2022 IEEE International Conference on Blockchain and Distributed Systems Security (ICBDS)

Pune, India. Sep 16-18, 2022

Implementation of Blockchain based Electronic

Health Record System using Java Eclipse and
MongoDB
Mehar Nasreen Sunil Kumar Singh*
Dept. of Computer Science & Information Technology, Dept. of Computer Science & Information Technology,
Mahatma Gandhi Central University, Mahatma Gandhi Central University,
Motihari, INDIA Motihari, INDIA
2022 IEEE International Conference on Blockchain and Distributed Systems Security (ICBDS) | 978-1-6654-2832-3/22/$31.00 ©2022 IEEE | DOI: 10.1109/ICBDS53701.2022.9935933

[email protected]; [email protected]
Orcid id: 0000-0001-9685-143X Orcid id: 20000-0001-8954-6648
*Corresponding author

Abstract— With the advancement in technologies, and validates each trade. It may be controlled independently,
Healthcare systems are facing different issues and challenges. without the need for a centralized authority. Because of these
Increase in population, increases the health issues. Large advancements, Blockchain has become the backbone of
amount of health data is being generated and to store these cryptocurrencies. Today, the design acts as the public record
data, centralized EHRs (Electronic Health Records) are used, for all bitcoin transactions. The file size of the records of all
due to which the problem of data security and privacy also transactions in the Bitcoin blockchain, has just increased
increases. To overcome this situation, a distributed-ledger from 20 GB to 100 GB [2].
technology (DLT), Blockchain is developed. Its far-reaching
potential has stretched its capabilities beyond the initial goal Blocks are the distributed nodes/miners provided with
and impacted a wide range of fields. Blockchain can innovate the databases, and it contains the information in digital form
community-based healthcare models. It stores the data in [3]. The genesis block is the first block of the Blockchain
distributed database and uses the concept of cryptography for with no preceding block. Blocks are linked together
security. This paper stores the EHRs in Blockchain and for its containing the previous block's hash value into the current
implementation, Java programming language is used. EHRs block. Each block contains the block header and list of
are accessed from MongoDB and stored in the Blockchain. transactions. Hash acts as the unique identifier of a block. It
Proof of Work (PoW) consensus mechanism is applied, to is generated by hashing the block header twice [4], and the
provide security to the health data.
cryptographic hash function adds security to the Blockchain.
Keywords— Blockchain; Electronic Health Records; Hash;
SHA-256 is used for that purpose.
Security; HIPAA; Data Preservation. Blockchain would provide healthcare with a safe and
secure mechanism for more efficient data sharing.
I. INTRODUCTION Blockchain is a comprehensive system for packaging data in
Every developed country spends large amount of their a form that can be trusted since specific users can only
GDP on Healthcare. Healthcare is the area where Blockchain update it. When data is generated, a block of information is
can be very applicable and useful. Data privacy and their formed. This information is broadcasted and validated on a
security is the main problem faced in centralized EHRs. peer-to-peer network. Those having the correct key, can
Patients need not to take their medical histories to the change and access these data. A new data block is validated
hospitals, as it can be achieved through the blockchain. and added to the chain when data is updated. If any
transaction or block in the blockchain is tampered with,
A blockchain is a decentralized and is used as public
permissioned members and validation tools collaborate to
ledger. It also records the transactions and track the assets.
authenticate or reject the new data. This method guarantees
Blockchain provides immutability of the records because of
that the Blockchain stays a secure, safe, and trustworthy
its decentralized features. This decentralized system uses the
source. The Blockchain can maximize actual data for
concept of cryptography for securing the system. It provides
healthcare by giving a new means of sharing, analyzing, and
better control of health records and patient care. It minimizes
validating information.
twice the number of medical practices by doctors and
monitoring the patient’s condition, saving both practitioners Blockchain enables to create the Electronic Health
and patients time and resources. Record (EHR) system for patients [5]. The Patient himself
gives the data authorization according to their needs, so that
The progress of Blockchain has been continuous and
it cannot be accessed through the unauthorized users and the
intriguing. Satoshi Nakamoto developed the notion of a
other parts of the data remains secure.
distributed blockchain in 2008 [1]. His original article used
the phrases "block" and "chain" individually but became Blockchain technology provides an unchangeable and
publicized as a single word, Blockchain, from 2016. He reliable ledger responsible for maintaining immutability and
enhances the architecture with a novel method of adding confidentiality in electronic health record systems. Sensitive
blocks to the chain without the need of trusted third parties. health records are guided through many regional and
The updated trees would have a secure history of data international regulations. The most important among these
transfers. It employs a peer-to-peer network to time stamp

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regulations is the Health Insurance Portability and different hospitals so that a doctor can have the preliminary
Accountability Act (HIPAA) [6]. information of the Patient’s health history, accessing those
records. They used Blockchain to access and retrieve the
The research focused on better utilizing blockchain EMRs easily and efficiently from different hospitals.
processing power and using its core functions to tackle real- Improved consensus mechanism is designed. Symmetric
world challenges in healthcare. Blockchain provides privacy cryptography is merged with customized access control
and security to the EHRs as compared to the traditional policies.
systems.
Further, Healthcare Information Exchange, BlocHIE is
designed [11]. They used Blockchain and compares two
types of healthcare data. They analyze the ways of storing
and sharing EMRs and personal healthcare data and on that
basis, they created two-loosely coupled blockchains. Off-
chain storage is merged with on-chain verification to keep
data secure. System throughput is improved. They designed
two packing algorithms for transactions.
In [12], a smart contract-based framework is proposed.
Patient records, lab results, doctor’s advice, and all other data
are stored in Blockchain in the form of blocks. Open and
secure application is designed and manual intervention is
eliminated. They implemented this design in Ethereum
platform and used in hospital.
A Healthcare management system is proposed using
Fig. 1. Blockchain architecture in healthcare system. Blockchain. They implemented a modified Merkle Tree data
structure [13]. Different smart contracts were designed to
The remaining part of this paper deals with the following: provide integrity management. Digital health record storage
Section II deals with the latest works done in the area of is also designed. They also analyze the system with different
Blockchain in healthcare. Data construction scheme of this performance metrics.
paper is discussed in Section III. The proposed work of
storing EHRs in the Blockchain using Java programming A blockchain enabled scheme is proposed that detects the
language is described in Section IV. Next in Section V, we diabetes of the patient[14]. For that, several machine learning
have analyzed the performance of the proposed work. classification algorithms are used. Registration,
Finally, Section VI concludes the paper. authentication and communication phases are created. EHRs
stores the symptoms to predict the diseases. Data are
II. LITERATURE SURVEY collected in IPFS file system via sensors attached to the
In this section, a few similar works done in Electronic patient’s body.
Health Records (EHR) using Blockchain are explored, which A framework called Ancile, based on blockchain is
are as follows. proposed in [15] for secure access of medical records. The
In [7], an algorithm of the EHR sharing system on the final control of data is given to the patients. Patient allows
Hyperledger platform is implemented. They proposed an and controls the accessibility of data and keeps track of it.
algorithm for Patient’s medical records accessibility, in Smart contracts are written using Ethereum platform and for
which each node was given a symmetric and private key. mining, QuorumChain consensus algorithm is used.
Block transaction methods were also created. Further, Unmanned Aerial Vehicle (UAV) is used to collect the
performance metrics latency, throughput, Round Trip Time health records of patient and store them in the nearest
were also optimized to find the improved outcomes. server[16]. UAV is connected to the sensors, that are
Considering the data leakage of EHR system, a model is attached to the patient’s body. A shared key is generated for
developed [8], in which, they have proposed an encrypted communication. It is encrypted by the sensors and then UAV
electronic health records system. They have applied a decrypts it. This is done using blockchain technology.
complex logic expression, which can be used as an index to Med-PPPHIS model is proposed in [17]. It consists of
search the records. The performance of the scheme is also both permissionless and permissioned blockchain. Med-
tested. Overheads to access the ID of the document is DLattice is used as permissioned blockchain in this model,
evaluated. They created smart contracts on Ethereum for the for managing the health records of the patient and is done by
transactions of data. using the directed acyclic graph structure. A prototype of this
According to [9], a data preservation system (DPS) for model is implemented in Anhui Province, China for
EHR is designed. They used blockchain technology to secure monitoring the health of patient. A blockchain based method
the privacy of user’s data with the help of cryptographic proposed the management of several diseases that are
algorithms. Data storage strategies were also used. Lost and persisting for a long time.
tampered data can be accessed and modified easily. They A storage scheme is proposed for the secure management
used the Ethereum platform for the implementation of their of patient’s health data using blockchain technology and
model. cloud
MedBlock [10] is an information management system,
developed to manage the records of a single Patient stored in

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 TABLE I. AN EXAMPLE OF EHRS
Admission_type_ Discharge_dispositi Diabetes
Unique_Id Full_Name Gender Age Time_in_Hospital Insulin Readmitted
Id on_id Med

1 ** ** ** ** ** ** ** ** **
2 ** ** ** ** ** ** ** ** **
.. ** ** ** ** ** ** ** ** **

storage[18]. They compared their proposed system with the from a database and stored in blocks and added to the
traditional storage systems. A framework for sharing the Blockchain.
medical records is also designed. Patients were given the
ownership of their data. In Blockchain technology, data are structured inside
blocks and each block stores the transactions records. In the
A secure EHR system is designed using blockchain proposed work, all the EHRs are stored in those blocks.
technology and cryptosystem based on attributes[19]. Whenever a new record is generated, it is stored in a new
Encryptions based on attribute and identity is used for block. That new block is then added with the previously
encrypting health data. Signatures based on identity is also created blocks in the blockchain. Each block contains the
used for implementing digital signatures. Blockchain hash value of previous block and they are connected together
technology is used for maintaining integrity and traceability in a cryptographic chain so that no one can tamper the data.
of patient’s records. MongoDB is a NoSQL database that contains the EHR and
through the use of Java Eclipse it is accessed from there and
III. DATA CONSTRUCTION stored in the blockchain. Each record is accessed one by one
All the electronic health records are stored in and stored in the blocks of distributed ledger technology,
NoSQL(Not only SQL) database, MongoDB, which blockchain as shown in Fig. 3.
considers each EHR as a document with a unique identifier.
The electronic health records (EHRs) used for the simulation
purpose of the developed program contain records of 1000
diabetic patients.
Each entry in the EHR contains the following fields as
shown in Table I.
Unique_Id: Unique Id assigned to each patient.
Full_Name: Patient’s full name.
Gender: Patient’s gender.
Age: Age of the patient.
Admission_type_Id: Patient admission status in hospital.
Discharge_disposition_id: Patient discharge status from
hospital.
Time_in_Hospital: Number of days of patient admitted in
hospital.
Insulin: Insulin level of patient.
DiabetesMed: Diabetes Medication status of patient.
Readmitted: Patient readmission status after discharge.
IV. THE PROPOSED WORK
This research focuses on storing EHRs using blockchain
technology and then enabling secure electronic record
storage of patient data, unlike traditional EHR systems.
EHRs main purpose is to convert Patient’s medical chart into
digital document. This gives the EHR system access to an
integrated blockchain-based solution that is scalable and
secure. Data encrypted using Blockchain cannot be changed
or deleted. This makes the Blockchain extremely effective in
securing the integrity and security of EHRs. Fig. 2. Flowchart of adding electronic health records to the Blockchain
A block is considered as primary component of
Blockchain. A single block can contain several transactions
and other valuable data. In fig. 2, the proposed work's
flowchart describes how the patient records are accessed

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 Repeat nonce++;
Until !hash(nonce, difficulty) equals getDifficulty()
5. End

Algorithm 2 illustrates the pseudo-code of applySha256(

), which generates the hash value of each block using the
proof of work consensus mechanism. Each block contains
the previous block's hash value, ensuring that nothing has
been changed in the previous blocks, with as new blocks are
added. MessageDigest class creates a cryptographic hashing
value and is found in java.security package. SHA-256 is one
of the hashing functions of MessageDigest class. An instance
of the SHA-256 hash function, as shown in equation (1), is
generated from MessageDigest class.
݄ܽ‫ ݄ݏ‬ൌ ܵ‫ܣܪ‬ଶହ଺ ሺͳሻ

Each block in the Blockchain follows some consensus

mechanisms so that it can be added to the Blockchain due to
which blockchain technology provides different consensus
algorithms. The most common among them is PoW
algorithm, applied by Satoshi Nakamoto in bitcoin network
[1]. In the PoW mechanism, whenever a new transaction
requests to get added in the blockchain network, then the
nodes/participants present in that network solves the complex
problems. This process is known as mining and nodes in this,
are the miners [20]. The node which succeeds in mining, gets
Fig. 3. Block diagram of Proposed Work the reward and adds the transactions to the blockchain
network. Nonce is a 32-bit randomly generated whole
The four different algorithms for the proposed work are number that can be used only once to generate the hash of
as follows: the values of the block.
Algorithm 3: Algorithm on Checking the Validity of Blockchain
cBlock = blockchain.get(i);
Algorithm 1: Algorithm on Block Generation pBlock = blockchain.get(i-1);
blockdata = data + previousHash + timestamp + hash 1. Start isChainValid( )
1. Start addBlock( ) 2. For(i=0; i<blockchain.size(); i++)
mineBlock(difficulty) 3. If ((!cBlock.hash) equals (cBlock.calculateHash()))
2. False
3. calculateHash( ) End If
4. applySha256( ) 4. If ((!pBlock.hash) equals (cBlock.previousHash))
5. Add previousHash to the new block False
End If
6. Add new block to the Blockchain 5. If ((!cBlock.hash(0,difficulty)) equals (hashTarget))
7. Display blockdata False
8. End End If
End For
6. Return True
Algorithm 1 shows the pseudo-code for addBlock(), 7. End
which adds each diabetic patient record, accessed from Algorithm 3 shows the pseudo-code of isChainValid( ), is
MongoDB, in the blocks and then, add these blocks to the used to validate the chain by returning the Boolean values.
Blockchain. mineBlock(difficulty) is invoked for the miner to Further, it recalculates the hash value and compare the
solve the complex problem to verify the block and then existing hash.
calculate the hash value through the proof of work consensus This method also checks the hash value of previous
mechanism. Also, difficulty is a measurement unit for mining block in the current block and lastly, the current block has
that can be increased or decreased depending upon the been mined or not.
number of miners. The system uses the SHA-256 algorithm
to calculate the hash of each block. Every block stores the Algorithm 4: Algorithm on the Creation of Blockchain using EHR
transaction data, hash of the previous block, timestamp, and Set difficulty = 4;
hash value where, timestamp contains the time in which the a = patient record accessed from MongoDB
1. Start ArrayList<block> blockchain;
block has been mined and validated by the network. 2. blockchain.add(new Block(a, Blockchain.get(blockchain.size() -
Algorithm 2: Algorithm on Hash Generation using Proof of Work 1).hash))
input = previousHash + timestamp + nonce + data 3. End
nonce = 0
1. Start applySha256(input)
2. MessageDigest digest = MessageDigest.getInstance(“SHA-256”); Algorithm 4 creates the blockchain variable of ArrayList
3. byte[ ] hash = digest.digest(input.getBytes(“UTF-8”)); of Block type. It calls the constructor of the Block class to
4. mineBlock(difficulty) store the blocks information. The patient records are

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accessed from MongoDB one by one and added to the blocks B. Experiment 2
of Blockchain. In this section, we have performed experiments to
‫ ݄݊݅ܽܿ݇ܿ݋݈ܤ‬ൌ  ሺ‫ܮܦ‬ǡ ‫ܲܥ‬ǡ ܵሻሺʹሻ measure the time required to store electronic health records
in the blockchain. In this experiment, we have measured the
Whereǡ ‫ ܮܦ‬ൌ ‫ݎ݁݃݀݁ܮ݀݁ݐݑܾ݅ݎݐݏ݅ܦ‬ǡ ‫ ܲܥ‬ൌ ‫ݏݑݏ݊݁ݏ݊݋ܥ‬ time required to add five set of 200 records.
ܲ‫݈݋ܿ݋ݐ݋ݎ‬ǡ ܵ ൌ ܵ݁ܿ‫ݕݐ݅ݎݑ‬ This experiment is conducted under different measures
Equation (2) shows the associated parameter for the and the time is calculated to add these records in the blocks
Blockchain creations. Algorithm 1-4, indicates the modules are divided into five rounds of records i.e., 0-200, 201-400,
used in the implementation of electronic health record based 401-600, 601-800 and 801-1000 as shown in Fig. 6.
Blockchain.
140
V. PERFORMANCE ANALYSIS 120
120 107 107 110

Execution Time (seconds)

The performance analysis of the proposed work is done
94
by writing the program in Java programming language using 100
Eclipse IDE. Java is chosen as a programming language
80
because of its high scalability and portability. In this work,
we have made the connectivity with MongoDB database to 60
access the records of patient. Finally, these records are added
40
to the Blockchain.
20
The computing environment used for the experiments are
Intel core i3-1005G1, 1.20 GHz processor, 12-GB memory, 0
and Windows-10 (64 bit) OS. 0-200 201-400 401-600 601-800 801-1000
Number of Patient Records
A. Experiment 1
This experiment shows the EHR that is stored in
MongoDB, and each record i.e. a document in MongoDB, Fig. 6. Execution time in the creation of blocks
can be displayed using the query db.scores.find().pretty(),
which can be seen in Fig. 4. C. Experiment 3
This experiment is conducted and executed in five rounds
to write the Patient’s record into the blocks. The time is
calculated for 200, 400, 600, 800 and 1000 records. The time
taken to store these 1000 electronic health records in the
blockchain is shown in Fig. 7.

600 539
Execution Time (seconds)

500
428
400
321
300
227
Fig. 4. Record of a Patient in MongoDB 200
120
100

0
1-200 1-400 1-600 1-800 1-1000
Number of Patient Records

Fig. 7. Block Creation Time

The proposed work is done to enhance the security and

integrity of the healthcare system. It also ensures the
decentralized storage and protected health information
exchange among different healthcare units. Integrity and
Fig. 5. Result after adding EHR to the Blockchain
consistency of Patient’s health records can be gained through
In Fig.5, the result is shown after accessing Diabetic the immutability of Blockchain. Further, we have also
Patient Records from MongoDB and adding it to the analyzed the time taken to add the number of records into the
Blockchain using Java Eclipse IDE. Contents of the block, blockchain.
previous hash, timestamp (block creation time) and current
hash value are displayed. Blocks are successfully mined and
added to the Blockchain.

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