Blockchain for IoT and Medical Data Management

doi:10.21203/rs.3.rs-3976623/v1

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Blockchain for IoT and Medical Data Management

https://doi.org/10.21203/rs.3.rs-3976623/v1

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This paper presents an innovative approach to enhance the security, sharing, and management of medical data in hospitals and clinics through the integration of blockchain technology and Internet of Things (IoT) devices. Traditional databases, while effective, may pose challenges related to data security and accessibility. In response, our proposed system leverages the inherent features of blockchain to establish a tamper-resistant and transparent framework for storing medical records. The core of our solution involves the integration of blockchain in medical data storage, utilizing Raspberry Pi devices equipped with sensors such as DHT11 for data collection. Each patient is uniquely identified and assigned an individualized ID number, acting as a secure password to access and manage their medical records. This not only ensures data privacy but also provides a seamless and secure method for patients to oversee their healthcare information. We propose a partially decentralized blockchain-based system for medical data storage, constructed from scratch using TypeScript. Additionally, we provide a proof of concept that demonstrates the practical implementation of blockchain in the realm of Electronic Health Records (EHR), utilizing a temperature sensor (DHT11) connected to a Raspberry Pi specifically designed for IoT medical records systems. This multifaceted approach contributes to advancing the field by offering a secure, transparent, and patient-centric system for healthcare data management.

Healthcare

IoT

Blockchain

Health records system

and Security

and web application

Blockchain is a revolutionary technology that aims to address the issue of trust among different entities without relying on third parties. It operates as a distributed ledger system and can store various types of data in the form of transactions. These transactions are grouped to form blocks, which are connected through cryptographic means. Each block contains the hash of the previous block, ensuring data integrity through a one-way encryption technique. This interconnectedness of blocks establishes the immutability of the blockchain, as any alterations made to the blocks can be easily detected. Consequently, blockchain is often referred to as an "add only" ledger [1-3].

The process of adding blocks to the blockchain is known as mining and involves various strategies or consensus algorithms. Some of the commonly used algorithms include:

Proof of Work (PoW): In this process, mining nodes compete to find a valid hash for a block by varying a value known as the nonce, which is contained within the block. The mining node that successfully discovers the valid hash is rewarded.
Proof of Stake (PoS): Unlike PoW, PoS eliminates the need for energy-intensive competition between nodes. Instead, the mining node is chosen randomly based on the amount of cryptocurrency they have staked in their wallet. The more cryptocurrencies a node has staked, the higher its chances of being selected to mine the next block.
Proof of Authority (PoA): In PoA, mining nodes are chosen based on their reputation and credibility instead of the amount of cryptocurrency they possess. This consensus algorithm is particularly suitable for private blockchains where trust among participants can be established through reputation.

By employing these consensus algorithms, blockchain networks ensure the security, integrity, and decentralized operation of the system. Each algorithm has its benefits and drawbacks, making them suitable for different use cases and requirements [1,4].

There are two primary categories of blockchains: public and private. A public blockchain, also known as a permissionless blockchain, allows anyone to participate and operate in a fully decentralized manner. The rules governing the use of a public blockchain cannot be altered by any single entity. On the other hand, a private blockchain is owned and controlled by a centralized authority, which retains the ability to modify the system's rules at any given time. As a result, private blockchains tend to exhibit a centralized nature [5].

From the abovementioned discussion about blockchain, we can conclude some benefits of a blockchain system, the benefits include the following:

Decentralization: in contrast to traditional database systems that are controlled by a central entity, the blockchain is a distrusted leger, each node in the network has a copy from the entire records.
Transparency: Blockchain ensures transparency by making the capture and execution of each transaction visible to the public.
Immutability: Once a data record is stored in a block on the blockchain, it becomes unalterable by anyone.
No Third-Party: Blockchain operates as an independent system without the need for third-party companies or intermediaries. This eliminates additional risks and allows transactions and communications to occur directly between the parties involved. [1-6]

From this point, we can enhance the healthcare domain especially electronic medical records (EMRs) as the following:

Health Records Exactness: Blockchain technology helps gather all important patient information in one digital format, such as medical documents, symptoms, treatment history, and payment details. This ensures that healthcare professionals have access to complete and up-to-date medical records, which helps them provide effective and timely care.
Health Records Interoperability: Different electronic health record (EHR) systems may have different technologies, making it hard to exchange information smoothly. Blockchain-based healthcare data management systems use standardized data codes, making it easier to share patient information across different healthcare settings, in addition, the blockchain is more easily to be shared between different entities.
Health Records Safety: Traditional healthcare systems are vulnerable to cyberattacks and data loss because they rely on centralized infrastructure. Blockchain technology enhances data security by using cryptography and storing data in multiple locations. This reduces the risk of data theft, abuse, or loss due to cyberattacks, natural disasters, or facility failures.
Health Data Managing Costs: Current healthcare systems spend a lot of money managing and transmitting patient records. Blockchain technology can reduce administrative costs by simplifying data recovery and transmission. It allows for easy access to patient records from various sources, eliminating the need for intermediaries and streamlining data management processes. [7]

IoT applications have found extensive use across various sectors, including healthcare. In the past, patient monitoring was restricted to periodic visits and telecommunication, but IoT has enabled remote monitoring, ensuring the well-being of patients. Wearable medical devices now allow continuous measurement of vital indicators, with the recorded data being stored in databases and subjected to further analysis [8]. The healthcare industry has witnessed a rapid increase in the utilization of IoT in recent years, particularly in studying the side effects of new drugs and evaluating treatment effectiveness. However, IoT systems are vulnerable to security breaches and unauthorized modifications that can compromise the integrity of electronic health records (EHR). To address these concerns, this paper proposes a model that employs Blockchain technology to secure IoT data and ensure data integrity.

The main contribution of this paper:

Building a blockchain system for medical data storage using typescript.
Real-time Data Collection with IoT Integration.
Measure the performance of the system and compare it with other systems that are used for the same purposes.

The remainder of the paper is structured as follows: Section 2 presents an overview of related works, Section 3 discusses the proposed system model and methodology, Section 4 provides the system implementation, Section 5 provides the experimental results and corresponding discussion, and finally, Section 6 delves into the conclusions drawn from the study and explores future possibilities.

In [9] their proposed scheme aims to improve the safety of medical data by creating a medical platform based on permissioned blockchain where different hospitals in a specific region can share electronic health records (EHRs). In [10] they propose a system for managing medical data using secure blockchain technology. The system allows users to maintain ownership of their reports while providing easy access for hospitals. The system architecture allows healthcare providers to request and update necessary patient records, and the entire infrastructure is organized within a network.

In [11] This paper describes a system design for a decentralized and secure blockchain-based framework for electronic health records (EHRs). The authors use the off-chain approach to solve the scalability problem of the blockchain. In this approach, the blockchain is used to save just an index for the data while the actual data will be stored in another platform like interplanetary file system (IPFS).

In [12] authors discuss the use of blockchain technology in creating a secure and transparent environment for storing medical records. The blockchain serves as the underlying database for storing and authenticating medical records using a 3-tier architecture. They also discuss the actions performed by different entities in the system, including login, viewing medical history, uploading, and modifying medical results, and consensus-based approval or decline of requests.

In [13] authors describe a proposed decentralized blockchain application for the medical field, focusing on the accuracy, completeness, privacy, and security of patient data. Users can sign up as doctors or patients, and their systems become part of the blockchain network. Patients can upload medical records, which are stored on the Interplanetary File System (IPFS) and identified by unique hashes. They can view and grant access to doctors, and revoke access if needed.

In [14] authors discuss the OmniPHR Multi-Blockchain model, which aims to solve problems in adopting blockchain technology for personal health record (PHR) data. The model introduces a novel architecture that differs from traditional blockchain platforms. It avoids replicating all data to all nodes while utilizing the distribution and security features of blockchain technology.

The system described in [15] demonstrates a way to store medical records. It emphasizes the involvement of patients in managing their records. The authors propose a model that relies on smart contracts and arrays to securely store encrypted medical records directly on the blockchain. This process is facilitated by hospital administrators. Each patient's health records are linked to their specific identity (IDs) and stored using their public keys. Healthcare organizations can access these records by utilizing the patient's private key and unique ID. However, a disadvantage of their method is that it directly stores the primary data on the Blockchain, leading to extra expenses and longer processing time.

Numerous research studies have explored the utilization of embedded systems with IoT technology for the purpose of capturing medical data. Furthermore, a significant body of literature advocates for the adoption of Blockchain technology to ensure the security and integrity of medical records. Our specific focus is directed towards works that employ a Raspberry Pi as the primary embedded device.

In [16], the authors present a system that involves the connection of a Raspberry Pi to various sensors including a temperature sensor, respiration sensor, heartbeat sensor, and accelerometer sensor. This system enables the monitoring of patient parameters directly through the Raspberry Pi itself, without relying on internet connectivity. The paper mentions the potential utilization of platforms such as dweet.io, IBM Cloud, or developer.ibm.com to access and utilize the captured readings, as these platforms are designed for IoT applications.

In [17], the authors employ a Raspberry Pi connected to an ECG sensor, heartbeat sensor, and body temperature sensor. The sensors transmit medical readings to the Raspberry Pi, which stores the data in a local database. Authorized doctors can remotely access the database and review the recorded information using a username and password. However, the challenge lies in ensuring the accuracy and correctness of the captured data.

In [18], the authors propose a system that utilizes a Raspberry Pi. Due to the Raspberry Pi's inability to directly process analog input signals, an analog-to-digital converter (ADC) is required to interface with analog medical sensors. However, the ADC may introduce noise into the readings. To overcome this limitation, the paper suggests employing an Arduino board in conjunction with the Raspberry Pi as an analog reading device instead of an ADC. In this configuration, the ECG sensor readings are processed within the Raspberry Pi through the Arduino and subsequently transmitted to the IBM Bluemix cloud. The cloud platform provides real-time readings that can be accessed by authorized entities for the purpose of reviewing the records.

In [19], a Raspberry Pi acquires input data from ECG machines connected to it, which are, in turn, connected to the patients. The Raspberry Pi updates a SQL database with the newly acquired readings. Subsequently, the database is utilized to update a webpage that can be accessed by doctors and other relevant entities. Simultaneously, the Raspberry Pi processes the incoming data and, in the event of abnormal readings, sends an alert message through the GSM module.

In their work [20], the authors propose a scenario in which IoT is integrated with Blockchain technology to enhance the security of health records. In this envisioned model, patients are equipped with various medical devices and remotely monitored by doctors. The proposed approach involves leveraging the Ethereum Blockchain and smart contracts to record critical sensor readings as events, while the actual measurements are stored in a designated electronic health records (EHR) storage database.

In contrast to the previously discussed works, our contribution involves a comparative study that examines the characteristics and costs of traditional systems in comparison to Blockchain-based systems. Additionally, we develop and implement a system that leverages the advantages offered by both approaches.

Medical records are important because they contain all the information about a person's medical history, like what illnesses they've had, what treatments they've received, and how well they've recovered. These records help doctors make informed decisions about a person's healthcare. It's crucial to keep medical records safe so that they can't be changed or copied incorrectly.

Our work aims to provide a health records storing system based on blockchain technology that will robust data security and data sharing. It is suitable for hospitals and analysis laboratories where doctors tend to save medical records related to patients and share the records with them.

Figure 1 shows the high-level architecture of the proposed system.

As shown in figure 1 the Raspberry Pi, a compact yet powerful computer, offers versatile applications, including healthcare. By integrating medical sensors with the Raspberry Pi, real-time data on vital signs such as heart rate, blood pressure, and temperature can be collected. the data collected by the Raspberry Pi can be incorporated into a Blockchain network to ensure data integrity in medical contexts. Utilizing blockchain enables medical professionals to access and analyze the data for diagnosis and assessment, regardless of their location.

Our system architecture is composed of two parts, front end part, and a back-end part. The front-end part is responsible for the pages that the user deals with. In the front-end pages, we provide the user with methods that can add, delete, update, and get medical information.

While the back-end layer will manage a blockchain system as a database. The system architecture is shown in Figure 2.

Our system is a partially decentralized blockchain programmed in typescript and has functions that provide the user with capabilities to add, delete, update, and get records in blockchain environments.

Add Process: In this process, a system user inserts a new record, this will add a block in the blockchain with state new, the insertion process could be through a web page or through an IoT device.
Delete Process: In this process, the program adds a new block to the chain with the same reference number as the deleted record and with its all information except that the state will now change to deleted.
Update: In this process, the program adds a new block with the same information as the old record but with updated fields and now its state will be changed to updated.
Get-Process: We used this process in queries, the get process involves returning specific records that match the search but without involving old version records.
Get the entire chain: This process is used to retrieve the whole chain including deleted and updated records in time sequence from old to new.

The patients can access their records through a web page or mobile app by using their unique id numbers.

System Implementation

The components used in building the software are as follows:

HTML (Hypertext Markup Language) and CSS (Cascading Style Sheets): are two fundamental technologies used in web development. HTML serves as the backbone of a web page, defining its structure and content through various tags and elements. CSS, on the other hand, is responsible for the visual presentation and styling of a web page. [21]
JavaScript and TypeScript: are both programming languages commonly used in web development. JavaScript, the more established of the two, is a lightweight scripting language that runs on the client side of web browsers. It provides interactivity and dynamic functionality to web pages. TypeScript, on the other hand, is a superset of JavaScript that introduces static typing and additional features. It enables developers to write more robust and maintainable code by catching errors during the development process. [22]
Node.js: is an open-source, server-side JavaScript runtime environment that allows developers to build scalable and high-performance web applications. [23]

The hardware components used in designing the proposed system include:

- DHT11: The DHT11 is a digital sensor capable of measuring temperature and humidity. It utilizes a capacitive humidity sensor and a thermistor to detect environmental conditions. This sensor is affordable, easy to use, and compatible with embedded systems, making it suitable for applications such as measuring body temperature [24].

- Raspberry Pi 4 Model B 2GB RAM: The Raspberry Pi is a series of compact single-board computers developed in the UK. The Raspberry Pi 4 Model B, specifically the variant with 2GB of RAM, is part of the latest generation of Raspberry Pi boards. It offers improved performance, increased memory, and enhanced connectivity options. The Raspberry Pi's affordability, modularity, and open design have made it a popular choice for a wide range of applications [25].

In the following section, we will discuss the system algorithm in the form of steps that are used to implement our proposed system.

Blockchain browser-based module:

Define and export a blockchain class with the following properties: nonce, hash, previous hash, index, timestamp, and data (which can be of type dataform1, dataform2 or dataform3).
Define three interfaces for dataform1, dataform2, and dataform3 to represent blood analysis, kidney/liver analysis, and temperature reading respectively.
Create a block class that contains the data of the patient and the analysis information.
Implement a mining function to find the valid hash by changing the nonce and calculating the hash.
Define a constructor to create a genesis block (the first block in the blockchain with all data set to zeros).
Implement an add block function to add new blocks to the blockchain.
Implement a search function to handle query requests.

Server:

Create a class for the blockchain and use it to handle the blockchain in the program.
Create a web page with options for admin or patient.
If the user is patient, prompt them to enter their reference number and display their analysis results.
If the user is an admin, prompt them to enter a password and display the appropriate options (add, delete, update, query, etc.).
Implement post methods for adding, deleting, updating, and querying data in the blockchain.
Implement a search function to scan the blockchain to find the requested data.
Implement a show all records function to display all blocks in the blockchain.
Implement error handling for cases where the requested reference number or password is incorrect.

Upon the initial connection of any client, its blockchain synchronizes with all connected users via WebSocket through a server. When a doctor or the system administrator initiates a process, it is first executed in the user's webpage blockchain. Subsequently, the process is broadcasted to all connected users through WebSocket and added to their ledgers. The key advantage of this system is its lack of a single point of failure. Even if the server is unresponsive, clients can still make queries, although they cannot add, update, or delete until the server responds. The system flow is depicted in Figure 3.

This section considers the results of the experiments accomplished to confirm the effectiveness of the proposed system. We present a case study as a proof of concept, illustrating a laboratory capable of conducting blood, kidney and liver analyses, and IoT temperature sensing data. The welcome page contains all system functions such as adding a record, deleting, updating, querying, and showing entire blockchain buttons.

The user has the ability to add a new record to the system. Initially, personal information is entered, followed by the related analysis data. Records can be deleted from the system by inputting the reference number associated with the record. The administrator has the capability to update stored records by first entering the reference number for the target record, then selecting the type of analysis. Subsequently, the administrator can choose the field and insert the new value for the update. The system administrator can search for a specific record or a group of records with common field values. The administrator can choose the field for the search and enter the required value. IoT data is integrated into the blockchain through a post-process, typically involving the submission of information through an HTML form. Subsequently, this data becomes accessible through a search process, allowing users to retrieve and analyze the relevant information stored in the blockchain. Accessing the "show all records" page allows authorized individuals to display the entire blockchain records, excluding the genesis block, and includes both deleted and updated records.

Performance analysis

We perform a load test for our blockchain project, we also perform a load test for a database that takes the same inputs using Apache JMeter 5.5 [26]. The results are shown in Figure 4,5 below, the results were taken for all processes and then were averaged.

The test was performed on a laptop:

Intel(R) Core (TM) i3 CPU M 380 @ 2.53GHz 2.53 GHz.
6.00 GB installed RAM.
Windows 10 Pro, 64-bit operating system.

The measurement metric is ‘Average’, Average – The average time taken (in milliseconds) to execute the requests under a given label. So, if 10 samples are getting executed then the average time taken will be:

Average = Total time taken by all samples /#samples

It is clear that in terms of data manipulation, conventional databases offer faster retrieval and reading of data for subsequent analysis, and this is normal as our work requires time to calculate hashes.

The overall performance of our project is still good and acceptable for real scenarios as indicated in the figures, in the case of 10 users working simultaneously the time delay is still in the range of 2 seconds. This is a fast response.

The implementation of our blockchain-based health records storing system offers numerous benefits in ensuring the security and sharing of medical information. This system is particularly valuable in the healthcare sector, where the accuracy and confidentiality of medical records play a crucial role in informed decision-making and patient care.

Enhanced Data Security: The use of blockchain technology ensures robust data security by employing cryptographic techniques, making it highly resistant to unauthorized access and tampering. This enhances the integrity and confidentiality of medical records, preventing any unauthorized changes or incorrect copying.
Facilitates Data Sharing: The blockchain-based system facilitates secure and efficient sharing of medical records among healthcare professionals, hospitals, and analysis laboratories. This promotes seamless collaboration and ensures that relevant information is accessible to authorized individuals when needed.
Real-Time Health Monitoring: Integration with Raspberry Pi, a versatile and compact computing device, allows for the collection of real-time data on vital signs such as heart rate, blood pressure, and temperature. This continuous monitoring provides healthcare professionals with up-to-date information, aiding in timely diagnosis and intervention.
Decentralized Access and Analysis: Utilizing blockchain enables medical professionals to access and analyze patient data regardless of their location. The decentralized nature of the blockchain ensures that authorized personnel can retrieve information securely, contributing to more efficient and collaborative healthcare practices.
User-Friendly Interface: The front-end part of our system offers a user-friendly interface, providing healthcare professionals with intuitive methods to add, delete, update, and retrieve medical information. This enhances the usability of the system, making it accessible to a wider range of users within healthcare settings.

Implementing a blockchain-based health records storing system on a large scale poses certain challenges that require careful consideration:

Data Size and Storage: As the volume of medical data increases, the storage requirements for the blockchain system grow exponentially. Managing and storing vast amounts of patient information efficiently may demand substantial computational resources and storage infrastructure.
Search Time Efficiency: With a large dataset, the time required for searching and retrieving specific medical records becomes a critical concern. Ensuring fast and efficient search functionality in a system with a significant amount of data requires optimization strategies and potentially advanced indexing techniques.
Scalability Challenges: Scaling the blockchain system to handle a growing number of users, healthcare providers, and data points is a complex task. Achieving scalability involves addressing issues related to network congestion, transaction processing speed, and ensuring that the system can seamlessly accommodate increased demand.

This paper has demonstrated the practical implementation of Blockchain technology in the healthcare sector, specifically emphasizing its application in managing Electronic Health Records (EHRs). The integration of a TypeScript-based blockchain, along with a Raspberry Pi featuring a DHT11 sensor for temperature measurement, illustrated the feasibility of utilizing Blockchain to ensure the integrity of health-related data. In addition, we highlighted the benefits of employing Blockchain technology in medical data storage, focusing on increased security, transparency, and efficiency within a TypeScript-based blockchain system. The proposed centralized blockchain-based API for medical data storage holds promise for enhanced security measures and presents opportunities for future advancements and improvements. The future scope of this API extends to integration with AI and machine learning algorithms for advanced data analysis, contributing to improved patient care. Furthermore, it has the potential to expand its reach beyond the healthcare sector, collaborating with other blockchain-based systems, complying with regulations, and integrating with IoT devices for real-time monitoring.

The authors declare no conflict of interest.

- Ethical Approval: There is no Ethical Approval required

- Availability of supporting data: Data shall be made available with communication with the corresponding authors

- Funding: There is no funding for this work

Authors’ contributions

Osama M. Abd El-Hamed co-developed the concept, developed the prototype and implement the design. He draws the performance figures and wrote the first draft. Prof. Fathi E. Abd El-Samie and , Saied M. Abd El-atty co-developed the concept and validated the design. Prof Wael Badawy reviewed the performance and wrote the final draft. All authors reviewed the current version of the submission

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No competing interests reported.

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Blockchain for IoT and Medical Data Management

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