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Cited by 116Blockchain Technology Applications and SecurityInternet of Things and AIIoT and Edge/Fog Computing

Blockchain-based healthcare workflow for tele-medical laboratory in federated hospital IoT clouds

Open access
Celesti, Antonio, Ruggeri, Armando, Fazio, Maria, Galletta, Antonino, Villari, Massimo, Romano, Agata·2020·Sensors
DOI 10.3390/s20092590PMC PMC7249089
Open this paper in CoChat — free accountOpen PDF

Abstract

In a pandemic situation such as that we are living at the time of writing of this paper due to the Covid-19 virus, the need of tele-healthcare service becomes dramatically fundamental to reduce the movement of patients, thence reducing the risk of infection. Leveraging the recent Cloud computing and Internet of Things (IoT) technologies, this paper aims at proposing a tele-medical laboratory service where clinical exams are performed on patients directly in a hospital by technicians through IoT medical devices and results are automatically sent via the hospital Cloud to doctors of federated hospitals for validation and/or consultation. In particular, we discuss a distributed scenario where nurses, technicians and medical doctors belonging to different hospitals cooperate through their federated hospital Clouds to form a virtual health team able to carry out a healthcare workflow in secure fashion leveraging the intrinsic security features of the Blockchain technology. In particular, both public and hybrid Blockchain scenarios are discussed and assessed using the Ethereum platform.

AI snapshot

Written from the paper’s full text.

TL;DR

The paper proposes a tele-medical laboratory service in federated hospital IoT clouds where clinical exams are performed locally and results are shared with doctors in federated hospitals, using Blockchain smart contracts for non-repudiation and immutability. It compares public versus hybrid Ethereum network configurations and reports that the hybrid approach improves processing time and reduces cost as transaction volume grows.

Key findings

  • A hybrid Ethereum network—where each Federated Hospital IoT Cloud runs a private Ethereum instance and only one MD5 hash of the last 100 concatenated treatment transaction hashes (or the last 24 h if fewer than 100 daily treatments) is written to the public Ethereum network—reduces waiting time and ETH cost compared with writing every treatment to the public network.
  • For roughly 80 treatment registration requests, both public and hybrid configurations show a similar time-to-mine trend; beyond that, the hybrid Ethereum network performs better due to reduced mining-queue waiting time.
  • The average cost of a single transaction written to the public Ethereum Blockchain is roughly 0.0002 ETH; the hybrid approach’s cost-saving increases with the number of transactions because only one public transaction is paid per one-hundred private treatments.
  • The paper reports that the hybrid approach maintains the same level of accountability and data certification as the public approach through Blockchain certification.

Methods

  • The authors designed an FHC architecture and prototype with a WSGI entry point (Flask on Gunicorn), Docker containers, NextCloud cloud storage, MongoDB NoSQL database, and Ethereum smart contracts written in Solidity; a Data Anonymization Module separates patient personal data from electronic health records.
  • Experiments compared public Ethereum versus hybrid Ethereum for healthcare workflow treatment registration, measuring total execution time and cost in ETH.
  • Each FHC was simulated on a server with Intel Xeon E3-12xx v2 @ 2.7 GHz, 4-core CPU, 4 GB RAM, Ubuntu Server 18.04; each test was repeated 30 times with 95% confidence intervals, and average results were plotted.

Limitations

  • The paper states that the hybrid network reduces mining power because fewer miners are present in the private network compared with the public one.
  • The paper states that future work will make public test instances with different consensus protocols available, implying that alternative consensus protocols were not evaluated here.
  • Evident from the text: the assessment is based on simulated FHC servers and varying transaction counts rather than a real hospital deployment or real patient data; the text does not report exact processing-time values, only plotted trends and the approximate 0.0002 ETH average public transaction cost.

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

Integrity signals

Registry

Crossref · 10.3390/s20092590

Cites

23 of 23 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 8 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The average cost of a single transaction (i.e., a simple Smart Contract representing a new treatment memorization or modification) that has to be written in the public Ethereum Blockchain is roughly 0.0002 ETH.

    “From our tests, we appreciated that the average cost of a single transaction (i.e., a simple Smart Contract representing a new treatment memorization or modification) that has to be written in the public Ethereum Blockchain, is roughly 0.0002 ETH.”
    Quote in the paperSubstantial claim
  • Findingreasoning

    For a small number of transactions there is not a perceptible convenience in preferring the proposed hybrid approach.

    “It can be noted that for a small number of transactions there is not a perceptible convenience in preferring the proposed hybrid approach.”
    Quote in the paperNot a substantial claim
  • Interpretationown data

    This paper demonstrated how a tele-medical laboratory service can be developed through a healthcare workflow running in a FHC environment leveraging Blockchain.

    “This paper demonstrated how a tele-medical laboratory service can be developed through a healthcare workflow running in a FHC environment leveraging Blockchain.”
    Quote in the paperSubstantial claim
  • May combine two claims. 11
  • Classified as probably not a substantial claim. 16

  • May combine two claims.

    Findingnone given

    The Blockchain hybrid network approach allows reducing the number of required transactions, hence enhancing processing time and reducing economic cost.

    “Moreover, we demonstrate that our Blockchain hybrid network approach allows reducing the number of required transactions, hence enhancing processing time and reducing economic cost.”
    • Also stated in: § 7. Conclusions and Future Work · boosted
      “Experimental results highlight that the performance of the Ethereum hybrid network certification system is improved in terms of cost and response time compared to an alternative public approach.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For roughly 80 treatment registration requests both configurations present a similar trend, whereas increasing the number of requests the hybrid Ethereum network shows better performances than the public one thanks to the reduced waiting time in the mining queue.

    “Looking at the graph, we can observe that for roughly 80 treatment registration requests both configurations present a similar trend, whereas increasing the number of requests the hybrid Ethereum network shows better performances than the public one thanks to the reduced waiting time in the mining queue.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    The money-saving increases exponentially increasing the number of transactions because only one public transaction every one-hundred of private treatments will be paid with ETH cryptocurrency, resulting in an important cost-saving for the FHC ecosystem.

    “However, it is clear that the money-saving increases exponentially increasing the number of transactions because only one public transaction every one-hundred of private treatments will be paid with ETH cryptocurrency, resulting in an important cost-saving for the FHC ecosystem.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Recently, a few related works were published for data anonymization in a Multi-Cloud storage environment considering a healthcare scenario, however, these do not guarantee that pieces of data are track-able and irreversible.

    “Recently, a few related works were published for data anonymization in a Multi-Cloud storage environment considering a healthcare scenario, however, these do not guarantee that pieces of data are track-able and irreversible [27,28].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [27] Galletta, A., Bonanno, L., Celesti, A., Marino, S., Bramanti, P., and Villari, M. (2017, January 3–6). An approach to share MRI data over the Cloud preserving patients’ privacy. Proceedings of the 2017 IEEE Symposium on Computers and Communications (ISCC), Heraklion, Greece. source

      Not checked in the free run.

    • cites [28] Galletta, A., Celesti, A., Tusa, F., Fazio, M., Bramanti, P., and Villari, M. (2017, January 2–5). Big MRI Data Dissemination and Retrieval in a Multi-Cloud Hospital Storage System. Proceedings of the 2017 International Conference on Digital Health, London, UK. source

      Not checked in the free run.

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

    Study design and conductnone given

    Every change in the files or content of the folder will be tracked making it possible to keep a history of the documentation and its modifications.

    “Every change in the files or content of the folder will be tracked making it possible to keep a history of the documentation and its modifications.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    A Blockchain engine is responsible to store information on the Blockchain to certify data non-repudiation and immutability of treatment details guaranteeing accountability and authenticity.

    “A Blockchain engine is responsible to store information on the Blockchain to certify data non-repudiation and immutability of treatment details guaranteeing accountability and authenticity.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Blockchain technology has intrinsic features of data non-repudiation and immutability.

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

    Study design and conductnone given

    The FHC architecture was designed to enable a virtual healthcare team to carry out every healthcare workflow such as that described in the previous Section.

    “The FHC architecture was designed to enable a virtual healthcare team to carry out every healthcare workflow such as that described in the previous Section.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    Each test has been repeated 30 times considering 95% confidence intervals and the average results are plotted.

    “Each test has been repeated 30 times considering 95% confidence intervals and the average results are plotted.”
    Quote in the paperNot a substantial claim

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

    Interpretationnone given

    Tele-medical laboratory allows performing blood exams, results validation, diagnosis and therapy assignment tasks in departments located in different hospitals.

    “Tele-medical laboratory allows performing blood exams, results validation, diagnosis and therapy assignment tasks in departments located in different hospitals.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    It is possible to improve access to health services by using the Blockchain technology to achieve greater transparency, security and privacy, traceability and efficiency.

    “In fact, it is possible to improve access to health services by using the Blockchain technology to achieve greater transparency, security and privacy, traceability and efficiency.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Zhang, P., White, J., Schmidt, D., Lenz, G., and Rosenbloom, S. (2018). FHIRChain: Applying Blockchain to Securely and Scalably Share Clinical Data. Comput. Struct. Biotechnol. J., 16. source

      Not checked in the free run.

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

    Study design and conductnone given

    This service is capable of detecting any modification that occurred to files or a folder using a listener called External script.

    “This service is capable of detecting any modification that occurred to files or a folder using a listener called External script.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The Ethereum hybrid network results in a negligible waiting queue and ETH cost but, on the other hand, there is a reduction of the mining power as a reduced number of miners are present in the private network as compared to the public one.

    “The result of this is a negligible waiting queue and ETH cost but, on the other hand, there is a reduction of the mining power as a reduced number of miners are present in the private network as compared to the public one.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Blockchain can drastically improve the security of hospital information systems.

    “Blockchain can drastically improve the security of hospital information systems as discussed in [12,13,14,15].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [12] Chakraborty, S., Aich, S., and Kim, H. (2019, January 17–20). A Secure Healthcare System Design Framework using Blockchain Technology. Proceedings of the 2019 21st International Conference on Advanced Communication Technology (ICACT), PyeongChang, Korea. source

      Not checked in the free run.

    • cites [13] Dasaklis, T.K., Casino, F., and Patsakis, C. (2018, January 23–25). Blockchain Meets Smart Health: Towards Next Generation Healthcare Services. Proceedings of the 2018 9th International Conference on Information, Intelligence, Systems and Applications (IISA), Zakynthos, Greece. source

      Not checked in the free run.

    • cites [14] Srivastava, G., Crichigno, J., and Dhar, S. (2019, January 5–8). A Light and Secure Healthcare Blockchain for IoT Medical Devices. Proceedings of the 2019 IEEE Canadian Conference of Electrical and Computer Engineering (CCECE), Edmonton, AB, Canada. source

      Not checked in the free run.

    • cites [15] Hossein, K.M., Esmaeili, M.E., Dargahi, T., and khonsari, A. (2019, January 5–8). Blockchain-Based Privacy-Preserving Healthcare Architecture. Proceedings of the 2019 IEEE Canadian Conference of Electrical and Computer Engineering (CCECE), Edmonton, AB, Canada. source

      Not checked in the free run.

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

    Premisecitation

    Blockchain has been increasingly recognized as a tool able to address existing open information access issues.

    “Blockchain has been increasingly recognized as a tool able to address existing open information access issues [16].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Zhang, P., White, J., Schmidt, D., Lenz, G., and Rosenbloom, S. (2018). FHIRChain: Applying Blockchain to Securely and Scalably Share Clinical Data. Comput. Struct. Biotechnol. J., 16. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    Only electronic health records are shared between FHCs, whereas pieces of patients' personal data are never shared to preserve their privacy.

    “Thus, only electronic health records are shared between FHCs, whereas pieces of patients’ personal data are never shared to preserve their privacy.”
    Quote in the paperSubstantial claim

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

    Interpretationnone given

    A distributed scenario where nurses, technicians and medical doctors belonging to different hospitals cooperate through their federated hospital Clouds to form a virtual health team able to carry out a healthcare workflow in secure fashion leveraging the intrinsic security features of the Blockchain technology.

    “In particular, we discuss a distributed scenario where nurses, technicians and medical doctors belonging to different hospitals cooperate through their federated hospital Clouds to form a virtual health team able to carry out a healthcare workflow in secure fashion leveraging the intrinsic security features of the Blockchain technology.”
    • Also stated in: § 1. Introduction · plain
      “Biomedical laboratory health technicians, nurses, doctors and other clinical personnel belonging to different Federated Hospital IoT Clouds (FHCs) cooperate to form a virtual healthcare team able to carry out a healthcare workflow.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Blockchain technology has intrinsic features of data non-repudiation and immutability.
    • Rests on an assumption: Smart contracts can make transactions related to the healthcare workflow track-able and irreversible.

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

    Study design and conductreasoning

    A local database instance containing both patients and hospital personnel data is isolated from other federated hospitals because these never require to be shared.

    “A local database instance containing both patients and hospital personnel data is isolated from other federated hospitals because these never require to be shared.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Test results demonstrate how the Ethereum hybrid network approach can be adopted to improve both processing time and cost-saving maintaining the same level of accountability and data certification as the public approach through certification on Blockchain.

    “Test results demonstrate how the Ethereum hybrid network approach can be adopted to improve both processing time and cost-saving maintaining the same level of accountability and data certification as the public approach through certification on Blockchain.”
    • Also stated in: § 7. Conclusions and Future Work · boosted
      “Experimental results highlight that the performance of the Ethereum hybrid network certification system is improved in terms of cost and response time compared to an alternative public approach.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Blockchain technology has intrinsic features of data non-repudiation and immutability.
    • Rests on an assumption: Smart contracts can make transactions related to the healthcare workflow track-able and irreversible.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The system assessment has been conducted analysing the total execution time required to perform a varying number of transactions in healthcare workflows.

    “The system assessment has been conducted analysing the total execution time required to perform a varying number of transactions in healthcare workflows.”
    Quote in the paperSubstantial claim

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

    Premisenone given

    Hospitals belonging to a Federation cooperate ensuring that appropriate therapies and procedures are carried out.

    “Hospitals belonging to a Federation cooperate ensuring that appropriate therapies and procedures are carried out.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    All the components are configured as Docker containers to take the advantages of virtualization technology allowing service portability, resiliency and automatic updates that are typical of a Cloud Infrastructure as a Service (IaaS).

    “All the components are configured as Docker containers to take the advantages of virtualization technology allowing service portability, resiliency and automatic updates that are typical of a Cloud Infrastructure as a Service (IaaS).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    Apart from processing time, considering the Ether (ETH) cryptocoin concurrency used in Ethereum, a small saving of ETH can result in putting aside a relevant amount of money (e.g., USD or EUR) in just a few months.

    “Apart from processing time, it is important to highlight that considering the Ether (ETH) cryptocoin concurrency used in Ethereum, a small saving of ETH can result in putting aside a relevant amount of money (e.g., USD or EUR) in just a few months.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    The hash code resulting from the mining of each transaction is stored in the MongoDB database and can be used for verification using services like etherscan.io.

    “The hash code resulting from the mining of each transaction is stored in the MongoDB database and can be used for verification using services like etherscan.io.”
    Quote in the paperNot a substantial claim
23 of 23

  • The paper relies on this without support.

    The need of tele-healthcare service becomes dramatically fundamental to reduce the movement of patients, thence reducing the risk of infection.

    “In a pandemic situation such as that we are living at the time of writing of this paper due to the Covid-19 virus, the need of tele-healthcare service becomes dramatically fundamental to reduce the movement of patients, thence reducing the risk of infection.”
    “Moreover, in the pandemic condition such as that we are living at the time of writing of this paper due to the Covid-19 virus, the need of tele-healthcare service becomes dramatically fundamental to reduce the movement of patients, thence reducing the risk of infection.”

  • The paper relies on this without support.

    Blockchain technology has intrinsic features of data non-repudiation and immutability.

    “Blockchain technology, thanks to its intrinsic features of data non-repudiation and immutability, has aroused a great interest in both scientific and industrial communities.”

  • The paper relies on this without support.

    Smart contracts can make transactions related to the healthcare workflow track-able and irreversible.

    “Considering the tele-medical laboratory scenario, smart contracts can make the transactions related to the healthcare workflow track-able and irreversible.”
    “In this regard, the Blockchain technology using smart contracts can make all transactions related to the healthcare workflow track-able and irreversible.”

  • The paper relies on this without support.

    A public Ethereum instance is available over the Internet and requires the payment of a fee for the execution of each transaction.

    “A public Ethereum instance is available over the Internet and requires the payment of a fee for the execution of each transaction.”

  • The paper relies on this without support.

    Ethereum public network time-to-mine and cost are subject to Ethereum network traffic (depending on the queue size, more time is required to extract transaction data, higher is the cost for transaction management).

    “Ethereum public network: each healthcare treatment is recorded in the public Ethereum Blockchain network where time-to-mine and cost are subject to Ethereum network traffic (depending on the queue size, more time is required to extract transaction data, higher is the cost for transaction management).”

  • The paper relies on this without support.

    The Ethereum platform can be downloaded and installed in a private network.

    “However, the Ethereum platform can be also downloaded and installed in a private network.”

  • The paper relies on this without support.

    A wrong decision by an unauthorized member can lead to a worsening of clinical condition or death of a patient.

    “It is important to guarantee that only authorized members of the virtual healthcare team are allowed to take actions because a wrong decision can lead to a worsening of clinical condition or death of a patient.”
7 of 7

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?

  • In Celesti et al.'s eHealth system, extensive performance analysis has not been carried out to demonstrate feasibility.

    “Although the authors described the healthcare workflow for the proposed system, extensive performance analysis has not been carried out to demonstrate the feasibility of the system.”

    From A survey on the adoption of blockchain in IoT: challenges and solutions (2021) · cites this paper as [166]

Cites

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Related

Authors
Celesti, A., Ruggeri, A., Fazio, M., Galletta, A., Villari, M., & Romano, A.
Affiliations
  • University of Messina (IT)
  • ASP Messina, 98123 Messina, Italy
Corresponding author
Celesti, Antonio
ORCID
Venue
Sensors
Publisher
MDPI AG
Published
2020-05-02
Volume
20
Issue
9
Pages
2590
ISSN
1424-8220 (ISSN-L)
DOI
10.3390/s20092590
PMC
PMC7249089
OpenAlex
W3021243282
Semantic Scholar
0bce5d95157ca4632216a0036047258ffb1674ec
Cited by
116
References
23
Citations by year
2026: 2 · 2025: 6 · 2024: 17 · 2023: 24 · 2022: 27 · 2021: 28 · 2020: 12
FWCI
21.42
Type
journal article
Language
en
Open access
Licence
Locations
  • Sensors (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Ministero della Salute (GR-2016-02361306)
Topics
  • Physical Sciences › Computer Science › Information Systems › Blockchain Technology Applications and Security
  • Physical Sciences › Computer Science › Information Systems › Internet of Things and AI
  • Physical Sciences › Computer Science › Computer Networks and Communications › IoT and Edge/Fog Computing
Keywords
blockchain, telemedicine, healthcare workflow, Internet of Things, COVID-19 pandemic, Ethereum, hybrid blockchain, public blockchain
MeSH terms
Cloud Computing, Betacoronavirus, Blockchain, COVID-19, SARS-CoV-2, Humans, Pneumonia, Viral, Computer Security, Telemedicine, Coronavirus Infections, Pandemics

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