SSHealth: Toward Secure, Blockchain-enabled

Healthcare Systems
Alaa Awad Abdellatif∗† , Abeer Z. Al-Marridi∗ , Amr Mohamed∗ , Aiman Erbad∗ , Carla Fabiana Chiasserini† ,
and Ahmed Refaey+
∗ Department of Computer Science and Engineering, Qatar University
† Department of Electronics and Telecommunications, Politecnico di Torino
+ Department of Electrical and Computer Engineering, Manhattan College

E-mail: {alaa.abdellatif, chiasserini}@polito.it, {aa1107191, amrm, aerbad}@qu.edu.qa,

ahussein01@manhattan.edu
arXiv:2006.10843v1 [cs.CY] 18 Jun 2020

Abstract—The future of healthcare systems is being shaped Moreover, medical data exchange across multiple entities can
by incorporating emerged technological innovations to drive new lead to a better quality level in the care for the patients,
models for patient care. By acquiring, integrating, analyzing, improving the response time in emergency conditions and a
and exchanging medical data at different system levels, new
practices can be introduced, offering a radical improvement to more accurate control and management of diseases. However,
healthcare services. This paper presents a novel smart and secure critical challenges have emerged, which need to be faced to
Healthcare system (ssHealth), which, leveraging advances in ensure high-quality services. Specifically,
edge computing and blockchain technologies, permits epidemics
• the massive real-time data collected from different health
discovering, remote monitoring, and fast emergency response.
The proposed system also allows for secure medical data exchange monitoring systems, which need to be efficiently stored,
among local healthcare entities, thus realizing the integration processed, and shared;
of multiple national and international entities and enabling the • fulfilling diverse security and privacy requirements, while
correlation of critical medical events for, e.g., emerging epidemics dealing with the complexity of data processing and trans-
management and control. In particular, we develop a blockchain-
fer;
based architecture and enable a flexible configuration thereof,
which optimize medical data sharing between different health • ensuring remote accessibility of medical data by different
entities and fulfil the diverse levels of Quality of Service (QoS) authorized entities to realize large-scale, low-cost health-
that ssHealth may require. Finally, we highlight the benefits of care and personalized medicine.
the proposed ssHealth system and possible directions for future
research. Additionally, it is worth noting that traditional healthcare sys-
Index Terms—Secure and smart health, blockchain, edge tems exhibit weak security protection and are often subject to
computing, medical data sharing, block verification. attacks: from 2016 to 2017, the number of reported healthcare
attacks1 increased by 89%. Thus, using encryption techniques
I. I NTRODUCTION in healthcare systems that provide high security levels is
Developing a smart, efficient and secure healthcare system essential, although they may result in high computational
for improving people’s quality of life is a top interest world- complexity and latency.
wide. A pivotal contribution to the development of smart- In this work, we argue that building a secure, trusted, and
health systems has come from some emerging technologies decentralized smart-healthcare system addressing the above
such as Internet of Things (IoT), Blockchain, and Edge challenges can be established leveraging edge computing and
Computing. Advanced e-health applications are expected to blockchain. Blockchain is a decentralized ledger of transac-
inspire fundamental transformations for the healthcare industry tions that are shared among multiple entities while preserving
towards Healthcare Industry 4.0 (Health 4.0) [1], especially the integrity and consistency of the shared data. It is considered
in pre-hospital emergency care situations and for geograph- as a revolutionary technology that will have a huge impact
ically remote areas [2]. In the age of IoT and Health 4.0, on the society: in the 2015 World Economic Forum2 report,
health-related applications are gaining momentum, as the 58% of the participants foresaw that 10% of global Gross
huge amount of data generated through that allows for more Domestic Product (GDP) will be related to the blockchain
in-depth medical studies and patients feel more secure if technology by 2025. Being decentralized, it well matches
their status is precisely monitored even outside the hospital. the potentiality of edge computing, which can effectively
support data storage and processing at different entities as
This work was made possible by grant # QUHI-CENG-19/20-1 from Qatar
University. The work of Abeer Z. Al-Marridi is supported by GSRA grant #
1 https://www.cryptonitenxt.com/resources
GSRA5-1-0326-18026 from the Qatar National Research Fund (a member of
Qatar Foundation). The findings achieved herein are solely the responsibility 2 https://www.weforum.org/reports/deep-shift-technology-tipping-points-
of the authors. and-societal-impact
well as their interconnection. We therefore aim at paving are crucial for the diagnosis and discovery of new therapies
the way to efficient, blockchain-based, smart-health systems for emerging diseases. However, medical data exchange across
and applications, by answering the following fundamental multiple organizations comes with many security and pri-
questions: vacy risks; in particular, without effective privacy-preserving
(i) is blockchain a valid solution for realizing healthcare schemes in place, users may not accept to share their data with
systems? others, which would impair the creation of a system integrating
(ii) and, how can we leverage the blockchain capabilities all healthcare entities. Thus, it is mandatory to provide secure
and the edge computing potentialities to fulfil diverse data access and to prevent tracking users’ identity as well as
healthcare applications’ requirements? raw data disclosure.
We address the above aspects as follows: Management of patients’ flow: While detecting and pre-
dicting patients’ state through data analytic within one orga-
1) we propose a smart, secure, and decentralized healthcare nization maybe possible, managing and correlating patients’
system that relies on blockchain and edge computing related data across multiple entities is quite hard. The problem
technologies to provide a convenient data sharing among is not due to insufficient resources, but due to insufficient
multiple entities; resource management. The challenge resides in the ability of
2) we formulate a flexible configuration model that enables healthcare providers to foresee patients’ flow, which demands
the blockchain system to support diverse QoS require- for predictive analytics and collaboration among different en-
ments, and we develop an efficient algorithm to solve tities to align available resources to the forthcoming demand.
this model;
Support of diverse QoS requirements: Different E-health
3) through numerical results, we show the effectiveness
applications require diverse QoS requirements, including high
of the proposed approach in improving the blockchain
data rates, data accessibility anytime and anywhere, low
performance for healthcare applications.
latency, etc. This imposes the need for designing a cus-
In what follows, we highlight the advantages of using tomized/reconfigurable system that can support diverse appli-
blockchain within a healthcare system and present some rele- cations’ requirements.
vant related work (Section II). We then introduce the proposed Blockchain appears as a perfect solution to all of the above
ssHealth system architecture leveraging edge computing and issues. It provides fast, secure exchange and storage of medical
blockchain, and we present the associated blockchain config- data, and it can aggregate different health entities, with diverse
uration model (Section III). Finally, we show the benefits of policies, and make them part of a unique national healthcare
leveraging blockchain and edge computing capabilities within system. The power of security in blockchain comes from the
the proposed architecture (Section IV), and conclude the paper collective resources of the crowd, since, most of the entities
by highlighting possible directions that are worth to be further have to verify each block of data using a consensus algorithm3 ,
investigated (Section V). e.g. Delegated Proof-of Stake (DPoS) [5]. Hence, any cyber
attack has to beat the resources of the whole crowd collectively
II. B LOCKCHAIN FOR H EALTHCARE S YSTEMS
to be able to hack the integrity of the data.
In this section, we discuss the key features of a blockchain-
based healthcare systems, also in the light of the recent, related B. Related work on blockchain-based healthcare systems
literature. Recently, different types of blockchains have been envi-
A. Why blockchain is needed for healthcare systems? sioned for the healthcare sector, including public and pri-
vate blockchains. Public blockchains offer decentralized and
A healthcare system comprises diverse organizations, peo- secure data sharing, however, when advanced control and
ple, and actions whose fundamental role is to monitor, pro- privacy are required, private or permissioned models turn
mote, and maintain people’s health. It includes, for instance, to be more efficient. Several blockchain frameworks (e.g.,
private clinics, pharmacies, hospitals, health insurance com- Ethereum and Hyper ledger Fabric), smart contracts4 , and
panies, occupational health and safety legislation, as well as consensus algorithms have been investigated in the literature.
the ministry of health. Effective e-health systems must provide The general blockchain architecture mainly consists of: data
fast response with high quality service level and security for sender, Blockchain Manager (BM), and verifiers. First, data
the entire population, while simultaneously promoting disease senders upload their data as “transactions” to the nearby
prevention and managing costs. To this end, the following BM. Then the BM acts as a verifiers’ manager: it generates
issues have to be adequately addressed. unverified blocks, distributes them across the verifiers, triggers
Security and privacy: Real-time access to clinical pa- the consensus process, and inserts the verified blocks in the
tient’s records enables e-health systems to give timely care
to the patients through the nearest point of care. Furthermore, 3 Consensus algorithms are mechanisms that ensure the integrity and con-

healthcare entities may need to share relevant data to provide sistency of the blockchain across all the participating entities [5].
4 A smart contract is a software that contains all instructions and rules agreed
national first response to epidemics, improved national wide
upon by all the entities to be applied on the blockchain: all the transactions
statistics, and enhanced quality of healthcare services. Finally, need to be consistent with the smart contract before being added to the
the dissemination, processing, and analysis of medical data blockchain.
 TABLE I
S UMMARY OF THE RELEVANT WORK ON BLOCKCHAIN IN HEALTHCARE SYSTEMS
Blockchain Type Description Limitations Entities
Private (Ethereum) Blockchain system links patients with doctors Latency Patients
Consensus: Practical Byzantine using customized smart contract to record scalability Hospitals
Fault Tolerance (PBFT) all events on the blockchain
class: patient [3]
Private (Ethereum) A blockchain framework is proposed Scalability Patients
Consensus: Proof of Work (PoW) for searching encrypted index of Electronic Hospitals
class: patient [4] Health Records (EHRs) while real data Medical labs
stored in database Insurance companies
Private (consortium) Parallel healthcare system using blockchain, Latency Patients
Consensus: delegated proof of technology is proposed to link various scalability Hospitals
stake (DPoS) parties for medical data sharing security Healthcare communities
class: patient [5] Researchers
Private (Ethereum) Blockchain framework is proposed to connect Scalability Patients
Consensus: PoW the patients with the hospitals to enable Hospitals
class: patient [6] health-related information exchange Healthcare institutions
Private (Hyperledger fabric) Blockchain framework is proposed for sharing Scalability Patients
Consensus: Byzantine fault-tolerant processed medical data between Patients approval Healthcare providers
state machine replication different healthcare entities
class: patient [7]
Private (Ethereum) Framework of dual blockchains is proposed, Storage System manager
Consensus: proof of conformance one to store and share the index of the scalability Hospitals
class: entity [8] EHR with multiple hospitals, and the
other to store the original data
Public (Ethereum) Propose a framework of two coupled blockchains Latency Patients
Consensus: PoW for managing the storage of two types of scalability Medical institutions
class: entity [9] data to enhance the throughput, accessibility, computational cost
and fairness among users
Private (MeDShare) Blockchain system is proposed to provide Privacy Patients
Consensus: using consensus nodes medical data sharing, auditing, and scalability Hospitals
class: patient [10] control over diverse entities Research institutions
Private (Hyper ledger fabric) Blockchain has been integrated with a tree-based Privacy Patients
Consensus: voting-based approach method for medical data sharing between scalability Doctors
class: patient [11] different entities Insurance companies

blockchain. Hence, the BM acts as the leader, while the for storing the data while the consortium blockchain stores
verifiers are the followers that cooperate to complete the block the index of the data. However, allowing data storage at a
verification task. In line with the traditional DPoS consensus single entity comes with the risk of a single point of failure,
scheme, the verifiers take turns to work as BM for a given while considering two types of blockchain may have an impact
period of time [12]. in terms of computational cost. We therefore envision a
solution that combines a blockchain-enabled architecture with
For healthcare applications, the blockchain architectures
intelligent processing at the edge, so as to support fast, secure,
that have been proposed so far can be broadly classified
and scalable exchange of medical data.
into two categories: patient-based and entity-based. In patient-
based architectures, patients participate in the blockchain and III. SS H EALTH A RCHITECTURE AND B LOCKCHAIN
transactions are driven by the patient directly. However, such C ONFIGURATION
architectures have a limitation in terms of system’s scalability. We now describe the proposed ssHealth system architecture,
In entity-based architectures, instead, health organizations, then we discuss the blockchain approach we adopt. Finally,
hospitals, research institutes, and alike are the main actors, we present a method for optimally configuring the blockchain
while patients only interact with the health organizations to system so that it effectively addresses the challenges and
acquire the service they need. According to our survey, 83% requirements posed by diverse e-health applications.
of the systems proposed since 2016 are patient based, while
17% are entity based. Table I reports recent works in this A. ssHealth architecture
area, highlighting the encryption techniques and consensus The proposed system architecture, shown in Figure 1, in-
algorithms they adopt, as well as some of the limitations they cludes two main network sub-systems: (a) a Local network
exhibit. In particular, several approaches suffer from poor and (b) a Blockchain network. For the sake of scalability,
scalability and slow response. Being swift response a major it is assumed that healthcare entities collect health-related
goal for emergency care, some studies aim to overcome these information from the local network, process these data, and
limitations using: (i) an external database at the data owner share important information through the blockchain network.
[4], which stores the raw data and shares the index to the data The shared data are validated and stored locally by the
in the blockchain, (ii) a private blockchain and a consortium different entities in the blockchain, which are trusted entities
blockchain [8], where the private blockchain is responsible with large storage and computational capabilities [13].
 Pharmacy

Local Network
Ministry of Public Health
Sub
trans mit
actio

D
Smart Home

at
n

a
Vali Verified transaction
d atio

ta
Da
n
Hospital secured
data
(LHSP) Blockchain
IE
Network
Patient’s
relatives
Patient Vali
d atio
n
Sm
Ho art
me

Hospital
Insurance company (EE)

Doctor
National Institute
of Health Private Clinic
Local Network

Fig. 1. Proposed ssHealth system architecture.

The local network stretches from the data sources located Importantly, the LHSP plays a significant role in monitoring
on or around patients to the Local Healthcare Service Provider of patients’ state not only inside the hospital (intra-hospital
(LHSP), e.g., a hospital. It contains the following major patient care), but also outside (e.g., home patient care). Also,
components: it can be connected with the private-local clinics that may
a.1) Internet of Medical Things (IoMT): A combination of transfer patients to it for more advanced care, or even with
sensor nodes attached/near to the patients to be leveraged for patient’s relatives to follow up on the patient’s conditions.
monitoring health conditions and activities within the smart
As far as the blockchain network is concerned (see Fig-
assisted environment. Examples include: body area sensor
ure 1), the core is the blockchain-based data sharing archi-
networks (i.e., implantable or wearable sensors that measure
tecture that enables secure access, processing, and sharing of
different biosignals and vital signs), smartphones, IP cameras,
medical data among healthcare entities. Blockchain is suitable
and external medical and non-medical devices.
for secure medical data sharing because of its immutability
a.2) Internal Edge (IE): This edge node implements local
and decentralization features, which are perfectly consistent
processing functions between the data sources and the LHSP.
with our proposed ssHealth architecture. Using blockchain, all
Specifically, the IE analyzes the gathered medical and non-
transaction blocks (i.e., containing health-related information)
medical data from different sources, obtains the information of
can be securely shared, accessed, and stored by physicians,
interest, and forwards the processed data/extracted information
decision makers, and other healthcare entities. The latter ones
to the LHSP. Moreover, IE can be a mobile node (e.g., a
include, but are not limited to:
smartphone) or an infrastructure edge node (e.g., a wireless
b.1) External Edge (EE): In the proposed architecture, a
router or an access point). Importantly, the IE can optimize
hospital or an LHSP have more advanced tasks than the ones
the medical data delivery based on the context (i.e., data type,
mentioned above: it can act as an EE that is responsible for
supported application, and patient’s state) as well as on the
data storage, applying sophisticated data analysis techniques,
conditions of wireless connectivity. Furthermore, different spe-
population health management, and sharing important health-
cialized healthcare applications can be implemented at the IE
related information with public health entities. Hence, lever-
to allow patients to actively participate in their treatment and
aging the power of edge computing, each entity can verify the
ubiquitously interact with their doctors anytime and anywhere.
authenticity and integrity of the medical data at the EE before
a.3) Local Healthcare Service Provider (LHSP): An LHSP
sharing it within the blockchain.
can be a hospital, which monitors and provides the required
b.2) Insurance companies: One important aspect for e-health
healthcare services for the local patients, records the patients’
systems is integrating healthcare providers, patients, and pay-
state, and puts in place fast emergency services if needed.
ers into one “digitized community”, in order to improve quality
of services and drive costs down. Indeed, to realize a sustain- blockchain configuration in terms of number of verifiers and
able healthcare-business model, healthcare providers will have number of transactions per block. These parameters should
to own health plans powered by insurance companies. be dynamically set based on the diverse applications’ require-
b.3) Pharmacies: The main pharmacies’ duties include pro- ments and data types, and in such a way that the optimal
cessing prescriptions, storing and providing access to dis- trade-off among security, latency, and cost is established. As
bursed prescriptions, and ensuring patients’ privacy. On top an example, Figure 2 illustrates the case where high-priority
of it, pharmacies have to coordinate with private insurance data are received requiring minimum security, e.g., emergency
companies to submit insurance claims, ensure payment, and notifications, and should be dealt with a restricted blockchain,
resolve denials of coverage. Pharmacies may also communi- i.e., minimum number of verifiers. On the contrary, for low
cate with prescribers to confirm the dosage and formulation priority types of data but requiring a high security level (such
(e.g., liquid or tablet), or to replace prescribed brand name as video monitoring), fully restricted blockchain mode should
with a generic equivalent. Thus, it is crucial to have a secure be used. In general, the more verifiers participate in the block
communication system to exchange such information with verification stage, the higher the security level is, but also the
different associated entities. larger the latency (due to the verification delay) and the higher
b.4) National Institutes of Health (NIH): NIH are major the cost (due to verification fees) that are experienced [12],
players in clinical research and health education. The latter in [14]. Instead, as the number of transactions per block grows,
particular is a process in which all public healthcare institutes, the latency increases, while the cost per transaction decreases.
hospitals, and medical care personnel are involved. Thus, NIH We also remark that data types and priorities are defined at the
should cooperate with healthcare service providers to develop edge by applying different data classification, event detection,
joint educational programs and services for pursuit scientific and summarization techniques.
research and preventive medicine. As a case study, we focus on private blockchain framework
b.5) Ministry of Public Health (MOPH): The main role with DPoS consensus scheme, which performs the consensus
of MOPH is monitoring the quality and effectiveness of process using pre-selected verifiers with moderate cost. Also,
healthcare services through coordination with different health we consider that the BM resides at the EE and has to: (i)
entities. MOPH waives the responsibility of healthcare services detect the patient’s context (including patient’s conditions, data
to the hands of public and private health sectors while regu- type, and security requirements), and (ii) map the patient’s
lating, monitoring, and evaluating their healthcare services to context into different configuration modes of the blockchain.
guarantee an acceptable quality of care level. Thus, MOPH To represent the different conflicting metrics the BM has to
is committed to establishing an environment that promotes play with, namely, latency (L), security (S), and cost (C), we
high-quality services by sharing relevant information with its define an aggregate utility U , which combines them into a
partners such as health insurance companies. single function:

B. Optimal blockchain configuration L sm C

U =α· +β· +γ· , (1)
lm S cm
Leveraging the above ssHealth architecture, we develop a
blockchain-based data sharing scheme that enables medical where α, β, and γ are weighting coefficients that represent
data access, processing, and sharing among the aforemen- the relative importance of the considered metrics, such that
tioned healthcare entities. However, blockchain poses a new α + β + γ = 1. However, these metrics has different values
challenge, i.e., finding the optimal trade-off among security and units, which must be normalized with respect to their
level, latency, and cost. Indeed, due to the need of coordinating maximum value (denoted by lm , sm , and cm , respectively)
the transactions of multiple entities, public blockchain is to make them comparable.
slower than traditional databases, implying a service latency The BM can then set the best blockchain configuration, by
that may be unacceptable for several applications (e.g., emer- solving the following problem:
gency management). We address this challenge by designing a L sm C
priority-based secure data sharing scheme, as detailed below. minimize α· +β· +γ·
m,θ lm S cm
We draw on the BM concept (see Section II-B), i.e., a (2)
subject to v ≤ m ≤ M,
logical role that any entity in the proposed architecture can
t ≤ θ ≤ N,
take on, possibly by taking turns, or that can be taken by the
EE that wants to share its data. In particular, in our scheme where m is the number of selected verifiers, with maximum
the BM is in charge of: (i) collecting the transactions received and minimum values equal to M and v, respectively, and
from the different entities, (ii) preparing and distributing un- θ is the number of transactions per block, with maximum
verified blocks to the verifies (e.g., hospitals, NIH, and MOPH, and minimum values equal to N and t, respectively. In (1),
which have sufficient computation and storage resources), (iii) the security level is defined as S = κ · mq , where κ is a
updating blockchain configuration considering urgency and coefficient given by the system, and q ≥ 2 is an indicator
security level of the collected data, and (iv) interacting with factor representing the network scale [12]. L refers to the
the verifiers to complete the block verification tasks. BM is verification latency, which includes the four steps of the block
thus a critical component, which should carefully select the verification process: (i) unverified block transmission from the
 Blockchain Security
Demand Level

Mode IV
Intensive Critical Security
Priority Data type
Level
High Mode III High Urgent Emergency notifications Low
High Physiological signals Moderate

Moderate Mode II Moderate Medium Vital images High

Low Video monitoring Critical
Low Mode I Low

Low Medium High Urgent

Priority
Fig. 2. Blockchain modes based on the data priority and required security level.

TABLE II Algorithm 1 Blockchain Mode Optimization

S IMULATION PARAMETERS 1: Input: xi , ρi , v, M , t, N .
Parameter Value Parameter Value 2: Initially: set m = v, θ = t, and compute U as in (1).
M 10 N 20
3: for m = v : M do
v 2 t 2
rd 1.2 Mb/s ru 1.3 Mb/s 4: for θ = t + 1 : N do
O 0.5 Mb B 1 kb 5: Update U based on (1).
6: if U (θ) > U (θ − 1) then
7: θ∗ = θ − 1.
BM to the verifiers, (ii) block verification time, (iii) verification
8: Break % θ∗ is obtained
result broadcasting and comparison among verifiers, and (iv)
9: end if
verification feedback transmission from the verifiers to the
10: end for
BM. Hence, the normalized latency is defined, according to
11: if m > v & U (m) > U (m − 1) then
[12], as
  12: m∗ = m − 1.
θ·B K O 13: Break % m∗ is obtained
L= + max + ψ · θ · B · m + , (3)
rd i∈{v,··· ,M } xi ru 14: end if
where B is the transaction size, K is the required computa- 15: end for
tional resources for block verification task, xi is the amount 16: Output: m∗ , θ ∗ .
of available computational resources at verifier i, O is the
verification feedback size, and rd and ru are, respectively,
the downlink and the uplink transmission rate, from the BM θ vary, for applications with similar requirements in terms of
to the verifiers and vice versa. In (3), ψ is a predefined security, latency, and cost (α = β = γ). Other simulation
parameter that can be defined leveraging the statistics on parameters are reported in Table II. Furthermore, Figure 4
previous processes of block verification (as P detailed in [12]). shows the convergence behavior of the proposed algorithm to
m
ci
Finally, the cost function is defined as C = i=1 θ , where ci the optimal solution obtained by exhaustive search (or brute-
is the computational cost of verifier i, given by ci = ρi · xi . force search) [16], for M = 10 and N = 20. We observe
Therein, ρi represents the payment from verifier i to a cloud that our algorithm requires only 23 iterations to reach the
service provider, in order to acquire the needed resources for optimal solution compared to exhaustive search that still does
the verification process. not converge after 200 iterations.
By defining the weighting coefficients α, β, and γ as
functions of data types and application’s requirements, the IV. B ENEFITS OF SS H EALTH
optimal number of verifiers m∗ and transactions per block θ∗ Given the requirements of e-health applications discussed in
are obtained by solving (2). However, the above optimization Section II, we now highlight the effectiveness of our ssHealth
problem is an integer programming optimization, which is an system in fulfilling such requirements.
NP-complete problem [15]. In light of the problem complexity, Privacy and security: Slicing the overall system into local
we propose Algorithm 1 for an efficient and swift solution. and blockchain network facilitates medical data processing,
In this algorithm, verifiers are selected in an ascending order accessing, sharing, and storage while dealing with encrypted
based on their associated latency, i.e., those verifiers that finish data throughout the entire process. The proposed ssHealth sys-
block verification faster will be selected first. tem enhances accessibility and information sharing between
Figure 3 depicts the variations in the objective U as the patients and hospitals to provide effective and safe healthcare
number of verifiers m and the number of transactions per block services, while protecting healthcare systems from cybersecu-
 the workload among different entities, enabling secure data
exchange, avoiding the hurdles of managing the available
resources or data warehouse. Furthermore, it enables building
0.5
a scalable and reliable healthcare system by: (i) connecting
0.4
different physician groups and health entities, which facili-
tates the implementation of clinically-integrated, high-value
0.3 networks for better patient care; (ii) enabling secure medical
data sharing, which helps health institutes and pharmacies to
U

0.2
anticipate and manage resources across their health systems
0.1 (e.g., hospital capacity and drugs).
Fulfilling diverse QoS requirements: The proposed ssHealth
0 system can not only transfer massive amounts of data securely,
10
20
but also analyze data efficiently at the EE to extract meaningful
5 15 and concise information to be shared with the other entities.
m 10
Moreover, it efficiently supports different types of applications
5 n
0 0 and data according to their QoS requirements, e.g., demands
Fig. 3. The proposed utility function as the number of verifiers (m) and the
for high data rates and swift response.
number of transactions per block (θ) vary. At last, we remark that the proposed system allows for
improved healthcare services by developing a patient-centric,
physician-aligned healthcare management model. Such ar-
0.5 Proposed algorithm
Exhaustive search
chitecture can be leveraged to avoid visits to the hospital
0.45 emergency wards in non-critical situations, thus reducing costs
and improving health-case services for patients with serious
0.4
conditions.
0.35
V. C ONCLUSIONS AND F UTURE D IRECTIONS
0.3
U

0.25
In this paper, we envisioned a novel e-health system for
creating effective, large-scale and collaborative systems able
0.2 to provide high-quality patients’ care and to make significant
advancements in disease treatments through secure data shar-
0.15
ing. The proposed ssHealth system integrates edge computing
0.1 and blockchain to enable the exchange of large amount of
0 20 40 60 80 100 120 140 160 180 200 medical data generated by different healthcare entities, while
Number of Iterations preserving the patients’ privacy. Additionally, we defined
Fig. 4. Convergence behavior of the proposed algorithm compared to the a novel mechanism that can be implemented within the
solution obtained through exhaustive search. blockchain network to ensure fast response, scalability, and
secure transmission of medical data. It is shown that map-
ping the characteristics of the collected data onto appropriate
rity threats. It also allows for preventing privacy threats that configurations of the blockchain can significantly enhance the
data sharing entails leveraging blockchain technology, which performance of the overall ssHealth system, while satisfying
provides a finite number of authorized entities with secure diverse applications’ requirements.
access to patients’ health records by embedding access control In this context, several promising directions for future
rules in the smart contracts. Moreover, edge computing capa- research emerge, which include:
bilities enable each entity (at the EE) to verify the authenticity (i) Developing various cybersecurity schemes at the IE and
and integrity of the medical data before sharing it within the EE to achieve a robust privacy protection of medical data
blockchain network. and patients’ profiles. Maximizing security level for health
We remark that designing novel privacy-preserving schemes applications may substantially degrade QoS and cause ser-
for the blockchain is not within the scope of this paper, but the vice disruption. Thus, considering the concept of quality
proposed architecture can accommodate different techniques at of protection (QoP) while providing security and privacy is
both the IE and the EE, in order to ensure the required privacy mandatory. In this regard, developing QoP-aware schemes can
level. ensure different levels of anonymity and privacy, and optimize
Scalability and management: For implementing an effective misbehavior detection and encryption, according to the type of
healthcare system, various entities should collaborate, and a the collected data and the level of emergency of the situations
global health system should be created. The proposed ssHealth we have to deal with.
system realizes such collaboration efficiently by: splitting (ii) Further optimizing the blockchain parameters, such as
block size, transaction size, and number of blockchain chan- [6] A. Al Omar, M. Z. A. Bhuiyan, A. Basu, S. Kiyomoto, and M. S.
nels. With the evolution of the blockchain, new features Rahman, “Privacy-friendly platform for healthcare data in cloud based
on blockchain environment,” Future Generation Computer Systems,
have been added for enhancing security and scalability. One vol. 95, pp. 511–521, 2019.
important feature is the multi-channel blockchain network, [7] B. Shen, J. Guo, and Y. Yang, “MedChain: efficient healthcare data
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