Blockchain enabled electronic medical record with hyperledger composer

Blockchain Enabled Electronic Medical Record with Hyperledger Composer 1 Blockchain Enabled Electronic Medical Record With Hyperledger Composer I Gusti Ayu Kusdiah Gemeliarana1, Delphi Hanggoro1, Riri[.]

2021 8th NAFOSTED Conference on Information and Computer Science (NICS) Blockchain-Enabled Electronic Medical Record With Hyperledger Composer I Gusti Ayu Kusdiah Gemeliarana1, Delphi Hanggoro1, Riri Fitri Sari1, Daniela M Romano2 Department of Electrical Engineering, Faculty of Engineering Universitas Indonesia Depok 16424, Indonesia i.gusti79@ui.ac.id, delphi.hanggoro@ui.ac.id, riri@ui.ac.id Department of Information Studies University College London WC 1E6BT London d.romano@ucl.ac.uk data is also required Searching for information is relatively time-consuming, such that it can interfere with the patient's handling process Written patient history records are often unclear and lead to errors in providing health services Information systems that support work efficiency, time, and human resources in recording patient medical history data need to be built to obtain convenience and fluency Abstract— Medical records are files that contain records and documents about patients' identities, examinations, treatments and actions, and other services while the patients are receiving health services Medical records are personal data that can only be accessed by authorized personnel Some problems occur, such as the difficulty in managing files for grouping patients' medical record data based on specific categories such as the documentation year or patients' biodata A large storage area is needed to hold medical record data and the absence of backup data in data storage Blockchain-based solutions help overcome this problem Hyperledger Composer is an open and extensive development framework for blockchain systems Hyperledger Composer allows us to quickly model business networks and integrate them into an application or system that we have created easy and save time Hyperledger consists of main files, model file, script file, and access control file, which have coding flexibility and are easier to understand Hyperledger Composer uses the JavaScript language for coding and has a client library for node.js In this study, we propose a medical record sharing model that combines blockchain with the Hyperledger Composer and conducts a performance evaluation of the implementation The result shows the increase of transactions during testing in which the system could store data into blocks to record medical transactions In recent years, there have been new technological discoveries, and one of such is blockchains A blockchain can be applied in several fields, including health, economics, and education A blockchain is a network of decentralized nodes that can communicate All communications are recorded in a centralized database Communication or transactions are recorded on several nodes and stored at the consensus of each node After the records are stored on the blockchain, no one can change them [1] Any unauthorized changes can be detected This new mechanism can bring trust between two agencies or two parties, such as patient and health personnel (doctors, pharmacists, and laboratory scientists), and allow them to conduct business transactions without involving trusted third parties In many use cases, providing medical records requires trust among various stakeholders The term electronic medical record (EMR) is an organized collection of patients' medical data to present information to providers, other authorized users, and, in some cases, patients The EMR includes non-electronic health record data such as references to clinical laboratory tests Blockchain-based solutions help overcome this problem One solution from IBM is providing Hyperledger Composers These composers are based on rolebased access control Mikula et al [2] proposed a system for identity and access management utilizing blockchain innovation to help validate and approve substances in advanced systems Their study assembled a model exhibiting a blockchain application in identity and access management utilizing the Hyperledger Fabric It provides a proof of concept-based use case on electronic health records from the health care domain with timeless and auditable history stored as patient data needs Liu et al [3] proposed the concept of sharing blockchain-based personal electronic medical record data called Blockchain Privacy-Preserving Data Sharing (BPDS) Their proposal uses a consortium blockchain to back up the index data, while the original data will be stored in the cloud The goal is to reduce the risk of leaking medical records Through blockchain smart contracts, we can share data securely and automatically As a result, their proposal is claimed to be an effective and safe way to share data By implementing BPDS, patients can fully control their medical record data In addition, if other parties need the data, the other Keywords— Electronic Health Record (EHR), blockchain, bitcoin, smart contract, hyperledger composer I INTRODUCTION At present, technology is increasingly developing, especially information technology The development of information technology makes it easier for humans to carry out activities Such developments have extended to the field of health services, in which information systems can help smoothen the manual process of recording medical records Medical records (health records) are files that contain notes and documents about patients' identities, examinations, treatments and actions, and other services while the patients are receiving treatment in a healthcare facility Medical records are personal and important data about a patient receiving health services The ownership of such information is the basic interest of a patient, and the data is confidential and only accessible by authorized personnel General medical records in the form of paper files along with document attachments are written manually by medical personnel Problems often occur, such as the difficulty in managing records for grouping patients' medical record data, are based on specific categories, such as the year of documentation or patients' bio-data A large storage area is needed to hold medical record data in data storage Backup 978-1-6654-1001-4/21/$31.00 ©2021 IEEE 71 2021 8th NAFOSTED Conference on Information and Computer Science (NICS) party can easily use the data without endangering the patient's privacy Zhang et al [4] propose a new access model and scheme for blockchain-based electronic medical record (EMR) sharing, namely a block-based access control scheme (BBACS) They propose to remove the agent layer (gateway) to regulate user access based on the granularity level of the block while maintaining compatibility with the underlying blockchain data structure Their proposed algorithm can make local computation efficient (time cost) and eliminate public key infrastructure Liang et al [5] propose a blockchain system controlled by mobile devices to access, collaborate and share medical record data They built the system on a permissioned blockchain Hyperledger fabric This blockchain system requires the validation of nodes in the network to create a private healthcare system with secure privacy and an emphasis on ownership of health data Wu et al [6] propose an electronic medical record security sharing model dependent on a blockchain (EMRSB) Blockchain innovation can guarantee that distributed medical information won't be lost and altered inside the most common way of sharing, saving time for information confirmation To overcome privacy leaks, we can use data masking technology The statistical characteristics of the data will be maintained but sacrifice a little the accuracy of some data In addition, IPFS is used to store various detailed medical record data and save storage resources in the blockchain De Oliveira et al [7] proposes an electronic medical record approach using a permitted and private blockchain, where patient information data will be encrypted as transactions in the blockchain They use asymmetric cryptographic algorithms on their blockchain system Patients are in control of the control to access and transact their information Thus the patient can provide access to control to a responsible and trusted party Patients can grant access control to their EMR description by creating a transaction to assign a session key to the address in question Linn et al [8] proposed health records with blockchain-based access control to address the industry interoperability challenges Health Information Technology (ONC) described Likewise, interoperability is a basic part of any framework supporting Patient-Centered Outcomes Research (PCOR) and the Precision Medicine Initiative (PMI) Blockchain-based national healthcare IT infrastructure can advance medical research and precision medicine and hold patients accountable for their health and data security Moreover, it benefits healthcare records compatible with the system for designing and sharing information across clinics or hospitals This paper makes the following contributions: We investigate the performance of the proposed model The Hyperledger Composer model is an open-source development tool that allows blockchain applications to be more accessible This device can integrate existing systems and data with the blockchain application We built a system specifically designed to share health documents (healthcare) in the Hyperledger Composer as tools among various roles to help prove all transactions in setting healthcare records for new healthcare applications designed on the blockchain The system is built using access control as a core function when working on the healthcare system II EHR & BLOCKCHAIN A Electronic Health Record (EHR) Since the emergence of health services, medical records are needed for historical records for patients Initially, medical records were made to record possible causes of illness and disease In the 1960-1970s, several governments of certain countries regulated and passed Medicare laws At the same time that health lawsuits began to grow, the government issued better regulations to regulate the industry, and the quality of health services became a necessity [9] The use of electronic health records has been slow to be understood by doctors and health care providers In 2009 it was estimated that less than 8% of hospitals had electronic health records [10] The lack of enthusiasm of doctors and health care providers in medical records is due to nonstandardized systems, huge system costs, and health care providers who spend a lot of time and money to comply with government regulations and patient privacy requirements [11] The EHR empowers clinical work cycles to be redesigned to make them more effective and save medical record work [12] B Blockchain The blockchain is a decentralized ledger initially intended to record digital currency transactions in digital currency networks Cryptography and blockchain, which Satoshi Nakamoto developed in 2008, make up the first decentralized digital currency technology, "Bitcoin" [13] Bitcoin is a peerto-peer (P2P) network that does not require a centralized system, so no one can set up or host from the system to centrally store transaction history Instead, the blockchain system will store all copies of transactions on all network members, thus forming a decentralized ledger Each node in the blockchain contains a private and public key Each transaction that begins includes some necessary information related to the sender, recipient, asset information, time, and an identifier for the previous sender transaction Assets can be any product in the supply chain or transactions between buyers and sellers [14] The blockchain uses the SHA256 cryptographic hash function to encrypt transaction to 16-digit hexadecimal The hash function wraps the block using transactional information and the sender's public key This In this work, we build a system specifically created to share healthcare documents in the Hyperledger Composer among various functions Our work is expected to prove all transactions in setting healthcare records Therefore, it can be used for new healthcare applications designed on the blockchain Access control is a core function needed when working in this healthcare system In the Hyperledger concept, a distributed mechanism is used to store transactions They have ensured that various stakeholders in e-health know about those who deal with e-Health resources to maintain data integrity, scalability, and authenticity Hyperledger Composer is an open and extensive development framework for blockchain systems Hyperledger Composer allows us to quickly model business networks and integrate them into an application or system that we have created easy and save time Hyperledger consists of main files, model file (.cto), script file (.js), and access control file (.acl), which have coding flexibility and are easier to understand These components build business networks by archiving the results of business networks in a bna file 72 2021 8th NAFOSTED Conference on Information and Computer Science (NICS) wrapping hash is unique because it combines transactional data and the sender's public key Several randomly grouped transactions are called a block This encrypted transaction information is translated to verify the transaction authenticity, and the sender can be decrypted only with brute force by randomly trying various possible combinations The hash completion process is called mining, and the node that verifies this transaction is called a miner After the network blocks form a collection of unverified transactions, available miners will compete to verify transactions by completing cryptographic hashes D Hyperledger Tools Hyperledger incubates and promotes various business blockchain technologies, including tools and utility libraries [15] Hyperledger Caliper: a tool to measure the performance (benchmark) of Hyperledger blockchain with a predefined use case Hyperledger Cello: Hyperledger Cello intends to fill in as the functional dashboard for blockchain, decreasing the work needed to oversee and utilize blockchains Moreover, it can likewise be used to make Blockchain a Service Hyperledger Composer: Open development toolset and framework to simplify blockchain application development Hyperledger Explorer: easy to understand Web application instrument used to see, conjure, send or query blocks, exchanges and related information, network data (list of nodes, status, name), chain codes and exchange families, just as some other important data stored in the ledger Hyperledger Quilt: inter ledger with Java implementation, a standard and a set of protocols and standards that allow interaction between applications for payments in any currency - fiat or crypto In a blockchain network, transactions can be carried out between two nodes (P2P) without authentication by a centralized system In this way, blockchain eliminates the role of a centralized system, eliminating server operating costs such as development and operation costs Blockchain also has several characteristics, namely: Persistency: Transaction data that is propagated on the network has been confirmed, entered into a block and then distributed to all network members Faking the process is nearly impossible In addition, every block received during propagation will be validated, and each block will be checked Therefore fictional transactions will be easily detected Anonymity: Each network member interacts with an anonymous address Members can generate multiple addresses to avoid identity exposure In the blockchain, no entity stores the personal information of the members Thus the blockchain can maintain the privacy of each member and transaction Auditability: All network members will validate all blockchain transactions and record them with an additional timestamp Thus users can track transaction records by accessing every node in the blockchain network Each block can be traced to the last block iteratively Thus blockchain can increase data transparency and easily track data in blocks [9] III SYSTEM DESIGN In this section, we explain the general system flow and the system design of the Hyperledger Composer C Hyperledger Platform The Hyperledger project was assigned to incubate blockchain technology built for business [15] Hyperledger has several platforms, including: Hyperledger Burrow [16]: Modular blockchain clients with smart contracts that allow translators to be partially developed with the Ethereum Virtual Machine specifications Hyperledger Fabric [17]: Modular platform for building a distributed ledger has high scalability, resilience, flexibility and confidentiality Hyperledger Fabric can easily be developed and adapted to the needs of other industries Hyperledger Indy [18]: A distributed ledger that provides reusable components, libraries and tools that have been specifically for decentralized identity Hyperledger Sawtooth [19]: A modular distributed ledger platform Used to run, deploy and build distributed ledgers Sawtooth introduces and implements a new type of consensus, Proof of Elapsed Time (PoET) which does not consume as many resources as Proof of Work (PoW) Figure General system design 73 2021 8th NAFOSTED Conference on Information and Computer Science (NICS) Figure Proposed Health Service Flow Figure shows the general system architecture Users such as doctors, patients, path labs and chemists can access the system from the runtime implementation, e.g., Web Hyperledger Composer empowers developers to make "fullstack" blockchain arrangements rapidly For example, a business rationale that sudden spikes in demand for the blockchain, REST APIs that uncover the blockchain rationale to a web or portable applications, just as incorporating the blockchain with existing endeavour frameworks of record Moreover, it coordinates the blockchain with existing undertaking recording frameworks Hyperledger Composer has been intended to help diverse pluggable runtimes, and right now, it has three runtime executions: Hyperledger Fabric, to store the state on the distributed ledger Web, which executes inside a website page It is utilized by the web base (Playground), and the state is put away in a program nearby capacity Embedded execution happens inside a Node.js interaction and is utilized fundamentally for unit testing business rationale B Hyperledger Composer Design In Hyperledger Composer, the network is defined by three main files, namely the model (.cto), which contains the structure of assets, transactions, and participants that will be recorded in the ledger; Script (.js) that contains business rules about transactions; and Access Control (.acl) access control for the types of roles that participants have, and what participants can create, read, and write under that role All transactions will be stored in the historian record 1) Model File (.cto) This business network file model defines the participants and digital assets The list of participants is shown in Table 1, and the list of assets in Table Table List of participants A Health Service Flow Figure describes the health service flow First, the patient comes to the hospital and registers All patients who receive healthcare services or get health services must register inpatient data and obtain a medical record number Patients are grouped to polyclinics to be addressed according to illness in registering After registering, patients wait for confirmation by a specialist to schedule a visit If the doctor has confirmed the schedule of visits, patients are examined by a specialist If the patient requires support services, the patient will receive laboratory support services such as blood, urine, ECG, X-ray checks, as the specialist recommends However, if patients not need support services, they will redeem their prescriptions and take them to the pharmacy The last stage is that the patient makes an administrative payment to the cashier's counter No Participant Doctor Patient Chemist Pathlab Description Someone who acts as medical personnel or someone who checks the patient A person receiving medical care Someone who has to distribute medicine/prescriptions Someone who serves as an examiner in the laboratory Table List of assets No Assets Appointment Insurance MedPresc Prescription Receipt Description Defines the examination agreement between the patient and a specialist Defines the health coverage the patient uses Describes the amount of medicine content and instructions for medicine use Defines the prescription of medicine that the doctor has given Defines the total payment payable by the patient 2) Confirm Appointment Transaction (.js) Confirm Appointment Transaction is an agreement transaction for examination conducted between patient and doctor To this transaction, we must make participants from Doctor, Patient, and asset Appointment 74 2021 8th NAFOSTED Conference on Information and Computer Science (NICS) This Confirm Appointment transaction is the first transaction made before the patient gets medical treatment This transaction consists of two participants, namely patients and doctors, and one asset appointment To complete a confirmed appointment transaction, an ID that has been previously recorded as a resource on participants and assets is required of transactions is 1000; the 1000 transactions are successfully stored on the blockchain is about 3091 ms b) Testing of Transactions against Time of Transaction 3) Permission Control (.acl) Permission Control in this business network functions to determine which participants can perform operations on specific resources under certain conditions One example, Participant Doctor has the right to view, create, and update the resource (resource) from the recipe, as shown in Table Table List of Participant's Access Rights to Assets N o Note: C R U D Partici pant Doct or Pati ent Chem ist Path lab Appoin tment CRUD Insur ance R MedP resc CRUD Prescri ption CRUD Rece ipt R CRUD R R R R R CRUD CRUD CRUD CRUD R R R CRU D R Figure Transaction Vs Time of Transaction Figure is the result of testing the transaction time for 1000 transactions The transaction time is calculated based on the timestamp between transactions In this test, the number of transactions was determined as 1000, and the average transaction time is 3.091 ms per transaction This means that all transactions in the Hyperledger system were recorded relatively fast; this is because, generally, an admin takes several minutes to record a medical transaction = Create = Read = Update = Delete V CONCLUSION An EHR is a comprehensive electronic record of patient health information and integrates several health information databases Information provided includes progress records, problems, drugs, vital signs, past medical history, and laboratory data The EHR documentation can be filled by clinical service providers such as doctors, nurses, or other medical officers, aiming to improve efficiency and accuracy and reduce recording time, which is often long This system is computerized, so that it requires a health record (HR) The HR documentation results in an automated system, which can then be accessed by other medical members, making it easier for officers to look for patient data or continue documenting patients This EHR technology seeks to improve health services If this technology is embraced with the right software, the health industry will benefit greatly In this study, a system was built to evaluate blockchain technology in the healthcare industry The prototype is based on an open-source blockchain framework called Hyperledger Composer, built under the Hyperledger fabric platform created to demonstrate the system's feasibility The proposed concept is applied and discussed in use cases with EHRs in the health sector The EHR can share data or related information, such as patient data, disease history, or drugs that patients have consumed, to network organizations The results of the study found that blockchain technology can be utilized in structured and systematic data storage within the Hyperledger Composer Playground tools In 1000 transactions, the system could store data into blocks in a total of 3091 ms, with an average transaction time of 3.091 ms This means that the system has a reasonably fast performance in storing transactions into blocks IV RESULT AND DISCUSSION This section describes our implementation result of blockchain technology for the medical record using Hyperledger Composer 1) Hyperledger Composer Performance Performance is a form of testing that is given to know firsthand the ability of a system to carry out a job at a specific time The performance objectives include seeing firsthand the system's strength to carry out an execution; the objectives also serve as a comparison with an existing system This study tests the time of recording data into the Hyperledger Composer platform to determine the system performance a) Testing of Transactions against Timestamp Figure Transaction vs Timestamp Figure shows the results from testing the number of transactions with the timestamp The timestamp is the time when an event is recorded in a block In this test, the number ACKNOWLEDGEMENT 75 2021 8th NAFOSTED Conference on Information and Computer Science (NICS) This work is supported by the Indonesian Government Scholarship PMDSU Grant number NKB357/UN2.RST/HKP.05.00/2021 from the Ministry of Research, Technology, Ministry of Research and Technology and National Research and Innovation Agency (Kemristekbrin) [16] REFERENCES [19] [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [17] [18] Z Zeng et al., "Blockchain technology for information security of the energy internet: fundamentals, features, strategy and application," Energies, vol 13, no 4, p 881, 2020 T Mikula and R H Jacobsen, "Identity and access management with blockchain in electronic healthcare records," in 2018 21st Euromicro conference on digital system design (DSD), 2018: IEEE, pp 699-706 J Liu, X Li, L Ye, H 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Since the emergence of health services, medical records are needed for historical records for patients Initially, medical records were made to record. .. various detailed medical record data and save storage resources in the blockchain De Oliveira et al [7] proposes an electronic medical record approach using a permitted and private blockchain, where... This section describes our implementation result of blockchain technology for the medical record using Hyperledger Composer 1) Hyperledger Composer Performance Performance is a form of testing