Secure and Efficient Data Accessibility in

Blockchain based Healthcare Systems

Vidhya Ramani1 , Tanesh Kumar1 , An Braeken2 , Madhusanka Liyanage1 , Mika Ylianttila1
1 Centre for Wireless Communications (CWC), University of Oulu, Finland
2 Industrial Engineering INDI, Vrije Universiteit Brussel VUB, Brussels, Belgium

Email: 1 [firstname.lastname]@oulu.fi, 2 [email protected]

Abstract—The healthcare industry is constantly re- and also potential leakage of the information. In such
forming and adopting new shapes with respect to the kind of healthcare systems, patients are mostly un-
technological evolutions and transitions. One of the cru- aware regarding which entities are storing and using
cial requirements in the current smart healthcare systems
is the protection of patients sensitive data against the their medical data without their consent. One of the
potential adversaries. Therefore, it is vital to have secure challenges with the current healthcare systems is the
data access mechanisms that can ensure only authorized secure accessibility of the medical data by various
entities can access the patients medical information. entities within the system/network. Blockchain can be
Hence, this paper considers blockchain technology as utilized in such cases to achieve the secure accessibil-
a distributed approach protect the data in healthcare
systems. This research proposes a blockchain based ity and integrity of the healthcare data. Therefore, the
secure and efficient data accessibility mechanism for the main focus of this research is to propose a secure and
patient and the doctor in a given healthcare system. efficient mechanism for data accessibility.
Proposed system able to protect the privacy of the Motivation:
patients as well. The security analysis of our scheme The current online healthcare services such as Elec-
shows that it can resist to well-known attacks along with
maintaining the integrity of the system. Moreover, an
tronic Health/Medical Record (EHR/EMR) play a key
Ethereum based implementation has used to verify the role for storing, sharing and maintaining personal
feasibility of our proposed system. medical records of the patients. However, there are a
Index Terms—Blockchain; Smart Healthcare; Data number of shortcomings which may lead to leakage of
Accessibility; Security; Privacy; Ethereum; Smart Con- the patients sensitive medical information. For exam-
tracts
ple, using the current approaches of managing health-
care systems, it becomes challenging for the patients
I. I NTRODUCTION
to keep track of which entity is actually accessing
The concept of blockchain is being well-known for the healthcare data and for what kind of purpose.
its use in bitcoin and cryptocurrencies. It has got Blockchain technology can be vital in such cases
widespread attention from various stakeholders due because it provides data ledger based features which is
to its immense business potential and utilization in distributed to all entities within the network. A patient
various applications such as banking, healthcare and can monitor which entity is actually accessing the
supply chain management [1]–[3]. Medical and health- data and can grant the accessibility permission to only
care services are one of the prominent and crucial the authorized entities accordingly. Therefore, the core
services which need to be delivered on the required motivation behind this work is to utilize blockchains
time and through secure and safer means. Blockchain for healthcare systems and to address the potential
as a decentralized and distributed technology can shortcomings in the current healthcare systems.
play a key role in providing such healthcare services. Our Contributions and Organization of Paper
Blockchain technology promises to provide immense Considering the recent security requirements of the
opportunities in the healthcare sector such as secure healthcare systems, there is a clear need of the secure
data storing and sharing among various stakeholders, and efficient blockchain based healthcare system that
nationwide data interoperability and flexible and quick can not only provide secure and easy data access to the
billing/payment modes [4]. patients but also to other key entities involved in the
With the recent advancements in the Internet tech- system such as doctor can also retrieve and append the
nologies, the world is facing a digital transformation in data with the patient’s consent. And at the same time,
terms of acquiring improved and better quality of daily the system must follow the key security features such
life services. Technologies such as Internet of Things as confidentiality, integrity and authentication. Thus,
(IoTs), sensing technologies and 5G among others are the goal of this paper is to propose the blockchain
providing numerous useful contributions in various based healthcare system in which append or retrieval
aspects of the healthcare services [5]. The current of patients medical data can be done securely by the
healthcare systems are mostly based on centralized authorized doctor and with the approval of the partic-
servers where multiple entities within the network ular patient. Moreover, our proposed system can also
require permission to access the medical information. offer the scalability feature which is a key requirement
This can cause delay in offering the medical services in the current healthcare systems.

978-1-5386-4727-1/18/$31.00 ©2018 IEEE

 The remainder of the paper is organized as fol- Ethereum is a public blockchain platform [18],
lows. Section II highlights the literature work related with possibility to create smart contracts and focuses
to blockchain based healthcare schemes. Section III on the Blockchain technology development. A Smart
defines the preliminaries considered in this paper. Contract is a computer based protocol, consisting of
Section IV presents the system model for the defined rules, agreed by the stakeholders according to their
problem statement. We evaluate the security strength requirements and also it has a Turing complete archi-
in Section V and implementation results in Section tecture for securing the patient’s data and the rules
VI. Performance Evaluation of the proposed system is that can also be modified by the legal person whose
mentioned in Section VIII. Finally we conclude the signature is in the agreement [19]. A Smart Contract is
paper in Section VIII. also used to interact with the blockchain and healthcare
providers according to their need and also manages
II. R ELATED W ORK the patient’s healthcare information by managing the
Healthcare data is considered as highly sensitive access control given by the stakeholder and secured
and requires secure and safer means to protect it. administration of the healthcare record [20].
Thus, the storage, sharing and managing medical data The healthcare systems presented in the above liter-
should be done in secure ways [6], [7]. There are ature are capable to ensure the secure data sharing of
various mechanisms already proposed to address such the patient records, for example, secure sharing of the
issues, for example, numerous authentication schemes patient’s EHR/EMR with the other entities. However,
are presented in [8], [9], [10] in order to fulfill the none of the system in the literature addresses the whole
need of secure and efficient medical data accessibility, append/retrieval process from patients and doctors. For
manageability and other key security requirements. example, a general healthcare scenario must include
These solutions were helpful at some extent in offering the append/retrieve operations from patients as well
various security requirements under desired healthcare doctor because doctor also require to retrieve the
scenarios. However, with the current advancement in patient’s data to check the previous medical history and
healthcare technology, these approaches are not just can append the data in the form of medical prescription
sufficient because the patient has been exploited by or any other medical report. Therefore, our proposed
various stakeholders through different means and with- system is particularly addressing such healthcare sce-
out their consent [11], [12]. In this context, researchers nario where append and retrieve operations can be
are keen to find various secure solutions based on performed by the both patients and doctors.
blockchain based healthcare approaches [13].
There have been various research studies related to III. P RELIMINARIES
potential utilization of blockchain in healthcare, pre- A. Problem Setting
sented by various researchers in the literature [14], [4]. In this work, we have taken a potential healthcare
Electronic medical treatment processes for manual scenario, where the patients healthcare record can
and remote access of the patients data and protect- be managed more securely by the hospital. For this
ing the privacy of the healthcare data are the most purpose, we have used the blockchain technology to
prior fields of application where Blockchain technol- ensure integrity and security of the medical data. We
ogy can create value [15]. The work in [16] has have assumed that the actual medical data is stored in
proposed MedRec in which a decentralized way of the medical server and the address of that record is
using blockchain technology is adopted to manage saved in the blockchain. The patient and doctor can
the EHR/EMR. The authors also provided a potential retrieve the actual medical data through the address,
case study of blockchain usage in healthcare, which which is stored in the blockchain. The healthcare data
provides a prototype for EHR/EMR. Moreover, the may include all kinds of medical records such as doc-
work in [17] presents MedShare that provides the tors prescriptions, medical history, laboratory reports
trustless way of sharing the healthcare data among var- and billing information. In this usecase, we consider
ious service providers using blockchain. Henceforth, that only patient and doctor are the authorized entities
research community are defining different mechanisms for accessing the patients healthcare information and
for the secure data accessibility of blockchain based with the patients permission. Therefore, the main focus
healthcare system. This work provides a contribution of this work is to propose a secure mechanism of
towards an efficient and improved data accessibility adding and retrieving the medical data by ensuring the
mechanism by using private/permissioned blockchain integrity of the blockchain.
for the secure and faster healthcare data access. Thus,
this paper proposes a methodology that is completely B. Network Setting
based on the patient’s access control for processing and We distinguish five different entities in the system,
accessing the data by other stakeholders. The medical being the Patient (P), the Doctor (D), the Registration
data is stored in the database located at peer to peer Center (RC) as a trusted party, the Mobile Device
networks whose address is stored in the blockchain. (MD), and the Blockchain (BC). The patient first
The degree of access is for function of the data which registers with the RC in person by providing personal
patient are permitted to access whereas doctor needs details (such as ID, Biometrics and PIN), together
access control from the patient. with the public key of the patient and the doctor.
 Fig. 1: System model of the proposed healthcare scenario

The public key(s) of the doctor(s) responsible for the points R and Q of Ep(a,b) , it is computationally
treatment of the patient are added to the information hard for any polynomial-time bounded algorithm
file of the patient. Note that the doctors, together to determine a parameter xFq , such that Q =
with the information on their public key, are already xR.
registered with the RC. After the registration process • The Elliptic Curve Diffie Hellman Problem
by the patient, the constructed information file about (ECDHP). Given two EC points R = xP ,Q =
the patient will be sent to the Blockchain, which is yP with two unknown parameters x, yFq , it
shown in Figure 1. is computationally hard for any polynomial-time
Next, the patient goes to the doctor for the required bounded algorithm to determine the EC point
treatment. The patient generates ID and a secret key xyP .
pair (private/public key pair) using the installed app on Furthermore, we denote the operation H as the
the mobile device to authenticate him/herself. Next, if one-way cryptographic hash function (eg. SHA2 or
the doctor wants to update the data, he/she will send SHA3) that results in a number of Fq . The encryption
a request to the BC using his/her key material. Upon and decryption of a message M and corresponding
receiving the update request by the BC, it will check ciphertext C using a symmetric key k is denoted
the validity of the doctor and whether the patient has by C = E k (M ) and M = Dk ((C) respectively.
granted the update permission to that particular doctor. As encryption algorithm AES or even a lightweight
If the check is successful, it performs the update crypto algorithm can be used. The concatenation of
operation. A similar kind of steps are also taken into two messages M1 and M2 is denoted by M1 kM2 .
account in the case of retrieving the patients data by
the doctor. D. Notations
The most frequently used notations in our scheme
C. Cryptographic Operations
are mentioned in Table 1.
The public key related operations in our proposed
scheme rely on Elliptic Curve Cryptography (ECC), IV. T HE S YSTEM M ODEL
offering more lightweight public key cryptographic Figure 1 presents the different phases in the scheme:
operations than the classical discrete logarithms or the registration (1), the request for data append-
RSA based systems. Let us denote the elliptic curve ing/adding (2), the data appending/adding operations
(EC)Ep(a,b) to be used in our scheme by y 2 = (3), the request for data retrieving (4) and the data
x3 + ax + b with a and b two constants in Fp and retrieving operations (5). We now discuss each of them
D = 4a3 + 27b2 6=0, together with the base point into more detail.
generator P of the curve of prime order q. All points
on Ep(a,b) , together with the infinite point form an A. Registration Phase
additive group. There are two elementary operations If a new patients arrives to the hospital for treatment,
related to ECC resulting in another point of the EC, the patient must first register with the RC before going
the EC multiplication R = rP with rFq and the EC to the doctor. Since, it is a one time registration, they
addition R1 + R2. ECC relies on two computational need to provide their details using their mobile device,
hard problems. such as their identity idp , their public key pkp and the
• The Elliptic Curve Discrete Logarithm Problem public key of the doctor(s) pkd treating them. For the
(ECDLP). This problem states that given two EC ease in notation, we consider exactly one doctor. Note
 TABLE I: Notation for proposed scheme • The doctor now checks if C1 , T , R, idp , pkd are
Notation Description unchanged and if K = kP . If this is the case,
P Patient it sends (idp , pkd , T, R, K, C1 , C2 ) to the BC.
D Doctor Note that it does not need to check the validity
idp Identity of patient of the signature as this will be performed by the
MD Medical device miners in the scheme.
idd Identity of doctor
RC Registration center
C. Data Appending/Adding Operation
H(.) Hash function Next, upon receiving the tuple, the BC performs the
Ek (.)/Dk (.) Symmetric encryption/decryption with key k following actions:
pkp Patients public key • First, the BC checks the timestamp T and looks
skp Patients private key up the public key of the patient and its corre-
k Concatenation operator
sponding registration contract.
⊕ XOR operator
• Then, it verifies the validity of the signa-
T Time stamp
k Key ture and thus the request by checking the
BC Blockchain equality C 2 P = pk P H(pkp kpkd kC1 kRkT ) ⊕
pkd Doctors public key KH(idp kRkC1 kT ). This check ensures that the
skd Doctors private key data is coming from patient idp and that the
M Patient’s record doctor with public key pkp is involved.
• Step 3: If this is positive, the tuple CSR is stored
on the BC.
that also relatives can be involved in the scheme, at
the same way as doctors but with only reading rights. D. Request for Data Retrieving
Next, the RC sends (idp , pkp , pkd ) to the BC signed If the doctor wants to retrieve the data of a patient
by the patient and by the RC. Note that (idp , pkd ) has in a certain time interval Tp , then the doctor will send
been already sent to the BC. Furthermore, then the BC (idp , idd , Tp ), signed by the doctor to the BC.
verifies the signatures of the patient and RC and keeps
E. Data Retrieving Operation
(idp , pkp , pkd ) on the BC.
After receiving this message, the BC will perform
B. Request for Data Appending/Adding the following steps:
In this phase, the doctor wants to update/add data • The BC now checks the freshness of Tp , the
M into the BC, with the approval of the patient. We validity of the signature and if the doctor is
here suppose, both doctor and patient possess their granted the permission by the patient to access
own M D on which the health application is running. the data (as stored on the BC).
Therefore, the doctor first encrypts the data with a • If so, it retrieves all data corresponding with
common key, derivable by the patient. Next, the patient that period. The data has the form CSR0 =
checks the validity of the encryption and if positive it (pkp , T, R, C1 , C2 ). Note that idp is replaced by
performs its signature on the encrypted value. Finally, pkp and pkd is removed from the stored tuple as
the doctor approves the signature of the patient and it is already known by the doctor. As the BC al-
transmits the information to the BC. To be more ready checked for the integrity, it is sufficient for
concrete, this results in the following steps: the doctor to compute the key k = H(skd , T )pkp
• Denote the current timestamp with T . The doctor and the corresponding decryption of C1 .
determines r = H(skd , T ), and computes R = V. S ECURITY A NALYSIS
rP . Next, the doctor derives the symmetric key
We now explain why our proposed scheme is able
k = rpkp and the corresponding ciphertext C1 =
to offer the required security features.
E k (M, T ). This value C1 together with T ,R is
transmitted to the patient. A. Confidentiality
• The patient is able to also compute k = skp R, This feature includes that only the patient at any
which can be used to decrypt C1 . The resulting time and the doctor at a predefined period, specified
message is checked with the current data shown into the RC contract, should be able to derive the
(presented in real) by the doctor to the patient and patients data. The data stored on the BC is of the
the timestamp. format (idp , pkd , T, R, K, C1 , C2 ). First of all, this
• If the check is positive, the patient data is constructed in such a way, due to the ECDHP
generates a signature by computing C2 = and ECDLP, that only the doctor and patient are able to
skP H(pkp kpkd kC1kRkT ) ⊕ kH(idp kRkC1 kT ). derive the clear text. In this case, the doctors secret key
It also computes K = kP , which is used equals to H(skd , T )pkp and the patients key equals to
for the signature verification. Finally the sk p R. Note that H(skd , T ) should be used instead of a
patient sends the output in the form of tuple random value r, because the doctor is not able to store
CSR = (idp , pkd , T, R, K, C1 , C2 ) to the doctor. all the different random values of all communications
of the different patients. Secondly, only the doctor Algorithm 1 Algorithm for the proposed system
that satisfies the conditions of the predefined contract if ¡function(checkprivilege)==true¿ then
stored on the BC is able to construct such a message. check timestamp ←
Due to the integration of the timestamp into the f or both patient and doctor
ciphertext, the signature request to the patient cannot f unction(retrieveaddress) ←
be replayed at a later moment by the doctor. retrieve address(record)
else¡Abort the session¿
B. Integrity
end if
This feature defines that nobody is able to change Retrieve data:
the patients data without notification of the patient. As if ¡function(agreement)==true¿ then
the patient provides its signature onto the encrypted retrieve data ← f rom the address(record)
message, assurance is obtained on the integrity of it. return(patientdata) ←
The BC checks the validity of the signature, before to the particular requestID(patient or doctor)
being stored. In fact, everybody with knowledge of the end if
public key of the patient is able to check the validity Append data:
of the signature, which is a feature also called public if ¡function(agreement)==true¿ then
verifiability. The proposed mechanism for the signature append data ←
is based on the Schnorr signature scheme [21], [22]. to the particular patient record
return(success) ← to the doctor
C. Authentication
end if
A scheme offers authentication if the entity claiming change privilege:
to send the message is correct. In this case, due to the function ¡ CHANGE PRIVILEGE ¿(¡
usage of a signature, which is based on the famous msg.sender==patient¿) ¡ Only patient can change
Schnorr signature scheme, this feature is inherently the doctor’s details or add some other person¿
included. Consequently, no other person is able to do end function
a man-in-the-middle attack or impersonation attack.
VI. I MPLEMENTATION
Before appending/retrieving the data, the smart con-
For implementing the healthcare blockchain, the tract first verifies the registration contract, to make sure
smart contract plays the vital role for executing or that the doctor has access rights to the patient’s data.
performing the agreement among various stakeholders If the doctor doesn’t have the access control then the
involved in the system. A smart contract can be created system sends false statement and aborts the session.
by developing the codes and these codes define the Therefore, it verifies the patient’s address and doctor’s
agreement signed by the various stakeholders/parties address with the existing details in the blockchain.
such as a patient or a doctor. The healthcare data can
be encrypted and shared to the whole ledger available VII. P ERFORMANCE E VALUTION
within the respective network.The smart contract can- Scalability: Since, it is a private blockchain, the
not access the other smart contract without having the time taken for the whole process is lesser than the
permission. Hence the system is a permit trusted, trans- main network. It is measured as the response time
parent and traceable transaction. The smart contract per transaction. The results shows as the average time
can be developed by using smart contract development for generation of a new block is around 13 secs that
tools, written through a programming language such as is also same for the smart contract transaction. For
Solidity. confirmation it takes 36 secs but it also depends on the
In our healthcare usecase, we mainly focus on gas price before confirming it generates the next few
the two operations, retrieve and append/adding the blocks, takes around 90-120 seconds. For retrieving
medical data through blockchain. We consider that the data, it takes 54 secs and for appending the data,
the patient and doctor both can retrieve the data. it takes 1-2 mins depends on the data.
And for appending the medical data, the doctor can Access control: Access control decisions are made
only modify/update the data along with the patients by the patient defined in the smart contract. If the third
permission. For retrieving and appending the data, parties/unknown entity want to access the system, the
the person must be authorized and approved by the smart contract will deny the request and aborts the
concerned person, being the patient, as indicated in system.
the registration contract. Also, the patient can only Integrity: Integrity plays a major role between
have the access rights to change or add the doctor’s patient and the smart contract. Since the patient already
details and also they can only add some other person signed with the smart contract, so no other person can
to see the patient’s record. After, all these steps then change/modify the signed agreement. In our scenario,
the encrypted data is sent to the requested person the doctor/ third parties cannot have a rights to change
(who sends the request for the data) with their address or alter the agreement in the smart contract
and the required steps are mentioned in the following TABLE II contains the features comparison of our
algorithm. proposed system with other existing blochain based
healthcare systems. In the comparison, we have set
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TABLE II: Comparison of various features of proposed and Pervasive Networks (EUSPN 2017) / The 7th International
Conference on Current and Future Trends of Information and
system with the existing systems Communication Technologies in Healthcare (ICTH-2017) /
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