Blockchain Technology and Associated Challenges in Smart Healthcare Systems

By: A. Khan, F. G. Penalvo

In recent years, data management systems in smart healthcare paradigm are facing various uncompromising challenges in terms of transparency, immutability, traceability, privacy and security. Furthermore, ancient data management systems in healthcare sector are adhered to a centralized architecture that is exposed to single point of failure. In view of fact that blockchain has acquired a lot of prevalence by virtue of crypto-currency [1]. The impact and tremendous potential of expansion of blockchain are penetrated into additional research applications. To strengthen the accuracy and security of electronic health/ medical records (EHRs/EMRs), to contrive patient-centric approaches and to linkup heterogeneous medical devices blockchain technology has enormous abilities.

The expeditious progression in the domain of Internet of Medical Things (IoMT) has metamorphosed the healthcare industry. We caught a glimpse of the manner in which the utilization of technologies is an eye catching transformation that moulds the world from off-beaten-track systems to ubiquitous Internet-enabled “medical-things”. Several healthcare applications have been integrated into consumer’s electronic gadgets to accumulate physiological data of patients wirelessly. Despite the fact that the adoption of new technologies in the healthcare sector is still in its initial phases, the seamless connectivity between M2M and some open source development platforms creates a gap for cyber criminals to violate the privacy between doctor and patients. Moreover, the traditional healthcare system is implemented in a centralized framework that is vulnerable to a single point of failure [2]. With the evolution of Blockchain technology, which was first used in crypto-currency it has gained the attention of researchers. In the present scenario, blockchain technology is not only utilized in financial work but it has penetrated into various new domains like in health care sector, smart cities and electrical grid framework to provide hassle-free services with more privacy and security. Figure 1 implies blockchain empowered smart healthcare system.

Blockchain technology yields ample scope for resilience of data, transparency, a decentralized data storage framework, security and privacy. The blockchain has acquired a terrific reputation as smart crypto currency technology since the publication of the Bitcoins on white paper in October, 2008 [3]. Bitcoin relies on blockchain technology as its foundation, the prime efficacy of blockchain technique is to fabricate a channel for the trade of digital currency among associates in a decentralized network deprived of any trusted third party (TTP). TTPs weakens a system as a single point of failure, as well as charging transaction fees, a TTP also adds delays to the transaction flow.

Fig. 1: Blockchain Empowered Smart Healthcare System [4]

A brief history of Blockchain Technology:

In the year 1991, Sir “Stuart Haber” and “Scott Stornetta” started work on the First Blockchain ever. In the year 2008, “Satoshi Nakamoto” from Japan published Bit-Coin white paper that became a burning matter at that time. At a local Papa John’s pizza shop in 2010, Laszlo Hanyecz spent 10,000 Bit-Coins to buy himself two slices of pizza in 2010. At the time, his Bit-Coins were only valued at about $40. With the continuity of time, Bit-Coin Marketplace Surpasses $1 Billion and “Vitalik Buterin” published “Ethereum” White Paper in 2013. “Ethereum” becomes the second generation of crypto-currency [5]. In the year 2015, NASDAQ committed validation to the use of blockchain within Finance. In 2018, Blockchain 3.0 came into existence that was the up gradation of already present generation. To overcome the issues present in existing technology, blockchain 3.0 came up with the FFM concept i.e. Fast, Feeless and Miner-less-concept. In addition to this, there are many predictions made by industrialists, that this industry will cross $10 Billions by the financial year 2022 [6].

Working of Blockchain Technology:

Using cryptographic hashes, a blockchain can be defined as a series of time-stamped blocks connected together. The chain continues to expand in size, every time a new block is attached to the chain; it contains a reference (i.e., a hash value) to the preceding block’s content. There are two keys for every node in the network i.e. Public Key and Private Key [7]. The utilization of the public key is done for encoding the messages shipped off to the node and private key is implemented to unscramble the messages and read them. A blockchain’s integrity, immutability, and authentication are ensured via the public key encryption method. The information encrypted with the associated public key can only be decrypted with the appropriate private key.

Types of Blockchain:

  • Public Blockchain
  • Private Blockchain
  • Consortium Blockchain

In public blockchain, data is accessible to the public and anyone can join the chain without any authentication and can act like miners or general node [8].

In private blockchain, it allows only fully authorized nodes to participate in the network. Private blockchains are partially decentralized in nature [8].

In consortium blockchains, only selected numbers of nodes are allowed to participate in the blockchain network. When a consortium blockchain is formed inside a specific business (for example, the banking sector), it is somewhat centralized and available to the public [8].

Distributed Consensus Protocols:

A distributed consensus protocol is a type of agreement that verifies the logical order of created transaction. Some consensus protocols are discussed below;

  • Proof-of-Work (PoW): In this, each node endeavor to interpret a cryptographic problem against the other. The node that finds a solution first has the authority to authenticate the transaction in order to establish a new transaction-implementing block [9].
  • Proof-of-Stake (PoS): According to the number of members in a network, validations are chosen at random. As a result, the more coins it holds, the more probable it is that it will be necessary to endorse the blocks, and therefore this node will evaluate the block’s legitimacy [9].
  • Delegated-Proof-of-Stake (DPoS): In order to maintain fairness, there are many variants of the PoS consensus protocol, each with a different way to selecting the validator. Due to the fact that shareholder vote determines the delegate, the difference between a conventional PoS system and one that uses delegated power of attorney is comparable to the difference between a direct democracy and one that uses representative democracy [9].

Some Challenges faced while using Blockchain in Smart Healthcare:

  • Throughput: While dealing within medical systems, high bandwidth is a concern because without it, a diagnosis that might save someone’s life could be jeopardized [10].
  • Latency: Verifying a block takes around 10 minutes, which might be harmful to network security services because serious assaults could occur during that period [10].
  • Security: This is a very important issue since a weakened healthcare system can lead to the loss of trust of healthcare organizations [10].
  • Resource Computation: Numerous devices are required to monitor patients in a healthcare system. Usage of blockchain might result in high processing and energy expenses [10].


[1] Hölbl, M., Kompara, M., Kamišalić, A., & Nemec Zlatolas, L. (2018). A systematic review of the use of blockchain in healthcareSymmetry10(10), 470.

[2] McGhin, T., Choo, K. K. R., Liu, C. Z., & He, D. (2019). Blockchain in healthcare applications: Research challenges and opportunities. Journal of Network and Computer Applications135, 62-75.

[3] Hasselgren, A., Kralevska, K., Gligoroski, D., Pedersen, S. A., & Faxvaag, A. (2020). Blockchain in healthcare and health sciences—A scoping reviewInternational Journal of Medical Informatics134, 104040.

[4] Khezr, S., Moniruzzaman, M., Yassine, A., & Benlamri, R. (2019). Blockchain technology in healthcare: A comprehensive review and directions for future researchApplied sciences9(9), 1736.

[5] Agbo, C. C., Mahmoud, Q. H., & Eklund, J. M. (2019, June). Blockchain technology in healthcare: a systematic review. In Healthcare (Vol. 7, No. 2, p. 56). Multidisciplinary Digital Publishing Institute.

[6] Katuwal, G. J., Pandey, S., Hennessey, M., & Lamichhane, B. (2018). Applications of blockchain in healthcare: current landscape & challengesarXiv preprint arXiv:1812.02776.

[7] Kassab, M. H., DeFranco, J., Malas, T., Laplante, P., & Neto, V. V. G. (2019). Exploring Research in Blockchain for Healthcare and a Roadmap for the FutureIEEE Transactions on Emerging Topics in Computing.

[8] Onik, M. M. H., Aich, S., Yang, J., Kim, C. S., & Kim, H. C. (2019). Blockchain in healthcare: Challenges and solutions. In Big data analytics for intelligent healthcare management (pp. 197-226). Academic Press.

[9] Yaqoob, I., Salah, K., Jayaraman, R., & Al-Hammadi, Y. (2021). Blockchain for healthcare data management: Opportunities, challenges, and future recommendationsNeural Computing and Applications, 1-16.

[10] Soltanisehat, L., Alizadeh, R., Hao, H., & Choo, K. K. R. (2020). Technical, temporal, and spatial research challenges and opportunities in blockchain-based healthcare: A systematic literature reviewIEEE Transactions on Engineering Management.

Cite this article

A. Khan, F. G. Penalvo (2021), Blockchain Technology and Associated Challenges in Smart Healthcare Systems, Insights2Techinfo, pp.1

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