Lightweight blockchain for healthcare
Open accessAbstract
Healthcare data management has been gaining a lot of attention in recent years because of its high potential to provide more accurate and cost-efficient patient care. The traditional client-server and cloud-based healthcare data management systems suffer from the issues of single point of failure, data privacy, centralized data stewardship, and system vulnerability. The replication mechanism, and privacy and security features of blockchain have a promising future in the healthcare domain as they can solve some of the inherent issues of the health management system. However, most of the recent research works on blockchain in the healthcare domain have primarily focused on the permission-less Bitcoin network that suffers from drawbacks such as high energy consumption, limited scalability, and low transaction throughput. Consequently, there is a need for a scalable, fault-tolerant, secure, traceable and private blockchain to suit the requirements of the healthcare domain. We propose a lightweight blockchain architecture for the healthcare data management that reduces the computational and communication overhead compared to the Bitcoin network by dividing the network participants into clusters and maintaining one copy of the ledger per cluster. Our architecture introduces the use of canal, that allows secure and confidential transactions within a group of network participants. Furthermore, we propose a solution to avoid forking which is prevalent in the Bitcoin network. We demonstrate the effectiveness of our proposed architecture in providing security and privacy compared to the Bitcoin network by analyzing different threats and attacks. We also discuss how our proposed architecture addresses the identified threats. Our experimental results demonstrate that our proposed architecture generates 11 times lower network traffic compared to the Bitcoin network as the number of blocks increases. Our ledger update is 1.13 times faster. Our architecture shows a speedup of 67% in ledger update and 10 times lower network traffic when the number of nodes increases.
AI snapshot
Written from the paper’s full text.
TL;DR
The paper proposes a lightweight permissioned blockchain architecture for healthcare data management that clusters network participants, maintains one ledger copy per cluster, uses canals for confidential transactions, and replaces Bitcoin-style mining with PBFT. Simulations show lower network traffic and faster ledger updates than Bitcoin as blocks or nodes increase.
Key findings
- The proposed architecture generates 11 times lower network traffic than Bitcoin as the number of blocks increases, and its ledger update is 1.13 times faster.
- When the number of nodes increases, it produces 10 times lower network traffic and a 67% speedup in ledger update compared with Bitcoin.
- The architecture avoids forking by using a Head Blockchain Manager (HBCM) to generate blocks and handle transactions, unlike the Bitcoin network.
- It uses canals to allow secure, confidential transactions within subgroups, with separate ledgers visible only to canal members.
Methods
- The paper designs a permissioned blockchain architecture for healthcare with HBCMs, Blockchain Managers (BCMs), clusters, canals, notification managers, PBFT consensus, and Monotonic Prefix Consistency replication.
- It qualitatively analyzes security and privacy threats from Bitcoin—accessibility, anonymity, and authentication/access-control threats—and discusses how the proposed architecture addresses them.
- It simulates Bitcoin and the proposed architecture in NS3: 100 nodes divided into 10 clusters, blocks increased from 10 to 50 at intervals of 10, nodes increased from 100 to 500 at intervals of 100, 1 MB blocks, SHA-256, and each experiment repeated 10 times with averages.
Limitations
- The paper states that future work will focus on a real implementation to extensively evaluate security, privacy, and performance, and that IoT integration is currently being pursued.
- Evident from the text: the performance evaluation is simulation-based, not a real-world deployment, and no clinical dataset or operational healthcare setting is evaluated.
- Evident from the text: the security and privacy analysis is a qualitative threat discussion rather than an empirical security evaluation.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
0 of 34 cited sources checked · 0 supported · 0 flagged
- Findingnone given
The proposed ledger update is 1.13 times faster.
“Our ledger update is 1.13 times faster.”
Quote in the paperSubstantial claim - Findingown data
The proposed architecture shows a speedup of 67% in ledger update when the number of nodes increases.
“Our architecture shows a speedup of 67% in ledger update and 10 times lower network traffic when the number of nodes increases.”
Quote in the paperSubstantial claim - Findingown data
The proposed architecture generates 10 times lower network traffic when the number of nodes increases.
“Our architecture shows a speedup of 67% in ledger update and 10 times lower network traffic when the number of nodes increases.”
Quote in the paperSubstantial claim - Findingown data
The proposed architecture generates 11 times lower network traffic compared to the Bitcoin network as the number of blocks increases.
“Our experimental results demonstrate that our proposed architecture generates 11 times lower network traffic compared to the Bitcoin network as the number of blocks increases.”
Quote in the paperSubstantial claim - Findingreasoning
On average, when the number of blocks increases, the amount of data transferred using the Bitcoin network is 11 times higher than the proposed network.
“On average the amount of data transferred using the Bitcoin network is 11 times higher than our proposed network.”
Quote in the paperSubstantial claim- Rests on an assumption: The NS3 simulation with the chosen parameters accurately represents the performance of the Bitcoin network and the proposed architecture in real deployments.
- Rests on an assumption: The random topology used in the simulation is similar to that of a blockchain network.
- Findingown data
When the number of nodes increases, the network traffic of the proposed architecture is 1/10 that of Bitcoin.
“Furthermore, results show that the network traffic is 1 10 that of Bitcoin and has a speedup of 67% in ledger update when the number of nodes increases.”
Quote in the paperSubstantial claim- Rests on an assumption: The NS3 simulation with the chosen parameters accurately represents the performance of the Bitcoin network and the proposed architecture in real deployments.
- Findingown data
On average, when the number of blocks increases, the Bitcoin network takes 1.13 times more time to replicate data compared to the proposed architecture.
“On average when the number of blocks increases, the Bitcoin network takes 1.13 times more time to replicate the data compared to our proposed architecture.”
Quote in the paperSubstantial claim- Rests on an assumption: The NS3 simulation with the chosen parameters accurately represents the performance of the Bitcoin network and the proposed architecture in real deployments.
- Rests on an assumption: The random topology used in the simulation is similar to that of a blockchain network.
- Findingown data
On average, when the number of nodes increases, the amount of data transferred using the Bitcoin network is 10 times higher than the proposed architecture.
“On average when the number of nodes increases, the amount of data transferred using the Bitcoin network is 10 times higher than our proposed architecture.”
Quote in the paperSubstantial claim- Rests on an assumption: The NS3 simulation with the chosen parameters accurately represents the performance of the Bitcoin network and the proposed architecture in real deployments.
- Rests on an assumption: The random topology used in the simulation is similar to that of a blockchain network.
- Findingown data
The proposed architecture generates 1/11 of network traffic compared to Bitcoin when the number of blocks increases.
“Our performance results demonstrate that our proposed architecture generates 1 11 of network traffic compared to Bitcoin when the number of blocks increases.”
Quote in the paperSubstantial claim- Rests on an assumption: The NS3 simulation with the chosen parameters accurately represents the performance of the Bitcoin network and the proposed architecture in real deployments.
- Findingown data
The difference between the processing times of the two approaches increases as the number of blocks in the network increases.
“The difference between the processing times with both approaches increases when the number of blocks in the network increases.”
Quote in the paperSubstantial claim- Rests on an assumption: The NS3 simulation with the chosen parameters accurately represents the performance of the Bitcoin network and the proposed architecture in real deployments.
- Rests on an assumption: The random topology used in the simulation is similar to that of a blockchain network.
- Findingown data
When the number of blocks increases, the proposed architecture takes less time to replicate data and update the ledger compared to the Bitcoin network.
“It shows that our proposed architecture takes less time to replicate data and update the ledger compared to the Bitcoin network.”
Quote in the paperSubstantial claim- Rests on an assumption: The NS3 simulation with the chosen parameters accurately represents the performance of the Bitcoin network and the proposed architecture in real deployments.
- Rests on an assumption: The random topology used in the simulation is similar to that of a blockchain network.
- Findingown data
When the number of nodes increases, the proposed architecture has a speedup of 67% in ledger update.
“Furthermore, results show that the network traffic is 1 10 that of Bitcoin and has a speedup of 67% in ledger update when the number of nodes increases.”
Quote in the paperSubstantial claim- Rests on an assumption: The NS3 simulation with the chosen parameters accurately represents the performance of the Bitcoin network and the proposed architecture in real deployments.
- Findingown data
When the number of nodes increases, the proposed architecture yields an average improvement of 67% in processing time required for data replication and ledger update compared to the Bitcoin network.
“Moreover, our architecture yields an average improvement of 67% in processing time required for data replication and ledger update compared to the Bitcoin network.”
Quote in the paperSubstantial claim- Rests on an assumption: The NS3 simulation with the chosen parameters accurately represents the performance of the Bitcoin network and the proposed architecture in real deployments.
- Rests on an assumption: The random topology used in the simulation is similar to that of a blockchain network.
- Interpretationown data
The proposed architecture provides security and privacy compared to the Bitcoin network, as shown by analyzing different threats and attacks.
“We demonstrate the effectiveness of our proposed architecture in providing security and privacy compared to the Bitcoin network by analyzing different threats and attacks.”
- Also stated in: § Abstract · plain
“We also discuss how our proposed architecture addresses the identified threats.”
Quote in the paperSubstantial claim - Also stated in: § Abstract · plain
- Interpretationnone given
The proposed architecture introduces canals that allow secure and confidential transactions within a group of network participants.
“Our architecture introduces the use of canal, that allows secure and confidential transactions within a group of network participants.”
- Also stated in: § I. INTRODUCTION · plain
“In this architecture, we introduce the concept of canals that allow secure and confidential transactions within a group of network members.”
Quote in the paperSubstantial claim - Also stated in: § I. INTRODUCTION · plain
- Interpretationreasoning
The proposed lightweight blockchain architecture for healthcare data management reduces computational and communication overhead compared to the Bitcoin network by dividing network participants into clusters and maintaining one copy of the ledger per cluster.
“We propose a lightweight blockchain architecture for the healthcare data management that reduces the computational and communication overhead compared to the Bitcoin network by dividing the network participants into clusters and maintaining one copy of the ledger per cluster.”
- Also stated in: § I. INTRODUCTION · plain
“We propose a lightweight blockchain architecture for healthcare data management that incurs low computation and communication overheads as compared to the traditional Bitcoin network.We achieve this by dividing the network participants into demographic clusters and maintaining one copy of the ledger per cluster.”
Quote in the paperSubstantial claim- Rests on an assumption: The healthcare domain requires a scalable, fault-tolerant, secure, traceable and private blockchain.
- Also stated in: § I. INTRODUCTION · plain
- Interpretationnone given
The proposed architecture uses canal that enables collaborating group within a network to perform confidential transactions maintaining a ledger accessible to the canal members.
“Moreover, our architecture uses canal that enables collaborating group within a network to perform confidential transactions maintaining a ledger accessible to the canal members.”
Quote in the paperSubstantial claim - Premisereasoning
Blockchain eliminates the need for a central database server that operates as an intermediate among peers.
“Blockchain eliminates the need for a central database server that operates as an intermediate among the peers.”
Quote in the paperSubstantial claim - Interpretationcitation
Energy-efficiency in the proposed architecture is achieved by using the PBFT consensus mechanism.
“Energy-efficiency in our architecture is achieved by using the PBFT consensus mechanism.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [41] source
Not checked in the free run.
- Interpretationnone given
The proposed architecture avoids forking, which is prevalent in the Bitcoin network, by using a Head Blockchain Manager (HBCM) to generate blocks and handle transactions.
“Furthermore, we propose a solution to avoid forking which is prevalent in the Bitcoin network.”
- Also stated in: § I. INTRODUCTION · plain
“We propose a solution to avoid forking (which is prevalent in the Bitcoin network) by using a Head Blockchain Manager (HBCM) to generate blocks and handle the transactions.”
Quote in the paperNot a substantial claim - Also stated in: § I. INTRODUCTION · plain
- Interpretationreasoning
Blockchain implements the monotonic reads replication strategy as well.
“Therefore, blockchain implements the monotonic reads replication strategy as well.”
Quote in the paperSubstantial claim - Premisecitation
Public blockchain transaction data is kept public over the network, leading to a data privacy issue.
“However, the transaction data is kept public over the network leading to the issue of data privacy [52].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [52] source
Not checked in the free run.
- Interpretationreasoning
The proposed architecture uses two HBCMs, a leader and a follower, to ensure data availability.
“In order to ensure single point of failure and data availability our architecture uses two HBCM (leader and follower) as shown in Figure 2.”
Quote in the paperSubstantial claim - Premisereasoning
Works [34]-[37] do not allow patients to disseminate their medical conditions and lifestyles data to the blockchain network.
“These works [34]- [37] do not allow patients to disseminate their medical conditions and lifestyles data to the blockchain network that would aid medical professionals for better prognosis/diagnosis and followup.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [34]- [37]
Not checked in the free run.
- Premisenone given
Very few works [34]-[40] have proposed health information systems using blockchain for sharing patients' medical records among different hospitals.
“Very few works [34]- [40] have proposed health information systems using blockchain for sharing of patients' medical records among different hospitals.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [34]- [40]
Not checked in the free run.
- Interpretationreasoning
Transactions in a canal are visible only to the participants of that sub-network, while other network participants are unaware of them.
“The transactions in a canal are only visible to the participants of that sub-network, while the other network participants are unaware of the canal's transactions.”
Quote in the paperSubstantial claim - Interpretationreasoning
Because BCMs are scattered in different canals, it is not possible to attack multiple BCMs due to the secure canal.
“However, as the BCMs are scattered in different canals in our architecture, it is not possible to attack multiple BCMs because of the secure canal.”
Quote in the paperNot a substantial claim- Rests on an assumption: Canals are secure such that an attacker cannot control multiple BCMs across canals.
- Premisecitation
Work [40] uses a mining-based consensus approach which consumes a high amount of energy to generate a block.
“However, the proposed framework uses a mining-based consensus approach which consumes a high amount of energy to generate a block.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [40]
Not checked in the free run.
- Premisenone given
In an attack that appends invalid blocks, an attacker should have control over multiple BCMs simultaneously.
“In the attack which involves appending invalid blocks, an attacker should have control over multiple BCMs simultaneously.”
Quote in the paperNot a substantial claim - Interpretationreasoning
If the HBCM receives several unsuccessful transactions in the same canal, it can block that attacker node from accessing the network.
“If the HBCM receives several unsuccessful transactions in the same canal, it can block that attacker node from accessing the network.”
Quote in the paperSubstantial claim- Rests on an assumption: The HBCM is trusted and will not act maliciously.
- Interpretationnone given
For a blockchain network that tolerates partitioning and requires all nodes to maintain the ledger synchronized, strong consistency is impossible.
“For a blockchain network that tolerates partitioning in large-scale distributed systems and requires all the nodes to maintain the ledger to agree on the entire chain in a synchronized manner, the implementation of strong consistency will be impossible.”
Quote in the paperSubstantial claim - Interpretationreasoning
The proposed blockchain architecture uses the Practical Byzantine Fault Tolerance (PBFT) consensus protocol to address the issues in PoW.
“To address the aforementioned issues in PoW, our proposed blockchain architecture uses the Practical Byzantine Fault Tolerance (PBFT) consensus protocol.”
Quote in the paperSubstantial claim - Premisecitation
For PBFT to function correctly, the number of malicious or crashed BCMs must be less than one third of the total BCMs in the same canal at a given time.
“For the PBFT protocol to function correctly, the number of malicious or crashed BCMs must not be equal or greater than n 3 out of the total n BCMs in the same canal at a given time.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [62]
Not checked in the free run.
- Interpretationreasoning
In the proposed architecture, all transactions are processed by the HBCM to mitigate DoS attacks.
“In our architecture, all the transactions are processed by the HBCM to mitigate this type of attack.”
Quote in the paperSubstantial claim- Rests on an assumption: The HBCM is trusted and will not act maliciously.
- Interpretationreasoning
The proposed architecture allows collaborating network participants to create a sub-network called a canal to perform private transactions.
“To facilitate this, our architecture allows collaborating network participants to create a sub-network, that we call a canal, to perform private transactions.”
Quote in the paperSubstantial claim - Premisecitation
An appropriate consistency strategy for a blockchain network should allow nodes to agree on the current chain, i.e., consistent prefix, except for a potentially small number of unconfirmed blocks.
“Thus, an appropriate consistency strategy for the blockchain network should allow the nodes in the network to agree on the current chain (i.e., consistent prefix) except for a potentially small number of unconfirmed blocks [65].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [65]
Not checked in the free run.
- Premisecitation
The high energy consumption of the Bitcoin network has an adverse effect on the environment.
“This high amount of energy consumption of the Bitcoin network has an adverse effect of the environment.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [55]
Not checked in the free run.
- Interpretationreasoning
If an attacker modifies or deletes data from the hospitals, the data can be queried from the corresponding cluster's BCM.
“If the attacker tries to modify or delete any data from the hospitals, then the data can be queried from the corresponding cluster's BCM.”
Quote in the paperSubstantial claim- Rests on an assumption: The HBCM is trusted and will not act maliciously.
- Interpretationown data
The proposed lightweight blockchain architecture for healthcare data management has low computational and communication overhead compared to the Bitcoin network.
“In this paper, we have proposed a lightweight blockchain architecture for healthcare data management that has low computational and communication overhead as compared to the Bitcoin network.”
Quote in the paperSubstantial claim- Rests on an assumption: The NS3 simulation with the chosen parameters accurately represents the performance of the Bitcoin network and the proposed architecture in real deployments.
- Interpretationreasoning
The improved data-transfer performance of the proposed architecture is because of its clustering approach, which performs data replication only on BCMs, unlike Bitcoin which replicates data on all nodes.
“This improved perform is because of the clustering approach in our proposed architecture which performs data replication only on BCMs as compared to Bitcoin which replicates data on all the nodes thereby requiring more broadcasts.”
Quote in the paperSubstantial claim - Interpretationreasoning
The lower processing time of the proposed architecture is because of its clustering approach, which eliminates data replication on all nodes.
“This is because of the clustering approach in our architecture which eliminates data replication on all the nodes.”
Quote in the paperSubstantial claim - Interpretationown data
The proposed architecture is scalable when the number of nodes increases.
“They show that our proposed architecture outperforms the Bitcoin network both in terms of data transferred and processing time, demonstrating scalability of our architecture.”
Quote in the paperSubstantial claim- Rests on an assumption: The NS3 simulation with the chosen parameters accurately represents the performance of the Bitcoin network and the proposed architecture in real deployments.
- Rests on an assumption: The random topology used in the simulation is similar to that of a blockchain network.
- Premisecitation
The optimal number of clusters in terms of energy consumption and performance for a group of 100 nodes is 10.
“The selection of the number of clusters is based on the work by [68], according to which the optimal number of clusters in terms of energy consumption and performance for a group of 100 nodes is 10.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [68] source
Not checked in the free run.
- Interpretationreasoning
Using Bitcoin in the healthcare domain would lead to scalability and energy issues.
“However, in healthcare domain where the hospitals and medical organizations form a trusted network, using Bitcoin would lead to scalability and energy issues as discussed.”
Quote in the paperSubstantial claim- Rests on an assumption: The healthcare domain is a trusted network where hospitals and medical organizations trust each other.
- Interpretationreasoning
The proposed architecture's use of a single entity (HBCM) to generate blocks solves the forking issue prevalent in the Bitcoin network.
“This approach where a single entity generates a block solves the issue of forking that is prevalent in the Bitcoin network which if it exists in the healthcare domain can trigger life threatening situations.”
Quote in the paperNot a substantial claim
- May combine two claims. 30
- The quote only partly states this claim. 1
- Classified as probably not a substantial claim. 18
May combine two claims.
Findingown dataThe proposed architecture outperforms the Bitcoin network in terms of the amount of network traffic generated and the time it takes to process data replication and ledger update.
“Our experimental results demonstrate that our proposed architecture outperforms the Bitcoin network in terms of the amount of network traffic generated and the time it takes to process data replication and ledger update.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataWhen the number of nodes increases, the proposed architecture outperforms the Bitcoin network in both amount of data transferred and processing time.
“They show that our proposed architecture outperforms the Bitcoin network both in terms of data transferred and processing time, demonstrating scalability of our architecture.”
Quote in the paperSubstantial claim- Rests on an assumption: The NS3 simulation with the chosen parameters accurately represents the performance of the Bitcoin network and the proposed architecture in real deployments.
- Rests on an assumption: The random topology used in the simulation is similar to that of a blockchain network.
May combine two claims.
Findingown dataWhen the number of blocks increases, the amount of data transferred for updating the ledger increases linearly for both the Bitcoin network and the proposed architecture, with the Bitcoin network using more data.
“The amount of data linearly increases for both cases with the Bitcoin network using more data leading to higher computational and traffic overheads.”
Quote in the paperSubstantial claim- Rests on an assumption: The NS3 simulation with the chosen parameters accurately represents the performance of the Bitcoin network and the proposed architecture in real deployments.
- Rests on an assumption: The random topology used in the simulation is similar to that of a blockchain network.
The quote only partly states this claim.
Findingown dataThe proposed architecture's ledger update is 1.13 times faster than Bitcoin.
“Our ledger update is 1.13 times faster.”
Quote in the paperSubstantial claim- Rests on an assumption: The NS3 simulation with the chosen parameters accurately represents the performance of the Bitcoin network and the proposed architecture in real deployments.
May combine two claims.
InterpretationreasoningThe proposed architecture is highly scalable with high performance because it divides the blockchain network into clusters with a Blockchain Manager (BCM) per cluster maintaining one copy of the ledger and allows dissemination of patient's medical and personal health data.
“In contrast, our proposed architecture is highly scalable with high performance because it divides the blockchain network into clusters with a Blockchain Manager (BCM) per cluster maintaining one copy of the ledger and allow dissemination of patient's medical and personal health data.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
PremisereasoningReplication of data in blockchain gives local access to data and improves fault tolerance when data on some nodes is corrupted or nodes behave maliciously.
“This replication of data gives local access to the data and also helps to improve fault tolerance when data on some of the nodes is corrupted or the nodes behave maliciously.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationTraditional client-server and cloud-based healthcare data management systems suffer from single point of failure, data privacy, centralized data stewardship, and system vulnerability.
“The traditional client-server and cloud-based healthcare data management systems suffer from the issues of single point of failure, data privacy, centralized data stewardship, and system vulnerability.”
- Also stated in: § I. INTRODUCTION · plain
“Moreover, the issue of a single point of failure along with data security and patient's privacy risk prevailing in the client-server-based system, still exist in cloud-based systems.”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [2]- [4]
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- cites [5] source
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- cites [6]
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- Also stated in: § I. INTRODUCTION · plain
May combine two claims.
PremisecitationMost recent research works on blockchain in healthcare have primarily focused on the permission-less Bitcoin network, which suffers from high energy consumption, limited scalability, and low transaction throughput.
“However, most of the recent research works on blockchain in the healthcare domain have primarily focused on the permission-less Bitcoin network that suffers from drawbacks such as high energy consumption, limited scalability, and low transaction throughput.”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [12]
Not checked in the free run.
- cites [13]
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- cites [14]
Not checked in the free run.
Classified as probably not a substantial claim. May combine two claims.
Premisenone givenBlockchain's decentralized network architecture gives all network participants equal influence and shares a copy of transactions' data as a ledger.
“Blockchain addresses these aforementioned issues through its decentralized network architecture wherein all the network participants have equal influence over the network and share a copy of the transactions' data in form of a ledger.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationBlockchain technology uses a shared, immutable, and transparent ledger and has potential to solve issues of real-time data access, vulnerability, data fragmentation, lack of traceability, security, and privacy in current client-server architecture.
“Blockchain technology [8] which uses a shared, immutable, and transparent ledger has a great potential to solve the issues of real-time data access, vulnerability, data fragmentation, lack of traceability, security, and privacy which exist in the current client-server architecture.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [8] source
Not checked in the free run.
May combine two claims.
InterpretationreasoningThe proposed architecture addresses the forking issue because all blocks are generated and transactions are handled by the HBCM.
“This issue is addressed in our architecture because all the blocks are generated, and the transactions are handled by the HBCM.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationThe blockchain network used in [34]-[36] is based on PoW consensus, which consumes a lot of energy and suffers from performance issues.
“In addition, the blockchain network used in [34]- [36] is based on the Proof of Work (PoW) consensus mechanism which consumes a lot of energy [12], [13] and suffers from performance issues [14].”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [12]
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- cites [13]
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- cites [14]
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May combine two claims.
PremisecitationCloud-based healthcare data management systems store patient records in a centralized database that suffers from single point of failure, making the system prone to errors, cyberattacks, and data loss.
“However, in these systems, a patient stores important health records in a cloudbased centralized database which suffers from a single point of failure making the system prone to errors, cyberattacks, and data loss.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [2]- [4]
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationThe annual carbon dioxide emissions by the bitcoin network are as high as 22.9 million metric tons, almost equivalent to the amount produced by Sri Lanka and Jordan.
“According to a research, the annual carbon dioxide emissions by the bitcoin network are as high as 22.9 million metric tons, almost equivalent to the amount produced by the countries like Sri Lanka and Jordan [55].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [55]
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe annual energy consumption of the Bitcoin network as of 25 August 2019 was 73.121 TWh.
“The annual energy consumption as of 25 August 2019 was 73.121 TWh [13].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [13]
Not checked in the free run.
Classified as probably not a substantial claim.
Premisenone givenMany research works propose using blockchain to store medical data in a distributed ledger to address single point of failure.
“To address the issue of single point of failure many research works propose the use of blockchain to store the medical data in a distributed ledger.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationreasoningThe proposed architecture uses a permissioned blockchain network rather than a permissionless one because permissionless networks have unauthorized participation, public transaction data, slow throughput, and transaction fees.
“We use the permissioned blockchain network over the permission-less because of the following issues associated with the latter”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S4 (based).
InterpretationreasoningHospitals are divided into clusters based on their demography to avoid unnecessary communication delays that cause higher latency.
“The hospitals are divided into clusters based on their demography to avoid unnecessary communication delays which cause higher latency.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationPBFT was proposed by Castro et al. in 1999 and assumes that all honest nodes will have the same exact copy of the ledger.
“PBFT was proposed by Castro et al. in 1999 [62], where all the network nodes communicate with each other with the goal of reaching an agreement by assuming that all honest nodes will have the same exact copy of the ledger.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [62]
Not checked in the free run.
- The authors state this as an assumption: In PBFT, all honest nodes will have the same exact copy of the ledger.
Classified as probably not a substantial claim. May combine two claims.
PremisecitationWork [40] allows both patients and hospitals to upload patients' medical data to the distributed ledger and provides a complete view of a patient's medical data history.
“The authors of [40] propose a health information system by using blockchain to share medical data among different patients and hospitals.This work allows both patients and hospitals to upload the patients' medical data to the distributed ledger and therefore provides a complete view of a patient's medical data history.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [40]
Not checked in the free run.
Classified as probably not a substantial claim.
InterpretationreasoningForking is not acceptable in the healthcare domain because delay in accessing a patient's critical medical data can trigger life-threatening situations.
“However, in the healthcare domain where the delay in accessing patient's critical medical data can trigger life threatening situations, forking is not acceptable.”
Quote in the paperSubstantial claim- Rests on an assumption: Delay in accessing a patient's critical medical data can trigger life-threatening situations.
Classified as probably not a substantial claim.
InterpretationreasoningA permissioned network allows only authorized participants to view and access data based on defined access rights.
“One solution to address this issue is to use a permissioned network where only the authorized participants can view and access the data based on the access rights defined for the data.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
PremisereasoningPublic blockchain networks are not highly scalable and suffer from low throughput because transaction validation and processing are done by a high number of participants spread across the world.
“Public networks are not highly scalable, and they also suffer from the issue of low throughput because the transaction validation and processing are done by a high number of participants spread across the world.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe main classes of threats in the Bitcoin network can be classified into accessibility threats, anonymity threats, and authentication and access control threats.
“The main classes of threats which exist in the Bitcoin network can be classified into three categories [67]: 1) accessibility threats, 2) anonymity threats, and 3) authentication and access control threats.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [67]
Not checked in the free run.
Classified as probably not a substantial claim.
InterpretationreasoningThe proposed blockchain architecture uses a combination of consistent prefix and monotonic reads, referred to as Monotonic Prefix Consistency (MPC).
“Based on the discussion, our proposed blockchain architecture uses a combination of two replication strategies: consistent prefix and monotonic reads; that is referred as Monotonic Prefix Consistency (MPC) [66].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [66]
Not checked in the free run.
May combine two claims.
Premisenone givenReplicating the ledger on all nodes increases computational and network overheads, leading to high energy consumption, low transaction throughput, and low scalability.
“The replication of the ledger on all the nodes increases the computational and network overheads leading to high energy consumption, low transaction throughput and low scalability.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
PremisereasoningData stored in blockchain is immutable; once stored, it cannot be modified or deleted.
“Furthermore, the data stored in the blockchain is immutable, i.e., once the data is stored, it cannot be modified or deleted.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationMost blockchain works [22]-[26] address security and privacy of medical records by storing hash of cloud data in blockchain, but the system remains vulnerable to single point of failure because of the cloud server and does not solve privacy when stored in a centralized cloud database.
“Most of these works [22]- [26] have used blockchain to address security and privacy concerns of medical records by storing the hash of the cloud data in the blockchain.However, in these works, the system is vulnerable to a single point of failure because of the cloud server.In addition, the approach does not solve the problem of privacy of patients' medical records when they are stored in central”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [22]- [26]
Not checked in the free run.
May combine two claims.
InterpretationreasoningThe proposed architecture uses a single HBCM to generate blocks in order to reduce computational overhead and address the high energy consumption associated with Bitcoin.
“Compared to the Bitcoin network, where there are multiple miners competing against each other to generate a block, our proposed architecture uses a single HBCM for this purpose in order to reduce computational overhead and to address the issue of high energy consumption associated with Bitcoin.”
Quote in the paperSubstantial claimMay combine two claims.
PremisereasoningIn client-server healthcare data management, hospitals are primary custodians of data, making it difficult for healthcare professionals to make precise prognosis/diagnosis and for patients to have a cohesive view of medical history.
“But in this type of healthcare data management system, the hospitals are the primary custodians of the data.This makes it difficult for healthcare professionals to make a precise disease prognosis or diagnosis when required and makes it difficult for patients to have a cohesive view of their medical history because their medical data is most likely to be stored at different hospitals and clinics.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [15]- [21]
Not checked in the free run.
Classified as probably not a substantial claim.
InterpretationreasoningThe data of the BCMs cannot be modified due to the immutability property of the blockchain.
“The data of the BCMs cannot be modified due to the immutability property of the blockchain.”
Quote in the paperSubstantial claim- Rests on an assumption: The HBCM is trusted and will not act maliciously.
May combine two claims.
InterpretationreasoningGrouping nodes into clusters in the proposed architecture eliminates the need for data communication and replication on all blockchain network nodes, reducing computational and communication overheads compared to the Bitcoin network.
“Consequently, the grouping of the nodes into clusters in our proposed architecture eliminates the need of data communication and replication on all the blockchain network nodes thereby reducing the computational and communication overheads compared to the Bitcoin network.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationProof of Work consumes a lot of energy and has low transaction throughput.
“However, PoW consumes a lot of energy and has low transaction throughput.”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [54]
Not checked in the free run.
- cites [13]
Not checked in the free run.
- cites [55]
Not checked in the free run.
May combine two claims.
PremisecitationIn 2017, bitcoin mining used around 30.14 TWh of energy, equivalent to Ireland's annual energy usage.
“In 2017, the bitcoin mining used around 30.14 Terrawatt hours (TWh) of energy, which is equivalent to the energy usage of Ireland in a year [54].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [54]
Not checked in the free run.
May combine two claims.
Interpretationnone givenIn the proposed architecture, the ledger is not stored at the user's node, restricting access to data only by query.
“In our architecture, the ledger is not stored at the user's node restricting the access to data only by query.”
Quote in the paperSubstantial claim- Rests on an assumption: The HBCM is trusted and will not act maliciously.
May combine two claims.
PremisecitationWorks [38][39] only allow medical professionals to view patients' medical records and do not allow these professionals to disseminate patient's medical data to the network.
“However, these works only allow the medical professionals to view the patients' medical records and do not allow these professionals to disseminate patient's medical data (such as diagnosis, laboratory and radiology results, treatment, and vaccinations) to the network.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [38] source
Not checked in the free run.
- cites [39]
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.
Premisenone givenPrivate blockchains have high transaction throughput and are more scalable than public blockchains.
“Private blockchains have high transaction throughput and are more scalable than the public blockchains.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataEach experiment was repeated 10 times and average values were calculated.
“We repeat each experiment 10 times and we calculate the average values.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationreasoningThe proposed architecture uses clustering to increase scalability and reduce energy consumption in the healthcare domain while satisfying security requirements.
“Our architecture uses the clustering technique to increase scalability and reduce energy consumption in healthcare domain while satisfying the security requirements.”
Quote in the paperSubstantial claim- Rests on an assumption: The healthcare domain is a trusted network where hospitals and medical organizations trust each other.
Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Interpretationnone givenMultiple queries from a user to a BCM can be fielded to the HBCM, which further investigates the issue.
“Multiple queries from a user to BCM can be fielded to the HBCM which further investigates the issue.”
Quote in the paperNot a substantial claim- Rests on an assumption: The HBCM is trusted and will not act maliciously.
May combine two claims.
Interpretationown dataThe proposed architecture reduces computational and communication delay, making it more scalable.
“Consequently, our architecture reduces the computational and communication delay making it more scalable.”
Quote in the paperSubstantial claim- Rests on an assumption: The NS3 simulation with the chosen parameters accurately represents the performance of the Bitcoin network and the proposed architecture in real deployments.
The paper relies on this without support.
The healthcare domain requires a scalable, fault-tolerant, secure, traceable and private blockchain.
“Consequently, there is a need for a scalable, fault-tolerant, secure, traceable and private blockchain to suit the requirements of the healthcare domain.”
The paper relies on this without support.
Delay in accessing a patient's critical medical data can trigger life-threatening situations.
“However, in the healthcare domain where the delay in accessing patient's critical medical data can trigger life threatening situations, forking is not acceptable.”
The authors state this as an assumption.
In PBFT, all honest nodes will have the same exact copy of the ledger.
“PBFT was proposed by Castro et al. in 1999 [62], where all the network nodes communicate with each other with the goal of reaching an agreement by assuming that all honest nodes will have the same exact copy of the ledger.”
The paper relies on this without support.
The HBCM is trusted and will not act maliciously.
“It is believed that a malicious attacker can be the BCM, patients, hospitals or a person who is not part of the network.”
The paper relies on this without support.
Canals are secure such that an attacker cannot control multiple BCMs across canals.
“However, as the BCMs are scattered in different canals in our architecture, it is not possible to attack multiple BCMs because of the secure canal.”
The paper relies on this without support.
The healthcare domain is a trusted network where hospitals and medical organizations trust each other.
“However, in healthcare domain where the hospitals and medical organizations form a trusted network, using Bitcoin would lead to scalability and energy issues as discussed.”
The paper relies on this without support.
The NS3 simulation with the chosen parameters accurately represents the performance of the Bitcoin network and the proposed architecture in real deployments.
“We did this by simulating a Bitcoin network and our proposed blockchain architecture using NS3 simulator.”
The paper relies on this without support.
The replication of the ledger in Bitcoin ensures data security and privacy in a permissioned network where participants do not trust each other.
“The replication of the ledger in Bitcoin ensures data security and privacy in a permissioned network where the participants do not trust each other.”
The paper relies on this without support.
The random topology used in the simulation is similar to that of a blockchain network.
“The nodes in each of the simulated networks are connected using a random topology similar to that in a blockchain.”
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?
Ismail et al.'s lightweight blockchain healthcare architecture cannot guarantee the tamper-proof of the ledger.
“The customized blockchain can reduce computational and communication delay but can not guarantee the tamper-proof of the ledger.”
From A survey on the adoption of blockchain in IoT: challenges and solutions (2021) · cites this paper as [198]
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.
2018 breach count is more than twice the 2017 count
MinorThe 2018 count is about 2.58 times the 2017 count, not twice it.
Reported 2 · recomputed 2.576121
“13,236,569 medical records were breached in 2018 which were as twice as compared to 5,138,179 records breached in 2017”
Conflicting claims about whether every Bitcoin node stores the ledger
MinorThe paper says all nodes in the Bitcoin network maintain a copy of the ledger, but its description of public blockchains says simple nodes do not store one.
“All the nodes in the network maintain a copy of the blockchain ledger (let us call it the main chain).”
“A simple node in the network can just send and receive transactions and does not store a copy of the ledger, neither validates a transaction, whereas a full node does.”
The citation lists haven’t been fetched yet
References 53 · Cited by 260
Research works printed but not linked: 17
- girault, 2017, Why you can’t beat blockchains: Consistency and high availability in distributed systems, arXiv 1710 09209
- 2019, Pseudonymity
- 2019, Confirmation—Bitcoin Wiki
- antonopoulos, 2014, Mastering Bitcoin Unlocking Digital Cryptocurrencies
- 2019, HIMSS—Healthcare Information and Management Systems Society
- 2019, Bitcoin Mining Consumes More Electricity a Year than Ireland
- 2019, Bitcoin Mining Consumes More Electricity a Year than Ireland
- 2019, Bitcoin energy consumption index
- uckert, 2002, Akteonline— An electronic healthcare record as a medium for information and communication, Stud Health Technol Inform, 90, 293
- 2019, Official Google Blog An Update on Google Health and Google Powermeter
- 2019, Hipaa Journal Healthcare Data Breach Statistics
- tian, 2016, An agri-food supply chain traceability system for China based on RFID & blockchain technology, Proc 13th Int Conf Service Syst Service Manage (ICSSSM), 1
- 2019, Representational State Transfer
- 2019, Web API
- 2017, Discussion paper on distributed ledger technology
- 2019, What is Practical Byzantine Fault Tolerance (pBFT)
- 2019, Remote Procedure Call
- Authors
- Ismail, L., Materwala, H., & Zeadally, S.
- Affiliations
- United Arab Emirates University (AE)
- University of Kentucky (US)
- Venue
- IEEE Access
- Published
- 2019
- Volume
- 7
- Pages
- 149935-149951
- ISSN
- 2169-3536 (ISSN-L)
- OpenAlex
- W2980440927
- Semantic Scholar
- 63e679dbf7b53323340e26d7de5fb776f337094d
- Cited by
- 260
- References
- 53
- Citations by year
- 2026: 21 · 2025: 27 · 2024: 43 · 2023: 53 · 2022: 53 · 2021: 52 · 2020: 11
- FWCI
- 36.09
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- IEEE Access (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- United Arab Emirates University (31R101)
- Topics
- Physical Sciences › Computer Science › Information Systems › Blockchain Technology Applications and Security
- Physical Sciences › Computer Science › Information Systems › Blockchain Technology in Education and Learning
- Physical Sciences › Computer Science › Information Systems › Cloud Data Security Solutions
- Keywords
- blockchain, health data management, data privacy, network traffic reduction, blockchain attacks
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.
Statistics and arithmetic are recomputed, not judged.
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