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A Systematic Review for Enabling of Develop a Blockchain Technology in Healthcare Application: Taxonomy, Substantially Analysis, Motivations, Challenges, Recommendations and Future Direction

  • Systems-Level Quality Improvement
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Blockchain in healthcare applications requires robust security and privacy mechanism for high-level authentication, interoperability and medical records sharing to comply with the strict legal requirements of the Health Insurance Portability and Accountability Act of 1996. Blockchain technology in the healthcare industry has received considerable research attention in recent years. This study conducts a review to substantially analyse and map the research landscape of current technologies, mainly the use of blockchain in healthcare applications, into a coherent taxonomy. The present study systematically searches all relevant research articles on blockchain in healthcare applications in three accessible databases, namely, ScienceDirect, IEEE and Web of Science, by using the defined keywords ‘blockchain’, ‘healthcare’ and ‘electronic health records’ and their variations. The final set of collected articles related to the use of blockchain in healthcare application is divided into three categories. The first category includes articles (i.e. 43/58 scientific articles) that attempted to develop and design healthcare applications integrating blockchain, particularly those on new architecture, system designs, framework, scheme, model, platform, approach, protocol and algorithm. The second category includes studies (i.e., 6/58 scientific articles) that attempted to evaluate and analyse the adoption of blockchain in the healthcare system. Finally, the third category comprises review and survey articles (i.e., 6/58 scientific articles) related to the integration of blockchain into healthcare applications. The final articles for review are discussed on the basis of five aspects: (1) year of publication, (2) nationality of authors, (3) publishing house or journal, (4) purpose of using blockchain in health applications and the corresponding contributions and (5) problem types and proposed solutions. Additionally, this study provides identified motivations, open challenges and recommendations on the use of blockchain in healthcare applications. The current research contributes to the literature by providing a detailed review of feasible alternatives and identifying the research gaps. Accordingly, researchers and developers are provided with appealing opportunities to further develop decentralised healthcare applications through a comprehensive discussion of about the importance of blockchain and its integration into various healthcare applications.

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  1. Alanazi, H. O. et al., Secure topology for electronic medical record transmissions. Int. J. Pharmacol. 6(6):954–958, 2010.

    Article  Google Scholar 

  2. O. A. Hamdan, et al., “Securing electronic medical records transmissions over unsecured communications: An overview for better medical governance,” J. Med. Plant Res., vol. 4, no. 19, pp. 2059–2074, 2010.

    Article  Google Scholar 

  3. Nabi, M. S. A. et al., Suitability of SOAP protocol in securing transmissions of EMR database. Int. J. Pharmacol. 6(6):959–964, 2010.

    Article  Google Scholar 

  4. Nabi, M. S. A. et al., Suitability of Using SOAP Protocol to Secure Electronic Medical Record Databases Transmission. Int. J. Pharmacol. 6(6):959–964, 2010.

    Article  Google Scholar 

  5. Kiah, M. L. M. et al., An Enhanced Security Solution for Electronic Medical Records Based on AES Hybrid Technique with SOAP/XML and SHA-1. J. Med. Syst. 37(5):9971, 2013.

    Article  PubMed  Google Scholar 

  6. M. S. Nabi et al., Suitability of adopting S/MIME and OpenPGP email messages protocol to secure electronic medical records. In Second International Conference on Future Generation Communication Technologies (FGCT 2013), 2013, pp. 93–97.

  7. Kiah, M. L. M. et al., Open source EMR software: profiling, insights and hands-on analysis. Comput. Methods Prog. Biomed. 117(2):360–382, 2014.

    Article  CAS  Google Scholar 

  8. Zaidan, A. A. et al., Evaluation and selection of open-source EMR software packages based on integrated AHP and TOPSIS. J. Biomed. Inform. 53:390–404, 2015.

    Article  PubMed  CAS  Google Scholar 

  9. Alanazi, H. O. et al., Meeting the Security Requirements of Electronic Medical Records in the ERA of High-Speed Computing. J. Med. Syst. 39(1):165, 2015.

    Article  PubMed  CAS  Google Scholar 

  10. Zaidan, A. A. et al., Multi-criteria analysis for OS-EMR software selection problem: A comparative study. Decis. Support. Syst. 78:15–27, 2015.

    Article  Google Scholar 

  11. Salman, O. H. et al., Novel Methodology for Triage and Prioritizing Using ‘Big Data’ Patients with Chronic Heart Diseases Through Telemedicine Environmental. Int. J. Inf. Technol. Decis. Mak. 16(05):1211–1245, 2017.

    Article  Google Scholar 

  12. Mat Kiah, M. L. et al., Design and Develop a Video Conferencing Framework for Real-Time Telemedicine Applications Using Secure Group-Based Communication Architecture. J. Med. Syst. 38(10):133, 2014.

    Article  PubMed  CAS  Google Scholar 

  13. Almahdi, E. M. et al., Mobile patient monitoring systems from a benchmarking aspect: Challenges, open issues and recommended solutions. J. Med. Syst. 43(7):207, 2019.

    Article  PubMed  CAS  Google Scholar 

  14. Almahdi, E. M. et al., Mobile-Based Patient Monitoring Systems: A Prioritisation Framework Using Multi-Criteria Decision-Making Techniques. J. Med. Syst. 43(7):219, 2019.

    Article  PubMed  CAS  Google Scholar 

  15. Mohammed, K. I. et al., Real-Time Remote-Health Monitoring Systems: a Review on Patients Prioritisation for Multiple-Chronic Diseases, Taxonomy Analysis, Concerns and Solution Procedure. J. Med. Syst. 43(7):223, 2019.

    Article  PubMed  CAS  Google Scholar 

  16. Kalid, N. et al., Based on Real Time Remote Health Monitoring Systems: A New Approach for Prioritization ‘Large Scales Data’ Patients with Chronic Heart Diseases Using Body Sensors and Communication Technology. J. Med. Syst. 42(4), 2018.

  17. Kalid, N. et al., Based Real Time Remote Health Monitoring Systems: A Review on Patients Prioritization and Related" Big Data" Using Body Sensors information and Communication Technology. J. Med. Syst. 42(2):30, 2018.

    Article  Google Scholar 

  18. Albahri, A. S. et al., Real-Time Fault-Tolerant mHealth System: Comprehensive Review of Healthcare Services, Opens Issues, Challenges and Methodological Aspects. J. Med. Syst., 2018.

  19. Albahri, O. S. et al., Real-Time Remote Health-Monitoring Systems in a Medical Centre: A Review of the Provision of Healthcare Services-Based Body Sensor Information, Open Challenges and Methodological Aspects. J. Med. Syst. (9):42, 164, 2018.

  20. Mohsin, A. H. et al., Real-Time Remote Health Monitoring Systems Using Body Sensor Information and Finger Vein Biometric Verification: A Multi-Layer Systematic Review. J. Med. Syst. 42(12):238, 2018.

    Article  PubMed  CAS  Google Scholar 

  21. Mohsin, A. H. et al., Real-Time Medical Systems Based on Human Biometric Steganography: a Systematic Review. J. Med. Syst. 42(12):245, 2018.

    Article  PubMed  CAS  Google Scholar 

  22. Albahri, A. S. et al., Based Multiple Heterogeneous Wearable Sensors: A Smart Real-Time Health Monitoring Structured for Hospitals Distributor. IEEE Access 7:37269–37323, 2019.

    Article  Google Scholar 

  23. Albahri, O. S. et al., Fault-tolerant mHealth framework in the context of IoT-based real-time wearable health data sensors. IEEE Access 7:50052–50080, 2019.

    Article  Google Scholar 

  24. Napi, N. M., et al., Medical emergency triage and patient prioritisation in a telemedicine environment: a systematic review. Health and Technology, 9:1-22, 2019.

  25. Nidhal, S. et al., Computerized algorithm for fetal heart rate baseline and baseline variability estimation based on distance between signal average and alpha value. Int. J. Pharmacol. 7(2):228–237, 2011.

    Article  Google Scholar 

  26. Zaidan, B. B. et al., Impact of data privacy and confidentiality on developing telemedicine applications: A review participates opinion and expert concerns. Int. J. Pharmacol. 7(3):382–387, 2011.

    Article  Google Scholar 

  27. Kiah, M. L. M. et al., MIRASS: Medical Informatics Research Activity Support System Using Information Mashup Network. J. Med. Syst. 38(4):37, 2014.

    Article  PubMed  CAS  Google Scholar 

  28. Zaidan, B. B. et al., A Security Framework for Nationwide Health Information Exchange based on Telehealth Strategy. J. Med. Syst. 39(5):51, 2015.

    Article  PubMed  CAS  Google Scholar 

  29. Zaidan, A. A. et al., Challenges, Alternatives, and Paths to Sustainability: Better Public Health Promotion Using Social Networking Pages as Key Tools. J. Med. Syst. 39(2):7, 2015.

    Article  PubMed  CAS  Google Scholar 

  30. Hussain, M. et al., The landscape of research on smartphone medical apps: Coherent taxonomy, motivations, open challenges and recommendations. Comput. Methods Prog. Biomed. 122(3):393–408, 2015.

    Article  Google Scholar 

  31. Hussain, M. et al., Conceptual framework for the security of mobile health applications on Android platform. Telemat. Informatics 35(5), 2018.

    Article  Google Scholar 

  32. Alsalem, M. A. et al., Multiclass Benchmarking Framework for Automated Acute Leukaemia Detection and Classification Based on BWM and Group-VIKOR. J. Med. Syst. 43(7):212, 2019.

    Article  PubMed  CAS  Google Scholar 

  33. Enaizan, O. et al., Electronic medical record systems: decision support examination framework for individual, security and privacy concerns using multi-perspective analysis. Health Technol. (Berl).:1–28, 2018.

  34. Hussain, M. et al., A security framework for mHealth apps on Android platform. Comput. Secur. 75:191–217, 2018.

    Article  Google Scholar 

  35. Iqbal, S. et al., Real-time-based E-health systems: design and implementation of a lightweight key management protocol for securing sensitive information of patients. Health Technol. (Berl).:1–19, 2018.

  36. Alonso, S. G., Arambarri, J., López-Coronado, M., and de la Torre Díez, I., Proposing New Blockchain Challenges in eHealth. J. Med. Syst. 43(3):64, 2019.

    Article  PubMed  Google Scholar 

  37. Mohsin, A. H. et al., Blockchain authentication of network applications: Taxonomy, classification, capabilities, open challenges, motivations, recommendations and future directions. Comput. Stand. Interfaces, 2018.

  38. Mohsin, A. H. et al., Based blockchain-PSO-AES techniques in finger vein biometrics: A novel verification secure framework for patient authentication. Comput. Stand. Interfaces., 2019.

  39. Mohsin, A. H., Based medical systems for patient’s authentication: Towards a new verification secure framework using CIA standard. J. Med. Syst., 2019.

  40. Bennett, B., Blockchain HIE Overview: A Framework for Healthcare Interoperability. Telehealth Med. Today 2(3):1–6, 2018.

    Article  Google Scholar 

  41. Nakamoto, S., Bitcoin: A Peer-to-Peer Electronic Cash System. Www.Bitcoin.Org , p. 9, 2008.

  42. Founder, G. W., and Gavin E., Ethereum: a secure decentralised generalised transaction ledger, 2014.

  43. Ethereum Foundation, Solidity 0.4.24 documentation. 2018.

  44. N. Atzei, M. Bartoletti, and T. Cimoli, A survey of attacks on Ethereum smart contracts (SoK), Lect. Notes Comput. Sci. (including Subser. Lect. Notes Artif. Intell. Lect. Notes Bioinformatics), vol. 10204 LNCS, pp. 164–186, 2017.

  45. Yli-Huumo, J., Ko, D., Choi, S., Park, S., and Smolander, K., Where is current research on Blockchain technology? - A systematic review. PLoS One 11(10):1–27, 2016.

    Article  CAS  Google Scholar 

  46. Li, X., Jiang, P., Chen, T., Luo, X., and Wen, Q., A survey on the security of blockchain systems. Futur. Gener. Comput. Syst., 2017.

  47. Feng, Q., He, D., Zeadally, S., Khurram, M., and Kumar, N., A survey on privacy protection in blockchain system. J. Netw. Comput. Appl., 2018.

  48. Reyna, A., Martín, C., Chen, J., Soler, E., and Díaz, M., On blockchain and its integration with IoT. Challenges and opportunities. Futur. Gener. Comput. Syst. 88:173–190, 2018.

    Article  Google Scholar 

  49. Panarello, A., Tapas, N., Merlino, G., Longo, F., and Puliafito, A., Blockchain and IoT integration: A systematic survey, vol. 18, no. 8. 2018.

    Article  Google Scholar 

  50. Gao, Z., Xu, L., Chen, L., Zhao, X., Lu, Y., and Shi, W., CoC: A Unified Distributed Ledger Based Supply Chain Management System. J. Comput. Sci. Technol. 33(2):237–248, 2018.

    Article  Google Scholar 

  51. Fernández-Caramés, T. M., and Fraga-Lamas, P., A Review on the Application of Blockchain for the Next Generation of Cybersecure Industry 4.0 Smart Factories. IEEE Access 7:45201–45218, Feb. 2019.

    Article  Google Scholar 

  52. Zheng, Z., Xie, S., Dai, H.-N., Chen, X., and Wang, H., Blockchain Challenges and Opportunities: A Survey. Int. J. Web Grid Serv.:1–24, 2016.

  53. Radanović, I., and Likić, R., Opportunities for Use of Blockchain Technology in Medicine. Appl. Health Econ. Health Policy, 2018.

  54. Androulaki, E., et al., Hyperledger Fabric: A Distributed Operating System for Permissioned Blockchains. ArXiv, 2018.

  55. Chase, B., and MacBrough, E., Analysis of the XRP Ledger Consensus Protocol. a, 2018.

  56. Dinh, T. T. A., Liu, R., Zhang, M., Chen, G., Ooi, B. C., and Wang, J., Untangling Blockchain: A Data Processing View of Blockchain Systems. IEEE Trans. Knowl. Data Eng. 30(7):1366–1385, 2018.

    Article  Google Scholar 

  57. Anoaica, A., and Levard, H., Quantitative Description of Internal Activity on the Ethereum Public Blockchain, 2018 9th IFIP Int. Conf. New Technol. Mobil. Secur., pp. 1–5, 2018.

  58. Feng, L., and Zhang, H., System architecture for high-performance permissioned blockchains. Front. Comput. Sci.:1–15, 2018.

  59. Khan, C., Lewis, A., Rutland, E., Wan, C., Rutter, K., and Thompson, C., A Distributed-Ledger Consortium Model for Collaborative Innovation. Computer (Long. Beach. Calif). 50(9):29–37, 2017.

    Google Scholar 

  60. Abouelmehdi, K., Beni-Hssane, A., Khaloufi, H., and Saadi, M., Big data security and privacy in healthcare: A Review. Procedia Comput. Sci. 113:73–80, 2017.

    Article  Google Scholar 

  61. Fernández-Alemán, J. L., Señor, I. C., Lozoya, P. Á. O., and Toval, A., Security and privacy in electronic health records: a systematic literature review. J. Biomed. Inform. 46(3):541–562, 2013.

    Article  PubMed  Google Scholar 

  62. Zaidan, A. A. et al., A survey on communication components for IoT-based technologies in smart homes. Telecommun. Syst., 2018.

  63. Zaidan, A. A. et al., A review on smartphone skin cancer diagnosis apps in evaluation and benchmarking: coherent taxonomy, open issues and recommendation pathway solution. Health Technol. (Berl). 8(4):223–238, 2018.

    Article  Google Scholar 

  64. Albahri, O. S. et al., Systematic Review of Real-time Remote Health Monitoring System in Triage and Priority-Based Sensor Technology: Taxonomy, Open Challenges, Motivation and Recommendations. J. Med. Syst. 42(5), 2018.

  65. Talal, M. et al., Smart Home-based IoT for Real-time and Secure Remote Health Monitoring of Triage and Priority System using Body Sensors: Multi-driven Systematic Review. J. Med. Syst. 43(3):42, 2019.

    Article  PubMed  Google Scholar 

  66. Zaidan, A., et al., A review on intelligent process for smart home applications based on IoT: coherent taxonomy, motivation, open challenges, and recommendations. Springer. 2018.

  67. Alsalem, M. A. et al., Systematic Review of an Automated Multiclass Detection and Classification System for Acute Leukaemia in Terms of Evaluation and Benchmarking, Open Challenges, Issues and Methodological Aspects. J. Med. Syst. 42(11):204, 2018.

    Article  PubMed  CAS  Google Scholar 

  68. Alsalem, M. A. et al., A review of the automated detection and classification of acute leukaemia: Coherent taxonomy, datasets, validation and performance measurements, motivation, open challenges and recommendations. Comput. Methods Prog. Biomed. 158:93–112, 2018.

    Article  CAS  Google Scholar 

  69. Zughoul, O. et al., Comprehensive Insights into the Criteria of Student Performance in Various Educational Domains. IEEE Access:1–1, 2018.

  70. Khatari, M. et al., Multi-Criteria Evaluation and Benchmarking for Active Queue Management Methods: Open Issues, Challenges and Recommended Pathway Solutions. Int. J. Inf. Technol. Decis. Mak.:S0219622019300039, 2019.

  71. Talal, M. et al., Comprehensive Review and Analysis of Anti-Malware Apps for Smartphones. Telecommun. Syst., 2019.

  72. Shuwandy, M. L. et al., Sensor-Based mHealth Authentication for Real-Time Remote Healthcare Monitoring System: A Multilayer Systematic Review. J. Med. Syst. 43(2):33, 2019.

    Article  PubMed  Google Scholar 

  73. Alamoodi, A. H. et al., A Review of Data Analysis for Early-Childhood Period: Taxonomy, Motivations, Challenges, Recommendation, and Methodological Aspects. IEEE Access, 2019.

  74. Li, H., Fan, K., Yang, Y., Ren, Y., and Wang, S., MedBlock: Efficient and Secure Medical Data Sharing Via Blockchain. J. Med. Syst. 42(8):1–11, 2018.

    Article  Google Scholar 

  75. Mikula, T., and Jacobsen, R. H., Identity and access management with blockchain in electronic healthcare records. In Proceedings - 21st Euromicro Conference on Digital System Design, DSD 2018, 2018, pp. 699–706.

  76. Tamazirt, L., Alilat, F., and Agoulmine N., Blockchain Technology: A new secured Electronic Health Record System. In 2018 International Workshop on ADVANCEs in ICT Infrastructures and Services (ADVANCE’2018), 2018, p. 134.

  77. Vora, J., et al., BHEEM: A Blockchain-Based Framework for Securing Electronic Health Records. In 2018 IEEE Globecom Workshops (GC Wkshps), 2018, no. 1, pp. 1–6.

  78. Sun, Y., Zhang, R., Wang, X., Gao, K., and Liu, L., A Decentralizing Attribute-Based Signature for Healthcare Blockchain. 2018 27th Int. Conf. Comput. Commun. Networks, pp. 1–9, 2018.

  79. Guo, R., Shi, H., Zhao, Q., and Zheng, D., Secure Attribute-Based Signature Scheme With Multiple Authorities for Blockchain in Electronic Health Records Systems. IEEE Access 6:11676–11686, 2018.

    Article  Google Scholar 

  80. Ramani, V., Kumar, T., Braeken, A., Liyanage, M., and Ylianttila, M., Secure and Efficient Data Accessibility in Blockchain based Healthcare Systems. In 2018 IEEE Global Communications Conference (GLOBECOM), 2018, no. pp. 206–212.

  81. Yang, H., and Yang, B., A Blockchain-based Approach to the Secure Sharing of Healthcare Data. in Norwgian Information Security Conference, 2017.

  82. Dagher, G. G., Mohler, J., Milojkovic, M., and Babu, P., Ancile: Privacy-preserving framework for access control and interoperability of electronic health records using blockchain technology. Sustain. Cities Soc. 39:283–297, 2018.

    Article  Google Scholar 

  83. Wehbe, Y., Al Zaabi, M., Svetinovic, D., and Member, S., Blockchain AI Framework for Healthcare Records Management: Constrained Goal Model. 2018 26th Telecommun. Forum, pp. 420–425, 2018.

  84. Wang, H., and Song, Y., Secure Cloud-Based EHR System Using Attribute-Based Cryptosystem and Blockchain. J. Med. Syst. 42(8), 2018.

  85. Kaur, H., Alam, M. A., Jameel, R., Mourya, A. K., and Chang, V., A Proposed Solution and Future Direction for Blockchain-Based Heterogeneous Medicare Data in Cloud Environment. J. Med. Syst. 42(8), 2018.

  86. Liu, J., Li, X., Ye, L., Zhang, H., Du, X., and Guizani, M., BPDS: A Blockchain based Privacy-Preserving Data Sharing for Electronic Medical Records. arXiv:1811.03223, 2018.

  87. Badr, S., Gomaa, I., and Abd-elrahman, E., Multi-tier Blockchain Framework for IoT-EHRs Systems. Procedia Comput. Sci. 141:159–166, 2018.

    Article  Google Scholar 

  88. Xia, Q., Sifah, E. B., Asamoah, K. O., Gao, J., Du, X., and Guizani, M., MeDShare: Trust-Less Medical Data Sharing among Cloud Service Providers via Blockchain. IEEE Access 5:14757–14767, 2017.

    Article  Google Scholar 

  89. Theodouli A., Arakliotis S., Moschou K., Votis, K., and Tzovaras, D., On the design of a Blockchain-based system to facilitate Healthcare Data Sharing. 2018 17th IEEE Int. Conf. Trust. Secur. Priv. Comput. Commun. 12th IEEE Int. Conf. Big Data Sci. Eng., pp. 1374–1379, 2018.

  90. Li, H., Zhu, L., Shen, M., Gao, F., Tao, X., and Liu, S., Blockchain-Based Data Preservation System for Medical Data. J. Med. Syst. 42(8):1–13, 2018.

    Article  Google Scholar 

  91. Rouhani, S., MediChain TM: A Secure Decentralized Medical Data Asset Management System. arXiv Prepr. arXiv1901.10645, no. Section II, pp. 1533–1538, 2019.

  92. Tian, H., He, J., and Ding, Y., Medical Data Management on Blockchain with Privacy. J. Med. Syst. 43(2):26, 2019.

    Article  PubMed  Google Scholar 

  93. S. Alexaki, G. Alexandris, V. Katos, and N. E. Petroulakis, “Blockchain-based Electronic Patient Records for Regulated Circular Healthcare Jurisdictions,” 2018 IEEE 23rd Int. Work. Comput. Aided Model. Des. Commun. Links Networks, pp. 1–6, 2018.

  94. Patel, V., A framework for secure and decentralized sharing of medical imaging data via blockchain consensus. Health Informatics Journal, 2018.

  95. Roehrs, A., André, C., and Righi, R., OmniPHR : A distributed architecture model to integrate personal health records. J. Biomed. Inform. 71:70–81, 2017.

    Article  PubMed  Google Scholar 

  96. Thwin, T. T., and Vasupongayya, S., Blockchain Based Secret-Data Sharing Model for Personal Health Record System, In ICAICTA 2018 - 5th International Conference on Advanced Informatics: Concepts Theory and Applications, 2018, pp. 196–201.

  97. Yue, X., Wang, H., Jin, D., Li, M., and Jiang, W., Healthcare Data Gateways : Found Healthcare Intelligence on Blockchain with Novel Privacy Risk Control. J. Med. Syst., 2016.

  98. Zhang, A., and Lin, X., Towards Secure and Privacy-Preserving Data Sharing in e-Health Systems via Consortium Blockchain. J. Med. Syst. 42(8), 2018.

  99. Ito, K., Tago, K., and Jin, Q., i-Blockchain: A Blockchain-Empowered Individual-Centric Framework for Privacy-Preserved Use of Personal Health Data. 2018 9th Int. Conf. Inf. Technol. Med. Educ., pp. 829–833, 2018.

  100. Zhang, P., White, J., Schmidt, D. C., Lenz, G., and Rosenbloom, S. T., FHIRChain : Applying Blockchain to Securely and Scalably Share Clinical Data. Comput. Struct. Biotechnol. J. 16:267–278, 2018.

    Article  PubMed  PubMed Central  Google Scholar 

  101. Velvkzhanin A., Kotsiuba I., Yanovich, Y., Bandurova, I. S., Zhygulin, V., and Dyachenko, Y., Decentralized e-Health Architecture for Boosting Healthcare Analytics. In 2018 Second World Conference on Smart Trends in Systems, Security and Sustainability (WorldS4). IEEE, 2019, pp. 113–118.

  102. Al Omar, A., Bhuiyan, M. Z. A., Basu, A., Kiyomoto, S., and Rahman, M. S., Privacy-friendly platform for healthcare data in cloud based on blockchain environment. Futur. Gener. Comput. Syst. 95:511–521, Jun. 2019.

    Article  Google Scholar 

  103. Chen, Y., Ding, S., Xu, Z., Zheng, H., and Yang, S., Blockchain-Based Medical Records Secure Storage and Medical Service Framework. J. Med. Syst. 43(1), 2018.

  104. Jiang, S., Cao, J., Wu, H., Yang, Y., Ma, M., and He, J., BlocHIE: a BLOCkchain-based platform for Healthcare Information Exchange. 2018 IEEE Int. Conf. Smart Comput., pp. 49–56, 2018.

  105. Uddin, A., Stranieri, A., Gondal, I., and Balasubramanian, V., Continuous Patient Monitoring with a Patient Centric Agent: A Block Architecture. IEEE Access PP(c):1, 2018.

    Google Scholar 

  106. Griggs, K. N., Ossipova, O., Kohlios, C. P., Baccarini, A. N., Howson, E. A., and Hayajneh, T., Healthcare Blockchain System Using Smart Contracts for Secure Automated Remote Patient Monitoring. J. Med. Syst. 42(7):1–7, 2018.

    Article  Google Scholar 

  107. Dwivedi, A. D., Srivastava, G., Dhar, S., and Singh, R., A decentralized privacy-preserving healthcare blockchain for IoT. Sensors (Switzerland) 19(2):1–17, 2019.

    Article  Google Scholar 

  108. Brogan, J., Baskaran, I., and Ramachandran, N., Authenticating Health Activity Data Using Distributed Ledger Technologies. Comput. Struct. Biotechnol. J. 16:257–266, 2018.

    Article  PubMed  PubMed Central  Google Scholar 

  109. Pham, H. L., Tran, T. H., and Nakashima, Y., A Secure Remote Healthcare System for Hospital Using Blockchain Smart Contract. In 2018 IEEE Globecom Workshops (GC Wkshps), 2018, no. 1, pp. 1–6.

  110. Zhou, L., Wang, L., and Sun, Y., MIStore: a Blockchain-Based Medical Insurance Storage System. J. Med. Syst. 42(8), 2018.

  111. Wang, S. et al., Blockchain-Powered Parallel Healthcare Systems Based on the ACP Approach. IEEE Trans. Comput. Soc. Syst. PP:1–9, 2018.

    Google Scholar 

  112. Choudhury, O., Fairoza, N., Sylla, I., and Das, A., A Blockchain Framework for Managing and Monitoring Data in Multi-Site Clinical Trials. arXiv:1902.03975, pp. 1–14, 2018.

  113. Ji, Y., Zhang, J., Ma, J., Yang, C., and Yao, X., BMPLS: Blockchain-Based Multi-level Privacy-Preserving Location Sharing Scheme for Telecare Medical Information Systems. J. Med. Syst. 42(8):147, 2018.

    Article  PubMed  Google Scholar 

  114. Zhao, H., Bai, P., Peng, Y., and Xu, R., Efficient key management scheme for health blockchain. CAAI Trans. Intell. Technol. 3(2):114–118, 2018.

    Article  Google Scholar 

  115. Liu, W., and Krieger, U., Advanced Block-Chain Architecture for e-Health Systems. In In e-Health Networking, Applications and Services (Healthcom), 2017 IEEE 19th International Conference on IEEE., 2017, no. Etpha, pp. 37–42.

  116. Novikov, S. P., Kazakov, O. D., Kulagina, N. A., and Azarenko, N. Y., Blockchain and Smart Contracts in a Decentralized Health Infrastructure, 2018 IEEE Int. Conf. "Quality Manag. Transp. Inf. Secur. Inf. Technol., pp. 697–703, 2018.

  117. Ichikawa, D., Kashiyama, M., and Ueno, T., Tamper-Resistant Mobile Health Using Blockchain Technology. JMIR mHealth uHealth 5(7):e111, 2017.

    Article  PubMed  PubMed Central  Google Scholar 

  118. Roehrs, A., da Costa, C. A., da Rosa Righi, R., da Silva, V. F., Goldim, J. R., and Schmidt, D. C., Analyzing the Performance of a Blockchain-based Personal Health Record Implementation. J. Biomed. Inform.:103140, 2019.

    Article  PubMed  Google Scholar 

  119. Zhang, P., Walker, M. A., White, J., Schmidt, D. C., and Lenz, G., Metrics for assessing blockchain-based healthcare decentralized apps. In 2017 IEEE 19th International Conference on e-Health Networking, Applications and Services, Healthcom 2017, 2017, vol. 2017, pp. 1–4.

  120. Zheng, K., et al., Model Checking PBFT Consensus Mechanism in Healthcare Blockchain Network. 2018 9th Int. Conf. Inf. Technol. Med. Educ., pp. 877–881, 2018.

  121. Kuo, T. T., Kim, H. E., and Ohno-Machado, L., Blockchain distributed ledger technologies for biomedical and health care applications. J. Am. Med. Inform. Assoc. 24(6):1211–1220, 2017.

    Article  PubMed  PubMed Central  Google Scholar 

  122. Gordon, W. J., and Catalini, C., Blockchain Technology for Healthcare: Facilitating the Transition to Patient-Driven Interoperability. Computational and Structural Biotechnology Journal 16. The Authors:224–230, 2018.

    Article  PubMed  PubMed Central  Google Scholar 

  123. Hölbl, M., Kompara, M., Kamišalić, A., and Zlatolas, L. N., A systematic review of the use of blockchain in healthcare. Symmetry (Basel). 10(10), 2018.

    Article  Google Scholar 

  124. Katuwal, G. J., Pandey, S., Hennessey, M., and Lamichhane, B., Applications of Blockchain in Healthcare: Current Landscape & Challenges. arXiv:1812.02776, pp. 1–17, 2018.

  125. Ahmed, K., Junejo, A., Siyal, A., Khalil, A., Zawish, M., and Soursou, G., Applications of Blockchain Technology in Medicine and Healthcare: Challenges and Future Perspectives. Cryptography 3(1):3, 2019.

    Article  Google Scholar 

  126. Kamel Boulos, M. N., Wilson, J. T., and Clauson, K. A., Geospatial blockchain: Promises, challenges, and scenarios in health and healthcare. Int. J. Health Geogr. 17(1):1–10, 2018.

    Article  Google Scholar 

  127. Mcghin, T., Choo, K. R., Liu, C. Z., and He, D., Blockchain in Healthcare Applications: Research Challenges and Opportunities. J. Netw. Comput. Appl., 2019.

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This study was funded by Universiti Pendidikan Sultan Idris, under Rising Star Grant, research code: 2019-0125-109-01.

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Correspondence to B. B. Zaidan.

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• Mapping the blockchain technology research landscape into a coherent taxonomy for healthcare applications

• Identification of the different types of blockchain technology used in healthcare applications

• Evaluation of the need to use blockchain in healthcare system

• Figure out the motivation to use blockchain technology in healthcare applications

• Highlight the open challenges and proposed solutions that hinder the use of blockchain technology in healthcare applications

• Recommend lists to improve the acceptance of blockchain integration with electronic record data to share medical data amongst different health and medical institutes

• Discussion of the purpose of blockchain technology with different applications in the healthcare sector

This article is part of the Topical Collection on Systems-Level Quality Improvement

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Hussien, H.M., Yasin, S.M., Udzir, S.N.I. et al. A Systematic Review for Enabling of Develop a Blockchain Technology in Healthcare Application: Taxonomy, Substantially Analysis, Motivations, Challenges, Recommendations and Future Direction. J Med Syst 43, 320 (2019).

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