The Principles of Blockchain Technology in Healthcare: Comparison
Please note this is a comparison between Version 1 by Hamed Taherdoost and Version 3 by Jessie Wu.

A blockchain may be seen as a distributed ledger that allows peers to exchange data. It was launched with Bitcoin and resolved a persistent issue: the double-spend problem. With Bitcoin, this is accomplished by a majority consensus of so-called mining nodes and the addition of legitimate transactions to the blockchain. Bitcoin was the first to use blockchain technology. Therefore, introducing a coin is not required to utilize blockchain and develop decentralized apps. 

  • blockchain
  • healthcare

1. Blockchain

A blockchain may be described as a sequence of time-stamped and cryptographically connected blocks. These blocks are permanently and securely sealed [1][27]. Each new block added to the end of the chain contains a reference to the content of the preceding block [2][28]. The shareholders, known as the blockchain’s nodes, are arranged in a peer-to-peer (P2P) network. Each node in the network has two keys [3][29]: a private key used for decrypting messages and allowing the node to read them, and a public key used for encrypting messages transmitted to the node. Hence, the public key encryption process is employed to assure the non-repudiation, irreversibility, and consistency of a blockchain [4][25]. Messages encrypted with the accompanying public key can only be decrypted with the matching private key. The term for this idea is asymmetric cryptography. While a comprehensive explanation is beyond the scope of this researchtudy, more information may be obtained in [3][29]. The so-called hash, which is created using a cryptographic one-way hash function, is used to connect every block on the blockchain. It also assures the block’s compactness, anonymity, and immutability [5][30].
This leads us to the significance of network nodes. Because the blockchain system is a P2P network, a node may be considered a peer when it begins to connect and interact with other nodes in the network; hence, peer node is the correct term. A full node is, in layman’s words, any computer that has the main blockchain client installed and runs a complete copy of the whole blockchain ledger [4][25]. A user who wishes to interact with the blockchain connects to the network through a node [6][31]. Miners are a subset of nodes since each miner needs to also run a fully functional node. Each miner is thus a node, but not every node is also a miner. This situation is known from a certain sort of public blockchain using the proof-of-work (PoW) consensus algorithm. Some forms of blockchain networks using different distributed consensus mechanisms, such as proof-of-stake (PoS), do not need mining [7][32].
Depending on the level of involvement [8][33], blockchain may be classified into the consortium, private, and public chain. As its name suggests, a public chain is entirely public and open to anybody. Due to the immutability of the data on the chain, public chains are regarded to be entirely decentralized. Participation in the consortium chain is restricted to authorized members, and the write/read rights and participation accounting permissions on the blockchain are constructed by the alliance’s norms. The private chain is exclusive to private organizations, and the write and read rights on the blockchain, as well as the permissions to participate in accounting, are constructed by the norms of the private organization. Participating nodes are restricted in reference [9][34].

2. Smart Contracts

Computer protocols known as “smart contracts” allow for the informational distribution, validation, and enforcement of contracts [10][35]. Smart contracts do not need the verification of a third party, and successful transactions are irrevocable and traceable. Computer software is used to create a legally binding contract that can be automatically executed. A smart contract is a program placed on the blockchain that guarantees the safety and security of transactions in the absence of third-party monitoring [11][36]. The process of smart contracts is shown in Figure 1. In the smart contract code, predefined response rules and trigger situations are encoded, triggering specific actions automatically when predetermined conditions are met. This eliminates the need for intermediaries and improves the contract execution process’s transparency, security, and efficiency. When trigger situations, such as specific dates, events, or conditions, occur, the smart contract implements predefined actions, such as transferring ownership, releasing funds, and updating records. By incorporating blockchain technology into smart contracts, participants gain an increased trust, lower costs, and reduced fraud risks. Combining blockchain technology and smart-contract streamline processes optimizes contract administration and provides a secure and transparent solution for a variety of industries. Table 1 displays the highlights of blockchain-enabled smart contracts.
Figure 1.
Blockchain in a smart contract process.

3. Importance of Blockchain in Healthcare

Blockchain may provide an effective, efficient, safe, and transparent method of data and information communication for all stakeholders involved in the healthcare business [12][37]. With tokenization and smart contracts, it is possible to decrease or eliminate the pre-authorization procedure in the healthcare industry [13][38]. While connecting with multiple parties, blockchain-based systems for health documentation protect the security of an individual’s data via the use of secure encryption methods [14][39]. Using the encryption methods, smart contracts, and tokenization used in blockchain network transactions, the pre-authorization method will be drastically streamlined, allowing patients to obtain essential and informed treatment more quickly. This is a consequence of the healthcare provider’s ability to immediately obtain pertinent information, whereas previously, they had to rely on the patient or on files physically delivered or emailed from many sources, such as local doctors, laboratories, etc. Not only may tokenization promote a more efficient contact and communication between insurance companies and healthcare practitioners, but it can also support and enhance patient–provider dialogue.
The expansion of the worldwide healthcare business may be aided by blockchain technology, which can also save money and stimulate additional investment in vital resources. With so much at risk, it is inconceivable that the current inefficient, excessively bureaucratic, and failing healthcare business can continue [15][40]. It is time for executives, practitioners, and patients to embrace the available technological and system-based innovations.
The misuse of available information prevents healthcare organizations from providing appropriate patient care and remarkably improved services. Even though these organizations are economically competent, they are unable to meet the needs of patients. Here are a few facts from Supporting Materials that illustrate this reality. Nowadays, healthcare data breaches in organizations are estimated to cost around USD 380 per compromised record. This amount is anticipated to increase with time. Several healthcare offices still use antiquated frameworks for maintaining patient records. These frameworks are beneficial for keeping patient information records close at hand. This might make it difficult for the professional to analyze, which can be tiresome for both the specialist and the patients. As a result, the cost of maintaining a patient-centered business increases substantially [16][17][41,42]. The majority of the present healthcare data infrastructure relies on reputable third parties. In numerous instances, however, they cannot be relied upon. A potential answer to this issue is the blockchain, which depends on consensus and does not need a central authority.
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