A GPOC should support global medical research on its precious contents. However, the co-owning patients should be able to opt-in for participation. Hence, a microflow of payments to patients needed to be modelled in the Sandbox. Moreover, the contribution possibility to global research and dissemination of AI needed to be considered. Also, bias mitigation and promotion of equal healthcare access. Potentially the AI development of GPOC may lead to a global increase of evidence based medicine (EBM).
Fully Homomorphic Encryption (FHE) is currently the most relevant to GPOC.23,34,35,36 It supports analytics on encrypted data.5
The most effective and ergonomic UX/UI is a science in itself.6 Its adaptability to local or personal preferences is relevant in patient-centric care. Large swathes of the world may access PHRs via smartphones. It is pivotal to adapt the UX/UI for elderly or impaired.7,8,9 The UX/UI of GPOC should lead to efficient workflow. In contrast, social media design wish to prolong logged in sessions and increase the advertising value. The PHR content is already valuable per se. Hence, less value in digital addiction. Relevant GPOC features are displayed in Fig. 2.
Illustrates the science of optimal UX/UI, which is relevant for a global platform such as GPOC. The central mission is to make it as accessible as possible and prevent discrimination against those with a disability etc. It should present a solution that is simple, inclusive, adaptive, efficient, and truly global. A suggested collection of ergonomic and minimalist UX/UI wireframes for GPOC is available on the article repository on Figshare, DOI: 10.6084/m9.figshare.c.7067762
Future developments may include large natural language processing, multichains, quantum AI and security for GPOC.37,38
In summary, every technical decision made in the development of the GPOC Sandbox has been intentionally aligned with the core principles of the GPOC concept, reinforcing its potential impact on global health and medical research.
Final Remarks
In conclusion, we created a GPOC Sandbox. It is freely available online for all interested parties to research and explore. Here, we incorporate the GPOC concept. It encompasses a PHR co-ownership, trisected between the patient, clinicians and clinic. It is a distributed platform based on blockchains. We aimed to include the insights from the articles in the GPOC-series. Thus, the presented cloud-based ledger-like Sandbox is the result. Its modules lie open for global research and adaption. Hence, it contributes to the democratisation of healthcare. It facilitates the research and spread of AI within medicine. The GPOC Sandbox may have impact on global health.