ACAD-F-40C

A
SEMINAR REPORT
ON

Integrating Blockchain for Data Sharing and

Collaboration in Mobile Healthcare Applications

Submitted By
Miss Tejal Jain
(T.E. Computer)

Guided By
Prof. G. B. Gadekar

(Savitribai Phule Pune University, Pune)

In the academic year 2018-19
Department of Computer Engineering
Sanjivani College of Engineering
Kopargaon - 423 603.

[77/2018-19]
 Sanjivani College of Engineering, Kopargaon

CERTIFICATE
This is to certify that

Miss Tejal Jain

(T.E. Computer)

Has successfully completed her seminar report on

Integrating Blockchain for Data Sharing and

Collaboration in Mobile Healthcare
Applications

Towards the partial fulfilment of

Bachelor’s Degree In Computer Engineering

During the academic year 2018-2019

Prof. G. B. Gadekar Dr. D. B. KSHIRSAGAR

[ Guide ] [ H.O.D. Comp Dept. ]

Dr. D. N. KYATANAVAR
[Principal]
 Acknowledgement

The entire session of seminar completion phase so far was a great experi-
ence providing me with great insight and innovation into learning various data
security concepts and achievement of it. As is rightly said, for the successful
completion of any work, people are the most important asset my seminar would
not be materialized without the cooperation of many of the people involved.
First and foremost, I am very much thankful to my respected seminar guide
and my seminar coordinator Prof. G. B. Gadekar for their leading guidance
and sincere efforts in finalizing this topic. They took deep interest in correcting
the minor mistakes and guided us through my journey so far. Also they has
been persistent source of inspiration for me.
I am also very thankful of Dr. D. B. Kshirsagar, Head of Dept. of
Computer Engineering for the symmetric guidance and providing necessary
facilities and I Express deep gratitude to all the staff members and our depart-
ment’s technical Staff for providing me needed help.

Miss Tejal Jain

T. E. Computer

Roll No: 77

I
 Contents

1 Introduction 1
1.1 Comparison of the distributed network topologies. . . . . . . . . 1
1.2 Potential Problems and Challenges . . . . . . . . . . . . . . . . 1
1.3 Scopes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.4 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

2 Literature Review 4

3 System Architecture 6
3.1 System Architecture . . . . . . . . . . . . . . . . . . . . . . . . 6
3.1.1 System Architecture Details . . . . . . . . . . . . . . . . 6

4 Implementation Details 9
4.1 Hyperledger. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
4.2 Hyperledger Fabric. . . . . . . . . . . . . . . . . . . . . . . . . . 9
4.3 Modules in the System. . . . . . . . . . . . . . . . . . . . . . . . 10
4.3.1 Personal Health Data Collection. . . . . . . . . . . . . . 10
4.3.2 Personal Health Data Integrity Protection and Validation 10
4.3.3 Data Sharing and Healthcare Collaboration. . . . . . . . 11
4.4 Hardware Requirements. . . . . . . . . . . . . . . . . . . . . . . 13
4.5 Software Requirements. . . . . . . . . . . . . . . . . . . . . . . . 13
4.6 Merkle Tree. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
4.7 Flowchart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

5 Results Analysis 16

6 Conclusion and Reference 17

Conclusion 17

References 18

II
 List of Figures

1.1 Comparison among distributed network topologies. . . . 1

1.2 Pictorial Representation of Blockchain . . . . . . . . . . . 2

3.1 System Architecture . . . . . . . . . . . . . . . . . . . . . . . 6

4.1 User Interaction . . . . . . . . . . . . . . . . . . . . . . . . . 10

4.2 User Interaction . . . . . . . . . . . . . . . . . . . . . . . . . 12
4.3 Merkle Tree . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
4.4 Flowchart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

5.1 Average Time For Integrity Proof Generation . . . . . . . . . . 16

5.2 Average Time For Integrity Proof Validation . . . . . . . . . . 16

III
 Abstract

Today technology is boon for mankind. It has grabbed every part of human
life where healthcare is not an exception. A drastic change can be seen in
healthcare sector too where growth and use of wearable and mobile enabled
technologies has been remarkable. Along with growth, issues regarding security
and convenient sharing of personal data have also made a way in the devel-
opment. So there is a proposal made where the security and vulnerabilities
associated with our private data is taken under consideration which is cru-
cial for the improvement of the interaction and collaboration of the healthcare
industry.
A user centric health data sharing solution is proposed by utilizing a de-
centralized and permissioned blockchain technology to protect privacy. At the
user level, a mobile application is deployed to collect health data from personal
wearable devices, manual devices and medical devices. The data collected will
be stored in cloud through which data can be shared with health care providers
and health insurance companies. To maintain the integrity of health data, a
blockchain network is anchored with the database.

IV
 Chapter 1 Introduction

1.1 Comparison of the distributed network topolo-

gies.

Figure 1.1: Comparison among distributed network topologies.

• Centralized network topology, which creates a single-point-of-failure (the

central intermediary). If the central intermediary is down or attacked,
the entire network stops working[7].

• Decentralized network topology, which does not contain single-point-of-

failure. If one of the nodes, such as Node 1, is down or attacked, the rest
of the network can still operate normally.

• Blockchain. If “everyone can see everything” and there exists a dis-

tributed timestamp mechanism, the double-spending problem can be
solved on such a decentralized network.

1.2 Potential Problems and Challenges

There are several potential challenges to be considered when adopting blockchain
technology in the biomedical/health care domain.

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 Integrating Blockchain for Data Sharing and Collaboration in Mobile
Healthcare Applications

• Transparency and confidentiality.

• Speed and scalability.

Figure 1.2: Pictorial Representation of Blockchain

An example of the nonce mechanism for the proof-of-work protocol. Each

block contains an additional “nonce” (32-bit or 8-hex-digits in this example),
which is a counter that serves as one of the inputs of the hashing function. To
“proof” the hashing work, the nonce is incremented by one bit each time for
the hash computation (ie, the “work”), until the hashed value (256-bit or 64-
hex-digits in this example) contains a predefined number of leading zero bits
(ie, “proof” of the work, 16-bit or 4-hex-digits in this example). Meanwhile,
the newly generated unconfirmed transactions are collected in a memory pool
on each node. The first node that successfully completes the proof-of-work
(Node 1 at 10:14:30 in this example) has the privilege to create a new block
(B2 in this example), verify the transactions, move the confirmed transactions
from the memory pool to a newly created block, and add the block to the
end of the longest chain (if there are competing chains). It also gets paid (eg,
12.5 bitcoins) for this work. Also, the remaining nodes (Nodes 2 and 3 in
this example) stop the proof-of-work mining for B2 when Node 1 completes
the proof-of-work. This way, the mining process becomes difficult (ie, one
needs to compute the difficult hashing problem by trying different “nonce”
values), while the checking process remains easy (ie, just one hash to see if the
predefined leading bits are all zeroes).

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 Integrating Blockchain for Data Sharing and Collaboration in Mobile
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1.3 Scopes
A mobile user controlled, blockchain-based system for personal health data
sharing and collaboration.

• Handling of large dataset is at low latency, indicates the scalability and

efficiency of the data process.

• Integration of wearable devices with cloud database and blockchain.

• Only personal health data is not covered in the system, not medical data.

1.4 Objectives
• To provide secure and integrated network creation between user, health-
care provider and health insurance company.

• To provide data sharing and healthcare collaboration

• To maintain history of patient which will be accessible to appropriate

viewers.

• To develop a new version of EHR(Electronic Human Record) systems

with user-centric access control and privacy preservation.

3 Sanjivani College of Engineering, Kopargaon

 Chapter 2 Literature Review

“Unpatients-why patients should own their medical data” was proposed by L.

J. Kish and E. J. Topol in the year 2015. Rather than simply falling, and often
are, obtained longitudinally, over the course of a lifetime, fulfilling the idea of
,long data. They proposed that the key step to liberating personal health data
and realizing their true potential in human research and clinical practice is
the provision of data management systems that give individuals the right to
own their own data. Without connecting to their medical data, people are
unnecessarily being hurt and dying.
“A Simple Approach to Share Users Own Healthcare Data with a Mobile
Phone” in the year 2016 proposed by Hyunsoo Kim, Hoyeong Song, Soobin
Lee, Hyangjung Kim, Inkwang Song. They proposed a simple approach which
makes sure that the patients secure the ownership of their own healthcare
data and control access of other people to the data. Moreover, has applied this
method into the smartphone-based rehabilitation application for those who are
suffering from shoulder dysfunction. Adopts an one-time security system to
ward off effectively the leakage of client’s personal information. The developed
mobile application gives patients the specific guide for rehabilitation exercises
and visual feedbacks in order to motivate patients. Also, the doctor can check
the condition of patient’s health status in real-time through the server and
give him the proper prescription. Healthcare data sharing, using server and
web, is limited to patient and doctor.
“A Blockchain-Based Approach to Health Information Exchange Networks”
proposed by Kevin Peterson, Rammohan Deeduvanu, Pradip Kanjamala, and
Kelly Boles Mayo Clinic in the year 2016. Centralized data stores and author-
ity providers are attractive targets for cyber attacks leads to ramphications
of a breach are a strong disincentive to sharing data. Therefore authors have
concern for privacy and anonymity of data. Assumptions are made regarding
access control i.e. no solid approach for assigning access control. Security is
provided by Blockchain Encryption. Ease of access through Privacy Preserv-
ing Keyword Searches. Under “Prevention is better than cure”, no prediction
is proposed in terms of diseases which can follow the patient history.

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 Integrating Blockchain for Data Sharing and Collaboration in Mobile
Healthcare Applications

“A Secure System For Pervasive Social Network-based Healthcare” pro-

posed by Jie Zhang, Nian Xue and Xin Huang in the year 2016. In this they
proposed a blockchain based health care system and emphasizes two protocols.
Former is an improved version of the IEEE 802.15.6 display authenticated as-
sociation and later uses blockchain technique to share health data among PSN
nodes.
“Security Implications of Blockchain Cloud with Analysis of Block With-
holding Attack” proposed by D. K. Tosh, S. Shetty, X. Liang, C. A. Kamhoua,
K. A. Kwiat, and L. Njilla in May 2017. They discussed the existing vul-
nerabilities such as Double Spending Attack, Selfish Mining Attacks, Block
Discarding Attack and Dificulty Raising Attack, Block Withholding Attack.
Attacker’s strategy is analyzed based on two different pools where reward
schemes are different where pay per last N shares (PPLNS) scheme could be
useful in keeping the attacker’s impact lesser than proportional reward scheme.
“Architecture of the Hyperledger Blockchain Fabric” proposed by Christian
Cachin in the year 2016. The Hyperledger Fabric is a permissioned blockchain
platform aimed at business use. It is open source and based on standards, runs
user defined smart contracts, supports strong security and identity features,
and uses a modular architecture with pluggable consensus protocols. The fab-
ric’s design uses a modular notion of consensus, which is aligned with the
well-established concept of consensus in distributed computing. This ensures
that the blockchain related features of the fabric can be developed indepen-
dently of the specific consensus protocol.
“Blockchain distributed ledger technologies for biomedical and health care
applications” proposed by Tsung-Ting Kuo, Hyeon-Eui Kim, and Lucila Ohno-
Machado in the year 2017. It identified benefits of blockchain compared to
traditional distributed databases for biomedical or health care applications,
and provided an overview of the latest biomedical or health care applications
of blockchain technology. Challenges faced are speed, scalability, transparency
and confidentiality. Anonymity regarding user identification also remains ques-
tionable.

5 Sanjivani College of Engineering, Kopargaon

 Chapter 3 System Architecture

3.1 System Architecture

The System Design and architecture gives the detail architecture for developing
the proposed system[1].

Figure 3.1: System Architecture

3.1.1 System Architecture Details

A. Users.

System users collect data from wearable devices which monitor users health
data such as walking distance, sleeping conditions, and heartbeat. Those data

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 Integrating Blockchain for Data Sharing and Collaboration in Mobile
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is then uploaded to the cloud database hosted on trusted platform via the mo-
bile application. User is the owner of personal health data and is responsible
for granting, denying and revoking data access from any other parties, such as
healthcare providers and insurance companies. If the user is seeking medical
treatment, the user would share the health data with the desired doctors. If
the treatment is finished, the data access is revoked to deny further access
from the doctors. Same scenario applies to user-insurance company relations.
Besides, user can also record everyday activities according to a particular med-
ical treatment such as medicine usage to share with the treatment provider for
adjustment and better improvement[1].

B. Wearable Devices.

Wearable Devices serve to transform original health information into human-

readable format and then the data is synchronized by the user to their online
account. Each account is associated with a set of wearable devices and possible
medical devices. When a piece of health data generated, it will be uploaded
to the blockchain network for record keeping and integrity protection[1].

C. Healthcare Provider.

Healthcare providers such as doctors are appointed by a certain user to perform

medical test, give some suggestions or provide medical treatment. Meanwhile,
the medical treatment data can be uploaded to the blockchain network for data
sharing with other healthcare providers under the user’s permission. And the
current healthcare provider can request access to previous health data and
medical treatment from the user. Every data request and the corresponding
data access is recorded on the blockchain[1].

D. Health Insurance Company.

User may request a health insurance quote from health insurance companies or
agents to choose a proper health insurance plan. To provide better insurance
policies, insurance companies request data access from users including user
health data from wearable devices and medical treatment history. Users with
previous medical treatment(s) may need to pay a higher rate and the history
cannot be denied by users to prevent insurance fraud. Users can choose not
to share exercise information due to privacy issues but mostly they would
desire to share because regular exercise can bring down the insurance pay
rate. However, users cannot hide or modify medical treatment history data
since those data is permanently recorded on the blockchain network and the

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 Integrating Blockchain for Data Sharing and Collaboration in Mobile
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integrity and trustworthiness is ensured. Moreover, the insurance claims can

also be recorded on the blockchain[1].

E.Blockchain Network.

The blockchain network is used for three purposes. For health data collected
from both wearable devices and healthcare providers, each of the hashed data
entry is uploaded to the blockchain network for integrity protection. For per-
sonal health data access from healthcare provider and health insurance com-
pany, each of the data access request should be processed to get a permission
from the data owner with a decentralized permission management protocol.
The access control policies should be stored in a distributed manner on the
blockchain which ensures stability. Besides, each of the access request and
access activity should be recorded on the blockchain for further auditing or
investigation[1].

F. Cloud Database.

The cloud database stores user health related data, data requests from the
healthcare provider and insurance companies, data access record and data
access control policy. Data access is accountable and traceable. Once data
leakage is detected,the malicious entity can be identified[1].

8 Sanjivani College of Engineering, Kopargaon

 Chapter 4 Implementation Details

4.1 Hyperledger.
The Hyperledger Project (www.hyperledger.org) is a collaborative effort to
create an enterprise-grade, open-source distributed ledger framework and code
base. It aims to advance blockchain technology by identifying and realizing
a cross-industry open standard platform for distributed ledgers, which can
transform the way business transactions are conducted globally. Established
as a project of the Linux Foundation in early 2016[8].

4.2 Hyperledger Fabric.

Hyperledger fabric is a modular architecture allowing pluggable implementa-
tions of various functions. The distributed ledger protocol of the fabric is run
by peers. The fabric distinguishes between two kinds of peers: A validating
peer is a node on the network responsible for running consensus, validating
transactions, and maintaining the ledger. On the other hand, a non-validating
peer is a node that functions as a proxy to connect clients (issuing transac-
tions) to validating peers. A non-validating peer does not execute transactions
but it may verify them.
Some key features[8] of the fabric release are:

• A permissioned blockchain with immediate finality;

• Persistent state using a key-value store interface, backed by RocksDB

(rocksdb.org);

• An event framework that supports predefined and custom events;

• A client SDK (Node.js) to interface with the fabric;

• Support for basic REST APIs and CLIs.

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 Integrating Blockchain for Data Sharing and Collaboration in Mobile
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4.3 Modules in the System.

4.3.1 Personal Health Data Collection.

Health data comes from wearable devices such as activity trackers, pacemakers
or defibrillation, as well as manual user input for treatment tracking such
as medicine usage and training. Users firstly need to register to the cloud
service provider for an online account with storage capability to synchronize the
personal data to the cloud for convenient access and further process. Following
figure shows the data collection and synchronization architecture.

Figure 4.1: User Interaction

4.3.2 Personal Health Data Integrity Protection and

Validation
The health data comes from a variety of devices all day, resulting in a large
number of data records. To facilitate scalable and effiient data processing and
integrity protection, we develop a tree-based method for the integrity manage-
ment of health data record. Some data records are batched to form a tree-based
data structure and handle dynamic data enrollment. The adoption of Merkle
tree realizes the scalability requirement, and most importantly improves the
efficiency to validate the data integrity. Merkle tree is a binary tree structure
where the input is a list of hashed data records. These records are ordered by
the time when they are generated. Every two records are grouped together
and the hashes of the two data records become two leaf nodes of the Merkle

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 Integrating Blockchain for Data Sharing and Collaboration in Mobile
Healthcare Applications

tree and consequently constitute a high level group node with the group hash
generated by concatenating two hashes.
Two group nodes will follow the same way to generate a new higher level
group node with a new hash. This step is repeated until there is a single hash
which will become the tree root, that is, the Merkle root. Chainpoint is an
open standard for creating a timestamped proof of any data, file, or series
of events, which proposes a scalable protocol for publishing data records on
the blockchain and generating a Merkle proof for each data record. In the
implementation, anchoring of a list of data records to multiple Fabric channels
by binding the Merkle root to a blockchain transaction and verify the integrity
and existence of data without relying on a trusted third-party. The hash of
data records brings two advantages. For one thing, each Merkle tree can host
a large number of records since only the hash of the data record is stored. For
another, the hash is an effective measure to detect changes so that once a piece
of data is modified, the action can be detected easily by traversing the tree.

4.3.3 Data Sharing and Healthcare Collaboration.

The user can share data with healthcare providers to seek healthcare services,
and with insurance companies to get a quote for the insurance policy and to
be insured. When data sharing is detected in the system, there will be an
event generated to record the data access request. The event record can be de-
scribed using a tuple as recordhash, owner, receiver, time, location, expirydate,
signature. This record is then submitted to the blockchain network which is
followed by several steps to transform a list of records into a transaction. A
list of transactions will be used to form a block, and the block will be validated
by nodes in the blockchain network. After a series of processes, the integrity of
the record can be preserved, and future validation on the block and the trans-
action related to this record is available. Each time there is an operation on the
personal health data, a record will be reflected to the blockchain. This ensures
that every action on personal health data is accountable. The proposed sys-
tem implemented an access control scheme by utilizing the Hyperledger Fabric
membership service component and the channel scheme.
The CA, also known as the membership service provider, is responsible for
membership enrollment by issuing enrollment certificates and transaction cer-
tificates for participating nodes in the Hyperledger Fabric blockchain network
and participating Fabric client, and generating the access control list during
channel establishment according to user settings and operations. Different
access type can be specified in the certificate, such as query and update op-

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 Integrating Blockchain for Data Sharing and Collaboration in Mobile
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erations for chaincode execution in the channel. Chaincode is a piece of code

that is deployed to Hyperledger Fabric for enabling interactions between peers
and the shared ledger. There are three operations on the chaincode, includ-
ing deploy, invoke and query. A chaincode can be installed on a blockchain
by executing a deploy transaction while a chaincode execution is launched by
invoke transactions. Channel is formed to isolate individual activities among
authorized parties.
Healthcare providers and insurance companies also communicate with the
server to request or update health data and health insurance information. With
the permission from users, these requests will be allowed to participate in a
certain channel. The cloud server is configured with a Fabric client to commu-
nicate with the Fabric blockchain network peer. For different user activities,
the data will be labeled with different channel ID to distinguish isolated do-
main. The query or update requests from the server will be forwarded to
the Fabric network via Fabric client for transaction confirmation. Distributed
peers will validate the incoming requests and propose transactions by execut-
ing chaincode. The ordering services are responsible for checking transaction
signatures and order them with channel IDs. For each channel, there is a sub-
ledger, as part of the system ledger, to record all transactions in the form of
blocks[1].

Figure 4.2: User Interaction

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 Integrating Blockchain for Data Sharing and Collaboration in Mobile
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For privacy concerns, the user can selectively share health data with data
requester, based on the necessity of how personal health data is required to
assist the healthcare service. For example, a user’s insurance history may not
be important when the user is talking to a dentist. Similarly, the user’s dental
treatment is not necessary for skin testing or other treatment. To issue a spe-
cific certificate, the user can state clearly in the certificate what category of
personal data is allowed access, whether read-only or read-write access is al-
lowed. Moreover, in different channels, different grained information is shared.
In this sense, the system provides a user-defined, fine-grained privacy protec-
tion and access control policy, enhancing the data ownership of individuals.

4.4 Hardware Requirements.

• Wearable devices

• Mobiles

• Cloud Platform(IaaS)

4.5 Software Requirements.

• Android System

• Cloud Platform(SaaS)

• Hyperledger Fabric Client

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 Integrating Blockchain for Data Sharing and Collaboration in Mobile
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4.6 Merkle Tree.

A Merkle tree is a hash-based data structure that is a generalization of the hash
list. It is a tree structure in which each leaf node is a hash of a block of data,
and each non-leaf node is a hash of its children. Typically, Merkle trees have a
branching factor of 2, meaning that each node has up to 2 children.Merkle trees
are used in distributed systems for efficient data verification. They are efficient
because they use hashes instead of full files. Hashes are ways of encoding files
that are much smaller than the actual file itself. Currently, their main uses
are in peer-to-peer networks such as Tor, Bitcoin, and Git.
Benefits:
In various distributed and peer-to-peer systems, data verification is very
important. This is because the same data exists in multiple locations. So, if
a piece of data is changed in one location, it’s important that data is changed
everywhere. Data verification is used to make sure data is the same everywhere.
However, it is time-consuming and computationally expensive to check the
entirety of each file whenever a system wants to verify data. So, this is why
Merkle trees are used. Basically, we want to limit the amount of data being
sent over a network (like the Internet) as much as possible. So, instead of
sending an entire file over the network, we just send a hash of the file to see if
it matches.

Figure 4.3: Merkle Tree

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4.7 Flowchart

Figure 4.4: Flowchart

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 Chapter 5 Results Analysis

A user-centric model for processing personal health data using blockchain net-
work. No worries regarding privacy and security of personal data as user access
control policies are been enforced. Accountability of manipulating and reading
of data is maintained, every action has been recorded in blockchain network.
System could handle large data at low latency indicating the scalability and
efficiency

Figure 5.1: Average Time For Integrity Proof Generation

Figure 5.2: Average Time For Integrity Proof Validation

By adopting Merkle tree method to batch data, system implemented an

algorithm with the computation complexity of O(log n). This has an important
advantage when the data records are collected at high frequencies.

16
Chapter 6 Conclusion and Reference

Design and implemention of a mobile healthcare system for personal health

data collection, sharing and collaboration between individuals and healthcare
providers, as well as insurance companies is proposed by the system. The sys-
tem can also be extended to accommodate the usage of health data for research
purposes. By adopting blockchain technology, the system is implemented in
a distributed and trust less way. The algorithm to handle data records can
preserve both integrity and privacy at the same time. Meanwhile, adoption of
concept of channel supported by Hyperledger Fabric is used to deal with the
isolated communication required by specific scenarios.

17
 References

[1] Xueping Liang, Juan Zhao, Sachin Shetty, Jihong Liu, Danyi Li,” Integrat-
ing Blockchain for Data Sharing and Collaboration in Mobile Healthcare
Applications”978-1-5386-3531-5/17/31.00 2017 IEEE.

[2] L. J. Kish and E. J. Topol, “Unpatients-why patients should own their

medical data,” Nature biotechnology, vol. 33, no. 9, pp. 921–924, 2015

[3] H. Kim, H. Song, S. Lee, H. Kim, and I. Song, “A simple approach to share
users own healthcare data with a mobile phone,” in Ubiquitous and Future
Networks (ICUFN), 2016 Eighth International Conference on. IEEE, 2016,
pp. 453– 455

[4] K. Peterson, R. Deeduvanu, P. Kanjamala, and K. Boles, “A blockchain-

based approach to health information exchange networks,” 2016.

[5] J. Zhang, N. Xue, and X. Huang, “A secure system for pervasive social
network-based healthcare,” IEEE Access, 2016

[6] D. K. Tosh, S. Shetty, X. Liang, C. A. Kamhoua, K. A. Kwiat, and L.

Njilla, “Security implications of blockchain cloud with analysis of block
withholding attack,” in Proceedings of the 17th IEEE/ACM International
Symposium on Cluster, Cloud and Grid Computing, ser. CCGrid 17. Pis-
cataway, NJ, USA: IEEE Press, 2017, pp. 458–467. [Online]. Available:
https://doi.org/10.1109/CCGRID.2017.111

[7] Tsung-Ting Kuo,Hyeon-Eui Kim, and Lucila Ohno-Machado,”Blockchain

distributed ledger technologies for biomedical and health care applica-
tions”Journal of the American Medical Informatics Association, 24(6),
2017, 1211–1220 doi: 10.1093/jamia/ocx068

[8] C. Cachin, “Architecture of the hyperledger blockchain fabric,” in Work-

shop on Distributed Cryptocurrencies and Consensus Ledgers, 2016.

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