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59
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El
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riv
a
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y
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a
n
d
se
c
u
rit
y
.
K
ey
w
o
r
d
s
:
B
lo
ck
ch
ain
Hea
lth
ca
r
e
IP
FS
Priv
ac
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Scalab
ilit
y
T
h
is i
s
a
n
o
p
e
n
a
c
c
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ss
a
rticle
u
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CC B
Y
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SA
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se
.
C
o
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r
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p
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A
uth
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r
:
Su
r
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d
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R
ed
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Salk
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ti
Dep
ar
tm
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t o
f
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d
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lectr
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n
g
in
ee
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o
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s
o
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g
Un
iv
er
s
ity
17
-
2
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J
ay
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g
-
D
o
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Do
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,
Dae
jeo
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4
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0
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R
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u
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o
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Ko
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m
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r
en
d
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@
wsu
.
ac
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k
r
1.
I
NT
RO
D
UCT
I
O
N
T
h
e
u
s
e
o
f
elec
tr
o
n
ic
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ed
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r
ec
o
r
d
s
(
E
MRs
)
h
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o
m
e
a
p
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p
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lar
to
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l
in
th
e
p
r
o
v
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io
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h
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r
e.
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MRs
en
h
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ce
p
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’
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e
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r
o
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t
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etails
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atien
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ca
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p
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,
tr
ea
tm
en
t
p
lan
n
in
g
,
an
d
co
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tin
u
ity
o
f
ca
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e.
Ho
wev
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,
h
a
v
in
g
E
MRs
s
to
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ed
ce
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tr
ally
in
t
h
e
tr
ad
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tem
s
is
a
s
ec
u
r
ity
a
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d
p
r
iv
ac
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is
s
u
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Data
b
r
ea
ch
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ca
n
leak
s
en
s
itiv
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p
atien
t
in
f
o
r
m
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th
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t,
f
in
an
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f
r
a
u
d
,
an
d
r
ep
u
tatio
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al
d
am
a
g
e
[
1
]
–
[
3
]
.
Als
o
,
th
e
ce
n
tr
alize
d
s
y
s
tem
s
d
o
n
o
t
s
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o
w
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etails
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d
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an
d
f
o
r
wh
at
r
ea
s
o
n
o
r
p
u
r
p
o
s
e
[
4
]
,
[
5
]
.
B
lo
ck
ch
ai
n
tech
n
o
lo
g
y
h
as
em
er
g
ed
as
a
p
o
ten
tial
s
o
lu
tio
n
to
ad
d
r
es
s
th
ese
ch
allen
g
es.
B
lo
ck
ch
ain
is
a
d
is
tr
ib
u
ted
an
d
d
ec
en
tr
alize
d
s
y
s
tem
o
f
r
ec
o
r
d
in
g
a
n
d
v
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f
y
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g
tr
a
n
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ac
tio
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o
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n
etwo
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ath
er
t
h
an
a
ce
n
tr
alize
d
co
n
tr
o
l
s
y
s
tem
[
6
]
,
[
7
]
.
E
v
e
r
y
tr
an
s
ac
tio
n
is
d
i
g
itally
s
ig
n
ed
an
d
co
n
n
ec
ted
s
eq
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e
n
tially
with
th
e
p
r
ev
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u
s
p
o
s
t
-
tr
an
s
ac
tio
n
;
th
is
m
ak
es
it
p
r
ac
tically
h
ar
d
f
o
r
a
n
y
o
n
e
to
m
an
ip
u
late
th
e
r
ec
o
r
d
s
[
8
]
.
I
t
is
m
ain
ly
f
o
r
th
is
r
ea
s
o
n
th
at
d
ata
in
c
o
r
p
o
r
ated
with
in
a
b
lo
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ch
ain
is
alm
o
s
t
im
p
o
s
s
ib
le
to
alter
o
r
m
a
n
ip
u
late
in
an
y
way
[
9
]
.
Var
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u
s
r
esear
ch
p
ap
e
r
s
r
ep
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r
ted
t
h
e
u
s
e
o
f
b
lo
c
k
ch
ain
tech
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lo
g
y
as
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p
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m
f
o
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s
af
e
an
d
a
u
th
o
r
ized
E
MR
s
to
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ag
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a
n
d
r
etr
iev
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C
u
r
r
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tl
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,
m
o
s
t
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ca
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s
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in
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s
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co
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p
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B
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as
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co
r
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tech
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lo
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y
th
at
ass
is
t
s
with
p
atien
t
-
ce
n
tr
ic
ca
r
e
[
1
0
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.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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I
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Vo
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1
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A
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r
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20
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5
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59
-
67
60
B
lo
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ch
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-
b
ased
h
ea
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tem
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ased
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o
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[
1
1
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[
1
2
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.
I
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also
k
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o
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p
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,
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th
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m
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1
3
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ter
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tr
ib
u
ted
a
n
d
d
ec
en
tr
ali
z
ed
p
latf
o
r
m
to
r
e
d
u
ce
th
e
p
r
o
ce
s
s
in
g
o
v
er
h
ea
d
o
n
th
e
b
lo
ck
c
h
ain
n
etwo
r
k
an
d
m
a
k
e
th
e
h
ea
lt
h
c
ar
e
s
y
s
tem
m
o
r
e
s
ca
lab
le
an
d
s
ec
u
r
e
[
1
4
]
,
[
1
5
]
.
I
n
th
e
I
PF
S
s
to
r
ag
e
s
y
s
tem
,
t
h
e
h
ea
lth
ca
r
e
d
ata
ar
e
d
iv
id
ed
i
n
to
ch
u
n
k
s
an
d
s
to
r
e
d
in
a
d
is
tr
ib
u
ted
m
an
n
e
r
,
wh
ich
a
r
e
cr
y
p
to
g
r
ap
h
ically
lin
k
ed
with
th
e
h
ash
v
alu
es [
1
6
]
.
2.
L
I
T
E
R
AT
U
RE
R
E
VI
E
W
Ku
m
ar
an
d
C
h
a
n
d
[
1
7
]
p
r
o
p
o
s
ed
a
Hy
p
er
led
g
e
r
Fab
r
ic
-
b
ase
d
Me
d
Hy
p
C
h
ain
m
e
d
ical
d
ata
ex
ch
an
g
e
s
y
s
tem
th
at
lev
er
ag
es
I
d
en
tity
-
b
ased
b
r
o
a
d
ca
s
t
g
r
o
u
p
en
cr
y
p
tio
n
to
s
ec
u
r
e
tr
a
n
s
ac
tio
n
s
,
ass
u
r
in
g
co
n
f
id
en
tiality
,
an
o
n
y
m
ity
,
tr
ac
ea
b
ilit
y
,
an
d
u
n
f
o
r
g
ea
b
ilit
y
.
I
t
s
ec
u
r
es
au
th
en
tici
ty
,
s
ca
l
ab
ilit
y
,
an
d
ac
ce
s
s
co
n
tr
o
l,
wh
ich
o
n
ly
au
th
o
r
ize
d
u
s
er
s
ca
n
ac
ce
s
s
.
Ver
m
a
[
1
8
]
p
r
esen
t
a
b
lo
ck
c
h
ain
-
en
a
b
led
clo
u
d
s
y
s
tem
f
o
r
h
ea
lth
d
ata
s
ec
u
r
ity
u
s
in
g
im
p
r
o
v
e
d
B
lo
wf
is
h
en
cr
y
p
tio
n
.
E
lep
h
an
t
h
er
d
i
n
g
o
p
tim
is
atio
n
with
o
p
p
o
s
itio
n
-
b
ased
L
ea
r
n
i
n
g
(
E
HO
-
OB
L
)
k
ey
g
e
n
er
atio
n
im
p
r
o
v
es
th
is
p
r
o
p
o
s
ed
s
y
s
tem
’
s
d
ata
i
n
teg
r
ity
an
d
au
th
en
ticity
.
W
ith
a
1
0
KB
f
ile
s
ize,
th
e
p
r
o
p
o
s
ed
m
eth
o
d
r
e
d
u
ce
s
k
ey
g
e
n
er
atio
n
tim
e
b
y
9
2
.
6
4
%
co
m
p
ar
ed
t
o
R
iv
estS
h
am
ir
-
Ad
lem
an
(
R
SA
)
,
B
lo
wf
is
h
,
ellip
tic
-
cu
r
v
e
cr
y
p
to
g
r
ap
h
y
(
E
C
C
)
,
ad
v
an
ce
d
e
n
cr
y
p
tio
n
s
tan
d
ar
d
(
AE
S
)
,
elep
h
a
n
t
h
e
r
d
in
g
o
p
tim
izatio
n
(
E
HO
)
,
m
o
th
-
f
lam
e
o
p
tim
izatio
n
(
MFO
)
,
a
n
d
wh
ale
o
p
tim
izatio
n
(
W
OA
)
m
o
d
els.
An
I
PF
S
an
d
p
er
m
is
s
io
n
B
lo
ck
ch
ain
-
en
ab
led
h
ea
lth
ca
r
e
d
ata
-
s
h
ar
in
g
s
y
s
tem
u
s
in
g
Hy
p
er
led
g
e
r
B
esu
’
s
I
s
tan
b
u
l
b
y
za
n
tin
e
f
au
lt
t
o
ler
an
ce
(
I
B
FT
)
co
n
s
en
s
u
s
alg
o
r
ith
m
an
d
t
h
r
esh
o
ld
s
ig
n
atu
r
es
is
p
r
o
p
o
s
ed
b
y
Sh
u
aib
et
a
l.
[
1
9
]
.
I
t
g
i
v
es
b
etter
r
esu
lts
th
an
ex
is
tin
g
B
lo
ck
ch
ai
n
h
ea
lth
ca
r
e
s
y
s
tem
s
in
tr
an
s
ac
tio
n
th
r
o
u
g
h
p
u
t,
laten
cy
,
an
d
f
ailu
r
e
r
ate.
Z
ak
zo
u
k
et
a
l.
[
2
0
]
p
r
o
p
o
s
ed
a
b
lo
c
k
ch
ain
-
b
ased
E
MR
m
an
ag
em
en
t
f
r
a
m
ewo
r
k
f
o
r
a
s
m
ar
t
city
h
ea
lth
ca
r
e
s
y
s
tem
th
at
p
r
io
r
itizes
p
atien
t
r
ec
o
r
d
s
ec
u
r
ity
,
p
r
iv
ac
y
,
an
d
o
wn
er
s
h
ip
.
Scalab
ilit
y
is
ac
h
iev
ed
b
y
o
f
f
-
ch
ai
n
s
to
r
ag
e
wh
ile
p
r
eser
v
in
g
th
e
au
th
en
ticity
o
f
m
ed
ical
r
ec
o
r
d
s
.
Ma
llick
et
a
l.
[
2
1
]
p
r
o
p
o
s
ed
a
f
o
g
n
o
d
e
co
m
p
u
t
in
g
-
b
ased
I
o
MT
an
d
B
lo
ck
c
h
ain
ar
c
h
itectu
r
e
t
o
r
ed
u
ce
laten
cy
,
co
n
g
esti
o
n
,
an
d
o
v
er
lo
a
d
.
A
p
r
o
x
y
m
o
n
ito
r
co
n
n
ec
ts
u
n
tr
u
s
ted
d
ev
ices,
a
n
d
I
PF
S
in
teg
r
atio
n
p
r
o
v
id
es
d
ec
en
tr
alize
d
,
s
ca
la
b
le,
s
ec
u
r
e,
an
d
p
r
iv
ate
d
ata
s
to
r
ag
e.
A
s
e
cu
r
e
I
o
MT
-
b
a
s
ed
d
ata
-
co
llectio
n
ap
p
r
o
ac
h
p
r
o
p
o
s
ed
b
y
Dew
an
g
an
an
d
C
h
an
d
r
a
k
ar
[
2
2
]
th
at
m
ain
tain
s
p
atien
t
d
ata
o
n
th
e
b
lo
ck
ch
ain
en
s
u
r
es
GDPR
co
m
p
lian
ce
.
Data
is
s
en
t
to
th
e
clo
u
d
th
r
o
u
g
h
th
e
p
atien
t
’
s
PDA
I
o
MT
d
ev
ic
es,
wh
er
e
a
m
in
er
s
elec
tio
n
p
r
o
ce
s
s
p
r
ev
e
n
ts
b
l
o
ck
ch
ain
b
ias.
T
h
e
s
y
s
tem
’
s
r
esil
ien
cy
was
v
er
if
ied
u
s
in
g
Scy
th
er
s
ec
u
r
ity
p
r
o
to
co
l
a
n
aly
s
is
an
d
B
ev
y
wis
e
in
ter
n
et
o
f
th
in
g
s
(
I
o
T
)
a
n
d
m
ess
ag
e
q
u
eu
in
g
telem
etr
y
tr
an
s
p
o
r
t
(
MQ
T
T
)
s
im
u
lato
r
ass
au
lts
.
A
b
lo
ck
ch
ain
-
b
ased
ac
ce
s
s
co
n
tr
o
l
m
o
d
el
(
B
B
A
C
M)
was
in
tr
o
d
u
ce
d
b
y
Ma
s
o
o
d
et
a
l.
[
2
3
]
t
o
im
p
r
o
v
e
p
atien
t
d
ata
p
r
iv
ac
y
an
d
s
ec
u
r
ity
i
n
S
-
C
I
.
I
n
a
p
ar
al
y
s
is
p
atien
t
u
s
e
ca
s
e,
au
th
o
r
izatio
n
r
ig
h
ts
f
o
r
p
atien
t
p
h
y
s
io
lo
g
ical
p
ar
a
m
eter
s
(
PP
Ps
)
an
d
PHI
a
r
e
s
u
cc
ess
f
u
lly
m
ain
tain
ed
b
y
B
B
AC
M.
B
lo
ck
ch
ain
’
s
d
ec
en
tr
ali
z
atio
n
a
n
d
im
m
u
tab
ilit
y
p
r
o
p
e
r
ties
en
h
an
ce
PHI
ac
ce
s
s
co
n
tr
o
l,
s
ec
u
r
ity
,
s
ca
lab
ilit
y
,
Priv
ac
y
,
an
d
av
ailab
ilit
y
o
f
h
ea
lth
ca
r
e
s
y
s
tem
s
.
Up
p
al
et
a
l.
[
2
4
]
p
r
o
p
o
s
ed
a
h
ea
lth
ca
r
e
s
y
s
tem
th
at
u
s
es
I
o
T
d
ev
ices,
I
PF
S,
an
d
b
lo
c
k
ch
ain
to
u
p
lo
a
d
an
d
m
o
n
it
o
r
h
ea
lth
d
ata
f
o
r
clin
ici
an
s
an
d
in
s
u
r
an
ce
co
m
p
a
n
ies.
I
t
u
s
es
Do
teC
o
in
s
to
tr
ad
e
co
n
s
u
ltatio
n
s
,
m
e
d
i
ca
tio
n
s
,
in
s
u
r
an
ce
p
a
y
m
en
ts
,
an
d
m
ed
ical
s
u
p
p
lies
ac
r
o
s
s
s
ix
b
lo
ck
ch
ain
s
.
Ad
d
itio
n
ally
,
it
p
r
o
v
id
es
em
er
g
en
cy
aler
ts
an
d
life
s
ty
le
n
o
tif
icatio
n
s
.
Ab
d
elg
ali
l
an
d
Me
jr
i
[
2
5
]
p
r
o
p
o
s
ed
th
e
Hea
lth
B
lo
ck
f
r
am
ewo
r
k
,
w
h
ich
in
teg
r
ates
tech
n
o
lo
g
ies
to
en
ab
le
E
HR
co
llab
o
r
atio
n
a
n
d
p
r
iv
ac
y
.
I
t
p
r
o
v
id
es
p
atien
ts
f
u
ll
o
wn
er
s
h
ip
o
v
er
t
h
eir
E
HR
s
,
wh
ile
Fab
r
ic
h
an
d
les
p
atien
t
ac
ce
s
s
co
n
tr
o
l
p
o
licies
an
d
d
eleg
atio
n
s
.
I
PF
S
s
to
r
es
an
d
s
h
ar
es
E
HR
s
o
f
f
-
ch
ai
n
,
ass
u
r
in
g
im
m
u
tab
ili
ty
.
A
co
n
s
o
r
tiu
m
b
lo
c
k
ch
ain
-
b
ased
E
MR
s
h
ar
in
g
m
eth
o
d
u
s
in
g
I
PF
S
was
p
r
o
p
o
s
ed
b
y
L
iu
et
a
l.
[
2
6
]
.
I
t
em
p
lo
y
s
attr
ib
u
te
-
b
ased
ac
ce
s
s
c
o
n
tr
o
l,
a
p
r
o
x
y
r
e
-
en
cr
y
p
tio
n
alg
o
r
ith
m
f
o
r
u
s
er
au
th
en
ticatio
n
,
an
d
d
ata
p
r
iv
a
cy
.
T
o
o
p
tim
i
z
e
en
er
g
y
co
n
s
u
m
p
tio
n
an
d
e
n
h
an
ce
d
ata
q
u
ality
in
I
o
T
-
b
ased
h
ea
l
th
ca
r
e,
a
s
ec
u
r
e
d
ata
f
u
s
io
n
-
b
ased
d
ata
ag
g
r
eg
atio
n
tech
n
iq
u
e
was
p
r
o
p
o
s
ed
b
y
Sin
g
h
an
d
Ku
m
ar
[
2
7
]
.
B
etter
co
n
n
ec
tiv
ity
an
d
s
en
s
o
r
s
elec
tio
n
ar
e
im
p
r
o
v
ed
u
s
in
g
th
e
ar
ch
im
ed
es
o
p
tim
is
atio
n
alg
o
r
ith
m
(
AOA)
an
d
ex
te
n
d
ed
b
elief
p
r
o
p
ag
ati
o
n
.
3.
P
RO
P
O
SE
D
P
RO
T
O
T
YP
E
M
O
DE
L
Fig
u
r
e
1
s
h
o
ws
th
e
p
r
o
p
o
s
ed
p
r
o
to
ty
p
e
m
o
d
el
wh
ich
en
s
u
r
es
th
e
E
MR
s
to
r
ag
e
an
d
co
n
t
r
o
l
o
f
d
ata
u
s
in
g
B
lo
ck
ch
ain
tech
n
o
lo
g
y
.
T
h
e
f
r
am
ew
o
r
k
h
ar
n
ess
es
cr
y
p
to
g
r
a
p
h
ic
m
ec
h
an
is
m
s
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d
s
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ar
t
co
n
tr
ac
ts
to
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8
7
7
6
E
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t b
lo
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a
in
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a
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tio
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fo
r
s
ec
u
r
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ica
l reco
r
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(
Deb
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a
s
a
d
Mis
h
r
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61
p
r
o
v
id
e
d
ata
tam
p
er
-
p
r
o
o
f
in
g
,
ac
ce
s
s
co
n
tr
o
l
at
a
g
r
an
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an
d
tr
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s
p
ar
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.
T
h
is
s
ec
tio
n
p
r
o
v
id
es
a
clea
r
o
v
er
v
iew
o
f
th
e
e
x
ec
u
tio
n
o
f
th
e
p
r
o
p
o
s
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m
o
d
el.
Fig
u
r
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1
.
Key
co
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p
o
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en
ts
o
f
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tem
3
.
1
.
Da
t
a
e
ncry
ptio
n
T
h
e
E
MRs
ar
e
en
cr
y
p
ted
to
e
n
s
u
r
e
th
at
th
e
d
ata
is
s
ec
u
r
e
b
ef
o
r
e
b
ei
n
g
u
p
lo
ad
e
d
to
t
h
e
I
PF
S
.
T
h
is
en
s
u
r
es
th
at
u
n
au
th
o
r
ized
in
d
iv
id
u
als
d
o
n
o
t
g
et
ac
ce
s
s
to
s
en
s
itiv
e
m
ed
ical
d
ata.
T
h
e
en
cr
y
p
tio
n
p
r
o
ce
s
s
em
p
lo
y
s
th
e
u
s
e
o
f
th
e
p
u
b
lic
k
ey
/
p
r
iv
ate
k
e
y
s
ec
u
r
ity
s
y
s
tem
wh
er
eb
y
th
e
p
atien
t
p
o
s
s
ess
es
th
e
p
r
iv
ate
k
ey
f
o
r
d
ec
r
y
p
tio
n
wh
ile
th
e
p
u
b
li
c
k
e
y
is
f
o
r
en
cr
y
p
tio
n
[
2
8
]
.
3
.
2
.
S
m
a
rt
c
o
ntr
a
ct
s
T
h
ey
ar
e
s
elf
-
e
x
ec
u
tin
g
p
r
o
g
r
am
s
th
at
r
u
n
o
n
th
e
b
lo
ck
c
h
ai
n
n
etwo
r
k
.
T
h
ese
co
n
tr
ac
ts
in
ac
tu
ality
p
r
o
v
id
e
t
h
e
ter
m
s
g
o
v
er
n
in
g
ex
ac
tly
wh
o
g
ets
to
u
s
e
th
e
p
atien
t
’
s
E
MRs
an
d
in
w
h
at
cir
cu
m
s
tan
ce
s
.
T
h
e
ac
ce
s
s
co
n
tr
o
l
p
o
licy
ca
n
b
e
d
ep
e
n
d
en
t
o
n
f
ac
to
r
s
s
u
ch
as
th
e
r
o
le
an
d
s
p
ec
ialty
o
f
th
e
HC
P
o
r
ev
en
th
e
in
f
o
r
m
atio
n
th
at
h
as b
ee
n
r
eq
u
ested
[
2
9
]
.
3
.
3
.
Acc
ess
co
ntr
o
l pro
ce
s
s
T
h
e
p
r
o
ce
s
s
o
f
ac
ce
s
s
co
n
tr
o
l
is
as
f
o
llo
ws:
(
i
)
R
eq
u
est
f
o
r
ac
ce
s
s
:
wh
en
ev
er
an
HC
P
r
eq
u
ir
es
th
e
p
atien
t
’
s
E
MR,
th
en
th
e
HC
P
p
u
ts
in
a
r
eq
u
est
t
o
th
e
b
lo
ck
ch
ain
n
etwo
r
k
.
T
h
is
r
eq
u
est
co
m
p
r
is
es
th
e
id
en
tific
atio
n
o
f
HC
P
an
d
t
h
e
d
etails
o
f
th
e
d
ata
th
e
y
n
ee
d
.
(
ii
)
Po
licy
ev
alu
atio
n
:
ac
ce
s
s
co
n
tr
o
l
im
p
lem
en
te
d
f
o
r
ea
c
h
E
MR
is
b
ased
o
n
a
s
m
ar
t
co
n
tr
ac
t
an
d
wh
en
th
e
p
a
tien
t
attem
p
ts
to
ac
ce
s
s
in
f
o
r
m
atio
n
,
th
e
r
eq
u
est
is
co
m
p
ar
ed
to
t
h
e
ac
ce
s
s
co
n
t
r
o
l
p
o
licy
.
(
iii
)
Gr
an
t/
d
en
y
a
cc
ess
:
i
f
th
e
p
o
licy
allo
ws
th
e
r
eq
u
ested
d
ata
,
th
e
s
m
ar
t c
o
n
tr
ac
t a
llo
ws ac
ce
s
s
as p
er
th
e
r
eq
u
est.
Oth
er
wis
e,
ac
ce
s
s
is
d
en
ied
.
3
.
4
.
Audi
t
a
bil
it
y
I
t
s
h
o
u
ld
also
b
e
n
o
ted
,
th
at
th
e
p
r
o
p
o
s
ed
f
r
am
ewo
r
k
h
as
h
ig
h
au
d
itab
ilit
y
.
An
y
ac
ce
s
s
attem
p
t
m
ad
e
to
war
d
p
atien
t
E
MR
is
s
to
r
e
d
p
er
m
an
e
n
tly
in
th
e
b
lo
c
k
c
h
ain
d
atab
ase
to
f
ac
ilit
ate
a
clea
r
tr
ai
l
o
f
wh
o
ac
ce
s
s
ed
th
e
d
ata,
wh
en
,
o
r
wh
y
.
T
h
ese
ac
ce
s
s
lo
g
s
m
ay
b
e
ch
ec
k
ed
b
y
a
u
d
ito
r
s
to
d
e
t
ec
t
an
y
u
n
d
esira
b
le
ten
d
en
cies,
o
r
attem
p
ts
at
ille
g
itima
te
ac
ce
s
s
.
Mo
r
eo
v
er
,
th
e
r
estricte
d
alter
atio
n
o
f
th
e
b
lo
ck
ch
ain
in
d
icate
s
th
at
th
e
ac
ce
s
s
co
n
tr
o
l p
o
licies ca
n
n
ev
e
r
b
e
c
h
an
g
e
d
,
wh
ich
,
in
tu
r
n
,
m
ak
es it a
h
ig
h
ly
au
d
i
tab
le
s
y
s
tem
[
3
0
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
7
7
6
I
n
t J I
n
f
&
C
o
m
m
u
n
T
ec
h
n
o
l
,
Vo
l.
1
4
,
No
.
1
,
A
p
r
il
20
2
5
:
59
-
67
62
3
.
5
.
I
m
pl
e
m
ent
a
t
io
n
c
o
ns
idera
t
io
ns
Sev
er
al
is
s
u
es
an
d
co
n
ce
r
n
s
th
at
n
ee
d
to
b
e
tak
en
in
t
o
co
n
s
id
er
atio
n
wh
e
n
im
p
lem
en
tin
g
th
e
p
r
o
p
o
s
ed
f
r
am
ewo
r
k
f
o
r
E
MR
m
an
ag
em
e
n
t in
clu
d
e:
−
Scalab
ilit
y
:
o
n
e
o
f
th
e
m
ain
w
ea
k
n
ess
es
ass
o
ciate
d
wi
th
p
u
b
lic
b
lo
ck
ch
ain
s
o
lu
tio
n
s
lik
e
E
th
er
eu
m
is
th
at
a
lar
g
e
n
u
m
b
er
o
f
tr
an
s
ac
tio
n
s
ca
n
s
lo
w
d
o
wn
th
e
p
r
o
ce
s
s
an
d
in
c
r
ea
s
e
th
e
tim
e
f
o
r
its
co
m
p
letio
n
.
T
h
er
e
is
an
ex
p
ec
tatio
n
th
at
p
er
m
is
s
i
o
n
ed
b
lo
ck
c
h
ain
s
[
3
1
]
,
[
3
2
]
c
an
b
e
a
s
o
lu
tio
n
to
b
o
th
is
s
u
es,
h
o
we
v
er
,
t
h
ey
in
v
o
lv
e
a
t
h
ir
d
p
a
r
ty
to
d
e
cid
e
wh
o
ca
n
b
e
a
p
ar
ticip
a
n
t.
−
I
n
ter
o
p
e
r
ab
ilit
y
:
d
if
f
er
en
t
b
lo
c
k
ch
ain
p
latf
o
r
m
s
m
a
y
h
a
v
e
v
a
r
y
in
g
p
r
o
t
o
co
ls
an
d
d
ata
s
tr
u
c
tu
r
es.
E
n
s
u
r
in
g
in
ter
o
p
er
a
b
ilit
y
b
etwe
en
d
if
f
e
r
en
t
b
lo
ck
c
h
ain
-
b
ased
E
MR
s
y
s
tem
s
is
cr
u
cial
f
o
r
s
ea
m
less
d
ata
ex
ch
an
g
e
in
th
e
h
ea
lth
ca
r
e
ec
o
s
y
s
tem
.
Stan
d
ar
d
ized
p
r
o
to
c
o
ls
an
d
d
ata
f
o
r
m
ats
ar
e
n
ee
d
ed
to
f
ac
ilit
ate
in
ter
o
p
er
a
b
ilit
y
.
Fig
u
r
e
1
e
x
p
lain
s
h
o
w
th
ese
c
o
m
p
o
n
en
ts
ar
e
r
elate
d
to
o
n
e
an
o
th
er
.
T
h
e
s
y
s
tem
co
m
p
r
is
es
f
o
u
r
m
ain
ac
to
r
s
:
s
elf
-
o
wn
er
s
:
(
i
)
Patien
ts
:
leg
al
en
titi
es
to
wh
o
m
ce
r
t
ain
m
ed
ical
d
ata
b
el
o
n
g
s
to
a
n
d
wh
o
g
r
an
t/d
en
y
ac
ce
s
s
.
(
ii
)
Hea
lth
ca
r
e
p
r
o
v
id
er
s
(
HC
Ps
)
:
h
ea
lth
ca
r
e
wo
r
k
er
s
wh
o
ar
e
leg
ally
p
er
m
itted
to
s
ee
an
d
am
en
d
p
atien
t
E
MRs
b
ased
o
n
t
h
eir
r
o
le.
(
iii
)
B
lo
ck
c
h
ain
n
etwo
r
k
:
a
d
is
tr
ib
u
ted
le
d
g
er
th
at
s
to
r
es
en
cr
y
p
te
d
E
MR
d
ata
an
d
ac
ce
s
s
co
n
tr
o
l
p
o
lici
es
[
3
3
]
.
(
iv
)
I
PF
S:
is
a
d
ec
en
tr
alize
d
s
to
r
ag
e
s
y
s
tem
wh
er
e
a
ll
f
iles
in
clu
d
in
g
all
im
ag
es will b
e
s
to
r
ed
.
A
u
s
er
in
t
h
e
n
etwo
r
k
ca
n
u
p
l
o
ad
a
f
ile
b
ased
o
n
th
e
c
o
n
te
n
t
ad
d
r
ess
o
f
th
e
f
ile.
Oth
er
p
ee
r
s
in
th
e
n
etwo
r
k
ar
e
also
allo
wed
t
o
l
o
o
k
u
p
an
d
s
u
b
s
eq
u
en
tly
r
eq
u
est
ce
r
tain
co
n
ten
t
f
r
o
m
an
y
n
o
d
e
in
th
e
n
etwo
r
k
u
s
in
g
a
d
is
tr
ib
u
ted
h
ash
tab
le
(
DHT
)
.
Fig
u
r
e
2
s
h
o
ws
th
e
ac
ce
s
s
co
n
tr
o
l
m
ec
h
an
is
m
d
is
cu
s
s
ed
ab
o
v
e
an
d
th
e
s
eq
u
en
ce
o
f
o
p
er
atio
n
s
th
at
will tak
e
p
lace
in
th
is
d
ec
e
n
tr
aliz
ed
m
ed
ical
s
to
r
ag
e
p
latf
o
r
m
.
Fig
u
r
e
2
.
Seq
u
en
ce
d
ia
g
r
am
4.
RE
SU
L
T
S
AND
D
I
SCU
SS
I
O
N
T
h
is
p
ap
er
p
r
esen
ts
a
p
r
ac
tical
im
p
lem
en
tatio
n
o
f
a
b
lo
c
k
ch
a
in
-
b
ased
m
ed
ical
r
ec
o
r
d
s
to
r
a
g
e
s
y
s
tem
.
C
u
r
r
en
tly
,
th
e
s
m
ar
t
co
n
tr
a
ct
is
d
ep
lo
y
ed
o
n
th
e
E
th
e
r
eu
m
Sep
o
lia
test
n
et
an
d
t
h
e
im
ag
es
ar
e
s
to
r
ed
in
th
e
I
PF
S.
Af
ter
u
p
lo
ad
i
n
g
a
d
o
c
u
m
en
t
in
th
e
I
PF
S,
a
h
ash
is
g
e
n
er
ated
,
a
n
d
th
is
h
ash
is
s
to
r
e
d
in
th
e
b
lo
c
k
ch
ain
.
Sto
r
in
g
th
e
en
tire
im
ag
e
o
r
d
o
cu
m
en
t
in
th
e
b
lo
c
k
ch
ain
wo
u
ld
b
e
ex
p
en
s
iv
e,
s
o
th
e
f
ir
s
t
i
m
ag
es
ar
e
s
to
r
ed
in
I
PF
S,
an
d
th
eir
h
ash
is
s
to
r
ed
in
th
e
b
lo
ck
ch
ain
.
T
h
e
s
o
u
r
c
e
co
d
e
is
p
r
o
v
id
ed
in
th
e
GitHu
b
lin
k
alo
n
g
with
th
e
wo
r
k
in
g
p
r
o
ject
lin
k
[
3
4
]
.
T
o
o
p
en
th
e
a
p
p
licatio
n
,
Me
t
aM
ask
m
u
s
t
b
e
in
s
talled
in
t
h
e
b
r
o
wser
an
d
th
e
r
em
ain
in
g
r
eq
u
ir
em
en
ts
ar
e
m
en
tio
n
ed
in
th
e
GitHu
b
r
ea
d
m
e
p
ag
e.
T
h
e
f
r
o
n
t
e
n
d
is
h
o
s
te
d
o
n
Netlif
y
,
b
u
t
to
im
p
r
o
v
e
its
s
ec
u
r
ity
e
v
en
f
u
r
th
er
,
it c
an
also
b
e
h
o
s
ted
o
n
th
e
I
n
ter
n
et
c
o
m
p
u
ter
b
lo
ck
c
h
ain
.
4
.
1
.
User
inte
rf
a
ce
a
na
ly
s
is
Fig
u
r
e
3
s
h
o
ws th
e
f
ir
s
t p
ag
e
o
f
th
e
ap
p
licatio
n
,
an
d
it h
as th
e
o
p
tio
n
to
ch
o
o
s
e
th
e
d
o
c
u
m
en
t,
u
p
lo
a
d
it
,
an
d
s
h
ar
e
it
with
t
h
e
h
ea
lth
ca
r
e
p
r
o
v
id
er
.
T
o
s
h
a
r
e
th
e
a
cc
ess
o
f
th
e
d
o
c
u
m
en
t
with
o
th
er
s
,
we
m
u
s
t
en
te
r
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J I
n
f
&
C
o
m
m
u
n
T
ec
h
n
o
l
I
SS
N:
2252
-
8
7
7
6
E
fficien
t b
lo
ck
ch
a
in
b
a
s
ed
s
o
l
u
tio
n
fo
r
s
ec
u
r
e
med
ica
l reco
r
d
ma
n
a
g
eme
n
t
(
Deb
a
n
i P
r
a
s
a
d
Mis
h
r
a
)
63
th
e
Me
taM
ask
ac
co
u
n
t
h
ash
a
n
d
th
e
n
s
elec
t
th
e
s
h
ar
e
o
p
tio
n
.
Fig
u
r
e
4
s
h
o
ws
th
e
in
ter
f
ac
e
to
s
h
ar
e
th
e
E
MR
with
h
ea
lth
ca
r
e
p
r
o
v
id
er
s
.
T
h
e
“Peo
p
le
with
ac
ce
s
s
”
o
p
tio
n
s
h
o
ws
th
e
lis
t
o
f
all
ac
co
u
n
ts
th
at
h
av
e
ac
ce
s
s
to
th
e
cu
r
r
e
n
t d
o
c
u
m
en
t.
Fig
u
r
e
3
.
User
in
ter
f
ac
e
o
f
th
e
b
lo
ck
ch
ai
n
b
ase
d
E
MR m
an
a
g
em
en
t sy
s
tem
Fig
u
r
e
4
.
Sh
ar
i
n
g
E
MR a
cc
ess
with
h
ea
lth
ca
r
e
p
r
o
v
id
e
r
s
4
.
2
.
E
nh
a
nced
s
ec
urit
y
T
h
e
p
r
esen
t
b
lo
ck
c
h
ain
-
b
ase
d
f
r
am
ewo
r
k
in
tr
o
d
u
ce
d
in
t
h
is
s
tu
d
y
is
s
u
p
er
io
r
in
th
e
s
ec
u
r
ity
o
f
E
MRs
o
v
er
th
e
co
n
v
en
tio
n
al
ce
n
tr
alize
d
s
y
s
tem
s
.
Du
e
t
o
t
h
e
u
n
alter
a
b
le
f
ea
t
u
r
e
o
f
b
lo
c
k
ch
ain
,
ev
er
y
b
lo
c
k
h
o
ld
in
g
in
f
o
r
m
atio
n
o
n
th
e
ex
ec
u
ted
tr
an
s
ac
tio
n
s
ca
n
n
o
t
b
e
tam
p
er
ed
with
.
I
f
o
n
e
wan
ted
to
ch
an
g
e
th
e
d
at
a
co
n
tain
ed
in
th
e
b
lo
ck
th
en
th
ey
wo
u
ld
h
a
v
e
to
ch
an
g
e
d
ata
in
all
s
u
b
s
eq
u
en
t
b
lo
ck
s
wh
ich
d
u
e
to
th
e
d
is
tr
ib
u
ted
n
atu
r
e
o
f
th
e
b
lo
c
k
ch
ain
wo
u
ld
b
e
m
ath
em
atica
ll
y
im
p
o
s
s
ib
le.
W
h
at
i
s
m
o
r
e
im
p
o
r
tan
t
is
th
e
f
ac
t
th
at
it
en
s
u
r
es
th
at
th
er
e
ar
e
n
o
ch
an
g
es
to
th
e
d
ata
th
at
h
av
e
alr
ea
d
y
b
ee
n
s
av
e
d
an
d
s
to
r
ed
s
in
ce
it
is
im
m
u
tab
le.
Fig
u
r
e
s
5
an
d
6
s
h
o
w
th
e
Me
taM
ask
tr
an
s
ac
tio
n
p
r
o
ce
s
s
an
d
its
co
n
f
ir
m
atio
n
s
tatu
s
r
esp
ec
tiv
ely
.
E
ac
h
tr
an
s
ac
tio
n
o
n
th
e
b
lo
ck
ch
ain
in
v
o
lv
es
s
o
m
e
g
as
f
ee
s
.
W
e
ca
n
s
ee
th
e
to
tal
tr
an
s
ac
ti
o
n
f
ee
s
r
eq
u
ir
e
d
f
o
r
th
e
u
p
lo
a
d
f
u
n
ctio
n
in
t
h
e
Sep
o
lia
test
n
et
o
f
th
e
E
th
er
e
u
m
b
l
o
ck
ch
ain
.
T
h
e
u
s
e
o
f
b
lo
c
k
ch
ain
k
ee
p
s
a
r
ec
o
r
d
o
f
all
th
e
ac
ce
s
s
attem
p
ts
m
ad
e
o
n
th
e
p
atien
t
E
M
R
s
,
as
well
as
en
s
u
r
in
g
th
a
t
t
h
e
r
ec
o
r
d
s
ar
e
tr
an
s
p
ar
e
n
t
a
n
d
d
if
f
icu
lt
to
alter
.
T
h
is
h
ig
h
le
v
el
o
f
a
u
d
itab
ilit
y
h
as
th
e
ad
v
an
tag
e
o
f
in
cr
ea
s
in
g
ac
co
u
n
tab
ilit
y
in
th
e
s
y
s
tem
an
d
th
e
in
teg
r
ity
o
f
th
e
h
ea
lt
h
ca
r
e
d
ata.
Desp
ite
th
e
v
ar
io
u
s
s
tr
en
g
t
h
s
o
f
th
e
f
r
am
e
wo
r
k
r
e
g
ar
d
i
n
g
s
ec
u
r
ity
,
th
e
a
s
p
ec
t
o
f
s
ca
lab
ilit
y
c
o
u
ld
b
e
a
p
r
o
b
lem
with
th
e
s
y
s
tem
.
C
en
tr
alis
ed
b
lo
ck
ch
ai
n
s
s
u
ch
as
E
th
er
e
u
m
ca
n
g
et
cr
o
wd
ed
w
h
en
th
e
r
e
ar
e
m
an
y
tr
an
s
ac
tio
n
s
an
d
th
is
r
esu
lts
to
in
cr
ea
s
ed
p
r
o
c
ess
in
g
tim
e
as
well
as
in
cr
e
ased
tr
an
s
ac
tio
n
f
ee
s
.
Per
m
is
s
io
n
ed
b
lo
c
k
c
h
ain
s
co
u
ld
b
e
a
p
o
ten
tial
s
o
lu
tio
n
t
o
th
is
b
u
t
th
e
y
in
v
o
lv
e
th
e
u
s
ag
e
o
f
a
co
n
tr
o
l
s
y
s
tem
to
r
eg
u
l
ate
th
e
p
ar
ticip
an
ts
h
en
ce
tak
in
g
s
o
m
e
o
f
th
e
d
e
ce
n
tr
aliza
tio
n
ad
v
a
n
tag
es
awa
y
.
T
ab
le
1
s
h
o
ws
th
e
ac
t
u
al
t
r
an
s
ac
tio
n
f
ee
s
f
o
r
ea
ch
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p
e
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atio
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lik
e
ad
d
in
g
th
e
im
ag
e
h
ash
to
th
e
b
lo
ck
ch
ai
n
alo
n
g
with
t
h
eir
b
l
o
ck
n
u
m
b
er
an
d
tr
a
n
s
ac
tio
n
h
ash
.
W
e
ca
n
s
ee
f
r
o
m
th
e
tab
le
th
at
th
e
g
as f
ee
s
v
ar
y
f
r
o
m
t
im
e
to
tim
e
an
d
with
t
h
e
n
etw
o
r
k
tr
af
f
ic.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
7
7
6
I
n
t J I
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f
&
C
o
m
m
u
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T
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Vo
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Fig
u
r
e
5
.
C
o
n
f
ir
m
in
g
t
h
e
tr
an
s
ac
tio
n
s
in
Me
taM
ask
Fig
u
r
e
6
.
T
r
an
s
ac
tio
n
co
n
f
ir
m
ed
s
tatu
s
in
Me
taM
ask
T
ab
le
1
.
Simu
latio
n
r
esu
lts
S.
No
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e
t
h
o
d
B
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o
c
k
n
o
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4
.
3
.
I
nte
ro
pera
bil
it
y
a
nd
s
t
a
nd
a
rds
T
h
e
ab
ilit
y
to
s
h
ar
e
d
ata
b
etwe
en
v
ar
io
u
s
b
lo
ck
c
h
ain
-
b
ased
E
MR
s
y
s
tem
s
wi
ll
r
eq
u
ir
e
in
teg
r
atio
n
to
en
h
an
ce
d
ata
s
h
ar
in
g
with
in
th
e
h
ea
lth
ca
r
e
s
y
s
tem
.
T
h
ese
b
lo
ck
ch
ai
n
s
ca
n
b
e
v
er
y
d
is
s
im
ilar
in
ter
m
s
o
f
d
ev
ices,
s
y
n
tactic
s
tr
u
ctu
r
es,
s
em
an
tics
,
p
r
o
to
co
ls
,
an
d
ev
e
n
p
r
o
g
r
am
m
in
g
p
a
r
ad
ig
m
s
,
w
h
ich
ca
n
r
ed
u
ce
th
e
ea
s
e
o
f
in
ter
co
n
n
ec
tiv
ity
.
T
a
b
le
2
c
o
m
p
ar
e
s
4
f
am
o
u
s
b
lo
ck
ch
ai
n
s
b
ased
o
n
v
ar
i
o
u
s
p
ar
am
eter
s
.
T
h
is
co
m
p
ar
is
o
n
allo
ws u
s
er
s
to
s
u
i
tab
ly
ch
o
o
s
e
th
e
b
lo
ck
c
h
ain
o
f
th
eir
ch
o
ice.
T
ab
le
2
.
C
o
m
p
a
r
is
o
n
o
f
b
lo
ck
ch
a
in
f
r
am
ew
o
r
k
s
in
h
ea
lth
ca
r
e
d
ata
m
an
ag
e
m
en
t
S.
No
F
e
a
t
u
r
e
H
y
p
e
r
l
e
d
g
e
r
F
a
b
r
i
c
Et
h
e
r
e
u
m
C
o
r
d
a
Q
u
o
r
u
m
1
C
o
n
se
n
s
u
s
m
e
c
h
a
n
i
sm
B
F
T
(
P
r
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c
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l
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)
P
r
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2
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[
1
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rg
y
so
u
rc
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s.
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c
a
n
b
e
c
o
n
tac
t
e
d
a
t
e
m
a
il
:
su
re
n
d
e
r@ws
u
.
a
c
.
k
r
.
Evaluation Warning : The document was created with Spire.PDF for Python.