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Recently, the role of blockchain technology in the healthcare domain has been surveyed in a number of scientific works.<ref name="GriggsHealth18">{{cite journal |title=Healthcare Blockchain System Using Smart Contracts for Secure Automated Remote Patient Monitoring |journal=Journal of Medical Systems |author=Griggs, K.N.; Ossipova, O.; Kohlios, C.P. et al. |volume=42 |issue=7 |at=130 |doi=10.1007/s10916-018-0982-x |pmid=29876661}}</ref><ref name="ZubaydiARev19">{{cite journal |title=A Review on the Role of Blockchain Technology in the Healthcare Domain |journal=Electronics |author=Zubaydi, H.D.; Chong, Y.-W.; Ko, K. et al. |volume=8 |issue=6 |at=679 |doi=10.3390/electronics8060679}}</ref><ref name="AgboBlock19">{{cite journal |title=Blockchain Technology in Healthcare: A Systematic Review |journal=Healthcare |author=Agbo, C.C.; Mahmoud. Q.H.; Eklund, J.M. |volume=7 |issue=2 |at=56 |doi=10.3390/healthcare7020056 |pmid=30987333 |pmc=PMC6627742}}</ref><ref name="HölblASys18">{{cite journal |title=A Systematic Review of the Use of Blockchain in Healthcare |journal=Symmetry |author=Hölbl, M.; Kompara, M.; Kamišalić, A. et al. |volume=10 |issue=10 |at=470 |doi=10.3390/sym10100470}}</ref><ref name="QadriTheFut20">{{cite journal |title=The Future of Healthcare Internet of Things: A Survey of Emerging Technologies |journal=IEEE Communications Surveys & Tutorials |author=Qadri, Y.A.; Nauman, A.; Zikria, Y.B. et al. |volume=22 |issue=2 |pages=1121–1167 |doi=10.1109/COMST.2020.2973314}}</ref> More specifically, some works have demonstrated that blockchain can drastically improve the security of [[hospital information system]]s (HIS).<ref name="ChakrabortyASec19">{{cite journal |title=A Secure Healthcare System Design Framework using Blockchain Technology |journal=Proceedings of the 21st International Conference on Advanced Communication Technology |author=Chakraborty, S.; Aich, S.; Jim, H.-C. |pages=1260–64 |doi=10.23919/ICACT.2019.8701983}}</ref><ref name="DasaklisBlock18">{{cite journal |title=Blockchain Meets Smart Health: Towards Next Generation Healthcare Services |journal=Proceedings of the 9th International Conference on Information, Intelligence, Systems and Applications |author=Dasaklis, T.K.; Casino, F.; Patsakis, C. |pages=1–8 |doi=10.1109/IISA.2018.8633601}}</ref><ref name="SrivastavaALight19">{{cite journal |title=A Light and Secure Healthcare Blockchain for IoT Medical Devices |journal=Proceedings of the 2019 IEEE Canadian Conference of Electrical and Computer Engineering |author=Srivastava, G.; Crichigno, J.; Dhar, S. |pages=1–5 |doi=10.1109/CCECE.2019.8861593}}</ref><ref name="HosseinBlock19">{{cite journal |title=Blockchain-Based Privacy-Preserving Healthcare Architecture |journal=Proceedings of the 2019 IEEE Canadian Conference of Electrical and Computer Engineering |author=Hossein, K.M.; Esmaeilli, M.E.; Dargahi, T. et al. |pages=1–4 |doi=10.1109/CCECE.2019.8861857}}</ref> However, up to now, most of these scientific initiatives are either theoretical or at an early stage, and it is not always made clear which protocols and pieces of a framework should be used to carry out system implementations that can be deployed in real healthcare environments.
Recently, the role of blockchain technology in the healthcare domain has been surveyed in a number of scientific works.<ref name="GriggsHealth18">{{cite journal |title=Healthcare Blockchain System Using Smart Contracts for Secure Automated Remote Patient Monitoring |journal=Journal of Medical Systems |author=Griggs, K.N.; Ossipova, O.; Kohlios, C.P. et al. |volume=42 |issue=7 |at=130 |doi=10.1007/s10916-018-0982-x |pmid=29876661}}</ref><ref name="ZubaydiARev19">{{cite journal |title=A Review on the Role of Blockchain Technology in the Healthcare Domain |journal=Electronics |author=Zubaydi, H.D.; Chong, Y.-W.; Ko, K. et al. |volume=8 |issue=6 |at=679 |doi=10.3390/electronics8060679}}</ref><ref name="AgboBlock19">{{cite journal |title=Blockchain Technology in Healthcare: A Systematic Review |journal=Healthcare |author=Agbo, C.C.; Mahmoud. Q.H.; Eklund, J.M. |volume=7 |issue=2 |at=56 |doi=10.3390/healthcare7020056 |pmid=30987333 |pmc=PMC6627742}}</ref><ref name="HölblASys18">{{cite journal |title=A Systematic Review of the Use of Blockchain in Healthcare |journal=Symmetry |author=Hölbl, M.; Kompara, M.; Kamišalić, A. et al. |volume=10 |issue=10 |at=470 |doi=10.3390/sym10100470}}</ref><ref name="QadriTheFut20">{{cite journal |title=The Future of Healthcare Internet of Things: A Survey of Emerging Technologies |journal=IEEE Communications Surveys & Tutorials |author=Qadri, Y.A.; Nauman, A.; Zikria, Y.B. et al. |volume=22 |issue=2 |pages=1121–1167 |doi=10.1109/COMST.2020.2973314}}</ref> More specifically, some works have demonstrated that blockchain can drastically improve the security of [[hospital information system]]s (HIS).<ref name="ChakrabortyASec19">{{cite journal |title=A Secure Healthcare System Design Framework using Blockchain Technology |journal=Proceedings of the 21st International Conference on Advanced Communication Technology |author=Chakraborty, S.; Aich, S.; Jim, H.-C. |pages=1260–64 |doi=10.23919/ICACT.2019.8701983}}</ref><ref name="DasaklisBlock18">{{cite journal |title=Blockchain Meets Smart Health: Towards Next Generation Healthcare Services |journal=Proceedings of the 9th International Conference on Information, Intelligence, Systems and Applications |author=Dasaklis, T.K.; Casino, F.; Patsakis, C. |pages=1–8 |doi=10.1109/IISA.2018.8633601}}</ref><ref name="SrivastavaALight19">{{cite journal |title=A Light and Secure Healthcare Blockchain for IoT Medical Devices |journal=Proceedings of the 2019 IEEE Canadian Conference of Electrical and Computer Engineering |author=Srivastava, G.; Crichigno, J.; Dhar, S. |pages=1–5 |doi=10.1109/CCECE.2019.8861593}}</ref><ref name="HosseinBlock19">{{cite journal |title=Blockchain-Based Privacy-Preserving Healthcare Architecture |journal=Proceedings of the 2019 IEEE Canadian Conference of Electrical and Computer Engineering |author=Hossein, K.M.; Esmaeilli, M.E.; Dargahi, T. et al. |pages=1–4 |doi=10.1109/CCECE.2019.8861857}}</ref> However, up to now, most of these scientific initiatives are either theoretical or at an early stage, and it is not always made clear which protocols and pieces of a framework should be used to carry out system implementations that can be deployed in real healthcare environments.


 
Blockchain has been increasingly recognized as a tool able to address existing open information access issues.<ref name="ZhangFHIR18">{{cite journal |title=FHIRChain: Applying Blockchain to Securely and Scalably Share Clinical Data |journal=Computational and Structural Biotechnology Journal |author=Zhang, P.; White, J.; Schmidt, D.C. et al. |volume=16 |pages=267–78 |doi=10.1016/j.csbj.2018.07.004 |pmid=30108685 |pmc=PMC6082774}}</ref> In fact, it is possible to improve access to health services by using blockchain to achieve greater transparency, security, privacy, traceability, and efficiency. One such example can be found in the work of Ramani ''et al.''<ref name="RamaniSecure18">{{cite journal |title=Secure and Efficient Data Accessibility in Blockchain Based Healthcare Systems |journal=Proceedings of the 2018 IEEE Global Communications Conference |author=Ramani, V.; Kumar, T.; Bracken, A. et al. |pages=206–12 |doi=10.1109/GLOCOM.2018.8647221}}</ref>, who describe a solution adopting blockchain with the purpose to guarantee authorized access to patients’ medical information. In particular, mechanisms able to preserve both patient’s identity and the integrity of their clinical history are proposed.<ref name="RamaniSecure18" /> Another application of blockchain regards the supply chain in the pharmaceutical sector and the development of measures against counterfeit drugs. While the development of new drugs involves substantial costs related to studies to evaluate the safety and efficacy of the drug, the use of smart contracts guarantees informed consent procedures and allows for certifying the quality of the study data.<ref name="BiggsBlock17">{{cite web |title=Blockchain: Revolutionizing the Global Supply Chain by Building Trust and Transparency |author=Biggs, J.; Hinish, S.R.; Natale, M.A. et al. |publisher=Rutgers University |work=Academia.edu |date=2017}}</ref> In another work, Shen ''et al.''<ref name="ShenMedChain19">{{cite journal |title=MedChain: Efficient Healthcare Data Sharing via Blockchain |journal=Applied Sciences |author=Shen, B.; Guo, J.; Yang, Y. |volume=9 |issue=6 |at=1207 |doi=10.3390/app9061207}}</ref> propose an efficient data-sharing scheme called MedChain, which combines blockchain, digest chain, and structured P2P network techniques to overcome the efficiency issues in healthcare data sharing. Experiments with the system show that work can be performed with higher efficiency, while at the same time satisfying the security requirements of data sharing. Khatoon<ref name="KhatoonABlock20">{{cite journal |title=A Blockchain-Based Smart Contract System for Healthcare Management |journal=Electronics |author=Khatoon, A. |volume=9 |issue=1 |at=94 |doi=10.3390/electronics9010094}}</ref> examines different medical workflows which have been designed and implemented using the Ethereum blockchain platform, which involves complex medical procedures like surgery and clinical trials. In particular, Khatoon examines the smart contract system for healthcare management and estimates the associated costs in terms of feasibility. And finally, Satamraju<ref name="SatamrajuProof20">{{cite journal |title=Proof of Concept of Scalable Integration of Internet of Things and Blockchain in Healthcare |journal=Sensors |author=Satamraju, K.P.; Malarkodi, B. |volume=20 |issue=5 |at=1389 |doi=10.3390/s20051389 |pmid=32138380 |pmc=PMC7085612}}</ref> discusses a framework that integrates IoT networks with a blockchain to address potential privacy and security risks for data integrity in healthcare. In that work, a medical IoT device represented by a Raspberry Pi 3 Model B+ is attached to the patient’s body to monitor their vitals, which are stored in an off-chain database that is accessed by the doctor, pharmacy, and insurance company via a DApp. All transactions take place utilizing smart contracts in a permissioned blockchain system implemented over Ethereum.




Revision as of 22:53, 10 May 2021

Full article title Blockchain-based healthcare workflow for IoT-connected laboratories in federated hospital clouds
Journal Sensors
Author(s) Celesti, Antonio; Ruggeri, Armando; Fazio, Maria; Galletta, Antonino; Villari, Massimo; Romano, Agata
Author affiliation(s) University of Messina, INdAM-GNCS, IRCCS Centro Neurolesi Bonino Pulejo, ASP Messina
Primary contact Email: acelesti at unime dot it
Year published 2020
Volume and issue 20(9)
Article # 2590
DOI 10.3390/s20092590
ISSN 1424-8220
Distribution license Creative Commons Attribution 4.0 International
Website https://www.mdpi.com/1424-8220/20/9/2590/htm
Download https://www.mdpi.com/1424-8220/20/9/2590/pdf (PDF)
Emblem-important-yellow.svg This article should be considered a work in progress and incomplete. Consider this article incomplete until this notice is removed.

Abstract

In a pandemic-related situation such as that caused by the SARS-CoV-2 virus, the need for telemedicine and other distanced services becomes dramatically fundamental to reducing the movement of patients, and by extension reducing the risk of infection in healthcare settings. One potential avenue for achieving this is through leveraging cloud computing and internet of things (IoT) technologies. This paper proposes an IoT-connected laboratory service where clinical exams are performed on patients directly in a hospital by technicians through the use of IoT medical diagnostic devices, with results automatically being sent via the hospital's cloud to doctors of federated hospitals for validation and/or consultation. In particular, we discuss a distributed scenario where nurses, technicians, and medical doctors belonging to different hospitals cooperate through their federated hospital clouds to form a virtual health team able to carry out a healthcare workflow in secure fashion by leveraging the intrinsic security features of blockchain technology. In particular, both public and hybrid blockchain scenarios are discussed and assessed using the Ethereum platform.

Keywords: blockchain, smart contract, workflow, healthcare, hospital, cloud computing, IoT, data federation

Introduction

Recent advancements in information and communication technology have paved the way toward new innovative telemedicine and other remote healthcare services, which are able to support the growing demand of even more accessible medical treatments.[1][2] Particularly, during a pandemic-related situation such as that caused by the SARS-CoV-2 virus, the need for these types of remote services becomes dramatically fundamental to reducing the movement of patients, and by extension reducing the risk of infection in healthcare settings. However, the recent innovation propogated by the cloud computing and internet of things (IoT) paradigms has been only partially taken into consideration by hospitals and, more generally, by medical centers so far. A crucial aspect that has slowed down wider adoption of these and other information and communication technology paradigms in hospitals is concern about the integrity, security, and privacy of exchanged data. Particularly within the healthcare domain, it is critical that shared clinical data be transmitted securely to prevent intentional or accidental illegal data manipulation. Furthermore, patients’ privacy must be guaranteed.

In recent years, cloud computing and IoT paradigms, along with the concept of data federation, have been combined to form new technological approaches. One such approach is the concept of a federated cloud infrastructure, defined as a mesh of cloud providers that are interconnected to provide a universal decentralized computing environment where everything is driven by constraints and agreements in a ubiquitous, multi-provider infrastructure.[3] With the advent of IoT, an IoT-driven cloud paradim has also arisen. In this case, a set of smart embedded devices are interconnected with a remote cloud infrastructure, platform, or software into an internet-connected distributed system able to provide IoT as a service (IoTaaS). The natural evolution of this IoT-driven cloud concept was a federated ecosystem composed of small, medium, and large IoT-driven cloud providers able to collaborate in order to gain economies of scale and to enlarge their processing, storage, network, sensing, and actuating capabilities to arrange even more flexible IoTaaS.[4] The healthcare domain can benefit from these paradigms to improve clinical services and push down management costs through the creation of hospital IoT clouds[5] able to federate themselves.

In this paper, we focus on the medical laboratory as a case study. We examine the applied science laboratory, typically placed in a hospital or in a clinical center where clinical pathology exams are carried out on clinical samples to obtain information about the health of a patient to diagnose, treat, and prevent diseases. Blood tests (e.g., complete blood count [CBC], blood sugar, and so on) are performed by biomedical laboratory health technicians directly in the clinical laboratory, and results are validated and analyzed by doctors to guide diagnosis and treatment. More specifically, we examine these hospital labs under the emerging context of the IoT-connected laboratory operating in a federated cloud. In the case of these laboratories, clinical exams are performed on patients directly in a hospital by technicians who use IoT-enabled medical diagnostic devices integrated into the hospital's cloud system, with results automatically being sent via the hospital's cloud to doctors of federated hospitals for validation and/or consultation. Biomedical laboratory health technicians, nurses, doctors and other clinical personnel belonging to different hospitals cooperate through their federated hospital clouds (FHCs) to form a virtual health team able to carry out a healthcare workflow.

However, one of the major concerns about the accomplishment of such a workflow regards how to guarantee the non-repudiation and immutability of all health decisions.[6] In recent years, different solutions have been proposed to solve such an issue; among solutions is the option of using blockchain technology. Thanks to its intrinsic features of data non-repudiation and immutability, blockchain has aroused significant interest in both scientific and industrial communities. One of the major applications of blockchain is through the smart contract, i.e., a computer protocol aimed to digitally facilitate, verify, and enforce the negotiation of an agreement between subjects without the need of a certifying third party. Blockchain has been increasingly recognized as a technology able to address existing information access problems in different application domains, including healthcare. In fact, it can potentially enhance the perception of safety around medical operators, improving access to hospital cloud services that are guaranteed by greater transparency, security, privacy, traceability, and efficiency. In the scope of IoT-connected laboratories running in the cloud, smart contracts can make the transactions related to such a healthcare workflow traceable and irreversible.

Specifically, this paper proposes an architecture blueprint and a system prototype of an FHC service that addresses the healthcare workflow of an IoT-connected laboratory operating in the cloud. A special emphasis is given to blockchain, comparing both public and hybrid cloud network scenarios using the Ethereum platform to assess both processing time and economic cost. In particular, addressing the latter is vital as the Ethereum public network platform, available over the internet, requires that users (in our case, federated hospitals) pay a fee to perform each transaction.

The remainder of this paper is organized as follows. A brief overview of most recent initiatives about the adoption of blockchain in healthcare is provided in the next section. Motivations for pursuing an IoT-connected cloud approach are discussed in the subsequent section. A blueprint of FHC architecture is then presented, followed by a description of one of its possible implementations. Experiments specifically focusing on blockchain comparing public and hybrid cloud network scenarios are discussed in the penultimate section. The paper ends with conclusions and promising future developments.

Related work

Recently, the role of blockchain technology in the healthcare domain has been surveyed in a number of scientific works.[7][8][9][10][11] More specifically, some works have demonstrated that blockchain can drastically improve the security of hospital information systems (HIS).[12][13][14][15] However, up to now, most of these scientific initiatives are either theoretical or at an early stage, and it is not always made clear which protocols and pieces of a framework should be used to carry out system implementations that can be deployed in real healthcare environments.

Blockchain has been increasingly recognized as a tool able to address existing open information access issues.[16] In fact, it is possible to improve access to health services by using blockchain to achieve greater transparency, security, privacy, traceability, and efficiency. One such example can be found in the work of Ramani et al.[17], who describe a solution adopting blockchain with the purpose to guarantee authorized access to patients’ medical information. In particular, mechanisms able to preserve both patient’s identity and the integrity of their clinical history are proposed.[17] Another application of blockchain regards the supply chain in the pharmaceutical sector and the development of measures against counterfeit drugs. While the development of new drugs involves substantial costs related to studies to evaluate the safety and efficacy of the drug, the use of smart contracts guarantees informed consent procedures and allows for certifying the quality of the study data.[18] In another work, Shen et al.[19] propose an efficient data-sharing scheme called MedChain, which combines blockchain, digest chain, and structured P2P network techniques to overcome the efficiency issues in healthcare data sharing. Experiments with the system show that work can be performed with higher efficiency, while at the same time satisfying the security requirements of data sharing. Khatoon[20] examines different medical workflows which have been designed and implemented using the Ethereum blockchain platform, which involves complex medical procedures like surgery and clinical trials. In particular, Khatoon examines the smart contract system for healthcare management and estimates the associated costs in terms of feasibility. And finally, Satamraju[21] discusses a framework that integrates IoT networks with a blockchain to address potential privacy and security risks for data integrity in healthcare. In that work, a medical IoT device represented by a Raspberry Pi 3 Model B+ is attached to the patient’s body to monitor their vitals, which are stored in an off-chain database that is accessed by the doctor, pharmacy, and insurance company via a DApp. All transactions take place utilizing smart contracts in a permissioned blockchain system implemented over Ethereum.


References

  1. ↑ Hassenteufel, P.; Schweyer, F.-X.; Gerlinger, T. et al. (2020). "The role of professional groups in policy change: Physician's organizations and the issue of local medical provision shortages in France and Germany". European Policy Analysis 6 (1): 38–57. doi:10.1002/epa2.1073. 
  2. ↑ Dubas-Jakóbczyk, K.; Domagała, A.; Mikos, M. (2019). "Impact of the doctor deficit on hospital management in Poland: A mixed-method study". International Journal of Health Planning and Management 34 (1): 187-195. doi:10.1002/hpm.2612. PMID 30132977. 
  3. ↑ Moreno-Vozmediano, R.; Huedo, E.; Llorente, I.M. et al. (2015). "BEACON: A Cloud Network Federation Framework". Proceedings of ESOCC 2015: Advances in Service-Oriented and Cloud Computing: 325–37. doi:10.1007/978-3-319-33313-7_25. 
  4. ↑ Celesti, A.; Fazio, M.; Giacobbe, M. et al. (2016). "Characterizing Cloud Federation in IoT". Proceedings of the 30th International Conference on Advanced Information Networking and Applications Workshops: 93–98. doi:10.1109/WAINA.2016.152. 
  5. ↑ Mulfari, D.; Celesti, A.; Puliafito, A. et al. (2013). "How cloud computing can support on-demand assistive services". Proceedings of the 10th International Cross-Disciplinary Conference on Web Accessibility: 1–4. doi:10.1145/2461121.2461140. 
  6. ↑ Lian, J-W.; Yen, D.C.; Wang, Y.-T. (2014). "An exploratory study to understand the critical factors affecting the decision to adopt cloud computing in Taiwan hospital". International Journal of Information Management 34 (1): 28–36. doi:10.1016/j.ijinfomgt.2013.09.004. 
  7. ↑ Griggs, K.N.; Ossipova, O.; Kohlios, C.P. et al.. "Healthcare Blockchain System Using Smart Contracts for Secure Automated Remote Patient Monitoring". Journal of Medical Systems 42 (7): 130. doi:10.1007/s10916-018-0982-x. PMID 29876661. 
  8. ↑ Zubaydi, H.D.; Chong, Y.-W.; Ko, K. et al.. "A Review on the Role of Blockchain Technology in the Healthcare Domain". Electronics 8 (6): 679. doi:10.3390/electronics8060679. 
  9. ↑ Agbo, C.C.; Mahmoud. Q.H.; Eklund, J.M.. "Blockchain Technology in Healthcare: A Systematic Review". Healthcare 7 (2): 56. doi:10.3390/healthcare7020056. PMC PMC6627742. PMID 30987333. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6627742. 
  10. ↑ Hölbl, M.; Kompara, M.; Kamišalić, A. et al.. "A Systematic Review of the Use of Blockchain in Healthcare". Symmetry 10 (10): 470. doi:10.3390/sym10100470. 
  11. ↑ Qadri, Y.A.; Nauman, A.; Zikria, Y.B. et al.. "The Future of Healthcare Internet of Things: A Survey of Emerging Technologies". IEEE Communications Surveys & Tutorials 22 (2): 1121–1167. doi:10.1109/COMST.2020.2973314. 
  12. ↑ Chakraborty, S.; Aich, S.; Jim, H.-C.. "A Secure Healthcare System Design Framework using Blockchain Technology". Proceedings of the 21st International Conference on Advanced Communication Technology: 1260–64. doi:10.23919/ICACT.2019.8701983. 
  13. ↑ Dasaklis, T.K.; Casino, F.; Patsakis, C.. "Blockchain Meets Smart Health: Towards Next Generation Healthcare Services". Proceedings of the 9th International Conference on Information, Intelligence, Systems and Applications: 1–8. doi:10.1109/IISA.2018.8633601. 
  14. ↑ Srivastava, G.; Crichigno, J.; Dhar, S.. "A Light and Secure Healthcare Blockchain for IoT Medical Devices". Proceedings of the 2019 IEEE Canadian Conference of Electrical and Computer Engineering: 1–5. doi:10.1109/CCECE.2019.8861593. 
  15. ↑ Hossein, K.M.; Esmaeilli, M.E.; Dargahi, T. et al.. "Blockchain-Based Privacy-Preserving Healthcare Architecture". Proceedings of the 2019 IEEE Canadian Conference of Electrical and Computer Engineering: 1–4. doi:10.1109/CCECE.2019.8861857. 
  16. ↑ Zhang, P.; White, J.; Schmidt, D.C. et al.. "FHIRChain: Applying Blockchain to Securely and Scalably Share Clinical Data". Computational and Structural Biotechnology Journal 16: 267–78. doi:10.1016/j.csbj.2018.07.004. PMC PMC6082774. PMID 30108685. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6082774. 
  17. ↑ 17.0 17.1 Ramani, V.; Kumar, T.; Bracken, A. et al.. "Secure and Efficient Data Accessibility in Blockchain Based Healthcare Systems". Proceedings of the 2018 IEEE Global Communications Conference: 206–12. doi:10.1109/GLOCOM.2018.8647221. 
  18. ↑ Biggs, J.; Hinish, S.R.; Natale, M.A. et al. (2017). "Blockchain: Revolutionizing the Global Supply Chain by Building Trust and Transparency". Academia.edu. Rutgers University. 
  19. ↑ Shen, B.; Guo, J.; Yang, Y.. "MedChain: Efficient Healthcare Data Sharing via Blockchain". Applied Sciences 9 (6): 1207. doi:10.3390/app9061207. 
  20. ↑ Khatoon, A.. "A Blockchain-Based Smart Contract System for Healthcare Management". Electronics 9 (1): 94. doi:10.3390/electronics9010094. 
  21. ↑ Satamraju, K.P.; Malarkodi, B.. "Proof of Concept of Scalable Integration of Internet of Things and Blockchain in Healthcare". Sensors 20 (5): 1389. doi:10.3390/s20051389. PMC PMC7085612. PMID 32138380. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7085612. 

Notes

This presentation is faithful to the original, with only a few minor changes to presentation. Some grammar and punctuation was cleaned up to improve readability. The original title—Blockchain-Based Healthcare Workflow for Tele-Medical Laboratory in Federated Hospital IoT Clouds—was changed slightly as "tele-medical laboratory" is a confusing phrase that elicits thoughts of "telemedicine," which is not an accurate portrayal of the article. The new title intends to capture the true spirit of the concept, and this change was also propogated throughout this version of the article. In some cases important information was missing from the references, and that information was added.

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