A Review of Blockchain Applications and Healthcare Informatics

Health IT, encompassing electronic health records (EHRs), telemedicine, data analytics, and artificial intelligence, has the potential to reshape healthcare in India. The convergence of technology and healthcare delivery is bridging gaps, improving access, enhancing quality, and increasing efficiency. Understanding the current state of Health IT and anticipating future trends is crucial to harnessing its full potential.

1.1 Present status of healthcare data management

1.1.1 Adoption of electronic health records (EHRs)

EHRs have witnessed significant adoption in India's healthcare ecosystem. These digital records are replacing paper-based systems, offering several advantages, current EHR issues are shown in Figure 1.

• Efficient Data Management.
• Improved Care Coordination.

1.1.2 Electronic health records

Patient files are stored in electronic health records, or EHRs. These were paper files in the past. To streamline patient documentation, the Affordable Care Act (ACA) of 2010 mandated that providers transition to electronic health record (EHR) systems. All clinical, health, and demographic data are included in EHRs.

1.1.3 Electronic medical records

Like EHRs are electronic medical records (EMRs). All the patient's medical history isn't always included in the electronic medical records (EMRs) that hospitals often employ. Doctors and nurses have access to a patient's electronic medical record (EMR) upon admission, which contains information about the patient's condition, treatment, and medical history.

1.1.4 Administrative and demographic data

Billing, insurance, reimbursement, scheduling, and payment details are examples of administrative data. Given that it contains private information like credit cards and Social Security numbers, this data needs to be very secure.

Their EHR system offers.

• Centralized Data Storage.
• Data Integration.
• Interoperability.

Health Information Exchanges (HIEs) are instrumental in enabling the secure exchange of patient data among healthcare providers. The interoperability enhances care continuity and reduces medical errors.

1.2 Blockchain for health records security

Blockchain technology holds immense promise for enhancing security, privacy of health records:

• Data Security: Patient records deployed on blockchain are immutable, safeguarded against unauthorized tampering. This ensures the integrity and authenticity of health data.
• Consent Management: Blockchain's smart contracts enable exact control over who can view and alter health information. Patients can grant permission securely, ensuring privacy while allowing healthcare providers access when necessary.

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Figure 1. Current EHR issues

1.3 Future trend - blockchain-based health records

In the coming years, we anticipate the broader adoption of blockchain for health records in India. Patients are provided with:

• Complete control over the sharing and access of their data, allaying worries about data breaches.
• Enhanced data security, instilling trust in healthcare systems.
• Improved interoperability between healthcare providers, promoting seamless care coordination.

Blockchain is an advanced, open, decentralized ledger that syncs data across many computer platforms and prevents any record from being altered in the past without impacting subsequent blocks. A long chain is formed through blockchain demonstration and association with the prior block. Blockchain is ultimately the call of the archive. A fair establishment of obligation is provided by Blockchain because every exchange is registered and publicly verified. Nobody can alter any of the insights included in the Blockchain once they have been recorded. It demonstrates that the records are authentic and undamaged. In Blockchain, data is maintained on networks rather than a simple data file, enhancing security and demonstrating its propensity to be compromised. Blockchain enables advertisers to keep track of the products they have utilized [1, 2].

Distributed ledger technology, or blockchain, offers insights and never removes or changes them without unanimous agreement. A cryptographic hash that links each information block with newly added insights block information determines the price of a Blockchain hash. Measurements are not managed individually thanks to the distributed Blockchain record structure, which makes it accountable and accessible to all organized customers. The patient will follow the acquisition of their records by monitoring health data on a blockchain [3, 4].

We use wearable technology and the Internet of Things (IoT) to use real-time Blockchain for healthcare to preserve and update vital patient data, such as blood pressure and sugar levels. It is beneficial for doctors to identify patients who are very susceptible to risks and to suggest and notify their families and employers in the event of an emergency. Blockchain's decentralized architecture makes it difficult to exploit and prevents any one copy of the data from being compromised [5, 6]. The research queries addressed in this article are as follows:

RQ1: To see the blockchain generation and its full healthcare ambitions.

RQ2: Learning about the ways in which blockchain technology can enhance the global healthcare system.

RQ3: To educate oneself on the implementation of blockchain technology's unified work-flow process in the provision of healthcare facilities.

Blockchain is no longer dependent on any one source for information acquisition. Rather, Blockchain is replicated and propagated by a computer network. A new block is reflected in the blockchain on every internet-connected computer. The fundamental operational processes of Blockchain generation are depicted in Figure 2.

A Blockchain device operates at the very top of the internet, on a P2P network of computers where everyone uses the same protocol and has the same copy of the transaction ledger. This enables machine consensus to support P2P fee transactions without the need for an intermediary. Blockchain technology comes in many varieties, including public, private, hybrid, and consortium. Every Blockchain community has unique benefits and drawbacks that affect its key uses.   

• The first generation of Blockchain is public Blockchain, and it was here that the idea for Bitcoin and other cryptocurrencies emerged, helping to advance distributed ledger technology (DLT). It eliminates the negative effects of centralization, like lack of security and transparency. DLT disseminates facts around a P2P network as opposed to preserving them in one location. It requires a few different techniques for fact authentication because of how decentralized it is.
• A private blockchain is a blockchain network that operates in a restricted setting, is closed, or managed by a single organization. It is noticeably smaller, but it performs similarly to a public blockchain community in terms of P2P networking and decentralization. In a non-public Blockchain, the network's creator is already familiar with the participants. On the public web, one cannot broaden a permission-based response, and users maintain complete anonymity.
• On occasion, companies seeking the best of both worlds will use hybrid blockchains, which blend elements of public and private blockchains. Businesses may build a public, permissionless system in addition to a private, permission-based one, allowing them to manage exactly what information is made public and who can access it on the Blockchain.

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Figure 2. The procedures involved in using blockchain technology

Numerous investigations were carried out to enhance the quality of healthcare by utilizing blockchain technology [11]. The healthcare sector is expanding both horizontally and vertically. The vertical direction of healthcare is expanding more quickly, bringing new drugs, vaccines, and medical equipment to the market and the capacities of blockchain technology for the healthcare domain is shown in Figure 6.

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Figure 6. Capacities of blockchain technology for the healthcare domain

But because most hospitals have been recording and sharing patient electronic health records (EHRs) using outdated technology for the past 20 years, the horizontal direction is only slowly expanding.

Blockchain adoption as a new horizontal breakthrough has the potential to completely transform the healthcare sector. This is because blockchain technology offers answers for a number of challenges related to data management for electronic health records (EHRs) in the healthcare sector, including scalability concerns [12], data blocking across healthcare organizations, and EHR manipulation.

3.1 Applications

1. MedRec is a decentralized document control device to deal with EMRs, developed with the use of blockchain era designed [13]. The gadget advanced the use of Solidity and Ethereum (Geth), but it was no longer developed on the Ethereum community instead, it constructed a small-scale private blockchain with comprehensive, one-of-a-kind APIs [14]. MedRec permits patients get the right of entry to their clinical statistics across vendors and remedy website.
2. Carechain, lead by IT pioneers Johan Sellstrom and Stefan Farestam, Carechain is a Swedish business that just unveiled a blockchain-based personal healthcare information management system. The system concentrates on the protocol stage and creates a new infrastructure that is manageable by anybody but does not belong to anyone.  The Carechain utilized the Ethereum method to build a national blockchain for fitness data that gives users ownership and control over their medical records. The device will place the character in the center and assign the character a regular virtual identification that is owned and controlled by the character. The system must ensure that facts are included with integrity, and an integrated policy must ensure traceability [15].
3. Dovetail Utilizing the Hyperledger material approach, Dovetail is a blockchain-based digital consent application that facilitates the sharing of patient data to enhance healthcare systems, products, and services. The gadget offers an audited ledger of scientific facts interactions to confirm identify, record consent, and generate tamper-proof audit records of each records exchange. Additionally, it capitalizes on the advantageous features of distributed ledger manufacturing [16].
4. MedHypChain is a patient-focused, interoperable hyper-ledger-based medical healthcare and information exchange device that protects patient privacy. Every transaction is protected by an identification-based broadcast organization encryption method [17]. The device enables the secure deployment of patient-targeted interoperability (PCI) information sharing between the patient and medical server, as well as interoperability and malicious user tracing. There are several ways that blockchain technology can improve healthcare around the world. The Blockchain has a wide range of applications and features in the healthcare sector. By managing the drug delivery chain, supporting the secure transfer of patient clinical data, and facilitating the safe switch of patient medical data, ledger technology enables medical researchers to decipher genetic codes. Figure 6 illustrates the types of capabilities and essential Blockchain concept enablers in numerous healthcare and related sectors.

Healthcare information security, extensive genome control, digital record management, clinical data, interoperability, digitalized tracking, problem emergence, and other technically complex and mind-boggling operations are some of the methods used to advance and implement the Blockchain era. The primary drivers behind the adoption of blockchain technology are its fully digitalized components and applications in healthcare-related products [18, 19]. With the help of Blockchain, the entire prescription process from manufacture to pharmacy shelves becomes transparent. Blockchain and IoT can be used to track speed, goods paths, and congestion.

The overall vision of Blockchain to revolutionize the healthcare market in the coming years can be to address problems impacting the current structure. It enables doctors, patients, and chemists to easily gain access to all the information available at any given time. Blockchain technology is being investigated, tested, and discovered by medical companies inside the clinical space for health information day and night. By decentralizing patient fitness records data, improving payment alternatives, and following prescription medications, it has established itself as an indispensable tool in the healthcare industry. In addition, advanced technology includes artificial intelligence and technologies that learn. Blockchain is a rather important component of the market. The way that blockchain is changing the healthcare sector has some real applications. To streamline the clinical delivery chain, the program is built using Blockchain monitoring technology [20-22].

The potential of blockchain allows for the creation of a complex data storage system that maintains a person's whole medical history, including diagnoses, examination results, previous regimens, and even measures from intelligent sensors. A doctor can quickly acquire all the data required to provide precise diagnoses and recommendations for the application of this method. Because every statistic is recorded in a single Blockchain device, it is protected from loss and change. It might use Blockchain to avoid a company's internal networks. Rescue assaults and other issues, including laptop corruption or hardware failure, could be eliminated if a healthcare organization successfully deploys a Blockchain community [23, 24].

3.2 Decentralized and secure affected person statistics control

Transferring paper medical records between several hospitals utilizing patients themselves is inconvenient and ineffective. A key strategy to raise the caliber of healthcare professionals and lower clinical costs is the sharing of medical data.

Although modern EHR systems offer numerous benefits, there are still many limits in place in healthcare data systems, which prevent comfortable and scalable data sharing among various organizations and, as a result, restrict the advancement of scientific research and decision-making. As mentioned previously, there are risks associated with a centralized device's information leaking attack. However, patients are unable to retain ownership of their personal information that they could share with a partner. It might lead to the unauthorized usage of confidential information by inquiring organizations. Furthermore, separate competing groups that lack relationships are less likely to share information, which could impede the growth of information sharing.

In this situation, it is essential to ensure protection and privacy protection and return to properly handling information returned to users to promote information exchange. When records are contained in a single organization, it is much easier to solve security and privacy concerns; but, when comfortable health information interchange occurs across different domain names, it will be more challenging. In the meanwhile, it also wants to continue to think about how to promote effective teamwork in the healthcare sector.

As one of the common strategies, a comfortable access control system demands only authorized entities to have access to sharing information. This approach consists of gaining universal access to the policy as well as the ability to manage a list (ACL) relevant to the data owner. ACL is a list of users with the appropriate permissions (examine, write, and update) to access specific statistics. Giving authenticated users permission to access the protected sources under established access rules is known as authorization. The authorization procedure is always carried out after the authentication system.

Combining blockchain technology with gaining access to control mechanisms to build an honest machine is promising. Customers can casually handle their data and keep shared information private. According to this new paradigm, patients can predefine the operations (read, write, update, delete), access permissions (authorize, refuse, revoke), and time to share their data using smart contracts on the blockchain without losing the ability to control it. Once all the prerequisites are satisfied, smart contracts can be created on the blockchain and can also offer an audit mechanism for each request entered the ledger. Smart contracts are being used in several current studies and programs to facilitate the sharing of healthcare data. Table 2 represents the main contributions and gaps identified in decentralized and secure patient data management.

Figure 7 shows how the database's patient records are organized, with access control rules contained in the block and medical metadata in the smart agreement, Figure 8 shows the combination of access control mechanism by smart contract.

The machine-getting-to-know technique can effectively provide innovative products and encourage the optimization of healthcare systems. How to store, distribute, and educate sensitive material securely is a major difficulty for practical systems using machine learning. To improve the security and privacy of datasets, system learning, and blockchain integration are becoming increasingly popular.

Table 2. Main contributions and gaps identified in decentralized and secure patient data management

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Figure 7. Patient database

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Figure 8. Integration of smart contracts with access control mechanisms

Federated mastery is an effective system learning technique that is accomplished among numerous computing nodes under the condition that sensitive data is kept secure and private during information exchange. Sharing encrypted datasets enables collaboration between various clinical settings to develop high-accuracy prediction algorithms. To ensure accountability and reliable collaboration, blockchain as a regulator can record associated training transactions in an unaltered and transparent manner. In this case, medical companies and researchers might be more eager to share encrypted datasets to advance the creation of medical treatments and public health.

Blockchain ensures the security of data entry by acting as the solid foundation for device-mastering algorithms. The key problem identified by and the sharing of enormous datasets using specialized software and domain names. To execute system learning on encrypted data, homomorphic encryption is a topic of ongoing research Gentry. However, in practice, homomorphic encryption has a high computational expense. In the future, sensitive data might be encrypted without affecting the system's search for intelligent options. Additionally, artificial intelligence can be used to create smart contacts automatically, enhancing flexible and comfortable operations. Additionally, blockchain could be used to improve the security of network slice sellers and the 5G community control layer.

3.3 Prescription and billing

Healthcare organizations can more effectively influence patients' data, such as their prescription history, thanks to virtual healthcare architecture. Through computational and multiplatform virtual tools, using technology to transmit patient information allows for more effective communication between healthcare experts and businesses (during times of social distance). When compared to paper-based prescriptions, the use of virtual prescriptions enables effective communication while minimizing discrepancies, providing the patient with higher-quality first-class medical care [31]. To govern scientific statistics, however, most methods use centralized digital systems.  The single point of failure problem that plagues centralized architectures makes it possible for healthcare providers to alter or abuse patient records. As a result, think about how records are accessible to healthcare organizations and how this is dependent on a single important server, as shown in Figure 9.

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Figure 9.  Electronic prescribing using a centralized architecture

On the other hand, decentralized blockchain technology guarantees the accuracy of statistics. The layout enables the blockchain to run independently of a central authority or middleman, and statistics are added to the chain by network node consensus, a decentralised architecture-based concept for electronic prescription is shown in Figure 10.

With the help of clever contracts, which are executable programs saved and operated on the blockchain, tasks like validating transactions may be automated without the need for 1/3-celebration interaction [32]. Ethereum is one of the most well-known decentralized application enhancement frameworks that make use of smart contracts. However, it makes use of the proof of work (Pow) consensus process, which has a high operational cost and requires the mining node to solve a cryptographic assignment [33, 34]. As these systems achieve consensus without mining, Sensible Byzantine Fault Tolerance 1 (PBFT) platforms, such as Tendermint and Istanbul Byzantine Fault Tolerance 2 (IBFT2), offer an alternative to PoW blockchains high processing costs. The consensus is broken down into stages, and the participants known as validators take part by presenting and validating blocks.

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Figure 10. A decentralised architecture-based concept for electronic prescription

Blockchain technology satisfies most of these requirements for combating fraud and prescription forgery under its inherent properties and decentralized architecture. In this way, it stops the patient from experiencing fitness issues because of prescription abuse. It offers the advantages listed below to e-prescription applications:

• Has no centralized authority and operates decentralized (no single point of failure).
• Maintains patient data on backup storage.
• Prevents the alteration of information for personal gain.
• Selling medications only with valid prescriptions.
• Effective and transparent communication between stakeholders.
• Decrease in medication errors and consistency.

As a result, developing a decentralized and fault-tolerant prescription model is highly feasible. A distributed consensus among the users of the network is used to add recent medical information or to complete the sale of medication. As a result, stakeholder dialogue will be more comfortable than with centralized systems and written prescriptions. An example of scientific truths. We investigate the use of blockchain technology and smart contracts to enable the selling of drug treatments best with valid data that is, data that was developed and signed by a doctor while also ensuring the availability, integrity, and transparency of the data. Table 3 shows the significant contributions of several writers in a decentralized architecture electronic prescription approach.

• Growing fake virtual prescriptions (without the digital signature of the doctor).
• Tampering with scientific documents, such as digital prescriptions. By doing so, it prevents the misuse of prescription pharmaceuticals and their side effects, such as overdosing [35].

Table 3. Significant contributions of several writers in a decentralized architecture electronic prescription approach

3.4 Healthcare interoperability and scientific statistics systems

• Healthcare information and Interoperability: Interoperability within the Blockchain community improves data exchange between players in this industry because every piece of information within the Blockchain adheres to a specific standard, making information exchange more effective.  Information security in the healthcare industry Blockchain community skills like hashing and information immutability make data healthcare more comfortable.
• Lower cost of healthcare statistics management: Because the records are kept in several locations and databases, the value of data management in traditional healthcare information systems is far higher than storing that information smoothly in a Blockchain network.
• Global sharing of healthcare records: A patient may receive treatment in one nation before traveling to another to continue receiving it. If standard hospital treatment procedures are used in this situation, transferring patient records among many special nations may not even be conceivable. Affected people's records may be easily shared internationally using a Blockchain network.
• Enhancing the audit of healthcare facts through the usage of Blockchain: The use of records audits in healthcare guarantees that organizations and stakeholders in this sector properly adhere to all laws and standards. The audit of healthcare data is improved since the Blockchain contains verifiable information and non-manipulative facts.

Interoperability, in a nutshell, is the main ability of specialized record-keeping systems to communicate, exchange, and use statistics in the healthcare environment. Following international standards, EHR systems can achieve interoperability and direct information sharing across a few healthcare carriers and institutions.

3.5 Pharmaceutical product authenticity and legitimacy

With the advent of device mastery and AI, providing opportunities to access information via smartphones, chemists might have clear and secure access to lab information for patients using a blockchain framework. This might facilitate better communication between chemists and prescribers in terms of maximizing pharmaceutical therapy. Pharmacists could play a stronger role in following patients to improve drug adherence and fitness outcomes if they have access to test findings and EHR.

We can go over the operation of a blockchain-based system for managing the entire pharmaceutical distribution chain. Let's imagine we've established a secure and reliable network where the parties who can be relied upon can join the community. The necessary transactions are stored on a blockchain on the backend, and once the information is recorded, it cannot be changed. In addition, we have a user-friendly mobile application that participants will utilize to conduct blockchain transactions.

A factory will generate a special hash and assign it to each new product as it is produced. The product's hash (unique identity) can be used to register it on the blockchain. The item might be viewed as a digital asset on the blockchain network, and its hash can be used to locate it at any moment. Depending on the manufacturer's preferences, any additional product records may be held either off-chain or on-chain backed by a trusted third party. Using an identifier, off-chain data can be blended with on-chain data. A hash-digest (for example, SHA-256) of all the off-chain data is typically generated and linked to the on-chain data in most blockchain-based programs. The best practice is to store text-only data on-chain and big documents (such as pictures) off-chain. A user-friendly mobile app can be used to quickly transfer ownership of a product to another participant after the maker has registered it on the blockchain. According to the license, the wholesaler must buy the pharmaceuticals from the manufacturer, who will then physically deliver them to the wholesaler while simultaneously registering the transfer transaction on the blockchain. The same process will be repeated by the wholesaler to transfer the pharmaceuticals to the distributor, who will then engage in an equal economic venture with the pharmacy. The basic layout of a blockchain-based pharmaceutical chain control is shown in Figure 11.

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Figure 11. Blockchain-based pharmaceutical supply chain management system

3.6 Counterfeit pills discovery and delivery chain

Blockchain technology and paperless systems offer a stable, decentralized system for thwarting fraud [36]. Smart contracts have been defined as blockchain-based systems that enable the importation of traceable non-modifiable data along the entire drug supply chain, from the producer to the end user [37]. Two of blockchain's unique characteristics are its compatibility with numerous technologies and its real-time accessibility across the whole pharmaceutical distribution chain. The pharmaceutical supply chain can benefit from a decentralized distribution system with the chance of inexpensive statistics storage, which gives smart contract stakeholders accessibility, dependability, and integrity [38]. Utilizing RFID tags, clever contracts can give someone access to tune false returns to the manufacturer and supplier [39, 40]. Patients and sponsors can both have real-time access to information about their clinical trials, which lowers the cost of the studies. Smart contracts can handle security-demanding scenarios by addressing common security concerns, making use of contemporary technology, offering permission-based blockchains, stopping unauthorized and additional drug purchases, monitoring the distribution of vaccines, and storing and validating data both on- and off-chain. 

Due to the open structure of the delivery chain, smart contracts were suggested as a solution to combat theft, loss, and fraud problems by providing stakeholders with security and transparency [40]. The integration of smart contracts into blockchain networks is currently gaining traction thanks to recent developments in the blockchain age. Many advantages result from this approach, including the elimination of intermediaries, self-execution, changelessness, and self-checking [41]. To preserve patient privacy, permission-based complete blockchains provide access to authenticated individuals [42]. With the help of QR code-enabled prescriptions, clever contracts written in the solidity language to operate on the Ethereum platform may be used to stop patients from buying excess medication that isn't prescribed to them to avert death [43]. The same study illustrates the use of multiple validation syntaxes to prevent reapplication attacks if the off-chain and on-chain do not match in terms of the write depend [44].

But for healthcare programs, using smart contracts might come with extra costs and hazards. A comparison of MultiChain, Hyperledger Fabric, and Ethereum finds that MultiChain may be the most user-friendly blockchain platform, Hyperledger Fabric is the most secure due to its layers of security, and Ethereum has the most developer support [45]. Similar benefits accrue to the pharmaceutical industry from Ethereum-based smart contracts built in the solidity language, including speed, cost savings, accuracy, and the ability to use backup [43].

Table 4. Main contributions and gaps identified in counterfeit pills discovery and delivery chain

Table 5. Main contributions and gaps identified under medical health insurance enterprise

Clever contracts help to deliver chain transparency by reducing the supply of fake capsules, reducing the financial burden of fake and inferior tablets, streamlining global options by exchanging product-related statistics, managing dynamic changes in cross-border distribution channels, and offering real-time cargo tracking. The selling of counterfeit medications can potentially be restricted by smart contracts. A sizeable chunk of the massive Asian counterfeit drug market is represented by the 30% of tested capsules in pharmacies in the Philippines that are fakes [46]. By utilizing a blockchain-based pharmacy surveillance technology to spot phoney and inferior drugs in the supply chain, this financial suffering could be mitigated [47]. Smart contracts are essential to the advancement of logistics and global trade.

It is difficult to detect fake goods because of the intricacy of distribution networks. Although one looks suggests a framework for the use of distributed ledgers and smart contracts to address this issue in the medication supply chain [42]. In this approved blockchain community, a transaction proposal is transmitted across the blockchain network. This transaction proposal is made possible by permitting all CRUD (create, review, update, and delete) operations on the data.

Smart contracts can enhance transparency and encourage thoughtfulness among supply chain actors [48]. All stakeholders are protected by the so-called end-to-quit protection and privacy across a blockchain, which offers benefits like enhancing chain auditing, identifying and mitigating the impact of incidents, and bringing transparency to the entire organization rather than just those who specialize in transactions [49]. Table 4 highlights the main contributions and gaps identified in counterfeit pills discovery and delivery chain. Clever contracts can help fitness-care applications—complex blockchain programs—create guidelines for health record users' use and foster a sense of agreement among users that data is immutable [50].

3.7 Blockchain and the medical health insurance enterprise

In this paper, we have a look at the feasibility and implications of these use cases in terms of ways blockchain may want to, directly and indirectly, enhance an insurer’s fundamental techniques and business models. The instances deal with upgrades in an insurance corporation’s operational capabilities in addition to dealings with vendors, intermediaries, and policyholders, thereby improving the purchaser experience, improving product cost. Table 5 highlights the main contributions and gaps identified under medical health insurance enterprise.

• Transferring towards interoperable, comprehensive health facts.
• Assisting administrative and strategic imperatives with clever contracts.
• Detecting fraud efficiently.
• Enhancing provider listing accuracy.
• Simplifying the application system with the aid of making it extra client-centric
• Facilitating a dynamic insurer/customer courting.

In the current device, the coverage claim method is coordinated between the fitness care companies and coverage companies by way of coverage dealers. Coverage dealers might also intentionally or unintentionally leak essential files like patient facts, clinical fitness information, and coverage policy records. The coverage-claiming process is completed manually and consumes lots of time and energy. In a traditional dispensed database, study/write operations are managed through a centralized device. Those statistics can get changed. With the upward thrust of the era and boom in the amount of data, information breaches and file tempering are a danger to the privacy and authentication of records whilst stored on a significant server. As a result, information integrity and getting entry to manipulate are primary issues in healthcare and coverage enterprises. Coverage industries also are facing the issue of declaring fraud. Fake facts can be furnished for the price of false claims through policy holder. Detecting fraud has grown to be a project which could result in losses to the corporation but also growth in the transaction processing time and charge settlement time because the business enterprise may additionally touch extra assets for records.

• Improve integrity and protection by way of providing better management of affected person records.
• Name for a better pleasant of scientific trial information.
• Lessen regulatory and compliance expenses.
• Set up new requirements and practices.
• Optimize interactions between healthcare specialists, insurance businesses, and policyholders.
• Shape partnerships with leading ventures using the blockchain era.

Based on keyword statistics, co-occurrence functions of different key phrases related to blockchain and insurance are taken into account to illustrate the sizable trends in keyword co-incidence. Figure 12 displays the co-prevalence network evaluation, association, and node of the 50 most often occurring terms in published publications on blockchain studies. Figure 12 suggests that the research area was divided into three major clusters. The red cluster was focused on an extremely generalized idea of blockchain that was primarily related to the insurance industry, smart contracts, Ethereum, the internet of things, cryptocurrency, bitcoins, consensus, and blockchain security. The blue cluster, on the other hand, was more focused on the area of medical insurance or healthcare.

Additionally, the unexperienced cluster revealed the keyword's proximity concerning financial insurance tech, generation, chance, and fintech banking. The Blockchain cluster is demonstrated to be of great importance and great interest for the good purpose of revolutionary research.

Blockchain's contribution to the insurance business.

• Blockchain deployments try to cut down on inefficiencies, expensive transaction fees, and protracted claim processing times by creating distributed ledgers. Information and payments are securely recorded, reducing risks, and increasing the amount of insurance on hand. Currently, fraud detection, automatic claim agreement, cash flow document tracking, and self-purchase insurance are the main applications of blockchain in the insurance sector.
• In the past, claims were often processed through KYC (Know Your Customer), however computerized claims have eliminated the need for KYC. Since the year 2000, financial institutions have been using KYC, one of the main methods of identifying often used by business entities around the world. Clients can grant insurance companies access to their identifying records as needed. Once the KYC profile has been reviewed, the consumer can avoid repeat authentication processes and obtain improved identification information before other agencies require it. Disintermediation, transparent transactions, and lack of centralized control are just a few benefits of a fully blockchain-based KYC system.

Many organizations have altered the way statistics are processed using the capabilities of blockchain de-mediation. For instance, Stratumn, a French insurance company with headquarters in Paris, shares verified customer data through blockchain, which reduces the cost and time associated with each request for a statistical analysis to determine whether the customer is eligible for insurance coverage. As a result, customers can purchase insurance on their own. In December 2018, Ant coverage published the "blockchain + declare" challenge, which allowed the use of digital notes as declared notes [51].

The smart contract era, which is entirely dependent on blockchain creation, is frequently used for fraud detection. Smart contracts are specialized protocols created to automate contract validation and compliance. We can conduct traceable, permanent, and comfortable transactions thanks to clever contracts, which eliminate the necessity for one-third of events. If the requirements are met, an intelligent settlement will include all the transaction information and best carry out the subsequent process. Computer systems create intelligent contracts, which makes them distinct from conventional paper contracts. As an illustration, Taikang Online deployed blockchain generation-based total coverage fraud detection for an Anti-Moth assignment. The company's clever contracting system can determine if the buyer is considering coverage and whether they meet the insurance requirements that not only protect privacy but also help to prevent coverage fraud [52].

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Figure 12. Co-occurrence network analysis

The characteristics of dispersed ledgers make it possible to track historical capital flow statistics. A dispersed ledger is controlled in a decentralized manner, spanning various locations, and does not depend on a third entity (such as a bank or clearinghouse) to maintain the accuracy of the records it maintains. A distributed ledger is a database made up of several independent computers (called nodes), and it is up to the nodes to verify, store, and update data. The ability of the dispersed ledger to serve as a dispersed witness makes it extremely challenging to target and attack the community. In a centralized ledger, it is most efficient for one entity to possess a replica of the ledger. However, in the event of an allocated ledger, every node in the community has a duplicate of the exact ledger. No one entity could alter the ledger without the agreement of all participating nodes because any new changes can be applied to all nodes in a matter of seconds. It uses cryptography to store all the data, and only the key and encrypted signature can be used to unlock it. As a result, the distributed ledger will not only help to explain the lengthy tracking of capital flow statistics, but it will also guarantee the complete security of the data that is being recorded.

3.8 Fraudulent medical health insurance claims

Due to the rapid advancement of clinical information technology, hospitals' record-keeping systems have amassed enormous amounts of data, prompting the scientific community to develop the technology of big facts. The discipline of science has greatly benefited from the introduction of medical big data, which has garnered interest from both academia and business [53]. An important area of research in scientific big statistics is the regulation of scientific cost. The traditional medical health insurance system pays for medical expenses based mostly on clinical provider items, which leads to too intensive medical procedures and rising medical costs. The single disease charge, which is entirely based on diagnosis-related agencies (DRGs), has been extensively researched and implemented to overcome the issues in the item-based fee system [53]. The single-disorder payment approach could be used for fraudulent health insurance. To take advantage of additional money from medical health insurance organizations, the healthcare provider, when assigning the diagnostic code for an inpatient, could swap out the genuine low-cost illness code for another high-fee disease code. The cost of manually reviewing each inpatient's medical statistics is incredibly high due to the enormous variety of inpatients. Since there are over 15 million inpatients in the Jiangsu province of China each year, it is impossible to personally audit each discharge diagnostic. As a result, the single illness price mechanism now faces an urgent problem how to successfully uncover plausible fraud.

3.9 Health information tracking, anonymizing records, and information encryption

In the study of Su et al. [54], the attribute-based signature technique was developed to secure the confidentiality of clinical stakeholders. Keys are known as master keys were introduced on this layout to indicate attributes connected to positive nodes and replace keys to authenticate users. In this plan, a few of the parties involved in the Blockchain community (which included doctors) were noted as having positive characteristics, such as "Hospital A. Department of Oncology. Senior Physician." These characteristics are removed from the affected person by an algorithm known as KUNodes after researching their background information.

In the study of Jeet et al. [55] they created a Blockchain-based system for collecting IoT data. In this system, wearables and sensors were used to gather and update patient statistics every second. As a result, brand-new signs of infection and sensitivity to pills might be immediately logged inside the Blockchain. This framework utilized SHA-256 encryption, and the techniques employed in this study shorten the encryption time. Table 6 shows the main contributions and gaps identified under Health information tracking, anonymizing records, and information Encryption.

In the research of Rajasekaran et al. [56] they offered a method for the healthcare Blockchain's cooperating parties to be authenticated. The anonymity of participating events within the healthcare Blockchain is supported by this lightweight authentication system. In this system, clinicians are permitted to share statistics about patients with other doctors without jeopardizing patient confidentiality or record security. Only authorized users can read the information about the healthcare topic using this scheme's authentication method.

Zhang et al. [57] proposed a Blockchain-based plan for secure medical data storage and sharing. A solution to the issue of information dispersion within the healthcare subject has been provided, and the authentication of all events involved in the healthcare system has been rigorously examined in this study.

In the study of Al Omar [58], they suggested MediBchain, a blockchain-based healthcare network where private data is encrypted using a public key encryption method (i.e. Elliptic Curve Cryptography (ECC)) across a secured channel. Additionally, Yang et al. [60] suggested that sensor data might be uploaded to the blockchain network using an exact pair of personal and public keys to protect the confidentiality and privacy of biometric records.

Zheng et al. [59] suggested using a threshold encryption technique along with a symmetric key scheme, such as Rijndael AES, to encrypt data before uploading it to cloud servers. Shamir's mystery-sharing approach can be used to divide the symmetric key into a few stocks that are distributed among several key keepers. The statistics requestor can only decipher the ciphertext if he obtains sufficient key stocks. Information leaking might no longer occur if a small number of key personnel (far less than the threshold) are compromised.

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Figure 13. The typical percentage of blockchain utilized in the publications that were reviewed

3.10 What sort of Blockchain became used within the present studies?

Figure 13, which shows the percentage of the Blockchain kind used in each study, illustrates the various types of Blockchains utilised in each paper. In the poll, private blockchain was used by 35% of respondents, hybrid blockchain by 10%, public blockchain by 43%, and consortium blockchain by 12%.

Table 6. Main contributions and gaps identified under Health information tracking, Anonymizing records, and information encryption

This review briefly discusses blockchain in healthcare and its use in different security issues. This security approach can account for various challenges and blockchain issues that depend on different aspects of security. Transaction Scalability, Availability, Security, and its Benefits. These security structures may be the subject of future research. This article aimed to present blockchain technology as a viable solution to EMR systems' interoperability and security issues in poor nations. Blockchain offers EMR system implementers the opportunity to overcome these challenges. The promise of blockchain is to enable efficient information exchange between stakeholders, protect patient privacy, and ensure data integrity. To date, the introduction of electronic health systems in many developing countries has met with significant resistance from physicians, patients, and regulators due to several legitimate concerns, including the security and privacy of patient records.

This article concludes that blockchain technology can address the current shortcomings of EMR system. The core of an EMR system is to ensure interoperability, privacy, and security of patient records. However, we argue that the adoption of blockchain applications should be gradual with each new technology. Additionally, unresolved issues surrounding the use of blockchain technology, among these are acceptance, rules, and ethics, which need to be taken into account.