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72 | Hamed & Yassin
the healthcare ecosystem by introducing programming capa- professional duties, such as physicians, nurses, and medical
bilities using smart contracts. were the first to propose the researchers, make up the user data. In practice, user data
use of blockchain technology in the design of healthcare or might be assigned to a separate sector of society, such as
the purpose of decentralized identity management. MedRec healthcare. It also includes users who are intimately con-
[14], was the first functioning prototype of a blockchain-based nected to a data owner (for example, family members or close
system for accessing health records that is built on Ethereum friends), and have access to EHRs based on access privi-
smart contracts. Additionally, a solution for identity manage- leges granted by the EHR’s owner. The architecture is made
ment and verification that uses blockchain technology was up of four parts: EHR owner (EHRWi ), EHR user (EHRUj ),
created [15]. The system aims to enable greater flexibility Cloud Health Server (CHS(CHSk)), a hospital certification
in health record access while simultaneously increasing pa- authority HCA assists a patient (EHRUj ) in generating the
tient data privacy. Furthermore, an efficient authentication patient’s migration permit signature to another hospital or
mechanism for a hospital network based on blockchain was medical center in the public key infrastructure (PKI); where
proposed [16] for the identification of distributed patients (1 = i = N),(1 = j = M),(1 = k = Z); each of N, M, Z repre-
among others. Additionally, [17] presented a group authenti- sent the number of patient EHRW , users (EHRU ), healthcare
cation approach that would allow authorized group members centers (CHS), respectively. The EHRWi is the individual
to access sensitive health information in the context of a re- whose medical information is contained in the record, and
mote medical monitoring system. Moreover, using blockchain he has full access to that data. The owner might share his
technology, [18] created a multi-identity verification system information with friends, physicians, or nurses to seek clinical
for a secure medical data sharing paradigm, preventing depen- advice. The EHRUj may be in the public or private sectors,
dence on a third party [19] which allows signers to update their and their rights are determined by their roles with the EHR
certificates without having to sign again. Furthermore, a de- owner. A user can be a healthcare professional such as a
centralized, secure, and lightweight certificate-less signature doctor, a friend, a family member, or emergency personnel.
protocol was proposed by transforming the logic of the key A CHSk is a storage facility that houses and manipulates sen-
generation center (KGC) into smart contract code, which can sitive health data. Maintaining data privacy and accuracy of
withstand KGC compromised attacks and distributed denial of patients necessitates a higher level of vigilance. The EHR
service attacks [20]. However, none of the above-mentioned owner relies on the cloud server for remote data storage and
approaches takes into account the integration of authentication record maintenance, alleviating the burden of establishing
with access control to increase the overall system efficiency. and maintaining local storage infrastructure. Most cloud data
Consequently, the fundamental purpose of this research is storage services also offer benefits such as availability, scala-
to provide a robust authentication technique based on cryp- bility, low cost, and on-demand data sharing among a group of
tosystem tools to solve issues highlighted in previous studies trusted users, such as physicians, insurance companies, emer-
and provide an efficient, verifiable, and practical EHR fair gency personnel, family and friends in a collaboration team,
exchange method, allowing each patient to safely transfer or employees in an enterprise organization. Because the data
their own EHR from one institution to another. The proposed owner no longer has physical control over the data, it is vital
approach may also provide ease, speed, and integrity. We built to allow the data owner to check that his data is being saved
a high-level, realistic, and verifiable EHR fair exchange plan and maintained appropriately in the cloud. The registration
with essential agreement for the health information system. A phase, the EHR migration phase, and the data exchange phase
patient could not only delegate the current hospital’s health in- comprise the four steps of our proposed scheme.
formation systems to move their personal EHR to the chosen
hospital system but also maintain their privacy. We demon- A. Registration Phase
strated the security of our protocol using security analysis and
the Scyther tool in the security analysis discussed in the fol- In this phase, hospital certification authority (HCA) is respon-
lowing section. The performance comparison and efficiency sible to distributes the key parameters and certificate between
analysis findings show that the proposed approach delivers main components.
a greater level of security while maintaining computational
economy. 1) Cloud Health Server Side
III. PROPOSED SCHEME Each health establishment (Cloud Health Server (CHSk))
should be identified as a health mother institution (hospital
The major purpose of the proposed scheme is to enable safe certification authority (HCA)) for the purpose of achieving,
patient-centric EHR access while also providing efficient data distributing, and exchanging data among different patients
security and administration. Users with access based on their belonging to different establishments. HCA applies the fol-
lowing steps for each CHSk.
