Information Sciences 612 (2022) 942–958

Contents lists available at ScienceDirect

Information Sciences
journal homepage: www.elsevier.com/locate/ins

A quantum blockchain-enabled framework for secure private

electronic medical records in Internet of Medical Things
Zhiguo Qu a,c,d,e,⇑, Zhexi Zhang a,d, Min Zheng b,⇑
a
Engineering Research Center of Digital Forensics, Ministry of Education, Nanjing University of Information Science and Technology, Nanjing, China
b
Hubei University of Science and Technology, Xianning, China
c
State key Laboratory of Networking and Switching Technology, Beijing University of Posts and Telecommunications, Beijing 100876, China
d
School of Computer Science, Nanjing University of Information Science and Technology, Nanjing, China
e
Jiangsu Collaborative Innovation Center of Atmospheric Environment and Equipment Technology, Nanjing University of Information Science and
Technology, Nanjing, China

a r t i c l e i n f o a b s t r a c t

Article history: There is a rising need for healthcare as a result of rising public awareness of health issues.
Received 14 January 2022 Electronic medical records include extremely confidential and sensitive information, and
Received in revised form 3 September 2022 blockchain technology can enable the safe exchange of these records across various med-
Accepted 5 September 2022
ical organizations. The current blockchain system is susceptible to quantum computer
Available online 12 September 2022
attacks, nevertheless, as a result of the advent of quantum computers. This research
designs a novel distributed quantum electronic medical record system and suggests a
2010 MSC:
new private quantum blockchain network based on security considerations. The blocks
00-01
99-00
in this quantum blockchain’s data structure are linked via entangled states. The time stamp
is automatically formed by connecting quantum blocks with controlled activities, which
Keywords: lowers the amount of storage space needed. Each block’s hash value is recorded using just
Blockchain one qubit. The quantum information processing is detailed in depth in the quantum elec-
Electronic medical records tronic medical record protocol. Every medical record can be tracked, and the security and
Quantum cryptography privacy of electronic medical records in Internet of Medical Things systems can be guaran-
Internet of Medical Things
teed. The protocol also ditches the traditional encryption and digital signature algorithms
Distributed database
in favor of a quantum authentication system. According to the mathematical analysis, the
quantum blockchain network has strong security against attacks from quantum computers
since it can withstand External attack, Intercept-Measure-Repeat attack and
Entanglement-Measure attack. The quantum circuit diagram for deriving the hash value
is provided, along with the correctness and traceability analysis of the quantum block.
The comparison between the proposed quantum blockchain model and a few other quan-
tum blockchain models is also included.
Ó 2022 Elsevier Inc. All rights reserved.

1. Introduction

The innovative idea of Bitcoin was first presented by Satoshi Nakamoto in 2008 [1], and an unheard-of transaction model
was created. Bitcoin is the first decentralized digital currency mechanism that is both secure and trustworthy [2]. Bitcoin is

⇑ Corresponding authors at: Hubei University of Science and Technology, Xianning, China (M. Zheng).
E-mail addresses: [email protected] (Z. Qu), [email protected] (Z. Zhang), [email protected] (M. Zheng).

https://doi.org/10.1016/j.ins.2022.09.028
0020-0255/Ó 2022 Elsevier Inc. All rights reserved.
Z. Qu, Z. Zhang and M. Zheng Information Sciences 612 (2022) 942–958

stable in the absence of centralized management, which is intrinsically tied to the ingenious blockchain technology that
underpins it [3].
Blockchain is a distributed database technology that uses a chain structure of blocks to keep an ever-growing, tamper-
proof data record. It can give a new cooperative trust paradigm in multi-party settings [4]. With rising public health aware-
ness, blockchain is also finding widespread application in the Internet of Things (IoT) [5]. The Internet of Things [6] allows
items to connect and collaborate via the Internet, enabling intelligent identification, position tracking, monitoring, and con-
trol of a variety of objects, including people. The Internet of Medical Things (IoMT) [7] uses diverse medical records of
patients to offer meaningful data for later treatment by connecting sensor devices such as medical wearables, medical
embedded devices, stationary medical equipment, and health monitoring systems to the network. The IoMT network is made
up of three layers: the sensing layer, the network layer, and the application layer. Fig. 1 depicts the network model
schematic.
Countless types of decentralized medical organizations produce vast quantities of medical data daily. The requirement for
patients to undergo repeated testing when they need to switch medical facilities necessitates the exchange of electronic
medical records between those facilities. However, for diagnosis and treatment, electronic medical records (EMRs) are extre-
mely sensitive private information [8]. Maintaining the privacy and security of EMRs is a serious issue since information
leakage occurs when information is exchanged across EMRs [9]. As analyzed in the literature [10], the unique properties
of blockchain such as decentralized storage and immutability can address these challenges faced by big data. By integrating
blockchain with big data, there are the following benefits: (1) Improving Big Data Security and Privacy: The decentralized
storage of blockchain is suitable for data sharing between various medical organizations, and its unique data encryption
method makes it difficult for any unauthorized user to access the data. (2) Improving Data Integrity: The data structure
of blockchain makes it impossible for data stored in the blockchain network to be tampered with, which ensure that EMRs
stored in it are secure and reliable. (3) Fraud Prevention: Existing big data cannot solve the problem of recording fake mes-
sages. When facing with potentially fraudulent EMRs, blockchain enables the medical institutions to evaluate in real time. (4)
Real-Time Data Analytics: Medical institutions can make comprehensive and systematic real-time diagnosis based on med-
ical information collected from different channels. By integrating blockchain technology with IoMT systems, the integrity,
confidentiality, and privacy of each EMR may be guaranteed [11]. EMRs can be shared among different medical institutions,
and previous data records can be retraced at any time to guarantee that no record has been altered [12].
Blockchain technology relies on classical cryptographic algorithms such as digital signatures [13] and elliptic curve cryp-
tography [14], which have certain security risks [15]. Existing blockchain systems are susceptible to assaults from quantum
computers [16] as a result of the advent of quantum computing [17] and quantum information technology [18]. Due to the
powerful calculation capabilities of Shor algorithm [19] and Grover algorithm [20], malicious medical organizations would
monopolize the mining of new blocks. Therefore, quantum technology poses a potential threat to blockchain technology
[21], and it is natural to consider designing a more secure and reliable quantum blockchain and quantum electronic medical
records (QEMRs) by taking advantage of the security of quantum cryptography itself [22].
This study suggests a new quantum blockchain network to enhance the security of blockchain networks against assaults
from quantum computers. The following is a summary of the contributions and characteristics.

1. A brand-new quantum blockchain network is built. The blocks in this quantum blockchain network are connected via
entangled states. Each block’s hash value is kept in a single qubit, and the time stamp is generated automatically when
joining quantum blocks with controlled operations, which lowers the amount of storage space needed.
2. This paper also proposes a new distributed quantum electronic medical record protocol that elaborately explains the
quantum information processing procedure. A quantum authentication procedure is introduced in this protocol. Every
medical record can be tracked, and the security and privacy of EMRs in IoMT systems can be guaranteed. To clearly
explain the viability of the new QEMR protocol, associated simulations are carried out and a concrete example is illus-
trated to elucidate the quantum information processing procedure in detail.

Fig. 1. Network model of IoMT systems.

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3. This paper gives a detailed security analysis. The theoretical derivation of security analysis demonstrates that the QEMR
protocol is able to withstand External attack, Intercept-Measure-Repeat attack and Entanglement-Measure attack. The
quantum circuit diagram for deriving the hash value of the relevant timestamp as well as the correctness and traceability
analysis of the quantum block are provided. This research also compares certain existing blockchain models, particularly
quantum blockchain models, with the proposed quantum blockchain.

This paper is organized as follows. Section 2 describes the preliminaries, including some related works in recent years,
theoretical basis of quantum computing and quantum hash function based on controlled alternate quantum walks. Section 3
gives the details of the designed quantum blockchain network, including the data structure of the quantum blockchain and
distributed quantum electronic medical record protocol. The feasibility of the protocol is proved by the specific examples and
experimental simulations. Section 4 analyzes collision resistance, security as well as accuracy and traceability of quantum
block in datail. In addition, comparisons with other existing blockchain models are given. Section 5 concludes the paper.

2. Preliminaries

This part will cover some of the fundamental concepts relevant to this paper, including some related works in recent
years, theoretical basis of quantum computing and quantum hash function based on controlled alternate quantum walks.

2.1. Related works

International and domestic academics have recently conducted some study and produced basic designs for quantum
blockchain.
In 2018, Ablayev [23] et al. applied the quantum Grover search algorithm to discover the necessary hash and nonce. In the
same year, Kiktenko [24] et al. employed Quantum Key Distribution (QKD) networks to establish secure authentication in
blockchain networks since digital signatures are susceptible to assaults from quantum computers. In addition, rather than
putting the creation of new blocks in the hands of a single miner, they adopted a broadcast protocol in information theory,
where all nodes agree on new blocks under equal conditions. Using the time of generation and disappearance of GHZ states
as timestamps, Rajan [25] et al. in 2019 encoded the blockchain to the temporal Greenberger Horne Zeilinger (GHZ) state of
photons that do not coexist at the same moment [26]. Sun [27] et al. created a quantum-secure and permissive blockchain
architecture to address the danger that quantum computing poses to blockchain technology. To reach consensus on the
blockchain, this system employed a voting-based consensus algorithm and a digital signature protocol based on QKD. In
2020 Gao [28] et al. proposed a new quantum blockchain scheme. They proposed a new concept of quantum blockchain,
created a new sort of cryptocurrency called quantum coin, and examined the scheme’s security in terms of popular threats
including double overhead attack, man-in-the-middle attack and state estimation attack. Coladangelo and Sattath [29] com-
bined quantum lightning with a classical blockchain capable of handling stateful smart contracts and constructed a simple
hybrid classical-quantum payment system. They used quantum states as banknotes and solved the trust problem of quan-
tum banknotes in a public-key quantum money scheme through blockchain. As a matter of fact, this paper only makes use of
classical blockchain in constructing quantum currency system, and does not give the design of quantum blockchain. In 2021,
El-Latif A [30] et al. suggested a quantum walk-based authentication and encryption protocol for building a blockchain
framework for safe data flow between IoT devices. Iovane [31] solved the democracy and randomness of block verification
as well as the assignment of the new blocks by using a multiscale approach, quantum and Relativistic Mechanics.
The research on quantum blockchain is still in the preliminary stage, and various details must be thoroughly investigated.
In addition, EMRs have been gradually combined with various technologies in recent years, with blockchain technology
being the most popular.
In 2019, Chen [32] et al. proposed a personal medical data storage scheme based on block chain technology to realize the
safe storage and data sharing, as well as a medical record sharing service framework that specifies the process of managing
personal medical data. Cao [33] et al. proposed a secure cloud-assisted eHealth system to protect outsourced EHRs from ille-
gal modification by using the blockchain technology. One year later, Tanwar [34] et al. proposed an access control policy
algorithm to enhance data operability between healthcare providers and support environment simulation for the implemen-
tation of a hyperledger-based electronic medical record sharing system using the chain code concept, in which blockchain is
used to enhance efficiency and security. In 2020, Stafford and Treiblmaier [35] conducted a qualitative analysis of EMR users
in the US using a theoretical approach and investigated how blockchain technology might be used for EMR, security, and
storage from the standpoint of business and academic practice. Sinsky [36] et al. proposed seven core measures for the
use of electronic medical records that reflect the multiple dimensions of practice efficiency and pointed out the importance
of electronic medical records as technology advances. Faced with the security and trust challenge of EMRs, Krishnan [37]
et al. proposed a novel credibility score-based approach (CSA) based on blockchain to ensure correctness and confidentiality
of EMRs. In 2021, Estiri [38] et al. used EMRs to forecast COVID-19 fatalities using historical medical data that was routinely
gathered in EMRs and understood the variations in risk variables among all age groups.
Although there are many research achievements in quantum blockchain and EMRs, there are still some practical prob-
lems. EMRs that rely on classical blockchain are vulnerable to attack by quantum computers, making it challenging to ensure
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their security. The study results on the precise data structure and information processing of quantum blockchain are still in
the early stages of development.

2.2. Theoretical basis of quantum computing

2.2.1. The basic postulates of quantum mechanics

The cornerstone of quantum computing, quantum mechanics’ fundamental postulates connect the physical world to its
mathematical representation. The following list contains some significant quantum mechanical postulates.
Postulate 1: Any isolated physical system is associated with a complex vector space with inner product (that is, a Hilbert
space), which is called the state space of the system. The system is completely described by its state vector, which is a unit
vector in the state space of the system.
Postulate 2: The evolution of a closed quantum system can be described by a unitary That is, the state jui of the system at
time t1 and the state ju0i at time t2 can be related by a unitary operator U. The unitary operator U depends only on the times
t1 and t2 :
ju0i ¼ U jui ð1Þ
Postulate 3: Quantum measurements are described by a collection of measurement operators fM m g, the measurement
P
operators satisfy the completeness equation m M ym M m ¼ I. These operators are acting on the state space of the system being
measured. The index m is the possible measurement outcomes in the experiment. If the state of the quantum system is jui
before the measurement, then the probability that result m occurs is:

pðmÞ ¼ hujMym Mm jui ð2Þ

The state of the system after measurement is:
Mm jui
qffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi ð3Þ
hujM ym M m jui

Postulate 4: The tensor product of the state spaces of the component physical systems is the state space of a composite
physical system. For sub-systems numbered 1; 2;    ; n, and the ith system is in the state jui i, then the joint state of the total
system is ju1 i  ju2 i      jun i.
Postulate 1 and Postulate 2 describe the state space and evolution of a system. Among these, Postulate 2 calls for a closed
system, which is not attainable in practice. However, there are systems out there that unitary development and the notion of
a closed system may both approach effectively. Postulate 3 is the fundamental assumption of quantum mechanics and
describes the method of observing quantum states. When the quantum state is measured, the system will collapse to the
corresponding eigenstate of the measurement result. In Postulate 4, unitary operators operating on a complex system are
represented by tensor products of unitary operators acting on a single system, which is how a composite system is defined.

2.2.2. Quantum bits and entanglement

Quantum bits (qubits) are represented by Dirac notation , for example, j0i and j1i are an orthonormal basis for a two-
dimensional Hilbert space. Unlike classical bits, a qubit can be in a state other than j0i and j1i. A qubit can be linear com-
binations of states, which is called superpositions:
jui ¼ aj0i þ bj1i ð4Þ

Among them, a and b are complex numbers and satisfy the normalization condition a2 þ b2 ¼ 1.
The explanations of various basic notation that is often used are shown in Table 1.
The nonlocal connection between several quantum systems is referred to as quantum entanglement. Unlike classical phy-
sics, the behavior of quantum entanglement in the macroscopic world often violates human intuition. The unique correlation
properties brought by quantum entanglement play an important role in quantum computing and quantum information.
pffiffiffi
Take the common Bell state jui ¼ ðj00i þ j11iÞ= 2 as an example, when the first qubit of jui is measured, the result will
be 0 or 1 with a probability of 0.5 respectively. When the result is 0, the second qubit collapses to state j0i at the same time.

Table 1
Some commonly used basic notation and their descriptions.

Notation Description
jui Vector(a ket)
huj Vector(a bra)
h/jui Inner product between the vectors j/i and jui
Ay Hermitian conjugate or adjoint of the matrix A
j/i  juiðj/ijuiÞ Tensor product of j/i and jui
h/jAjui Inner product between j/i and Ajui

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Z. Qu, Z. Zhang and M. Zheng Information Sciences 612 (2022) 942–958

When the result is 1, the second qubit collapses into state j1i at the same time. In other words, there is a correlation between
the first and second qubit measurements, which are always the same.

2.3. Quantum hash function based on controlled alternate quantum walks

Quantum walks [39] is a process in which a particle moves randomly according to a different path. There are several ways
to use quantum walks in the creation of quantum algorithms since they have quicker diffusion features than traditional ran-
dom walks [40]. In quantum blockchains, quantum walks [41] can offer hash functions for verification. In 2013, Li [42] et al.
proposed a quantum hash scheme based on two-particle interacting quantum walks and discussed its feasibility and secu-
rity. In order to enhance the privacy of a quantum key distribution system, Yang [43] et al. employed a quantum hash func-
tion based on quantum walks in 2016. The results showed that the security of the protocol is improved. They further
discussed the application of quantum hash function in image encryption and proposed a new image encryption algorithm.
Two years later, Yang [44] et al. proposed a new hash function by introducing alternating single quantum bitcoin operators
in discrete time quantum walks. Compared with the existing quantum walks-based hash functions, this hash function has
excellent collision resistance and is easier to implement. In the same year, Li [45] et al. proposed a quantum hash function
based on controlled alternate quantum walk (CAQW). The security, statistical performance, and scalability of this quantum
hash function dramatically lower the resources needed for its practical experimental implementation.
Assume that there are N points on the circle, the system of controlled alternate quantum walks consists of two parts: the
coin and the pedestrian (H ¼ HC  HP ). The coin system is a Hilbert space tensorized by fj"i; j#ig. The pedestrian system is a
double quantum state jxijyi, the displacement operator S determines the walking direction of the pedestrian, and the evo-
lution operator of the whole system is:
 
U ¼ ½Sx ðC  IÞx  Sy ðC  IÞ y ð5Þ

Displacement operators Sx and Sy are similar:

X X
Sx ¼ j"ih"j  jðx þ 1ÞmodNihxj þ j#ih#j  jðx  1ÞmodNihxj
x x
X X ð6Þ
Sy ¼ j"ih"j  jðy þ 1ÞmodNihyj þ j#ih#j  jðy  1ÞmodNihyj
y y

The coin operator C is equivalent to the rotation operation on the coin system:
 
cos h  sin h
C¼ ð7Þ
sin h cos h
Where h is the parameter to be set. Preset h0 ; h1 and h2 , when the binary string m of the message is 0, select h0 , when the
value is 1, select h1 . Select h2 when the number of run steps exceeds the message length of m. The initial state of the system
H is ju0 i, and after r steps, the state of the system is:

jur i ¼ ðUðmÞÞ ju0 i

r
ð8Þ
The probability of the pedestrian being in each position is:
X 
Pi ¼ hi; cjðUðmÞÞr ju i2 ð9Þ
0
c

The controlled alternative quantum walk method finally yields a N  N matrix of probability distributions. This matrix may
be used to generate the hash of message m.

3. Quantum blockchain network

This section introduces the structure of the proposed quantum blockchain, describes the flow of the distributed QEMR
protocol, and gives a concrete example illustration with related simulations.

3.1. Data structure of quantum blockchain

As shown in Table 2, a quantum block consists of a block header and a block body. The block header includes the version
number, the quantum state with the hash and timestamp of the current block, the Merkle root of the medical records list, the
target threshold difficulty target and nonce required for mining. The block body includes the list of medical records packed in
the current block.
Unlike the classical blockchain, in this quantum blockchain, the block header does not need to store the timestamp and
the previous block hash. Adjacent blocks are connected by controlled Z operation in the form of entangled states, and the
timestamps of each block are generate automatically, which reduces the resources required for storage.
The form of the controlled Z operation is:
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Z. Qu, Z. Zhang and M. Zheng Information Sciences 612 (2022) 942–958

Table 2
List of members of the blockchain data structure.

Block Header Version

Quantum state with hash and timestamp
Merkle root
Difficulty target
Nonce
Block Body Medical records list

   
1 0 1 0
CZ ¼ j0ih0j  þ j1ih1j 
0 1 0 1 ð10Þ
¼ j0ih0j  I þ j1ih1j  Z
When the control qubit is j0i, no operation is performed on the target qubit. When the control qubit is j1i, Z operation is
performed on the target qubit.
The hash value is generated using the quantum hash function based on controlled alternate quantum walks introduced in
Section 2. Suppose the n-bit binary form hash of a block is h; h ¼ h0  2n1 þ h1  2n2 þ    þ hn1  20 . h is embedded in the
qubit by the quantum Fourier transform. When performing the quantum Fourier transform, n  1 auxiliary particles are
need. Make n particles in state jh0 h1    hn1 i first, the quantum states before and after the transformation are:
 E

jhi ¼ h0  2n1 þ h1  2n2 þ    þ hn1  20
  ð11Þ
! j0i þ e2pi0:h0 h1 hn1 j1i    j0i þ e2pi0:hn1 j1i =2n=2

Among them, h ¼ h  2n ¼ h0  21 þ h1  22 þ    þ hn1  2n ; h 2 ½0; 1Þ. Discard the n  1 auxiliary particles, then the
quantum state becomes:
j0i þ e2pih j1i
jBi ¼ pffiffiffi ð12Þ
2
It can be seen that a string of n bits requires only one quantum bit to store, which greatly reduces the consumption of
resources. The following is a concrete example to illustrate. Assuming that the binary string has 4 bits, prepare the initial
state jq0 ijq1 ijq2 ijq3 ibased on the binary string h first. When hi ¼ 0; jqi i ¼ j0i. When hi ¼ 1; jqi i ¼ j1i. Then, jq1 i; jq2 i and
jq3 i acts as the controlling party in turn and performs the controlled Rk operation on the quantum state jq0 i, where
 
1 0
Rk ¼ 2pi=2k . When the quantum state is jqi i; k ¼ i þ 1. The quantum circuit of the process is shown in the Fig. 2.
0 e
Through the evolution of the circuit, the quantum state jq0 ieventually becomes the desired quantum state jBi.
If nodes gain consensus to receive a newly released block, all nodes conduct a controlled Z operation on the block to be
joined and add this new block to the blockchain, with the last block in the blockchain acting as the controlling party and the
block to be joined acting as the controlled party. If there is only one block in the current blockchain B1 , when B2 joined, the
hash chain is:
2pih 2pih
jw2 i ¼ CZ 12 j/1 ij/2 i ¼ CZ 12 j0iþepffiffi2 j1i j0iþepffiffi2 j1i
1 2

 ð13Þ
¼ 12 j00i þ e2pih2 j01i þ e2pih1 j10i  e2piðh1 þh2 Þ j11i

Fig. 2. The process of embedding four particle hash value.

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Where, the superscript of CZ represents the control bit, the subscript represents the controlled bit. After adding another
block, the hash chain is:

jw3 i ¼ 2p1 ffiffi2 e2pih1 j100i þ e2pih2 j010i þ e2pih3 j001i
þj000i  e2piðh1 þh2 Þ j110i  e2piðh2 þh3 Þ j011i ð14Þ
þe2piðh1 þh3 Þ j101i þ e2piðh1 þh2 þh3 Þ j111i

It is known that when n quantum blocks are connected, the final hash chain is:

jw i ¼ CZ n1    CZ 23 CZ 12 j/1 ij/2 i    j/n i

 2pnih n
¼ 2
e 1 j10    0i þ    þ e2pihn j00    1i þ others
p1ffiffiffinffi ð15Þ

ffi e2pih1 jtime1 i þ    þ e2pihn jtimen i þ others
¼ p1ffiffiffi
2n

Where, quantum state j10    0i; j01    0i;   ; j00    1iare the timestamps corresponding to each block, and the relative
phase corresponding to each timestamp stores the hash value of that block. The chain structure of the quantum blockchain
is shown in Fig. 3.

3.2. Distributed QEMR protocol

The Internet of Medical Things (IoMT) is a paradigm for healthcare services with the goal of achieving intelligent identi-
fication, placement, tracking, management, and monitoring of medical facilities using information sensing technology. In
order to give patients with more thorough healthcare management, the proposed quantum EMR protocol, which is based
on blockchain, maintains a public EMR across multiple medical facilities. The shared medical records will make the entire
treatment process transparent, and can supervise the correct implementation of each treatment process.
A quantum network of medical institutions collaborates to maintain a quantum blockchain system. When the system is
activated, sensors generate raw medical data about patients, and medical personnel enter treatment records. Different med-
ical institutions form a quantum network and work together to maintain a quantum blockchain system. When the system is
running, sensors generate raw medical data of patients, medical staff add treatment records. These data will be tagged with
the patient’s identity. Along with the time the data was generated and the sources of the data, these data form a medical
record together. The schematic diagram of the process is shown in Fig. 4. The flow chart of the QEMR protocol is shown
in Fig. 5. The specific steps of the protocol are as follow.
Initialization: Different medical institutions work together to form a private distributed quantum network. Each node is
completely honest, capable of preparing, storing and measuring quantum states, and capable of communicating quantum
states and classical information to one another. Every two quantum nodes in the quantum network share a string of keys
of length N between them, and the keys are distributed using the BB84 protocol [22] or the B92 protocol [46] with uncon-
ditional security.
Release medical records: Suppose Alice, a node in the quantum network, wants to publish a medical record. She broad-
casts information about the medical record and its hash to other nodes in the quantum network.
Authentication: By replacing the traditional digital signature and encryption algorithms with quantum authentication,
the quantum blockchain network is protected from quantum computer assaults. All nodes send an authentication request
to Alice after getting her medical record information. The following is an example of Charlie initiating an authentication
request to Alice to explain the process of authentication in detail. For convenience, the pseudocode of identity authentication
is shown in Algorithm 1.
 E

(Step 1) Charlie randomly selects and prepares N/2 + p Bell states to form a sequence S ¼ fju1 i; ju2 i;   ; uN=2þp g from
Eq. 16–19 and records the state of each Bell state at each position.
 þ
U ¼ p1ffiffiffi ðj00i þ j11iÞ ð16Þ
2

1
jU i ¼ pffiffiffi ðj00i  j11iÞ ð17Þ
2

 þ
W ¼ p1ffiffiffi ðj01i þ j10iÞ ð18Þ
2

1
jW i ¼ pffiffiffi ðj01i  j10iÞ ð19Þ
2
(Step 2) Charlie keeps the first particle of each Bell state in S to form sequence S1 , and then sends the sequence S2 formed
by the second particle in S to Alice. Alice selects p/2 Bell states Se in S2 to detect eavesdropping. She records positions of Se
and randomly selects measurement bases in base fj0i; j1igor fjþi; jigto measure particles in Se , and then announces the
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Fig. 3. Structure diagram of quantum blockchain.

Fig. 4. The schematic diagram of the protocol process.

measurement bases and the measurement results. Charlie selects the same measurement basis to measure the particles in Se ,
and then compares the measurement results. The measurement results of the two particles in the Bell state are correlated,
and the specific corresponding relationship is shown in the Table 3.
If the error rate is less than threshold, Alice and Charlie discard the p/2 particles, get S02 and S01 , and then enter (Step 3).
Otherwise, the communication process is considered to be eavesdropped and the communication is abandoned.
(Step 3) Alice randomly selects N/2 particles in S02 and records their positions. Then she performs unitary transformations
on the N/2 particles according to the key keyAC shared with Charlie. The sequence S02 becomes S002 . Alice sends S002 back to
Charlie. The relationship between keyAC and unitary transformation is given in Eq. 20.

   
1 0 1 0
U 00 ¼ ; U 01 ¼ ;
0 1 0 1
    ð20Þ
0 1 0 1
U 10 ¼ ; U 11 ¼ :
1 0 1 0
(Step 4) After Charlie receives the particle sequence S002 , he performs joint Bell state measurements on the remaining p/2
particles and compared them to the initial quantum state. If the error rate is less than the threshold, Charlie discards this p/2
 E

particles and obtains S0 ¼ fU Key ju1 i; U Key ju2 i;   ; U Key uN=2 g. Charlie performs joint Bell state measurements on the particle
sequence S0 and gets Alice’s key information key0AC based on the initial state of the Bell state S. Within a certain margin of
error, if key0AC ¼ keyAC , then Charlie acknowledges Alice’s identity as true. If the error rate is higher than the threshold, Alice’s
identity is forged and this communication is abandoned.
For convenience, the Algorithm 1 gives the process of Authentication.
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Algorithm 1: Pseudocode of Charlie initiating an authentication request to Alice

   E

1: Charlie selects and prepares S ¼ fu1 ; u2 ;   ; uN=2þp g and records their positions.
2: Charlie keeps sequence S1 and sends sequence S2 to Alice.
3: Alice selects p/2 Bell states Se in S2 and records their positions.
4: Alice selects measurement bases in fj0i; j1igor fjþi; jigrandomly to measure particles in Se .
5: Alice announces the measurement bases and the measurement results.
6: Charlie selects the same measurement basis to measure particles in Se , and then compares the measurement results
refer to the Table 3.
7: if The error rate is less than threshold then
8: Alice and Charlie discard the p/2 particles;
9: else 10: The communication is abandoned.
11: end if
12: Alice selects N/2 particles in S02 and records their positions.
13: Alice performs unitary transformations on the N/2 particles according to the key keyAC shared with Charlie and gets
S002 .
14: Alice sends S002 back to Charlie.
15: Charlie performs joint Bell state measurements on the remaining p/2 particles and compared them to the initial
quantum state.
16: if The error rate is less than threshold then
   E

17: Charlie discards this p/2 particles and obtains S0 ¼ fU Key u1 ; U Key u2 ;   ; U Key uN=2 g;
18: else
19: The communication is abandoned.
20: end if
21: Charlie performs joint Bell state measurements on the particle sequence S0 and gets key0AC based on the initial state
of the Bell state S.
22: if key0AC ¼ keyAC then
23: Charlie acknowledges Alice’s identity as true;
24: else
25: Alice’s identity is forged and this communication is abandoned.
26: end if

Verify medical records: After the remainder of the network’s nodes verify Alice’s identification, they verify the correct-
ness of the medical record according to the hash. If there are no errors, they add the medical record to the medical records
pool to be packaged, otherwise they discard this medical record.
Create blocks: The time interval of block generation is controlled around 10mim using the difficulty of finding random
numbers and each medical institution distributes profits by competing for bookkeeping rights. Assuming that node Bob is
granted bookkeeping rights, he packs the medical records in the medical records pool to be packaged during this time into
blocks and broadcasts them to other nodes.
Verify and add blocks: The other nodes check the integrity of the medical records list in the block, the compliance of the
difficulty goal and nonce relating to mining, and the correctness of the block hash value after receiving the block information
published by Bob. If all the information in the block is correct, each node in the quantum network adds the block to the local
copy of the blockchain, otherwise the block is discarded. The hash values of each block are connected in the form of entan-

ffi e2pih1 jtime1 i þ    þ e2pihn jtimen i þ others .
gled states jwn i ¼ p1ffiffiffi
2n

3.3. Example description and simulation implementation

This section provides a concrete example of the distributed QEMR protocol process outlined in Section 3.2, in which the
quantum hash function based on controlled alternate quantum walks is simulated via python.
Initialization: As shown in Fig. 6, take a quantum network with four nodes as an example. The four nodes are A, B, C, and
D, and each pair of nodes may interact with the others. Each node can store, prepare, and transmit quantum states. There are
both quantum and classical channels between each two nodes, and each two nodes share a string of keys of length 20 with
each other, such as keyAB ¼ 10101100010101011110. The keys are distributed by the BB84 protocol[22].
Release medical records: Assuming that two medical records are generated over a period of time, nodes A and B publish a
medical record respectively, which are Medical record A (M A ) and Medical record B (M B ). The remaining nodes get informa-
tion about the medical data, the patient’s identification, the sources of the data, a timestamp, and a hash of that medical
   pffiffiffi   pffiffiffi 
; C 1 ¼ 12 p1ffiffiffi  3 ; C 2 ¼ 12 1
1 1 3 p ffiffiffi . Select
record. Suppose there are eight points on the circle, take C 0 ¼ p1ffiffi2
1 1 3 1 1 3
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Fig. 5. The flow chart of the QEMR protocol.

Table 3
The contents of the packaged block.
 þ  þ
U jU i W jW i

fj0i; j1ig 00 00 01 01
11 11 10 10
fjþi; jig ++ +- ++ +-
– -+ – -+

Fig. 6. Schematic diagram of a four-node quantum network.

the total number of steps walked as 500. The 192-bit hash value is generated using the quantum hash function in Section 2.2.
The hash values are generated by simulation of Python, the relevant data and results are shown in Table 4.
Authentication: After all the nodes receive the medical record information, nodes B, C, and D initiate authentication
requests to node A, nodes A, C, and D initiate authentication requests to node B. Take the example of node B initiating an
authentication request to node A. Node B prepares 20 Bell states for authentication, assuming that all these Bell states

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Z. Qu, Z. Zhang and M. Zheng Information Sciences 612 (2022) 942–958

Table 4
Hash value and ratio of the same bits to Ainit .

MA 101011110011010110001010110001110100
MB 0101011100100001001111010110110100101110
hashA 0x356fc60a20190c462e08e4fe05d8650a2d5413b984201c34
hashB 0xef2eb1bff1708434918a38d3a86a2064b4304bba8073017
root hash 0x1c9d15000aaa03e75b0449bd0b638d09ac6f5ce75201c657

Table 5
Measurement bases and results of particles at positions 2, 5, 8, 12 and 17.

Particle2 Particle5 Particle8 Particle12 Particle17

Bases fj0i; j1ig fjþi; jig fj0i; j1ig fjþi; jig fj0i; j1ig
Results j0i ji j0i jþi j1i

Fig. 7. Process of verify medical records.


are Uþ . Node B sends the sequence S2 to node A, who selects particles at positions 2, 5, 8, 12 and 17 for measurement. The
measurement bases and results are shown in the Table 5.
Node A publishes the measurement bases and the measurement results, and node B measures the particles at positions 2,
5, 8, 12, and 17 in the sequence S1 with the same measurement bases to obtain j0i; ji; j0i; jþi; j1irespectively. At this point
there is no eavesdropping in the channel, and then go to (Step 3). Node A selects particles 4, 7, 10, 15, and 18 as subsequent
eavesdropping detection particles. According to keyAB ¼ 10101100010101011110, node A do the
U 10 ; U 10 ; U 11 ; U 00 ; U 01 ; U 01 ; U 01 ; U 01 ; U 11 and U 10 operations on the remaining particles separately, and then sends the particle
sequence S002 back to B and expose the position of the eavesdropping particles. B receives the particle sequence S002 , performs

Bell state measurements on the particles at position 4, 7, 10, 15, 18 and obtains Uþ , so the communication process is not
eavesdropped. Next, node B performs Bell state measurements on the remaining ten pairs of Bell states and obtains
 þ  þ  
W ; W ; jW i; Uþ ; jU i; jU i; jU i; jU i; jW i; Wþ . It can be concluded that the key of node A is
10101100010101011110, which is consistent with the key of B. Therefore, node A passes the identity authentication request
of node B. Assume that all nodes in the network are honest and have passed the identity authentication request.
Verify medical records: Nodes B, C, and D validate the medical records published by node A using the hash of that medical
record, and nodes A, C, and D validate the medical records released by node B using the hash of that medical record. Fig. 7
shows the verification process of medical record A. Assuming all medical record information is valid, medical record A and
medical record B are added to the medical record pool to be packaged.
Create blocks: Suppose that node D has obtained the bookkeeping right. He packages the medical record information in
the medical records pool to be packaged during this time with the version, Merkle root, difficulty Target and Nonce into a
block and broadcast it to other nodes. The contents of the packaged block are shown in the Table 6.
Verify and add blocks: After receiving the block information released by D, the remaining nodes verify whether the med-
ical record is in the medical records pool to be packaged, and if it exists, the medical record is considered legitimate and
delete it from the pool. Then, verify the correctness of the root hash value and the hash value of the whole block. If all val-
idations are passed and the nodes reach consensus, the block hash is obtained:
0xfa11713027b077754123d26082b590da4523c1d7b0a514b
2pih
The hash of the block is then embedded in the quantum state jBi ¼ j0iþepffiffi2 j1i and the block is connected to the known local

ffi e2pih1 jtime1 i þ    þ e2pihn jtimen i þ others using a controlled Z operation, the timestamp
block chain in the form of jwn i ¼ p1ffiffiffi
2n
is generated automatically. Taking node A as an example, the process of verifying and adding blocks is shown in the Fig. 8.

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Table 6
The contents of the packaged block.

Version 10000000
Merkle root 0x1c9d15000aaa03e75b0449bd0b638d09ac6f5ce75201c657
Difficulty Target 0xfa11713027b079754123d26282b590da4523c1c7b0a514a
Nonce 1001001010010110
Medical record A 0xaf358ac74
Medical record B 0x57213d6d2e

Fig. 8. Process of verifying and adding blocks.

The experimental scenario shows how this distributed QEMR protocol may ensure that QEMR is feasible in the IoMT sys-
tem and that it is adequate to provide a safely shared EMR in the IoMT system.

4. Results

This section evaluates the feasibility and security of the proposed quantum blockchain network and distributed QEMR
protocol, as well as the simulation results. Furthermore, comparisons with various current blockchain models are provided.

4.1. Collision resistance analysis

The hash function has the feature of collision resistance, which is the key to ensure tamper-proof and traceable block-
chain technology. The hash function based on CAQW is the cornerstone of the quantum blockchain network.
The security of quantum hash functions is guaranteed by the infinite possibilities of the initial state and the irreversibility
of measurement rather than hard mathematic problems. In the absence of initial states, no one can get any information from
the intercepted probability distribution. In addition, the probability distribution is transformed into a hash value using mod-
ular operators. This process is irreversible, because it’s a many-to-one relationship. It is almost impossible to convert the
hash value back to the correct probability distribution.
In this section, the collision resistance of the hash function is examined. The test is completed by changing one bit in a
random message string and observing the generated hash value. This section chooses a circle with eight points and take
   pffiffiffi   pffiffiffi 
; C 1 ¼ 12 p1ffiffiffi  3 ; C 2 ¼ 12 1
1 1 3 p ffiffiffi . The total number of steps walked is selected as 500 and the gen-
C 0 ¼ p1ffiffi2
1 1 3 1 1 3
erate hash value is 192-bit.
Select an initial value Ainit at random, and then the first, last, and 20th bits of the message are changed respectively to get
message value Afir ; Alast and A20 . The four messages and ratio of the same bit with hashAinit are shown in Table 7.
Fig. 9 shows a comparison of the initial message with three slightly modified hash values. A change of 0.52% to the initial
message string can result in a hash difference of at least approximately 30%. As a result, the slightly altered hash value differs
dramatically from the original message. Because the quantum hash function based on CAQW has great statistical perfor-

Table 7
Hash value and ratio of the same bits to Ainit .

value ratio
Ainit 101101110010110110101010111101000010110100111001
Afir 001101110010110110101010111101000010110100111001 70.8%
Alast 101101110010110110101010111101000010110100111000 51.0%
A20 101101110010110110111010111101000010110100111001 55.2%

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Fig. 9. Plots of hashAinit ; hashAfir ; hashAlast and hashA20 .

mance and can effectively prevent the information in the block from being tampered with, the blockchain network has high
practicality.

4.2. Security analysis

Based on security considerations, this study addresses generic attack models and assesses the security of the QEMR
against External attack, Intercept-Measure-Repeat attack and Entanglement-Measure attack.

4.2.1. External attack

Suppose there is a malicious third-party node Eve outside of the private quantum network, she wants to release a fake
medical record to interfere with the patient’s normal treatment. When the rest of the nodes receive this medical record, they
need to initiate an authentication request to Eve. Since the nodes in this private quantum network share the key through
quantum key distribution, Eve cannot know the information of the key, so she cannot pass the authentication stage and can-
not release the fake medical record maliciously. Therefore, this quantum blockchain network can prevent malicious third-
parties from releasing fake medical records and guarantee the proper and secure operation of the QEMR protocol.

4.2.2. Intercept-Measure-Repeat (IMR) attack

Assume Eve intends to use an Intercept-Measure-Repeat attack to steal the key between Alice and the rest of the nodes in
order to publish a fake medical record and interfere with the patient’s routine treatment. Take the example of Charlie
requesting Alice for authentication.
If Eve intercepts the transmitted particle sequence S2 in (Step 2) and then measures it on the basis fj0i; j1ig, the Bell state
 E

sequence S ¼ fju1 i; ju2 i;   ; uN=2þp g collapses into the direct product state. Then Eve prepares the particle sequence SE
based on her measurement results and sends it to Alice. If Alice chooses the measurement basis for detecting eavesdropping
with equal probability, when Alice chooses to detect eavesdropping under the basis fjþi; jig, there is a probability of 1/2
that the particle sequence cannot correspond to S1 , so this detection eavesdropping process has an error probability of 1/4,
which is much larger than the threshold value for detecting eavesdropping, so Eve will definitely be detected. If Eve inter-
cepts the sequence S002 transmitted in (Step 3), measures them on the basis fj0i; j1ig. Then she reprepares the single quantum
state based on the measurement results and sends them back to Charlie. At this point, the Bell state collapses into a straight
product state. After Charlie receives the particles, she performs the joint Bell state measurement of p/2 particles used to
detect eavesdropping. There is an error probability of 1/2, which is much greater than the threshold for detecting eavesdrop-
ping, so Eve will definitely be detected.
Therefore, if Eve performs an IMR attack on the authentication process between two nodes, she will definitely be discov-
ered and she will not be able to obtain any key information. IMR attack will not be possible on this quantum blockchain
network.
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4.2.3. Entanglement-Measure (EM) attack

Consider Eve trying to publish a fake medical record by using an EM attack to steal the key connecting Alice to the other
nodes. Take the example of Charlie requesting Alice for authentication.
In order to get the information of the target particle, Eve needs to entangle the particle in transmission with the auxiliary
particle in her hands through unitary operation. The unitary operation is defined as:

U j0ijEi ¼ a0 j0ijE0 i þ b0 j1ijE1 i

ð21Þ
U j1ijEi ¼ a1 j0ijE2 i þ b1 j1ijE3 i

Among them, ja0 j2 þ jb0 j2 ¼ 1; ja1 j2 þ jb1 j2 ¼ 1. jEiis the auxiliary particle of Eve.
In (Step 2), in order to avoid detection of the eavesdropping process, the unitary operation need to meet:

tr E U j0ijEihEjh0jU þ ¼ j0ih0j

tr E U j1ijEihEjh1jU þ ¼ j1ih1j
 ð22Þ
tr E U jþijEihEjhþjU þ ¼ jþihþj

tr E U jijEihEjhjU þ ¼ jihj

At this point, b0 ¼ 0; a1 ¼ 0; a0 jE0 i  b1 jE3 i ¼ 0, that is a0 jE0 i ¼ b1 jE3 i. Obviously, when the above conditions are met, the
unitary operation meets:

U juijEi ¼ a0 juijE0 i ð23Þ

Under the action of unitary operation, the intercepted particles and the auxiliary particles are in a direct product relation-
ship, so Eve will not get any valid information through the auxiliary particles. Therefore, Eve cannot obtain any information
by EM attack in (Step 2).
If Eve intercepts the sequence S002 transmitted in (Step 3) and then performs the unitary operation with the particles in
her hands. The quantum states after the unitary operator are shown in Eq. 21.

Take the Bell state Uþ as an example, after the unitary operation, the auxiliary particle jEi is entangled with the Bell state
 þ
U .

U Uþ jEi

¼ 12 Uþ ða0 jE0 i þ b1 jE3 iÞ þ 12 jU iða0 jE0 i  b1 jE3 iÞ ð24Þ

þ 12 Wþ ðb0 jE1 i þ a1 jE2 iÞ þ 12 jW iðb0 jE1 i  a1 jE2 iÞ

At this point, Charlie has only a 1/4 probability of getting the correct Bell state, so Eve will be detected by the detection
eavesdropping process. Therefore, if Eve performs an EM attack on the authentication process between two nodes, she will
definitely be discovered and will be unable to gain any key information.

4.3. Accuracy and traceability of quantum block

When a malicious node Eve wants to change the information contained in the quantum block, but she is unable to do so
because she cannot change the hash value of this and following blocks at the same time. The protocol can ensure the con-
fidentiality and accuracy of the data in the block as long as the verified information is recorded in the quantum block.
 2pih
For a string of blocks connected by a form of entangled states jwn i ¼ p1ffiffiffiffi
2n
e 1 jtime1 i þ    þ e2pihn jtimen i þ others , if the
information of a certain block needs to be traced and extracted, the quantum phase estimation algorithm can be used to
extract the relative phase of the corresponding timestamp. By using a sufficient number of auxiliary particles, the phase
value can be accurately extracted. Assuming that the number of auxiliary particles is t, the relative phase corresponding
to the quantum state jtimei i needs to be extracted. Since the time stamp of the information to be extracted is known, the
j
quantum state jtimei i can be prepared. Suppose a black box operation of controlled jwn ihwn j2 can be performed, where
j ¼ 1; 2;    ; t  1. Fig. 10 shows a quantum circuit diagram for extracting the relative phase corresponding to timei .
According to the above analysis, the quantum blockchain proposed in this paper can guarantee the correctness of the
information in the quantum block, as well as achieve information tracing by extracting the hash value under the appropriate
timestamp.

4.4. Performance analysis

In this section, the proposed quantum blockchain is compared with some existing blockchain models, especially quantum
blockchain models. The relevant comparison among [24,25,27,28,30,47] are shown in the Table 8.
Literature [24] only used QKD on the urban optical fiber network to carry out theoretical security authentication of infor-
mation, so as to replace the traditional digital signature. They did not give the actual form of quantum blockchain, but just an
attempt for quantum blockchain. Literature [27] also used a digital signature protocol based on quantum key distribution.
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Fig. 10. The quantum circuit diagram for extracting the relative phase of quantum state jtimei i.

Table 8
Comparison with other blockchain models.

Literature [24] [25] [27] [28] [30] [47] Ours

Information traceability   U   U U
Block structure  U U U  U U
Resist quantum
computer attacks U U U U U  U
QKD U  U U   U
Quantum walk     U  U

Literature [25] encoded blockchain to temporal GHZ state of photons that do not simultaneously coexist, which gives a
degree of quantum advantage, but as the photons disappear, so does the stored information.
Literatures [28,29] used quantum states as banknotes and designed quantum coin. In fact, electronic money only needs to
exist as a record, and the design of quantum coin actually increases the resources required for transmission.
Literature [30] introduced Quantum walk into the framework of quantum blockchain, and the randomness of quantum
walking is used to generate hash values. However, no specific structure is given in the design of quantum blockchain.
Some classical blockchain frameworks like [47] have been very complete in structure and form, but their security cannot
be effectively guaranteed under the attack of quantum computers.

5. Conclusions and the future work

Electronic medical records are critical, highly sensitive and private information in healthcare that needs to be shared
between different healthcare providers. Blockchain can provide shared, tamper-proof and transparent medical records,
building a multi-party trust model. However, the current blockchain system is susceptible to quantum computer assaults
as a result of the advent of quantum computers. Based on security considerations, this paper proposes a new private quan-
tum blockchain network and designs a new distributed quantum electronic medical record protocol. The blocks in this quan-
tum blockchain’s data structure are linked via entangled states. The quantum information processing is detailed in depth in
the quantum electronic medical record protocol. Every medical record can be tracked, and the security and privacy of elec-
tronic medical records in IoMT systems can be ensured. The mathematical study indicates that the quantum blockchain net-
work is secure against quantum computer attacks. The accuracy and traceability analysis of the quantum block are
examined. Furthermore, this article compares the proposed quantum blockchain model to various existing quantum block-
chain models.
Quantum blockchain, in contrast to traditional blockchain, uses the nonlocality of quantum entanglement, which
enhances security and efficiency to some level. In comparison to other research findings, the quantum blockchain framework
proposed in this paper gives specific data structure of quantum blockchain and information processing process of EMR pro-
tocol. However, the work still has some limitations. This study does not provide a detailed strategy for the EMR protocol’s
implementation specifics. It hasn’t been tried out in a real experimental setting because of constraints of conditions. Quan-
tum communication and quantum computing technologies will be extensively integrated with the Internet as a result of
ongoing technical advancements. Other information security applications, in addition to QKD, will be gradually implemented
in the future quantum Internet. However, the current quantum communication network is still under construction, and the
level is in its early stages. There is no quantum network condition that can enable quantum blockchain to be realized. If the
quantum blockchain framework and quantum EMR protocol proposed in this paper can really have the opportunity to test in
the actual quantum network, the first problem to be faced is the interference of noise to the protocol. In quantum commu-
nication, quantum noise is unavoidable. There are four types of quantum noise: bit flip noise, phase flip noise, amplitude
damping noise, and depolarizing noise. Another issue to address is the difficulty of preserving quantum states over lengthy
periods of time. Practical challenges include figuring out how to keep block carriers of quantum states stable. Future research
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Z. Qu, Z. Zhang and M. Zheng Information Sciences 612 (2022) 942–958

on quantum blockchain should concentrate on its enhanced methodologies and practical applications. We should focus to
create a more mature and realistic quantum blockchain with carrier that is simple and easy to prepare, has strong security
and scalability, and can be implemented on a genuine quantum computer.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have
appeared to influence the work reported in this paper.

Acknowledgements

This work was supported by the National Natural Science Foundation of China (No. 61373131, 62071240, 61601358),
Natural Science Foundation of Jiangsu Province (Grant No. BK20171458), Sichuan Youth Science and Technique Foundation
(No.2017JQ0048), Open Foundation of State Key Laboratory of Networking and Switching Technology (Beijing University of
Posts and Telecommunications) (SKLNST-2020–1-17), PAPD and CICAEET funds.

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