Blockchain for Internet of Medical Things

Introduction

Internet of Medical Things (IoMT) is the type of IoT used in healthcare. Since IoMTs will allow for the connectivity and remote monitoring of all medical equipment, they represent the future of healthcare. These advancements allow for faster and cheaper healthcare delivery. The core components of an IoMT system that offers telemedicine services are healthcare professionals (nurses, doctors, etc.), medical data servers, and medical sensor equipment.

The Internet of medical things (IoMT) significantly contributes to global health and medical access. As it continues to expand exponentially, IoMT is profoundly affecting our way of life. 

Remote monitoring and processing of patient clinical data in a real-time data system, followed by transmission to a third party for future use, such as the cloud, can significantly reduce the need for patients to make hospital visits. IoMT is a data-intensive field constantly expanding; thus, we must safeguard sensitive data to prevent tampering. 

Blockchain technology allows for secure, decentralized, and immutable peer-to-peer data sharing and transaction recording. With blockchain, members who don’t trust each other can still have direct conversations without any third party.

Before IoMT can be widely used, much work remains to be done. However, the processing power and battery life of most implanted and wearable medical sensor equipment cannot make complicated encryption systems practicable. This indicates that the wireless data transfer within the IoMT is vulnerable to attacks from the outside world. 

Medical records contain sensitive information about patients, so it’s important to know that only people who are allowed to can see them. Poor interoperability is also an issue since there is such a large variety of medical sensor devices and IoMT networks.

Blockchain integration with IoMT may solve all of these problems. Critical characteristics of blockchain technology are transparency, immutability, trustworthiness, and decentralization. Blockchain technology could solve interoperability, privacy, and security issues. Using blockchain, parties without trust can still carry out a wide range of network transactions.

The Internet of Medical Things

Multiple devices having Internet access and the ability to exchange data and perform tasks together constitute a typical IoT architecture. In a broader sense, the Internet of Things (IoT) comprises any electronic item that can connect to and exchange data with other Internet nodes, such as mobile phones. 

The concept behind IoMT is to connect healthcare providers and patients with wireless technology so that information about patient care may be shared more efficiently. Therefore, significant privacy and security concerns arise from this particular context: The network security must be enough to preserve the confidentiality of health data. 

Public and private European organizations are subject to the GDPR. Since “genetic data,” “biometric data,” and “health data” all have origins in the susceptible category of “health information,” they require exceptional management. So, unless certain circumstances apply (such as occupational medicine, health therapy, or public interest), they cannot be utilized without consent. Data portability has the same limitations, which restrict data sharing. 

Therefore, we have emphasized the importance of considering privacy and security concerns. Malicious individuals can quickly attack devices using the network for data exchange. Even if the device has security issues (in its software or hardware), a secure data-sharing network is still necessary to avoid this scenario in the healthcare industry. 

Because of this, most implementations end up anonymizing the data, which negatively affects data exploitability because it necessitates removing personally identifying information, affecting data integrity and quality. 

Distributed Ledger Technology and Blockchain 

Stuart Haber and W. Scott Stornetta introduced the concept of a “blockchain” in 1991 (“How to time-stamp a digital document”); a blockchain is a growing list of data structures, called blocks, that are connected and secured by cryptography. Conceptually, blockchain guarantees the spread of information in a decentralized way, meaning there is no central body to tamper with the data. 

Thus, blockchain is a decentralized, immutable, and transparent technology. One example is Bitcoin, released under Satoshi Nakamoto and was the first successful attempt to use the technology. Later, Buterin et al. created Ethereum, the first Blockchain platform that included smart contracts. Blocks on the Blockchain can have any data in them besides the link to the preceding block. This connection is typically a Hash, a “fingerprint” of the block with a set length. 

Blockchain technology belongs to the Distributed Ledger Technologies (DLT) family, yet it does something different than other DLTs. Distributed ledger technology (DLT) is a more general word for distributed databases operated by numerous parties. IBM Hyperledger is an example of DLT that is distinct from the blockchain. 

A Blockchain can only grow with everyone agreeing to contribute new blocks. The degree to which participants in a DLT can reach a fully decentralized consensus is a common point of differentiation between DLTs. Additionally, the blocks that make up a DLT may be public or private, resulting in “Permissioned” and “Permissionless” solutions, respectively. 

Public Blockchains are permissionless systems that operate on the principle of not allowing a single organization to exercise centralized authority over the network. Therefore, if the peers in the network have faith in the technology, the blockchain can function as a decentralized network wherein all participants share a cryptographically secure, immutable ledger. 

In contrast, permissioned systems, like private blockchains, are only available to a select group of users in a network. This method of implementing the blockchain compromises decentralization in favor of more administrative oversight. The ability to restrict block creation to a select group of actors is essential in scenarios where the network’s growth requires the involvement of just those individuals.

Benefits of Implementing Blockchain in Healthcare

1)Patient-centric electronic health records

According to research from Johns Hopkins University, medical mistakes due to poor care coordination rank third among the leading causes of death in the United States. Data silos are a problem in every country’s healthcare system. This means that patients and their healthcare workers must clearly understand their medical histories. 

One possible solution is to create a blockchain-based system for medical records that connects to current electronic medical record software and gives a single view of a patient’s record. It is crucial to highlight patient data that does not enter the blockchain. The blockchain decrypts each prescription, doctor’s note, and lab result into a unique hash function. Only the data owner can decode the hash, making each one unique.

2)Supply Chain Transparency

Verifying the legitimacy of medicinal supplies is a significant problem in the healthcare industry. We can monitor products from their initial creation to their final disposal using a blockchain-based system. Using this strategy, buyers can thoroughly examine the products they purchase.

Supply chain transparency is especially valued in emerging nations, where counterfeit prescription drugs kill hundreds yearly. Due to the rapid growth of remote health monitoring, protecting medical instruments from malicious actors is becoming increasingly important.

Critical applications of the blockchain when paired with AI:

Customer confidence: Understanding where consumers’ orders have been at all points in the supply chain, from manufacturing to shipping, is crucial for maintaining their confidence in your business.

Supply chain optimization: Once all the data is in one place, companies use AI to predict better about demand and make sure they have enough supplies.

3)Patient Data Management and Sharing

The Department of Health and Human Services was informed of more than 350 data breaches, which exposed 13,020,821 patient records.

The HIPAA has strict rules about keeping patient data private. Several parties, besides the patient and their doctor, may need access to those documents, making it impossible to keep them private. 

However, because patient data is spread across numerous healthcare databases, processing patient data in a typical manner can be challenging.

Blockchain technology solves these problems by providing a central database for maintaining all critical data with complete control over who has access to it. By using the patient’s unique ID, we may store pieces of patient data in blockchain blocks. If a patient prefers to maintain anonymity, this procedure allows transmitting medical records (blocks) without revealing the ID.

Population health data management is another area where blockchain can provide a reliable answer. The conventional method disperses patient data over several incompatible systems, making aggregating health data for a specific population cluster challenging. This makes blockchain a reliable platform for people to participate in and monetize population health investigations.

4)Drug traceability

It is a reliable method for ensuring the validity of drugs because it is possible to trace the origins of any given drug using blockchain technology. We can utilize the blockchain to store information about the medicine during its entire development process. Every block holding pharmacological information will include a timestamp that we cannot change and a hash connected to another block.

All authorized parties can see the drug’s transactions in the blockchain, allowing for transparent, real-time tracking of the drug’s distribution network. Customers who purchase pharmaceuticals will verify their legitimacy by scanning the QR code and accessing information about the product’s maker and other supply chain participants. In such a system, it would be tough to distribute fake medicine.

5)Cryptocurrency payments

When it comes to healthcare payments, blockchain technology has potential use cases. Using blockchain, people may now get medical care and pay for it with digital currency. Aveon Health is a good illustration of a medical organization focusing on technology. Aveon Health recognizes Bitcoin’s merits as a virtual currency. Using Bitcoin wallet software, users may send and receive Bitcoins digitally.

Blockchain technology also makes it possible to implement micropayments. Micropayments are an innovative value-based strategy that financially compensates patients who comply with their doctor’s recommendations and lead healthier lives. This micropayment model will keep a complete record of the patient’s actions during the treatment review, and it will only function on a specific blockchain.

How Blockchain Works in Healthcare

Distributed Ledger: Blockchain is a distributed ledger system, which means that rather than having a single entity in charge of the data, it is held across a network of computers known as nodes. The distributed ledger, or blockchain, is immutable and tamper-proof because every node maintains a complete copy.

Encrypting and hashing data: Information about health care is protected and stored in blocks. A cryptographic algorithm creates a hash for each block. Hashes ensure data integrity and immutability.

Consensus process: Blockchain networks rely on consensus to verify and add new data blocks to the chain. Proof of Work (PoW) and Proof of Stake (PoS) consensus procedures ensure that all network nodes agree on the information’s authenticity before adding it.

Smart Contracts: Smart contracts are smart agreements that may carry out their terms following the regulations encoded into the blockchain. Smart contracts can automate and enforce agreements between players in the healthcare field. For example, a smart contract can set the rules for healthcare providers sharing patient information, ensuring compliance and protection.

Interoperability: Blockchain helps interoperability by allowing different healthcare systems to share information safely. Blockchain streamlines data exchange and reduces administrative costs by eliminating intermediaries.

Data Security and Privacy: Blockchain provides a tamper-proof and auditable record of all transactions, enhancing data security. Patients can have complete control over their data by using private keys to store and distribute it. Access to patient data can be limited so that patients’ privacy and consent are protected.

Medical Research and Clinical Studies: Blockchain allows the collection of large amounts of anonymous patient data for research and studies in medicine. Researchers have access to reliable data, and individuals can decide how much information they want to share with researchers.

Supply Chain Management: Pharmaceutical supply chain management can benefit from blockchain technology since it will increase transparency and accountability. It reduces counterfeit pharmaceuticals and ensures patient safety by tracing drugs from manufacturing to delivery.

Auditability and Compliance: Because blockchain is transparent, it is easy to check on activities in healthcare. It helps authorities check for irregularities and make sure everyone follows the rules.

Use Cases of Blockchain in the Internet of Medical Things

The Internet of Medical Things (IoMT) is a rapidly growing area that includes many devices, sensors, and systems in the healthcare industry. Blockchain’s decentralized structure, immutability, and transparency promise to enhance the IoMT ecosystem’s security, privacy, and efficiency.

Some of the most important applications of blockchain technology in the IoMT are as follows:

Security of Patient Data: Blockchain can provide a safe and tamper-proof way to store and share private information about patients. By encrypting and distributing data across a distributed network, blockchain ensures that patient information stays private and safe from outside interference.

Interoperability and Data Sharing: Blockchain makes it easy for different IoMT devices and systems to work together. It enables safe communication between various healthcare institutions and technologies, improving the quality of care for patients. Blockchain technology also helps with consent management, putting patients in charge of their data-sharing decisions.

Medical Supply Chain Management: Blockchain can track and authenticate drugs, medical devices, and supplies across the supply chain. This helps stop fake goods from getting on the market, keeps patients safe, and lowers the chance of medication mistakes.

Clinical Trials and Research: Blockchain can help speed up clinical trials and research projects. It can allow for the safe and open exchange of trial data, protecting the honesty of findings and preventing any attempts at data manipulation. Smart contracts based on the blockchain can automate compliance, consent management, and payments for trial members.

Telemedicine and Remote Monitoring: Blockchain can facilitate trustworthy and effective telemedicine services by keeping an immutable record of digital patient interactions like consultations, medications, and medical data. It can also allow for safe remote monitoring of a patient’s health data, which helps doctors make correct diagnoses and act quickly.

Medical Device Authentication: Blockchain can help check that medical gadgets are authentic and work properly. Putting a device’s history and maintenance records on the blockchain makes it easier to find fake or hacked devices. This ensures patients are safe and reduces the risk of device-related problems.

Health Insurance and Claims Processing: Claims processing and health insurance are two areas where blockchain technology has the potential to improve efficiency significantly. Claim processing can be done automatically with smart contracts, which saves money on paperwork and improves speed while ensuring accuracy and trustworthiness.

Data Monetization and Research Consent: With blockchain, people can have more control over their health data and choose to share it for research while keeping their privacy. Patients can give access to their anonymous data and get paid directly with tokens based on the blockchain. This helps create a fair and open data marketplace.

Benefits of Using Blockchain Technologies in IoMT Systems

Some of the many advantages of using blockchain technology are discussed below. Some examples are a distributed ledger, smart contracts, tamper-proofing, open architecture, and trustless consensus.

• One definition of “open architecture” is a technological infrastructure for which the designers make their blueprints publicly available. It includes government regulations and custom-built structures.

• Distributed consensus, which supports blockchain-based IoMT applications, eliminates the need for traditionally trusted intermediaries like banks or governments.

• Transparency: all peers in the network can see all block data and cannot change it. Verifying and safeguarding vital drug information is feasible by keeping track of all transactions between drug manufacturers, pharmacists, and patients, which can help combat issues like counterfeit drugs. As a result, we’ll have the means to trace the origin of illegal substances.

• Because recordings are unchangeable, any attempts to steal or alter a patient’s medical history will be immediately detected. For instance, the dishonest practice of falsifying or changing data from clinical research might be stopped.

• Smart contracts will ensure that only authorized parties can access patient data in rule-based ways. With smart contracts, IoMT devices and third parties like patients and doctors can safely communicate with one another and conduct financial transactions without fear of fraud.

• The blockchain is immune to attack since no single entity controls the network.

Privacy and Security

The following are some potential privacy and security benefits of integrating a blockchain with IoMT systems:

• Smart contracts may enable access to control property to ensure that only those needing access to a patient’s medical records do so under the lawful administrator’s standards.

• Everyone involved in an IoMT system is concerned about maintaining their privacy. Blockchain uses the digital identity of transactions to hide their records and protect the privacy of its users.

• Blockchain protects data integrity by signing blocks. It is challenging, if possible, to alter the contents within a block due to the hash-based linking and the requirement for unanimity. Construction also provides high availability by copying and storing the data in all nodes. However, blockchain’s built-in transparency and verifiability checks for every data transaction pose a privacy risk. Implementing blockchain prioritizes data quality and availability over hiding. Suppose a high level of secrecy is required. In that case, the system must provide additional security, as application-level encryption and other ways where (critical) data is not instantly accessible by unauthorized nodes are outside the scope of this study.

Internet of Medical Things (IoMT)-Blockchain Challenges

Without a doubt, blockchain technology improves the safety of the IoMT (internet of medical things). But combining the two technologies isn’t easy at all, and it’s hard because they have different requirements:

– Processing: The mining process and robust cryptography in blockchain are energy- and resource-intense, requiring intensive computing and significant energy consumption, neither of which can be supported by resource-constrained IoMT devices. 

– Storage: IoMT devices produce massive amounts of data with high flow rates. It is a considerable problem to properly handle and preserve this data in the blockchain without compromising its security. In reality, blockchain technology needs its nodes to provide distributed storage that is too expensive for IoMT devices to deliver. 

– Mobility: Blockchain was set up for a static network architecture. However, implantable/wearable medical devices are in constant motion, causing the topology to evolve.

– Real-Time: IoMT applications are usually critical and need an instant response in real-time. However, making blocks takes a lot of effort and time. Every 10 minutes, Bitcoin generates 1MB per block. Organizing these data streams into chunks that meet the real-time requirement is problematic.

– Traffic Overhead: Constant communication between blockchain nodes for synchronization causes a lot of unnecessary loads. IoT devices with low data transfer rates cannot afford this.

– Blockchain Scalability: To handle data in an auditable and transparent way, use blockchain, an immutable and append-only database. Each block contains a hash of the previous block, and the entire structure appears as a collection of links. There is a lot of research into the blockchain scalability challenge. Due to inefficient architecture and consensus mechanisms, blockchains struggle with scalability.

Bitcoin, for example, has a transaction confirmation period of about 10 minutes and can support up to 7 transactions per second. Large-scale transaction processors like Visa process over 24,000 transactions per second. 

The following metrics are of crucial interest when addressing blockchain scalability:

• The approval period for a transaction is known as its latency. For the authorization procedure, other metrics include bootstrap time and cost per confirmed transaction (CPCT).

• If you want to know how many transactions a blockchain can confirm per second, you need to know the largest size of a block and how long an average block lasts.

Conclusion

The blockchain-based Internet of Medical Things (IoMT) is gaining traction because of its potential to improve healthcare quality and save costs through constant and real-time monitoring of patients. The Internet of Medical Things (IoMT) includes many stakeholders, such as sensor nodes, the Internet of Things (IoT), wearable medical devices, patients, healthcare facilities, and insurance firms. 

However, there are still challenges to overcome, including scalability concerns, regulatory compliance, and the inability of multiple blockchain networks to communicate with one another. Since scalability is crucial to blockchain’s utility, designing a blockchain framework for large-scale applications is challenging.

Frequently Asked Questions (FAQs)