Trends in Blockchain

Dr. Shelly Sachdeva

Department of Computer Science and Engineering
National Institute of Technology Delhi, India

11th International Conference– CONFLUENCE’ 2021 at Amity University Uttar Pradesh, Noida
(Jan 28-Jan29, 2021) 1
Contents
• Introduction

• Marketplaces leveraging Blockchain

• Research challenges of blockchain-enabled marketplaces

• Current Healthcare Marketplace

• Evolution of healthcare

• Challenges

• Blockchain enabled Patient centric Healthcare System

• Blockchain Data Management and Analytics

• Research Challenges

• References
2
 Centralized Vs Decentralized
Encyclopedia Wikipedia

Centralized Content
Decentralized Content
-Books either available for purchase or in library.
-Millions of content generators
-Access limited to only handful of people.
-Internet available to more people than books
-Much faster generation of content 3
 •Combination of Nodes
Blockchain Network B •Each node carrying same copy of Ledger
•Peer-to-Peer N/w
C
A

E
F

D
H G

4
Blockchain – A simplified View
A block is a container data structure that contains a series of transactions

Genesis Block

1 2 3

Data: … Data: …
Data: …
Prev. hash: 000000 Prev. hash: 45ks0mn781
Prev. hash: 034dfacdmn
Hash: 034dfacdmn Hash: 9l2kdj74n3
Hash: 45ks0mn781

Blocks are cryptographically linked together 5

 Blockchain
Traditional Relational Database
• DDL & DML
• Data can be deleted or altered
• Centralized Relational DB
• Stored Procedures
• Data-Validation
• Access Control
Blockchain
• Append only Distributed Ledger
• No deleting or editing of recorded data
• Decentralized
• Smart Contracts (stored on blockchain &
executed automatically to serve as agreements or
a set of rules that oversee a blockchain transaction)
• Immutability
• Assets Transactions
• Identity Management
6
 • Decentralisation
•
Blockchain autonomy •
•
Consensus
Immutability
primary enabler for
verification-driven
transactions between
parties that do not
have complete trust
among themselves.

Block validation process in blockchain

Panarello, Alfonso, et al. "Blockchain and Iot integration: A systematic survey." Sensors 18.8 (2018): 2575.
7
Decisive action for the use of blockchain

8
 Types of Blockchain
Permissioned/ Private
• Hyperledger Fabric
• BFT (Byzantine Fault Tolerant)
• Many business networks may have a
need for a distributed ledger that is
only accessible to a closed
community of known entities
• Adv- Higher Transaction throughput
• Lower consensus Latency
Permissionless/ Public
• Bitcoin
• PoW (Proof of Work)
• entities that participate in the
transfer of assets are anonymous
and any entity can participate
• Disadv- Computationally Inexpensive
9
Objectives

Marketplaces which can be leveraged by the blockchain

To identify the challenges in current healthcare marketplace

Blockchain Data Management and Analytics

10
Blockchain in various marketplaces
Marketplaces Benefits Applications
Financial Eliminates the need for reconciliation of transactions  Bitcoin
domain[28] Treasury authorities have a real-time view of the ecosystem  Ripple
Regulatory authorities can use the information for policy management  Stellar
Money laundering can be reduced
Get rid-off paperwork which makes the system efficient
Intermediaries can be eliminated

Land records[29]  Accelerates the process  Chrma Way

 Saves time and money  Lantmateriet
 Eliminates the need for intermediaries  X-Road
 Environment-friendly  Electron
 Easily verifiable
 Prevention from fraudulent transactions
Healthcare  It makes the system patient-centric  Medrec
domain[30]  Data availability can be improved  Medicalchain
 The reconciliation problem of scattered data can be resolved  Dentacoin
 Curtailing the exposure to radiation or infuriating procedures  Factom
 Accessing longitudinal data at the point of care
 Resolves the problem of universal patient-id and information blocking

11
 Blockchain in various marketplaces
Marketplaces Benefits Applications
Supply chain  Improves cost-effectiveness  Agridigital
management[31]  Adds improvements in provenance and traceability of food items  Agunity
 Ensures the right product reached to the right customer at the right time  Agriledger
 It provides greater visibility and combats the distribution of counterfeit products  Banqu
 Gives transparency to the agriculture-related insurance process

Logistics  Increases business profits and customer satisfaction  Tradelens

domain[32]  Flow of information from one end to another endin a secure and compliant way  Trip
 Eliminates frauds related to over-invoicing, under-invoicing, and duplicate-  Bita
invoicing
 It significantly reduces time and cost
 It eliminates various disputes between buyers, suppliers, and carriers
Media and digital  It provides fairness across the ecosystem  Aditus
art domain[33]  No party can cheat the other party of their dues  Artchain
 Facilitates automated payments  Artbyte
 Digital artist preserves the integrity of their work and gets compensated for their  Artlery
effort
 It eliminates the risk of copying and spreading by some malicious entity over the
internet
 Digital scarcity is created to preserve the integrity of artists work

12
Research challenges of blockchain-enabled marketplaces
Issues Research Challenges

Scalability How to make blockchain scalable in terms of joining nodes?

How to make blockchain scalable in terms of transactions per second?

Privacy How to preserve information privacy when multiple entities are part of
the blockchain ecosystem?

Security How to make blockchain secure from vulnerabilities like smart contract
program, message hijack, 51% attack, and Goldfinger attack.

Energy consumption How to check energy consumption in various domains?

Cost and unawareness How to make a blockchain-enabled system cost-effective and motivate
people to use them?

Blockchain interoperability How to facilitate the transfer of information amongst multiple chains?

13
 Evolution of healthcare
Generations Techniques Pros Cons
First-generation Hard-copy/paper-based Simple to use Non-portable
The log is hard to maintain
Tedious from a chemist perspective
Costly and time-consuming

Second generation EHR (Electronic Health Supports portability and It cannot reconcile real-time data quickly
Record)-based (Digital) accessibility to some extent. The patient won’t get precise treatment
It is less time consuming as always
compared to the previous system Availability, accessibility, interoperability,
  security, and privacy are issues

Third generation Cloud-based Health Supports portability and Privacy, interoperability, security, and
Information System accessibility. integrity are the issues
Reconcile real-time data quickly

Fourth generation Blockchain-based Health Supports privacy, security, and Interoperability is an issue.
Information System integrity Complex to implement.
Not following HIPPA compliances

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Challenges in blockchain-enabled healthcare
Challenges Pain points
Cost-effectiveness High development cost blockchain systems.
Usability complexity Lack of knowledge to use.
Immature and untested infrastructure.

Interoperability The prescription of one practitioner is not meaningful to other practitioners.

No global standard is defined for information transfer.

Parallel chains Need for private corporations and government bodies which may defeat the
purpose of decentralization.

Privacy How to deal with hashes and metadata privacy protection laws?

Lack of standards Lack of rules for the storage and transfer of information
Immutability How to deal with incorrect information, once it is stored on the blockchain
How to stop practitioners from using incorrect information.

Quantum computing Researchers have to create quantum-resistant encryption algorithms

15
Blockchain enabled Healthcare System

To design patient centric healthcare system

To handle huge volume of clinical data by ensuring data integrity

16
System design and architecture
Patient, Doctor, Insurance Company,
Lab Staff User Layer

User-Logical Layer Interface

Logical layer Services

Logical Layer
Smart Authorizati
Authentication
Contract on

Logical-Storage
Layer Interface

Storage Layer

Off-chain
Blockchain Storage
Storage

Figure. Three layered architecture of proposed framework 17

Various stakeholders of the system
Authority ID Stakeholder Authority
1 Patient Store health information to the off-chain
storage and provide authorization to other
stakeholders.

2 Doctor Can access patient basic and medical

information and append his prescription.

3 Pharmacist Can access doctor prescription and general

patient information.
4 Insurance company Can access patient treatment history, doctor
prescriptions during the claim.

18
 Functions executed in smart contracts
Smart contracts allow the shared business processes within a business network to be standardised, automated and
enforced via computer programs to increase the integrity of the ledger.

Function name Input parameters Return value

isPatientAuthorized() patientID true: if the patientID is real
false: if the patientID is not real

isDoctorAuthorized() patientID true: if the doctorID is allowed to see the patient healthcare
data.
false: if the doctorID is not authorized
isPharmacyAuthorized() patientID true: if the pharmacyID is allowed to see the patient
prescription data.
false: if the pharmacyID is not authorized

isInsurerAuthorized() patientID true: if the insurerID is allowed to see the patient healthcare
records.
false: if the insurerID is not authorized
storePatientInformation() patientID, Patient’s data is stored in the database after its successful
patient_body_parameters authentication.
else the transaction is cancalled and function reports failed
transaction.

19
Contd..
Function name Input parameters Return value
prescribeMedicines() patientID, doctorID, prescription_details After positive authentication the patient’s
data is stored in the database.
otherwise the transaction is cancelled
and function failed transaction files.

getPrescription() patientID, prescriptionID After successful authentication of the

pharmacy it retrieves patient’s prescription
from the database.
otherwise the transaction is terminated and
function reports failed transaction.

getPatientRecord() patientID, insurerID After successful authentication of the insurer

records of the patient are collected from
database.
otherwise the transaction terminated and
function reports failed transaction.

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 .

Data retrieval by the patient

Blockchain

Patient
Off-Chain
Smart Storage
contract

Doctor

21
 .

Data retrieval by the pharmacy

Patient

Blockchain
Off-Chain
Storage
Smart contract

Doctor

22
 .

Data retrieval by the insurer

Blockchain
Off-Chain
Storage
Smart contract

Patient Doctor

23
Evaluation Parameters
• Execution time: This is the time delay (in seconds) between
confirming a transaction and executing a transaction in the blockchain
network
• Throughput: Refers to the quantity of data to be transferred in a unit
amount of time from one point to another
• Latency: It is recognized as the time difference between submitting a
request and getting of first response for the request. In terms of the
time, it ought to be referred to as the difference between deployment
and completion time of the transaction

24
Comparison between Traditional and Proposed Healthcare system
  Traditional Healthcare Proposed Healthcare
Confidentiality End to end encryption is provided to the Same level of confidentiality.
transmitted data.

Immutability Databases are vulnerable to malicious Once block is added it is computationally

manipulation. infeasible to mutate.

Traceability Information may alter which hampers Transactions are traceable to their provenance
traceability. guarantees immutability.

Availability Backups must be managed manually to All nodes having exact copy of the blockchain
tackle the failure. which provides high fault tolerance.

Privacy Data is transmitted in encrypted form Anonymous references protect the privacy and
which can be traced back to the data discard any possibility of association.
owner.

Speed Transactions are mainly depending on Negligible delay occurs due to validation of block.
network transfer rate.

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Blockchain Data Management and Analytics
• Use of blockchain as a transaction service in non-cryptocurrency
applications, for example, business networks, is at a very nascent
stage
• Time is ripe for database community to get more deeply involved in
solving open problems pertaining to data management and analytics
in a permissioned blockchain network for business applications

26
Question
• building blocks of blockchain include some combination
• database,
• transaction,
• encryption,
• consensus and
• Other distributed system technologies,
• Is it possible to utilize existing capabilities of mature data and
information systems through robust integration into blockchain
systems?

27
Non-cryptocurrency applications
• Supply Chain (IoT enabled blockchain)
• (A blockchain enables IoT devices to send data for inclusion in a shared transaction repository with tamper-resistant
records, and
• enables business parties to access and supply IoT data without the need for central control and management.
• Can optimize supply chains by tracking objects as they traverse the export/import supply chain while enforcing shipping
and expediting incremental payments)
• Car micro-insurance application
• pay-as-you-go insurance
• every party (the driver, the insurance company, and the financial institution) in the insurance contract is
confident that the data are tamper-proof and traceable.
• Benefits : claim request regarding to a trip can be processed quickly and indisputably
• Micro-insurance application also requires accessing multiple risk analytic databases such as past driving
behaviour statistics and past vehicle runtime statistics for computing premiums, a system architecture
that allows for maintaining and analyzing both on-chain and off-chain data was also proposed [].
• Online Voting Systems
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 Leverage capabilities of mature data and
information systems
• Multi-storage and index support
• novel techniques are needed for supporting multiple types of data stores such as key-value, document, SQL and
spatial data stores simultaneously in the same blockchain system
• Ethereum adopt key-value data model,
• R3 Corda use relational data model
• Hyperledger Fabric [8] opt for pluggable storage model,
• either LevelDB (key-value store) or CouchDB (document store)
• develop blockchain systems with built-in offline storage strategies for handling big data
• Digital Documents infeasible to store due to several constraints such as storage size, bandwidth and transaction throughput
• third-party offline storage (requires integration of blockchain and offline storages)
• Master data management
• organizations need master data management rules, processes and techniques in order to consolidate data across
multiple blockchain networks that they participate in
• different data schema and may record a different version of some common data
• Scalable transaction throughput
• not suited for large-scale data processing workloads- need of novel methods. Eg, BigchainDB[35]
• ACID properties
• develop novel concurrency control models for blockchains so that they are applicable to a wider range of applications
29
Year DataBase Technology Pros Cons DataBase Systems

1960 Hierarchical and High performance and Owing to no or limited data IMS, IDS
Network Databases throughput independence, application programs
  are complex to write and modify,
even for simple queries
1970 Relational Databases Provides a substantial With regard to the increasing use of Oracle, DB2, MySQL,
degree of data object-oriented programming PostgreSQL
independence by languages for application programs,
decoupling the logical and software developers encountered
physical impedance mismatch
representations of data
1980 Object-Oriented The application program Failed to become dominant due to Matisse, ObjectStore,
Databases and the database are the enormous Versant
integrated investments put into the relational
seamlessly databases
Early NoSQL Databases High availability Migration from SQL to NoSQL require Cassandra,
2000s and scalability an in-depth understanding of the MongoDB, Riak
existing NoSQL Stores and their
various features
Late NewSQL Databases Tackle the high scalability Doesn’t support full access to the H-Store, NuoDB
2000s and reliability requirements traditional SQL tools
of modern
OLTP applications

30
 Enhance Information Protection
• Confidentiality
• Access Control Mechanism
• Insufficient to provide protection from data exposure
• Data stored on Distributed Ledger- Encrypted
• Determine the “computational hop” in which data shall remain encrypted
• Querying data on blockchain has to be enabled even when the data is encrypted
• Models such as “search on encrypted databases”  Impact on performance of blockchain system
• Privacy
• GDPR and EU regulation- Right-to-Forget (Healthcare, Finance)- User ask blockchain provider to
delete some or all records-- Hard to support (Bcoz of immutability of blockchain)
• Information Leakage Prevention
• Support fine-grained access control (certain data entities within document should be prohibited)
31
 Blockchain Data Analytics
• Built-in analytics for Blockchain
• Parallel processing systems such as Mapreduce and Spark
• Use cases such as IoT applications in the supply chain domain in which lightweight or
edge analytics capability may be needed
• Integration and analytics across on-chain and off-chain data
• Exploration on query federation, translation, and optimization, as well as data
security in the context of analytics over both on-chain and off-chain data
• Intelligent Blockchain Systems
• Iot devices volume of data limits of transaction throughput& storage capacity
• self learn the relevance of incoming data to the business

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Research Questions

 How blockchain framework can be used to curb the novel

Coronavirus disease?

 To solve the problem of interoperability in healthcare domain

To provide better and accurate information to the patients in real-

time

33
Blockchain and Artificial Diagnostics 2020, 10, 198; Self-testing of Covid-19 test has been successfully Not everyone is expert in
Intelligence Technology for doi:10.3390/diagnostics10040198 performed. handling mobile devices so
Novel Coronavirus Disease Those people who test positive can be traced and received data may not be
2019 Self-Testing quarantined. correct.
Data can be collected instantaneously and real-time  
analysis over data can be performed.

How Can Blockchain Help Journal of Medical Systems 44, no. Blockchain make direct interaction between patient and  
People in the Event of 9 (2020): 1-2. final authority without needing intermediaries.
Pandemics Such as the COVID- It improves efficiency and response time of the overall
19? process.
Results of the outbreak are open and transparent to
everyone.

Optimizing the Journal of Medical Systems (2020) Immunity passport would encourage those people who System is not immune from
Implementation of COVID-19 44: 140 already develop immunity to help others who are second Covid-19 infection.
“Immunity Certificates” Coronavirus infected by incentivizing them. Immunity certificates may
Using Blockchain increase the social
discrimination.
COVID-19 Blockchain arXiv preprint Framework is forecasted to be a base support in taking  
Framework: Innovative arXiv:2004.06081 (2020). critical decisions by governments and health
Approach authorities.
It helps citizens to detect the sources of contagion
within a crowed cluster of people.

Blockchain in Healthcare: International Journal of Improvement on new drugs. Operational cost.

Insights on COVID-19 Environmental Research and Public Lack of trust in the application
Health 17, no. 19 (2020): 7167. Mitigation of clinical risk in diagnosis, treatment and of a new technology by
virus dissemination. healthcare workers.

34
Title Publication details Pros Cons
Blockchain Paradigm for Symmetry, 12(8), Health records query for the blockchain platform The blockchain-based system model is more
Healthcare: 1200. is faster compared with the client/server model costly than
Performance Evaluation the client/server system.
Medblock: Efficient and secure Journal of medical The MedBlock distributed ledger allows for They ensured a concept of greater security. It
medical data sharing via systems 42.8 secure and efficient EMRs access. failed to provide sufficient privacy to the identity
Blockchain. (2018): 136. The ameliorate consensus of the patient.
mechanism attain a consensus for EMRs without They claimed ’medblock’ is energy efficient but
major power usage and network congestion. failed to provide any strong argument behind
their claim.
Blockchain and electronic Computer, 51(12), Provides economical, timely, and quality Huge data storage and bandwidth results in
healthcare records 59-63. treatment. scalability problems.
  Features such as audit trail, granular access, and Lack of awareness and educational challenges.
security make it superior to existing data models.
Blockchain technology for Computational Providing integrity, security, and audit trail to the Handling of a high volume of the clinical data,
healthcare: facilitating the and structural clinical data. privacy, and distribution of incentives are
transition to patient-driven biotechnology The patient can connect to different caregivers in challenges.
interoperability journal, 16, 224- real-time.
230.
 
Blockchain distributed ledger Journal of the Medical Record Management will be improved. Transparency, confidentiality, speed, scalability,
technologies for biomedical and American Medical Acceleration of clinical, biomedical research and and resistance to malicious actors.
health care applications Informatics insurance claim process will be enhanced.
Association:
JAMIA,
24(6):1211–1220,
2017.

35
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