Blockchain In Healthcare Sector: A case study of Nepal

Name: Reshma Ghimire

Date: 05/06/2021
Course Number: CT095-6-M
Email: reshma.ghimire@study.lbef.edu.np
Lord Buddha Education Foundation

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Abstract
In present days the use of digital
platforms, such as big data and Machine
Learning, has proven to be effective in
numerous applicable areas and industries.
We are currently on the edge of a profound
change due to the emergence of the
blockchain. Even without a bank or other
financial organization, we can exchange
value through technology. Any existing
system or platform cannot be compared to
Block Chain. It can be utilized in a place
that creates trust between both end users.
Block Chain has earned its popularity in
the decentralized approaches to create
management value. Many government and
non-government organizations have
introduced the concept of block
chain because of the benefits provided by
technology. It delivers some of the most
vital services such as security, scalability,
and efficiency enhancement. More than
three-quarters of Nepal's limited electronic
health systems are unconnected and
scattered, and information security is
inadequate, compounding the situation. It
is essential to successfully steer health care
systems, making them more citizen-
centric, in order to build a secure and
unified online healthcare system. This
research will investigate how the block
chain is being used in Nepal's healthcare
sector. Consensus ensures that data are
valid and transactions with blockchain
technology are safeguarded. Patients are at
the heart of the health-care system, thanks
to blockchain technology, which enhances
medical data privacy and interoperability.
This article illustrates how Blockchain
technology can be used to address health
data management challenges.
Introduction
Blockchain has become one of the most
successful in the past decade technologies,
attracting the interest of numerous
academic research and industries.
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Decentralization, privacy, and security are
three of the most intriguing characteristics
of blockchain that are useful to healthcare
applications. For example, blockchain
technology may guarantee patients and
other stakeholders may have secure access
to medical data. (insurance companies,
hospitals, doctors, etc.) (Fekih, 2020).
Overview and Architecture of
Block chain
A Blockchain transaction is a tiny unit of
labor that is recorded in publicly
accessible blocks. A majority of the
system's users double-check each
transaction. Tamper proofing is
accomplished after transactions are
recorded on the blockchain. In terms of
immutability, each participant duplicates,
hosts, and maintains a single copy of the
ledger. (Fekih, 2020).
Intelligent agreements that execute
themselves on the blockchain frame,
allowing direct processing regardless of
the kind of blockchain, are used to write
the business logic. When smart contracts
are integrated into the blockchain, they
become permanently tamper-proof since
no one can change what has been written,
self-verifying due to automated
capabilities, and self-enforcing when the
rules are obeyed at all levels.
A few of the advantages of blockchain are
the decentralization through making the
blockchain accessible to all participants,
immutability by making it almost
impossible to manage and to censor,
availability through providing all pairs
with a copy of the blockchain to access all
time-stamped transmission records. with
the blockchain using a randomly generated
address.
Blockchain transactions are encrypted and
incorporated into blocks, which are then
appended to the ledger without being
erased. Blockchain is verified by a hash-
linked list of encrypted transactions.
Patients have simple access to their data
via this service, which is critical in
creating a decentralized medical care
arrangement comprised of both patients
and providers. The blockchain is an
immutable and unchangeable data
structure that operates on a global scale
and is based on a cryptographically secure
basis. An immutable key reference system
connects the blocks, and those blocks are
complexly linked with one another. (Jain,
2020).
Figure 1:Block chain Networking Model
This diagram shows the Blockchain data
structure components:
 Blockchains have a list of valuable
blocks that are secured within the
network.
 Same Blockchain data structure
instances for a peer-to-peer
network
 An agreement that allows the
Blockchain to follow a coherent
trajectory.
 A security technique that protects
the immutability of data stored in
the Blockchain network.
With the advancement of blockchain
technology, we are currently on the verge
of a fundamental upheaval. Even in the
absence of a bank or other financial
institution, we can distribute value only
through technological means. First and
foremost. Blockchain is not illegal in
Nepal or any other country, however it is
unlawful in terms of cryptocurrencies.
Undeveloped nations, such as Nepal, have
much poorer health-care systems. Even
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though evidence-based consolidated
healthcare data is uncommon, it is critical
for assisting health-care organizations in
effectively planning and allocating
resources. The failure to cooperate with
each other across institutions and
departments, the lack of knowledge and
competitiveness, privacy issues, safety
concerns and compatibility are all
contributory factors. The situation
deteriorates when a patient with a serious
illness needs the long treatment procedure,
as well as rehabilitation and surveillance
after therapy. She or he may be asked to
consult or be transferred from one hospital
to another in multiple medical institutions.
A secure electronic healthcare system may
be used as a tool to identify the optimal
way to bridge this gap. (Pranita
Upadhyaya, 2018).
Background
Nepal cannot afford to be left behind in
terms of Internet, electrical, and
technological advancements that provide
services. These applications are constantly
susceptible to existing and future security
challenges and threats that limit e-services
growth. According to recent publications,
the majority of security methods used to
manage public infrastructure resources are
based on the PKI. In this scenario, the best
option would be a Blockchain-based
system because this is a safe, distributed
leader that does not rely upon a single
security organization.
Blockchain in healthcare
According to researchers, the healthcare
industry faces a number of problems that
are concerning to healthcare professionals.
Inefficiency, for example, is a well-known
problem in healthcare throughout the
world, and it may have a detrimental effect
on patient care, either directly or
indirectly. The substantial financial loss
and human health and safety risk presented
by counterfeit, theft, and diversion of
medicines is a major complication in the
context of the drugs supply chain (Rejeb,
2019 )As a consequence of this problem, a
number of blockchain-based healthcare
applications have been proposed. (Fekih,
2020).
Benefits of Blockchain in
Healthcare
Blockchain technology has the major
significant in the healthcare sector.
 It allows for efficient data
management. The safe and
transparent sharing of medical data
is now feasible thanks to this
technology. Providers may now
share data across several industries.
 With blockchain technology, It is
simple to create medical records
administrative costs are eliminated
by the system. It also allows for
more efficient health-care use. This
technique also eliminates the need
for several middlemen.
 In the healthcare industry,
blockchain provides transparency
and efficiency. practitioners have
more time to focus on their primary
duty, which is to enhance the
health of their patients. Providers
may also get access to a full image
of a patient's medical record. In the
healthcare system, all past health
data is irreversible. It is possible to
see changes in the data.
 Transparency and data integrity are
improved. One of the most
significant benefits of Blockchain
is the proper handling of medical
data. It solves the majority of the
issues that plague the healthcare
industry. Fraud and data loss
during disasters are now a thing of
the past.
Data completeness and
compatibility are also improved
(Research, 2018).
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Opportunity of blockchain in
healthcare
Transparency,accountability,decentralizati
on, record accuracy, secure transactions,
interoperability,costreduction, cooperation,
and agility are all factors addressed when
considering the importance of blockchain
in the healthcare system. Blockchain
technology and health data integration
(Gökalp, 2018).
1. Transparency
Because of blockchain's
decentralization, we can build accurate
and objective data sources from which
consumers may get Updated health
system supplier data, figures and
evaluations. Patients may also freely
exchange their confidential health data
with medical practitioners thanks to
patient-centered treatment and a secure
peer-to-peer network, without risk of
data theft. Citizens are therefore
empowered to make decisions. Patients
who feel empowered are less likely to
be anxious while interacting with
healthcare providers and are more
likely to make good decision.
2. Accountability
One of the most irritating and
complicated parts of the healthcare
business is the insurance and payment
procedure. Insurance companies and
government agencies do not want to be
overcharged or defrauded by
physicians who perform medically
unnecessary treatments. The
blockchain technology has the
potential to greatly simplify
documentation and sharing. As
medical information becomes more
accessible, shared, and verifiable, all
healthcare stakeholders must become
more accountable.
3. Record Accuracy
 Patients may face errors in their health
records in existing health information
systems, for example, their medical
history may not be shared with all
parties. As a result, using conventional
health information management
systems, data integrity across
healthcare service providers is a major
problem. Medication errors may be
decreased significantly as a analytics, machine learning and
consequence of improved
communication and record accuracy.
Patients may have greater confidence
in their physicians if all members of a
healthcare network have access to
Precise information.
4. Secure transaction
Blockchain enables the use of state-of-
the-art encryption and decryption
methods based upon private and public
key pairs to preserve security and
prevent human assaults in the middle.
It improves data security while
reducing the costs, time and resources
needed to provide a secure
environment for medical information
exchange and payments processing.
5. Interoperability
We can use blockchain technology to
combine and standardize data from a
variety of sources, Mobile healthcare
apps, home health devices, wearables,
and electronic health records are all
examples of electronic health records.
into a standardized format As a
consequence, blockchain may enable
Individuals and healthcare
professionals may now access data
from a variety of platforms, including
DNA banks, organ donation programs,
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and blood banks, resulting in health
data interoperability. This
interoperability also increases the
speed with which relevant data from
different data sources may be accessed,
as well as the quality and quantity of
data accessible for medical research.
Blockchain data may be utilized for
further analysis, utilizing Big Data
profound learning technologies, of the
confluence of demographics, genetic
markers and a range of other data sets
for research and development reasons.
6. Lower cost
Patients benefit from blockchain
because it makes recorded and accurate
information accessible to them,
allowing them to make better decisions
about the financial elements of their
therapy. Patients may keep track of
their spending and become more aware
of how much they pay The services
provided by the suppliers. Blockchain's
availability also lowers the cost of
operating and maintaining the
operating systems of the providers.
7. Collaboration
Evaluating Possibilities and Threats
181 people and service providers may
get transparent access to information
about health goods, medicines, MRI
equipment, surgical materials, and
other items
8. Agility
Furthermore, real-time health data may be
utilized to detect unexpected changes in
key markets during an emergency medical
situation.
Articl Full Main Research Main Why is this Other
e Reference Question/Objective results/Issue paper remarks
(Harvard s s relevant (e.g.
Referencin Theme etc.
g Style)
1. (Pranita To propose a blockchain- The research Ultimately, this This research
based safe healthcare demonstrates a study seeks to lacks the
Upadhyaya, system (with a focus on suggested improve the centralized
2018) poor countries) and to controlled healthcare permissioned
validate it using a balanced decentralized system in
scorecard to ensure that it Blockchain-based impoverished
Blockchain-
performs effectively and healthcare nations such as based
generates revenue. paradigm that has Nepal through healthcare
been proven to financial gain. approach that
available has been
shown to be
technically
and
financially
effective in a
hospital
setting in
poor nations

2 (Chakrabort The proposed The research The major This research

y, Aich, & methodology discussed study establishes concept lacks a secure
in this article totally very clearly the detected in this method for
Kim, 2019) resolves the issue of comprehensive instance is the protecting
inefficiency, as well as supervision of a data's data from
the security of data cure, an ongoing trustworthines misuse and
created in the current treatment, or s or also for
healthcare system. generic authenticity. establishing a
healthcare from foundation of
start to finish. trust between
the many
parties.
3. 2019 The main goal of this This study Numerous This study
project is to improve a highlights the applications makes no
current blockchain dangers associated have specific mention of the
technology, which will be with mining criteria that are level of
used by academics in incentives, mining not addressed by awareness
academia and industry to attacks, and key a large number required for the
begin exploring applications management. of the general public
focused toward healthcare blockchain trials to comprehend
use. that have been the benefits of
conducted, as blockchain.
emphasized in
this survey
paper.

5
4. (Ebru The main objective of this This article The report This paper does
research is to propose a highlights several examines the not go into
Gökalp, complete blockchain problems, opportunities detail about
2018) architecture that includes all including and barriers for blockchain in
stakeholders in healthcare governance blockchain the healthcare
and analyzes the concerns, absence technology sector, but
implications and challenges of legislation, deployment in rather focuses
associated with such a confidence and the healthcare on the obstacles
system. privacy problems, business from a and
scalability, holistic opportunities.
participant perspective.
acceptance and
operating costs.
5. (Heston, The objective of this article This article According to Additionally,
is to highlight the potential highlights how the this study, findings
2017) uses, challenges, and majority of blockchain indicate that the
possible directions for research is technology majority of
healthcare blockchain focused on research in evaluated study
research. presenting unique healthcare is sections omit
structural designs rising, and it is technical
via frameworks, currently being specifics on the
architectures, or utilized mostly blockchain
models. for data elements
exchange, health employed and
record that the
management, majority of
and access study omits any
control. prototype
implementation
or
implementation
specifics.
6. Harjula, E., & This study seeks to This research This study This study
Ylianttila, M. investigate how blockchain highlights the outlines critical identifies
(2018). technology might be used in hurdles and application areas crucial areas of
today's healthcare system. limitations that within the application in
must be overcome healthcare the medical
prior to the domain where field in which
effective adoption blockchain technology
of a healthcare technology blockchain may
application, such could be be
as scalability beneficial. advantageous.
constraints and
high development
costs.
7. (Magar, The primary purpose is to This article This study has This project is
investigate the intricacies of demonstrates that been promoted to develop a
2019) the existing healthcare the majority of in order to Blockchain-
system and the associated current health establish a based health
challenges. record systems are blockchain- record
centralized, based architecture in
missing architecture. order to address
interoperability present issues
-To ascertain the advantages and data with
and disadvantages ownership by interoperability
associated with patients. , data privacy,
implementing an electronic and data
health care system in ownership.
developing nations such as
Nepal.

8. (Mettler, The major objectives of According to this This paper show Does not
this research is to show how study, all past the various mention the
2016) Blockchain technology research has been impacts, financial
works may be used in a conducted for ambitions, and incapacity that
variety of ways in the financial gain. potentials blockchain
healthcare sector, including associated with requires.

6
 Medical research utilizing blockchain
personal patient data and technology.
pharmaceutical
counterfeiting are utilized to
gain a better understanding
of users in public health
management.
9. (Miah, Attempts to Worries about This article This study is
compartmentalize concerns data integrity identifies some deficient in its
2019) about the implementation stemming from significant approach to
and development of concerns about application financial
blockchain applications. confidentiality and sectors that opportunities.
protection present research to advance and
possibilities and distribute
difficulties for superior
future medical
improvements research
and directions
benefit of
information
systems
researchers and
professionals.
10. (Ray, 2021) This article introduced an The study This study Further study
improved, secure, illustrates how the demonstrates will focus on
transparent and efficient usage of how integrating
blockchain
IoT-based eHR blockchain the IoB The
technology might
healthcare access and lessen
and Internet of IoT-based
management framework centralization. Things EHR
for e-Healthcare data. technology management
can be used to health data-
improve flow
services architecture
using a cost-
efficient,
dependable,
convenient
and resource-
limited
protocol and
tool set.
11. (Rim Ben The key objective is to This study shows The research Blockchain
solve scalability, security that scalability in findings showed researchers
Fekih, 2020) and privacy constraints so blockchain-based a number of could
that stakeholders can systems, future uses for investigate
increase their faith in this especially when present state of further study in
technology and implement big amounts of the art, fields
it in healthcare. health data are including the Biomedical
involved, is a installation of research,
major problem. electronic pharmaceutical
medical records, supply chain
remote management,
monitoring and and insurance
the are a few
administration examples.
of the supply
chain
12. (Satyabrata The primary purpose of this According to this The research This study is
research is to resolve the study, the major proposes a well- deficient in its
Aich*, efficiency and security concept that is defined approach to
2019) concerns associated with the consistently seen framework for financial
data created in the in the case of the opportunities.
conventional healthcare healthcare data comprehensive to advance and
system. research is the supervision of a distribute
data's cure, an ongoing superior

7
 trustworthiness or therapy, or medical
authenticity. generic research
healthcare from
start to finish.
13. (Shahnaz, The ultimate focus of this The Electronic This study This
session is to explain how Health Record explores the framework
Qamar, & blockchain technology systems are scalability represents a
Authors, works. can be used to concerned with challenge of combination of
2019) transform EHR. data security, blockchain safe record
integrity and technology storage and
administration. generally granular access
through the controls for
usage of off- these
chain record documents. It
storage. develops an
easy-to-use
user system.
14. (Tanesh The study's primary aim is This research This report The research
to examine the possibility of demonstrates the covers major has proposed
Kumar1, blockchain technology obstacles and fields of an intelligent
2018) being used in the healthcare obstacles to the Blockchain agreement for
sector systems and to successful technology is blockchain
identify the most critical introduction of being used in healthcare
system requirements, such blockchain the area of systems, which
as trustworthy, transparent technology in healthcare.This is crucial for
healthcare systems. healthcare paper examines establishing
systems. also specific pre-defined
requirements agreements
and concerns among multiple
about stakeholders.
blockchain-
based solutions
for the
healthcare
sector.
15. (jan,2020) This article focuses mostly The examples The study By introducing
on the solution of provided suggests a artificial
difficulties related to health demonstrate the unique model of information,
care data management unintended health care yet the internet,
utilizing Blockchain consequences of in its infancy, and much more
technology. EHR use. The but which can available
health care model undoubtedly information
described in this become a basis technology,
study addresses a for many more blockchains
number of these models of have been
issues and offers healthcare. strengthened to
viable remedies. enable a more
comprehensive
medical model
to evolve in the
future.

Relative Theories in the workplace. According to the idea, a

TAM ( Technology Acceptance Model )
The TAM is an information technology
paradigm that has been tried in older
populations to evaluate users' acceptance
and usage of new technologies, especially
person's intention to use (acceptance of
technology) and use behavior (actual use)
of a technology are determined by their
views of the technology's utility (benefit
from utilizing the technology) and
simplicity of use. External factors such as

8
individual variations, system features, determinants of behavioral intention and,
social influences, and enabling ultimately, behavior, and that these
circumstances, according to the TAM, are constructs are moderated by gender, age,
mediated by judgments of utility and ease experience, and voluntariness of use.
of use. Researchers and practitioners will be able
to assess an individual's desire to use a
UTAUT ( Unified theory of acceptance particular system by evaluating the
and use of technology ) existence of each of these components in a
According to the UTAUT, the four core "real world" setting, allowing for the
constructs (performance expectancy, effort discovery of important effects on
expectancy, social influence, and acceptance in any given situation.
facilitating conditions) are direct

Conclusion
Blockchain technology has evolved over
time in the real estate and finance
industries, with the unmatched benefits in
mind. It would not be wrong to say that
health models based in Blockchain are the
future of healthcare and can alter the
management of people and secure their
records of health in Nepal. The concepts
behind the deployment of Blockchain are
mostly unexplored. This study suggests an
in-depth examination of block chain
technology in Nepal's health care industry.
With the deployment of Artificial
Intelligence and the internet of Things and
with the availability of many more
technologies, there is extra potential to
improve in future to construct more
comprehensive health model.

References

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  Blockchain in healthcare applications: Research challenges and opportunities. (2019).
Journal of Network and Computer Applications, 62-75.
https://doi.org/10.1016/j.jnca.2019.02.027

 Chakraborty, S., Aich, S., & Kim, H.-C. (2019). A Secure Healthcare System Design
Framework using Blockchain Technology. International Conference on Advanced
Communication Technology (ICACT) (pp. 1-10). PyeongChang, Korea (South):
IEEE. 10.23919/ICACT.2019.8701983

 Ebru Gökalp, M. O. (2018). Analysing Opportunities and Challenges of Integrated

Blockchain Technologies in Healthcare. SpringerLink (p. 10 ). Ankara: SpringerLink .
10.1007/978-3-030-00060-8_13

 Fekih, R. B. (2020). Application of Blockchain Technology in Healthcare: A

Comprehensive Study. springerlink , 10. https://doi.org/10.1007/978-3-030-51517-
1_23

 Gökalp, E. (2018). Analysing Opportunities and Challenges of Integrated Blockchain

Technologies in Healthcare. Lecture Notes in Business Information Processing , 10.
10.1080/10580530.2020.1812014

 Heston, T. (2017). A case study in blockchain health care innovation. International

Journal of Current Research, 10-20. 10.22541/au.151060471.10755953

 Jain, S. (2020). Blockchain and Machine Learning in Health Care and Management.
International Conference on Mainstreaming Block Chain Implementation (ICOMBI)
(p. 5). Banglore India : IEEE.

 Jain, S. (2020). Blockchain and Machine Learning in Health Care and Management.
Proceedings of the International Conference on Mainstreaming Block Chain
Implementation (p. 10). banglor: IEEE. 10.1109/COMST.2020.2975911

 Magar, N. (2019). Electronic Health Record System Using Blockchain in Context of

Developing Countries. researchgate , 1-46. 10.13140/RG.2.2.28682.90560

 Mettler, M. (2016). Blockchain technology in healthcare: The revolution starts here.

International Conference on e-Health Networking, Applications and Services
(Healthcom) (pp. 1-3). Munich, Germany: IEEE.
10.1109/HealthCom.2016.7749510


 Miah, S. J. (2019). Blockchain in healthcare . Australasian Journal of Information

Systems, 1-22. https://doi.org/10.3127/ajis.v23i0.2203

10
  Pranita Upadhyaya, S. K. (2018). Revolutionizing healthcare systems of a developing
country using Blockchain . kathmandu : IEEE Xplore. 10.1109/ICCIC.2018.8782417

 Ray, P. P. (2021). Blockchain for IoT-Based Healthcare: Background, Consensus,

Platforms, and Use Cases. IEEE SYSTEMS JOURNAL, 1-10.
10.1109/JSYST.2020.2963840

 Rejeb, A. (2019 ). Potentials of Blockchain for Healthcare: Case of Tunisia. An

international Scientific journal , 21.

 Research, S. I. (2018, 03 13). Blockchain in Healthcare Market Research. Retrieved

from greenbook directory: https://www.SIS International
Research.org/case-study/blockchain-in-healthcare-market-research

 Rim Ben Fekih, M. L. (2020). Application of Blockchain Technology in Healthcare:

A Comprehensive Study. springer (pp. 20-40). springer. https://doi.org/10.1007/978-
3-030-51517-1_23

 Satyabrata Aich*, S. C.-i.-C. (2019). A Review on Benefits of IoT Integrated

Blockchain based Supply Chain Management Implementations across Different
Sectors with Case Study. International Conference on Advanced Communications
Technology (pp. 1-4). PyeongChang, Korea: IEEE.

 Shahnaz, A., Qamar, U., & Authors, A. K. (2019). Using Blockchain for Electronic
Health Records. IEEE Access, 1-14.

 Tanesh Kumar1, V. R. (2018). Blockchain Utilization in Healthcare: Key

Requirements and Challenges. International Conference on e-Health Networking,
Applications and Services (Healthcom) (pp. 1-7). Oulu, Finland: IEEE.

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