Scaling Blockchains to Support Electronic Health Records for Hospital Systems

Abstract

Electronic Health Records (EHRs) have improved many aspects of healthcare and allowed for easier patient management for medical providers. Blockchains have been proposed as a promising solution for supporting Electronic Health Records (EHRs), but have also been linked to scalability concerns about supporting real-world healthcare systems. This paper quantifies the scalability issues and bottlenecks related to current blockchains and puts into perspective the limitations blockchains have with supporting healthcare systems. Particularly we show that well known blockchains such as Bitcoin, Ethereum, and IOTA cannot support transactions of a large scale hospital system such as the University of Kentucky HealthCare system and leave over 7.5M unsealed transactions per day. We then discuss how bottlenecks of blockchains can be relieved with sidechains, enabling well-known blockchains to support even larger hospital systems of over 30M transactions per day. We then introduce the Patient-Healthchain architecture to provide future direction on how scaling blockchains for EHR systems with sidechains can be achieved.

Blockchain Personal Health Records: Systematic Review

“…Scalability solutions have already been studied and experimented on, such as Proof-of-Authority and the novel Byzanthine fault tolerance (BFT) consensus mechanisms [ 44 , 56 , 67 ]. Other methods include enhancing the blockchain architecture through tiered-chain [ 40 , 64 ] or side-chain structures [ 57 ]. Although privacy solutions were more limited in our review, we came across one by Reen et al [ 70 ] who proposed storing InterPlantary Naming System records instead of the conventional hash of the medical records directly on the blockchain.…”

“…One of the major areas regarding blockchain PHRs that is still undergoing much research is scalability. We came across a few ideas such as Proof-of-Authority, novel BFT consensus mechanisms, and other modified blockchain architectures such as tiered-chains and side-chains [ 40 , 44 , 56 , 57 , 64 , 67 ]. Apart from blockchain PHR teams working on this, the space may also benefit from parallel innovations from the larger blockchain ecosystem.…”

RETRACTED ARTICLE: Blockchain for COVID-19: a comprehensive review

“…To maintain integrity of data, the proof of integrity is attached to the BC network; to ensure privacy, an access control mechanism was put in place; and for security, a channel formation scheme was used [74] in their approach. Donawa et al [33] identified scalability issues in traditional BC networks of large-scale healthcare systems, which can generate up to 7.5 million medical records per day and proposed a BC-based system capable of handling over 30 million records daily as a solution for the prevailing scalability issue [54]. To achieve this, they proposed a sidechain and the main network to relieve its load and prevent bottlenecking.…”

“…The main chain performs tasks such as handling the joining/leaving of the patients in the network and produce a discharge summary at the end of the patient visit. Their proposed model can revolve the scalability issue of the BC when dealing with a large amount of transactions [33].…”

Two-Level Blockchain System for Digital Crime Evidence Management

“…With the recent developments in the field of big data, many studies have investigated the storage and management of large amounts of data, such as videos and images, in blockchains in various fields, such as medicine, forensics, and education [ 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. A permissioned blockchain framework for forensic applications of connected vehicles was proposed in [ 20 ].…”