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Cited by 168Blockchain Technology Applications and SecurityElectronic Health Records SystemsAccess Control and Trust

EACMS: Emergency Access Control Management System for Personal Health Record Based on Blockchain

Open access
Rajput, Ahmed Raza, Li, Qianmu, Taleby Ahvanooey, Milad, Masood, Isma·2019·IEEE Access
DOI 10.1109/access.2019.2917976
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Abstract

Personal health records (PHRs) are private and vital assets for every patient. There have been introduced many works on various aspects of managing and organizing the PHR so far. However, there is an uncertain remaining issue for the role of PHR in emergencies. In a traditional emergency access system, the patient cannot give consent to emergency staff for accessing his/her PHR. Moreover, there is no secured record management of patient's PHR, which reveals highly confidential personal information, such as what happened, when, and who has access to such information. This paper proposes an emergency access control management system (EACMS) based on permissioned blockchain hyperledger fabric and hyperledger composer. In the proposed system, we defined some rules using the smart contracts for emergency condition and time duration for the emergency access PHR data items that patient can assign some limitations for controlling the PHR permissions. We analyzed the performance of our proposed framework by implementing it through the hyperledger composer based on the response time, privacy, security, and accessibility. The experiments confirm that our framework provides better efficiency compared with the traditional emergency access system.

AI snapshot

Written from the paper’s full text.

TL;DR

The paper proposes EACMS, a permissioned blockchain system using Hyperledger Fabric and Hyperledger Composer to let patients predefine smart-contract rules for emergency access to personal health records. It reports faster emergency access than traditional trusted-contact systems, with average registration and data retrieval totaling about 15–18 seconds.

Key findings

  • EACMS lets patients set emergency access rules and time constraints via smart contracts; the emergency doctor can access PHR data only during the defined period, after which access is denied.
  • In the reported experiments, average emergency doctor registration time was 6.9 s and average patient data retrieval time was 6 s, giving up to 15–18 s to reply to the ED.
  • The paper contrasts this with traditional emergency access systems, where average response time for receiving text messages from trusted members was 431.28 s (up to 7 minutes), and call response time was considered 8 minutes.
  • The system claims privacy, security, and accessibility benefits from a decentralized permissioned network, including no single point of failure, identity management via MSP, channels, and a traceable ledger.

Methods

  • Design and implementation: permissioned blockchain using Hyperledger Fabric and Hyperledger Composer, with model, script, access-control, and query files; PHR data stored off-chain with URI on-chain; REST client interface via Postman; smart contracts for patient, doctor, and emergency doctor registration and `get_patient_data`.
  • Data/sample: the example PHR system is My HealtheVet Blue Button; participants are patient, doctor, and emergency doctor; assets are PHR data items such as personal basic information, lab tests, and treatment drugs. Experiments used JSON client data input through Postman servers.
  • Analysis: performance evaluated on response time, privacy, security, and accessibility; each server was built in an AWS EC2 virtual environment on the same local computer with Linux 16.04.1, 16 GB RAM, and 1 GHz single vCPU, using Docker 1.10.2, Oracle VirtualBox 5.1.21, and Docker-compose 1.5.2.

Limitations

  • The paper states that blockchain is a moderately new development and that its framework is entirely separate from existing systems; Table 3 is said to summarize highlights and limitations versus traditional emergency access, but those details are not given in the text.
  • Evident from the text: the implemented network uses a single peer node, a single ordering node, and a certificate authority, so multi-node or consortium-scale performance is not demonstrated.
  • Evident from the text: the performance comparison relies on prior reported traditional response times rather than a direct head-to-head deployment, and privacy/security claims are architectural rather than formally proven.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1109/access.2019.2917976

Cites

43 of 43 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 11 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    After registration, EACMS average time to get patient data is 6 s.

    “and after registration, get patient data average time is ''6 s.''”
    Quote in the paperSubstantial claim
  • Findingnone given

    The emergency doctor triggers the smart contract and obtains PHR data subject to emergency access time constraints.

    “The ED triggered the smart contract and obtained the PHR data with the function of emergency access time constraints.”
    Quote in the paperSubstantial claim
  • Findingown data

    EACMS provides better efficiency compared with the traditional emergency access system.

    “The experiments confirm that our framework provides better efficiency compared with the traditional emergency access system.”
    Quote in the paperSubstantial claim
  • Findingreasoning

    During the defined time limitation, the current emergency doctor can see patient data.

    “During the defined time limitation, the current ''Emergency_doctor'' can see patient data.”
    Quote in the paperSubstantial claim
  • Findingown data

    EACMS average registration time is 6.9 s.

    “But, in practice, the EACMS takes the time for average registration time is ''6.9 s''”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 24
  • May combine two claims. 20

  • Classified as probably not a substantial claim. May combine two claims.

    Findingnone given

    Authorization to an emergency doctor is granted by the patient and controlled by an organization of the blockchain consortium.

    “Authorization to an ED will be granted by the patient controlled by an organization of blockchain consortium.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    Emergency_Access_End_Time is always two hours greater than Emergency_Access_Start_Time.

    “Emergecy_Access_End_Time always be two hours greater than Emergency_Access_Start_Time.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingnone given

    For emergency conditions, the patient defines rules allowing an emergency doctor to access PHR data with his certified license number.

    “For the emergency condition, the patient defined the rules for an ED that he/she can access with his certified license number.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Patients are able and willing to predefine access control policies for doctors and emergency doctors.
    • Rests on an assumption: An emergency doctor's certified license number is sufficient to authenticate and authorize the emergency doctor.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    All identity management services are conducted by an admin peer controlled by the consortium organization that deploys the blockchain.

    “All the identity management services are conducted by admin peer controlled by consortium organization which deploys blockchain.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    In EACMS, there are no trusted members for emergency contact because the patient assigns smart contracts to an emergency condition for the emergency doctor request.

    “But, in our framework, there are no any trusted member for emergency contact because we use Hyperledger composer in which the patient assigns smart contracts to an emergency condition for the ED request.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning

    In EACMS, new participants (Doctor, ED) with suitable identity functions can be added at any time by an admin peer administered by an organization of the Hyperledger Composer consortium.

    “In our EACMS, at any instance of time, new participants (Doctor, ED) with suitable identity functions can be added to manage a particular case by admin peer administered by an organization of Hyperledger composer consortium.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingnone given

    The patient defines the access control policy allowing a doctor to access PHR data when the patient is conscious.

    “Patient defined the access control policy for the doctor that he/she can access with the permission when the patient is conscious.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Patients are able and willing to predefine access control policies for doctors and emergency doctors.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    EACMS comprises three main components: a permissioned blockchain, off-chain storage, and a patient-centric user experience accessed through a REST client interface.

    “Our system includes three main components a permissioned blockchain, off-chain storage, and a patient-centric user experience accessed through a REST client interface (postman).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingreasoning

    After the time limit defined in the emergency access time constraints ends, the emergency doctor cannot access PHR data items.

    “After ending the time limit which is defined in the function of emergency access time constraints the ED cannot access the PHR data items.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    The emergency doctor has only short, timely access; after the time limitation, the emergency doctor cannot access PHR data.

    “The ED has just short, timely access in the system, after the time limitation of his/her access data the ED could not access the PHR data.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    EACMS is a Hyperledger Composer based blockchain application that alleviates the problems of traditional emergency access with an architecture that is extensible and scalable.

    “Our system is a hyperledger composer [19] based Blockchain application that alleviates these problems with an architecture that allows our system to be both extensible and scalable: a blockchain based EACMS, off chain data storage and a patient-centered mobile and web interface.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [19] source

      Not checked in the free run.

    • Rests on an assumption: In traditional emergency access systems, there is no secured record management of patient's PHR that reveals highly confidential personal information such as what happened, when, and who accessed it.
    • Rests on an assumption: In traditional PHR emergency cases, the system does not verify the identity of the person or organization that sent the PHR request.
    • Rests on an assumption: The blockchain network is fundamentally resilient and has no single vulnerability for hackers to exploit.
    • Rests on an assumption: The blockchain system records information transparently to each node and is apparent to update data, so blockchain can be trusted.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The blockchain is a decentralized architecture that features a distributed immutable ledger in which all transactions are recorded.

    “The blockchain is a decentralized architecture that features a distributed immutable ledger in which all transactions are recorded.”
    • Also stated in: § I. INTRODUCTION · plain
      “More generally, blockchain is a secure and decentralized data store of ordered records, including events, called blocks [17].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17] source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    In traditional emergency access systems, there is no audit or transaction log where the patient can trace all accesses of PHR information because the patient cannot participate in emergency access authorization.

    “There is no audit or transaction log where the patient can trace all the accesses of PHR information because, in the emergency condition, the patient cannot participate in the emergency access authorization.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    MedRec is the first and only functioning prototype proposed for electronic medical record management on blockchain.

    “Azaria et al. [30] until now MedRec functioning prototype is the first and only prototype has been proposed.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationreasoning

    The proposed framework operates based on smart contracts of the ledger, which makes the system protected, effective and auditable.

    “The proposed framework operates based on the smart contracts of the ledger which makes the system protected, effective and auditable.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The blockchain network is fundamentally resilient and has no single vulnerability for hackers to exploit.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The blockchain network only gives PHR data to authorized EMT staff which have granular access rights from the database according to the patient's rules.

    “The blockchain network only gives the PHR data to authorized EMT staff which have the granular access rights from the database according the permissions (patient's rules).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The blockchain network is fundamentally resilient and has no single vulnerability for hackers to exploit.

  • May combine two claims.

    Interpretationreasoning

    EACMS includes a smart contract that enables a patient to impose permission access control policy for data items and permits dynamic PHR data sharing to ED during emergency.

    “We developed a smart contract that will enable a patient to impose permission access control policy for his/her data items easily and permits dynamic PHR data for sharing to ED during the emergency condition.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The blockchain network is fundamentally resilient and has no single vulnerability for hackers to exploit.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Access control constraints specifying who should access what role and under which condition are preset in the permission.acl file of the emergency access control network in Hyperledger Composer.

    “The constraint like who(participant) should access what role and under which condition access should be given to participants, are all presets in access control policy in ''permission.acl''file of emergency access control network in the Hyperledger composer.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    EACMS prevents the risks of slow access and single-trusted-authority security problems by employing a distributed blockchain technology network.

    “The EACMS prevents these risks by employing a distributed blockchain technology network.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Existing studies in emergency access for PHR without blockchain are the traditional system, and some studies based on blockchain do not address access to PHR in an emergency condition.

    “These existing studies in emergency access for PHR without blockchain are the traditional system, and also there are some studies based on blockchain but not access to PHR in an emergency condition.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [38] source

      Not checked in the free run.

    • cites [15] source

      Not checked in the free run.

    • cites [39] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In prior emergency access systems, the trusted user's response to emergency staff for approving PHR access is considered 8 minutes for receiving call response time.

    “The trusted user gives the respond to emergency staff for approving the PHR access, it is considering the ''8minutes'', for receiving call response time.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15], [16]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The EACMS permits granular access inspections to confirm the authentication of the recommended ED.

    “It permits granular access inspections to confirm the authentication of the recommended ED.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The blockchain network is fundamentally resilient and has no single vulnerability for hackers to exploit.

  • May combine two claims.

    Interpretationreasoning

    The blockchain network stores or updates data requests from EMT staff and provides an accountable and traceable data access record from the PHR ledger.

    “The blockchain network stores or updates data requests from the EMT staffs, and provides data access record from the PHR.This record is accountable and traceable from the ledger.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The blockchain network is fundamentally resilient and has no single vulnerability for hackers to exploit.

  • May combine two claims.

    Premisecitation

    Previous emergency access systems require much time to provide access to PHR data and have security problems due to depending on a single trusted authority.

    “In the previous studies, emergency access systems have been proposed in [15], [16] In their experiments, it can be observe that such systems requires much time for providing access to PHR data, and they have security problems due to depending on a single trusted authority.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [15], [16]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationreasoning

    By operating permissioned blockchain technology, EACMS provides ED access for expediting consent management and speeding up PHR data fetch from the PHR system.

    “By operating permissioned blockchain technology, our solution provides an ED access for expediting the consent management and speeding up PHR data fetch from the PHR system.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The blockchain network is fundamentally resilient and has no single vulnerability for hackers to exploit.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Using the decentralized ledger system, prescribers can easily update medication histories through a simple client user interface.

    “Using the decentralized ledger system, prescribers can easily update medication histories through a simple client user interface.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationreasoning

    In the Hyperledger Composer network, the proposed model operates based on defined participant identities, so there are no ways for malicious users to access PHR data.

    “In the Hyperledger composer network, the proposed model operates based on the defined participant's identities.Therefore, there are no ways to access the PHR data for malicious users.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The decentralized network eliminates the need to cooperate with a set of privatized central repositories.

    “The decentralized network eliminates the need to cooperate with a set of privatized central repositories.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    EACMS protects PHR data against ransomware and similar security breaches such as unauthorized access because it is a decentralized network topology without a single point of failure or central repository for intruders.

    “The EACMS protects the PHR data against ransomware and similar security breaches such as unauthorized access.Because it is the decentralized network topology, and does not have a single point of failure or central repository for intruders to infiltrate.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationreasoning

    EACMS provides high-speed and protected access to PHR data under the patient's rules.

    “Our framework provides a high speed and protected access to the PHR data under patient's rules.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Experimental results confirm that EACMS provides security of sensitive patient's PHR data items and guarantees time efficiency, privacy, accessibility, and granular access control management.

    “The experimental results confirm that this framework provides the security of sensitive patient's PHR data items so that it guarantees time efficiency, and privacy, accessibility, and granular access control management.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Emergency access to PHR is needed when a patient cannot operate access authorization at the emergency location.

  • May combine two claims.

    Interpretationnone given

    EACMS stores patient's data in an immutable and transparent ledger that tracks all transactions on the system, which could enhance management of health data.

    “The EACMS stores patient's data in an immutable and transparent ledger, which grips track of all the transactions on the system, that could enhance the management of health data.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Channels in Hyperledger Fabric consist of nodes in which privacy protection and confidentiality of PHR are defined.

    “Thus, these channels consist of nodes in which the privacy protection and confidentiality of PHR defined within them.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    EACMS assures availability of PHR data items without validation by any trusted member or third party.

    “It assurances the availability of PHR data items without validation by any trusted member or third party.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    When patients visit different medical institutions, prescribers can query medication histories easily with the approval of the patient.

    “When patients visit different medical institutions, prescribers can query medication histories easily with the approval of the patient.”
    Quote in the paperNot a substantial claim
35 of 35

  • The paper relies on this without support.

    In traditional emergency access systems, there is no secured record management of patient's PHR that reveals highly confidential personal information such as what happened, when, and who accessed it.

    “Moreover, there is no secured record management of patient's PHR, which reveals highly confidential personal information, such as what happened, when, and who has access to such information.”

  • The paper relies on this without support.

    In traditional PHR emergency cases, the system does not verify the identity of the person or organization that sent the PHR request.

    “In the traditional PHR emergency cases, the system not verifies the identification of the object either a people or organization sent the PHR request.”

  • The paper relies on this without support.

    The blockchain network is fundamentally resilient and has no single vulnerability for hackers to exploit.

    “The Blockchain network is fundamentally resilient and has a no-single vulnerability for hackers to exploit.”

  • The paper relies on this without support.

    The blockchain system records information transparently to each node and is apparent to update data, so blockchain can be trusted.

    “The blockchain system records the information transparent to each node, and it is also apparent to update the data, that's why blockchain can be trusted.”

  • The paper relies on this without support.

    In current PHR systems, patient information is not accessible without the patient's permission.

    “Currently, if any of these PHR data required for the emergency condition from the patient PHR and the patient's information is not accessible without the permission of the patient.”

  • The paper relies on this without support.

    In current PHR systems, consent management and data fetching are complicated and inconvenient because EMT staff need to contact the emergency contact person, who may not reply on time.

    “Consent management and data fetching are complicated and inconvenient the EMT staff need to contact emergency contact person in the PHR, and the emergency contact person did not reply on time at any cost, or some other problem may occur with the emergency contact person then what will do the EMT staff at the emergency condition?”

  • The paper relies on this without support.

    In current PHR systems, after cure, the patient cannot trace whether a doctor entered with permission of the emergency contact person on behalf of the patient because there is no record.

    “The patient after cure can trace the existing information in a PHR system that if any doctor already entered with the permission of emergency contact person behalf of the patient, there is no any record to show the tracking.”

  • The paper relies on this without support.

    The ledger is a tamper-immune history of all state transactions.

    “The ledger is a consequence, temper immune history of all state transactions.”

  • The paper relies on this without support.

    Emergency access to PHR is needed when a patient cannot operate access authorization at the emergency location.

    “As we already described, the EACMS is designed for the emergency condition at the hospital to treat the patient when he/she could not operate the access authorization at the emergency location.”

  • The paper relies on this without support.

    Patients are able and willing to predefine access control policies for doctors and emergency doctors.

    “Patient defined the access control policy for the doctor that he/she can access with the permission when the patient is conscious.For the emergency condition, the patient defined the rules for an ED that he/she can access with his certified license number.”

  • The paper relies on this without support.

    An emergency doctor's certified license number is sufficient to authenticate and authorize the emergency doctor.

    “For the emergency condition, the patient defined the rules for an ED that he/she can access with his certified license number.”
11 of 11

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Single-node deployment conflicts with no-single-point-of-failure claim

    Major

    The described network has only one peer node and one ordering node, yet the security analysis says it has no single point of failure. Failure of either sole node would interrupt the described network.

  • PHR storage is described as both wholly off-chain and on the ledger

    Minor

    The architecture says all PHR data are stored in a cloud repository, whereas the conclusion says the EACMS stores the patient's data in the ledger. These are conflicting accounts of where the patient data reside.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 9

  1. kapur, 2019, Blockchain Explained What it is and How it Works
  2. 2017, Architecture Explained Read the Docs
  3. 2017, The Difference Between Permissioned and Permissionless Blockchains
  4. 2018, Permissionless vs Permissioned Blockchain Networks
  5. buterin, 2014, A next-generation smart contract and decentralized application platform
  6. szabo, 1996, Smart contracts: Building blocks for digital markets, EXTROPY The Journal of Transhumanist Thought, 18
  7. 2018, Welcome to Hyperledger Composer
  8. 2008, Personal Health Records and the HIPAA Privacy Rule
  9. 2017, Manage Your Health Records

Cited by

Sorted by citations

Related

Authors
Rajput, A. R., Li, Q., Taleby Ahvanooey, M., & Masood, I.
Affiliations
Nanjing University of Science and Technology (CN)
ORCID
Venue
IEEE Access
Publisher
Institute of Electrical and Electronics Engineers (IEEE)
Published
2019
Volume
7
Pages
84304-84317
ISSN
2169-3536 (ISSN-L)
DOI
10.1109/access.2019.2917976
OpenAlex
W2945754909
Cited by
166
References
43
Citations by year
2026: 10 · 2025: 16 · 2024: 28 · 2023: 24 · 2022: 33 · 2021: 33 · 2020: 20 · 2019: 2
FWCI
27.38
Type
journal article
Language
en
Open access
Licence
Locations
  • IEEE Access (publishedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Chinese Government Scholarship (2015GXZW13)
  • ZTE (2016ZTE04-11)
  • Jiangsu Province Key Research and Development Program: Social Development Project (BE2017739)
  • Jiangsu Province Key Research and Development Program: Industry Outlook and Common Key Technology Projects (BE2017100)
  • 2018 Jiangsu Province Major Technical Research Project “Information Security Simulation System
Topics
  • Physical Sciences › Computer Science › Information Systems › Blockchain Technology Applications and Security
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
  • Social Sciences › Sociology and Political Science › Access Control and Trust
Keywords
personal health records, blockchain, Hyperledger Fabric, Hyperledger Composer, smart contracts, permissioned blockchain, health data privacy, access control management

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