/

1. Secure Requirements Engineering for Blockchain with BC-SQUARE Method
&BPMN Modelling and Simulation
Methods and Design Principles: service components with soaML
Reference Architecture for SSEF-BC (REF4BC)
Tools (Hyperledger Fabric, Ethereum: Building decentralized applications
(dApps). Example MedRec for healthcare, Corda: Permissioned blockchain
platform that is designed for enterprise use cases, EOSIO: Designed for high-
performance decentralized applications
SSEF-BC Applications: BC_FinTech, BC4SE, BC4SPI, BC4QI, BC-LandRegistry,
Service Level agreement as a Service (SLaaS), CPS-IoT Energy Management, CPS-
IoT Service Delivery, Service Security and Privacy Protection, CPS-IoT Smart City,
CPS-IoT Smart Grid, CPS-IOT Smart Transportation, CPS-IoT Smart E-Government,
Smart Home, etc. Healthcare Applications with Hyperledger Fabric for building
electronic health record (EHR) systems, clinical trial management platforms,
and medical supply chain solutions,
SSEF-BC Adoption Models
Blockchain Testing (Smart contract Testing and Blockchain Transaction Testing),
Evaluation & Applications
Dr Muthu Ramachandran PhD FBCS Senior Fellow of Advance HE, MIEEE, MACM
Visiting Professor @ University of Southampton & IIT Dhanbad, India
Research & Educational Consultant @ AI Tech, UK.
Email: muthuram@ieee.org
Google Scholar: https://scholar.google.com/citations?user=RLmKWYYAAAAJ&hl=en
LinkedIn: https://www.linkedin.com/in/muthuuk/
Amazon Author, https://tinyurl.com/Muthu-Amazon-Author
Email: muthuram@ieee.org

2. Research Questions?
• What are the current applications of Blockchain?
• How to integrate AI with Blockchain and vice versa?
• What are the three key components to blockchain technology: The distributed ledger, the consensus mechanism, and the smart contracts?
• To Understand the key trend in current blockchain applications?
• What are the key challenges in blockchain for healthcare applications?
• How do we systematically apply (process & standards) and develop blockchain to be secure, safe, and sustainable technology in healthcare
applications?
• What are the design principles for a driven reference architecture for secure, sustainable and software engineering approach to healthcare
blockchain applications (S3EF-SHBCAs)?
• What are services comprising reference architecture for S3EF-SHBCAs in Healthcare?
• How to classify technologies and services for blockchain applications?
• How do we classify application domain for building sustainable & reusable blockchain in Healthcare?
• What are the key challenges of sustainability in SHBCAs mean?
• What are the key challenges of security in SHBCAs?

3. Learning Outcome
• To Understand the three key components to blockchain technology: The distributed ledger, the consensus mechanism, and the smart
contracts;
• To Understand the key trend in the application of AI in Blockchain versus Blockchain for AI
• To understand the current trends in smart healthcare blockchain applications (SSHBCAs)
• To identify some of the key characteristics of Blockchain relevant to SHBCAs
• To understand the security, sustainability, and software engineering approach in SHBCAs Framework (S3EF-SSHBCAs)
• To understand Requirements Engineering for S3EF-SSHBCAs
• To acquire knowledge on Domain Classification for Blockchain Applications
• To understand Blocks-Points Effort & Complexity Estimation
• To understand Reference Architecture for Blockchain in S3EF-SSHBCAs
• To understand BPMN modelling & simulation using a Case Study and Evaluation of REF-ArcBC with BPMN: Electronic Health Record (EHR)
• To understand the Evaluation Techniques of BPMN simulation for Reference Architecture for S3EF-SSHBCAs.

4. Research
Motivation
• Blockchain applications in healthcare have grown rapidly. BC
in healthcare applications includes record keeping, clinical
trials, medical supply chains, patient monitoring, etc where
BC characteristics are needed to improve safety, privacy, and
security. BC is one of the biggest disruptive technologies
today. However, Porru, et al (2017) have reported it lacks
processes, tools, and techniques:
• How do we systematically apply blockchain to be secure,
safe, and sustainable technology in healthcare applications?
• What are the design principles for a driven reference
architecture for S3EF-SHBCAs?
• What are services comprising reference architecture for S3EF-
SHBCAs in Healthcare?
• How to classify technologies and services for blockchain
applications?
• How do we classify application domain for building
sustainable & reusable blockchain in Healthcare?

5. Agenda
• Research Motivation
• Current & Previous Research Projects
• Background to BC
• Current AI Potentials in Healthcare
• Characteristics of AI & Blockchain
• Research Trends in S3EF-SHBCAs
• S3EF-SHBCAs Framework
• Requirements Engineering for S3EF-SHBCAs
• Domain Classification & Evolution of Smart Health 5.0 Using Blockchain Applications
• Blocks-Points Effort & Complexity Estimation
• Reference Architecture for Blockchain in S3EF-SHBCAs
• Case Study and Evaluation of REF-ArcBC with BPMN: Electronic Health Record (EHR)
• Evaluation of S3EF-SHBCAs
• Key points and Q&A
• References
AI, ML, DL, RL
Data Science
Software
Security
Engineering &
Cybersecurity
Engineering
Cloud
Software
Engineering

6. Exploring the
Intersection of
Artificial Intelligence
(AI) and Blockchain
• https://www.youtube.com/watc
h?v=MLoVeD99Pd4

7. Global Blockchain AI Market
Gartner 2023

8. Current & Previous Research
Projects

9. AI, DS & BC for SE and SE for AI, DS & BC (ABCD Paradigm) Key
Research Challenges
Domain-Specific
Approaches: Modelling &
Languages: reuse of
Knowledge with AI, ML,
NLP (Example, FinTech,
Aerospace, etc)
AI, ML, & Data Science
for Software Security
Engineering and Cyber
Security
Integrated Approaches &
Frameworks to Security,
Privacy, & Trust (SPT)
Smart transport &
Autonomous Vehicle (Self-
Driving Cars)
Prognostics Analytics &
Modelling for SE
AI as a Service (AIaaS),
MLaaS, Data Science as a
Service (DSaaS)
AI for COVID-19 AI Ethics and Standards
Smart Farming &
Agriculture
Robotics, Blockchain, IoT,
Cloud, IIoT
9

10. Background

11. Introduction to Blockchain
• Blockchain technology is a distributed ledger that allows secure and transparent transactions between parties
without the need for intermediaries.
• Its characteristics of decentralization, immutability, transparency, and security make it a perfect fit for
healthcare applications, where privacy, data security, and data integrity are crucial.
• However, building blockchain-based applications for healthcare requires a specific software engineering
framework.
• This presentation provides an overview of the software engineering framework for blockchain in healthcare,
covering characteristics of blockchain, requirements engineering, design method, reference architecture,
testing strategies, evaluation framework, and quality framework.
• Good video, What is Blockchain?
• Blockchain explained. Shai Rubin, CTO of Citi Innovation Lab, explains in an easy and simple way the basics of
blockchain.
• https://www.youtube.com/watch?v=93E_GzvpMA0
• Research Challenges
• Security
• Sustainability
• Lack of Systematic Approach

12. Bitcoin Transaction Volume
Scale of exponential growth, Aggarwal, et al.(2019)

13. Definitions
• Blockchain, a relatively recent technological trend, is a distributed network and chain of cryptographic blocks
combined together to form a Peer-to-Peer (P2P) network that is decentralized and distributed in Nature.
• BC is a distributed data management platform where data may be shared across a distributed network
securely with business logic.
• In blockchain, each node has its own distributed ledger for storing the history of the transactions.
• A blockchain is a distributed ledger of transactions implemented as data batched into blocks that use
cryptographic validation to link the blocks together. Each block references and identifies the previous block
using a hashing function which forms an unbroken chain (i.e., blockchain).
• Oracle: feed data from outside sources into smart contract
• Zero Knowledge Proof: confidentiality of bc as it proven integrity of transactions without showing
information about the sender, recipient, and assets, etc.
• Example: zcash, quorum

14. An example blockchain network
The key components of a typical blockchain-based network model are as follow.
• Devices consist of nodes, sensors, machines and servers in the blockchain
network. These devices communicate, sense, and process the data using a
gateway and routers.
• Gateways are used in the network for connecting ‘n’ devices. It provides
connectivity to the network devices and facilitates additional functionality
such as security, data collection, and data management.
• Normal nodes are ordinary nodes which have the full information of the
blockchain in their ledger. They perform coordination and cooperation of the
transactions which are authenticated by miner nodes in the network
• Miner nodes are used to authenticate and validate the transactions and
data exchange using different consensus mechanism or protocols.
• Smart Contract is a protocol used to authorize the devices and to check that
these devices do not operate beyond their limits. It provides a secure
communication platform between various smart devices and the distributed
network.
• Consensus is an agreement which is signed between the different nodes of
the network. There are various type of consensus protocols used for
agreement between the nodes, and popular ones used for consensus
include Proof-of-Work (PoW), Proof-of-Stake (PoS), and Delegated Proof-of-
Stake (DPoS).

15. Decentralized versus
centralized data
stores
Bambara, J.J., and Allen, P.R (2018) Blockchain: A Practical
Guide to Developing Business, Law, and Technology Solutions,
McGraw Hill

16. Types of ledger systems: (1) Centralized (2a) Permissioned (2b)
Permissionless
Aggarwal, et al.(2019)

17. Core Concept of a Blockchain
Distributed system of record (blocks)
Security, Verifiability, & Provenance (each transactions
has a unique hash which can’t be changed/traced)
Embedded Business Terms (Smart Contracts)
Consensus & Agreement

18. Blockchain has several key characteristics that make it
a suitable technology for healthcare applications
Decentralization: Blockchain
operates on a decentralized
network, where all nodes in the
network maintain a copy of the
ledger, and consensus
mechanisms ensure that all
nodes agree on the state of the
ledger.
Immutability: Once a block is
added to the blockchain, it
cannot be altered or deleted.
This makes the blockchain
tamper-proof and ensures the
integrity of data.
Transparency: All transactions
on the blockchain are visible to
all network participants, making
it easy to track transactions and
identify any inconsistencies.
Security: Blockchain uses
smart contract programming &
cryptographic techniques to
ensure that only authorized
parties can access and modify
data on the blockchain.

19. Application of Blockchain
& Current Trends

20. BC Applications
Smart Grid, Smart Energy
Healthcare System
Intelligent Transportation System
IoT and Smart City, Insurance, Real Estate, Land Registry
Data Centre & Networking
Financial System
Voting System, Publishing, DocuSign, Digital Media

21. BC in Supply chain, Transport, Logistics,
manufacturing, Government, Healthcare, E-Vote

22. Research Trends in AI & Secure and
Sustainable Software Engineering
Framework in for Healthcare
Blockchain Applications (S3EF-
SHBCAs)

23. Current Trends in Technology

24. Security Issues in Blockchain
• Destefanis et. Al. (2018) has reported that there is a need for smart
contract programming based on a disciplined approach and have
reported several incidents of vulnerabilities causing freezing more than
500K users with the loss of $150 millions of dollars. In addition, existing
studies on software engineering for blockchain dApps sought for a
systematic approach (Beller and Hejderup, 2018; Destefanis et. Al. 2018;
Chung L, do Prado Leite JCS 2009).
• Smart contracts are powerful tools, but they are not immune to
vulnerabilities.

25. Smart Contract Diagram

26. Running a Smart Contract (SC) on the Ethereum Blockchain (Ethereum Virtual Machine (EVC)).
Each node runs the same bytecode
Marchesi, M (2018)

27. Building Sustainable AI & S3EF-SHBCAs
• Lack of repeatable & reusable applications
• Lack of energy-efficiency
• Meeting Sustainable Development Goals (SDG)

28. More
Challenges
Legal, Governance and Ethical
Challenges

29. Governance & Legal Challenges in Blockchain
The Rule of Code vs. The Rule of Law
https://harvardpress.typepad.com/hup_publicity/2018/04/blockchain-and-the-law.html
Governance challenges of blockchain and decentralized autonomous organizations (DAO)
Permissioned and permissionless vs traditional IT situations
Types of dApps
Rikken, O., Janssen, M., & Roosenboom-Kwee, Z. (2019). Governance challenges of blockchain and decentralized autonomous organizations. Information Polity, 24(4), 397-
417. https://doi.org/10.3233/IP-190154

30. AI and Blockchain in
Healthcare Applications

32. Why AI for
Blockchain?
• The design and operation of a blockchain
involves thousands of parameters and trade-offs
between security, performance, decentralization,
and many others.
• AI can ease those decisions, and automate and
optimize blockchain for higher performance and
better governance.
• Moreover, as all data on blockchain is publicly
available, AI plays a key role in providing users
confidentiality and privacy.
• AI & Data Science can help Blockchain in
Algorithmic Optimization, Ethics of Blockchain,
etc.
• Privacy and personalization

33. Why
Blockchain
for AI
Applications?
• Blockchain and AI can be combined to address certain challenges and enhance the capabilities
of AI applications in several ways. Here are some reasons why the integration of blockchain
with AI is considered beneficial:
• Data Security and Privacy
Immutable Ledger: Blockchain provides an immutable and decentralized ledger that records
all transactions. This feature ensures that once data is recorded, it cannot be altered or
tampered with. In AI applications, where data integrity is crucial, blockchain can enhance
security and trust.
• Controlled Access: Blockchain allows for fine-grained control over data access. Users can define
and manage permissions, ensuring that only authorized parties can access and contribute to
the data. This is particularly important in AI, where sensitive data is often involved.

34. The integration of AI and blockchain: blockchain for AI, and AI for
blockchain
Dinh, Thang N. and My T. Thai. “AI and Blockchain: A Disruptive Integration.” Computer 51 (2018): 48-53.

35. Types of AI in Healthcare
AI
in
Healthcare
Treatment & Diagnosis Applications with
Predictive Analytics & Image Analysis
with DL (ML/NN/DL). MYCIN (1970)
Natural language processing (Analyses
Clinical Notes & Front-end ChatGPT and
Chatbots)
Rule-based Expert Systems (Clinical
Decision Support & EHR)
Physical robots (Welding, Repositioning
Objects & Assemble as there are 2000
robots worldwide
Surgical robots (Common surgical
procedures using robotic surgery
include gynaecologic surgery, prostate
surgery and head and neck surgery)
Patient engagement and adherence
applications
Administrative applications
Davenport, T and Kalakota, R (2019) The potential for artificial intelligence in healthcare, Future Healthcare Journal 2019 Vol 6, No 2: 94–8, https://medicalchain.com/en/

37. The Promise of AI in Healthcare
AI algorithms can analyze vast amounts of medical data to assist in diagnosing
diseases, predicting patient outcomes, and personalizing treatment plans.
AI in
Diagnostics
and Treatment
Chatbots and virtual assistants can offer 24/7 support, while AI-powered
monitoring systems enhance patient care through real-time data analysis.
Improving
Patient Care
AI can streamline administrative tasks, optimize resource allocation, and
reduce healthcare costs.
Operational
Efficiency

38. The Power of Blockchain
in Healthcare
• Data Security
Blockchain's immutable ledger ensures data integrity and
security, reducing the risk of data breaches and unauthorized
access.
• Interoperability
Blockchain facilitates secure sharing of patient records across
different healthcare providers, enhancing patient care and
streamlining workflows.
• Supply Chain Management
Blockchain can be used to track the pharmaceutical supply chain,
ensuring the authenticity and safety of medications.

39. Smart
Healthcare 5.0
Evolution &
Applications

40. Benefits of blockchain to healthcare applications
Decentralization
Improved data security and privacy
Health data ownership
Availability/robustness
Transparency and trust
Data verifiability

41. The Evolution of Smart Healthcare
Healthcare 4.0 Combines Cloud/Fog Computing (inspired from Industry 4.0)
Evolution of Blockchain and Consumer Internet-of-Things-Based Fog/Cloud
Computing (CIoT)
Healthcare 5.0 Combines Blockchain, Digital Twin, CIoT, AI, AR/VR/MR & Robotics
CIoT market has been boosted during the development of Industry 4.0/Healthcare
4.0, with 86.7 Billion USD in 2021, and even +13.2 Billion (100 billion USD in 2026
meanwhile, coordination of CIoT network will embrace new opportunities and
challenges, correspondingly with Blockchain and AI

42. S3EF-SHBCAs Framework

43. The Need for a
Systematic Approach
• Blockchain Software Engineering
Adopting a structured process for blockchain development ensures that healthcare
applications built on blockchain technology are robust, secure, and efficient.
• Software Engineering for Blockchain
Designing AI-powered healthcare systems that leverage blockchain requires expertise in
developing software that integrates seamlessly with blockchain technology.
• Compliance and Regulation
A systematic approach ensures adherence to healthcare regulations, data privacy laws,
and industry standards.
• Ethics of AI and Blockchain
• Requires ethics by design approaches, global regulation monitoring, managing
automated decision with human-centred and trustworthy AI approaches

44. S3EF-SHBCAs Framework
Secure Requirements Engineering for Blockchain with BC-SQUARE Method & BPMN Modelling and Simulation
Methods and Design Principles: service components with soaML
Reference Architecture for SSEF-BC (REF4BC)
Tools (Hyperledger Fabric, Ethereum: Building decentralized applications (dApps). Example MedRec for healthcare, Corda:
Permissioned blockchain platform that is designed for enterprise use cases, EOSIO: Designed for high-performance decentralized
applications
SSEF-BC Applications: BC_FinTech, BC4SE, BC4SPI, BC4QI, BC-LandRegistry, Service Level agreement as a Service (SLaaS), CPS-IoT
Energy Management, CPS-IoT Service Delivery, Service Security and Privacy Protection, CPS-IoT Smart City, CPS-IoT Smart Grid, CPS-
IOT Smart Transportation, CPS-IoT Smart E-Government, Smart Home, etc. Healthcare Applications with Hyperledger Fabric for
building electronic health record (EHR) systems, clinical trial management platforms, and medical supply chain solutions,
SSEF-BC Adoption Models
Blockchain Testing (Smart contract Testing and Blockchain Transaction Testing), Evaluation & Applications

45. Requirements Engineering for S3EF-
SHBCAs

46. Requirements Engineering for S3EF-SHBCAs
• Requirements engineering is a critical phase in software engineering,
where the requirements for the system are gathered and documented. In
the context of blockchain-based healthcare applications, the
requirements engineering process should focus on the following aspects:
 Functional & Non-Functional Blockchain Services
 Privacy and security: The system must ensure the privacy and security of sensitive
healthcare data.
 Interoperability: The system must be interoperable with existing healthcare systems to
enable seamless integration.
 Scalability: The system must be scalable to handle large volumes of healthcare data.
 Regulatory compliance: The system must comply with relevant healthcare regulations,
such as HIPAA.

47. Requirements
Engineering
Classification for S3EF-
SHBCAs
RE for
Blockchain
Functional
Services RE
Develop Newly
Required Blockchain
for Domain Specific
Applications
Compute
Blockchain
Services
Transferring blockchains requested
data to the cloud and back
Composing New
Blockchain Services
Blockchain Service Repository
Non-
Functional
RE as smart
contracts
Resource Management (Storage & Caching Management, Resource
Allocation, energy Efficient Algorithms for longer battery life, low
bandwidth, etc.)
Load Balancing
Dependability (Understanding
data consumers and data
producers, ability to compose
simple services, and cognitive
edge computing capabilities)
Build Security In
(BSI)
Build Privacy In (BPI)
Build Trust In (BTI)
Extensibility
Autonomic Recovery
Reliability
Reusability (smart Contracts)
Low Latency
Offloading/Transferring/Uploading
Energy Efficiency
Traceability

48. Requirements Engineering Method for Blockchain (BC-SQUARE)
Agreed
Definitions and
classification
for Domain-
Specific
Blockchain
Applications
Identify Build
Security, Privacy
and Trust In
(BSPTI) Goals
Develop BSTI
artefacts and
Perform Risk
Assessments
Identify &
Select a
Requirement
Elicitation
Technique
Elicit NFR,
Security &
Privacy
Requireme
nts
Categorise and
create smart contract
for NFR, Security &
Privacy
Requirements
Identify, Classify, &
Combine (link &
associate) relevant
smart contracts for
NFR Blockchain
Domani-Specific
Functional
Requirements
Prioritise
Functional & NFR
Blockchain
Requirements
Create
Structures for
smart contract
Map and associate smart contract
with blockchain functions/services
(functional requirements for
blockchain (for each blocks &
transactions))
Validate, Verify, and Inspect
Functional & NFR Requirements
using BPMN Modelling and
Simulations Tool & Smart Contract.
Adopt static analyser for smart
contract for vulnerability analysis
(Slither Tool, Fiest, J. et al. 2019)

50. Blocks-Points Effort & Complexity Estimation
• Blocks-Points Effort & Complexity Estimation is based on modified cloud COCOMO model with weighting for cloud
computing projects are: a = 2, b = 2.1, c = 3, d = .2. Therefore, the effort and cost estimation equations are:
• 𝐵𝑙𝑜𝑐𝑘𝑐ℎ𝑎𝑖𝑛 𝑝𝑟𝑜𝑗𝑒𝑐𝑡 𝑒𝑓𝑓𝑜𝑟𝑡 𝑎𝑝𝑝𝑙𝑖𝑒𝑑 𝐸𝐴 = 𝑎 × 𝐵𝑙𝑜𝑐𝑘 𝑃𝑜𝑖𝑛𝑡𝑠 𝑏
(𝐻𝑢𝑚𝑎𝑛 𝑀𝑜𝑛𝑡ℎ𝑠)
---- (1)
• 𝐵𝑙𝑜𝑐𝑘𝑐ℎ𝑎𝑖𝑛 𝑑𝑒𝑣𝑒𝑙𝑜𝑝𝑚𝑒𝑛𝑡 𝑡𝑖𝑚𝑒 𝑑𝑡 = 𝑐 × 𝐸𝑓𝑓𝑜𝑟𝑡 𝐴𝑝𝑝𝑙𝑖𝑒𝑑 𝑑 𝑀𝑜𝑛𝑡ℎ𝑠
---- (2)
• 𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑆𝑒𝑟𝑣𝑖𝑐𝑒 𝐷𝑒𝑣𝑒𝑙𝑜𝑝𝑚𝑒𝑛𝑡 𝐸𝑛𝑔𝑖𝑛𝑒𝑒𝑟𝑠 𝑅𝑒𝑞𝑢𝑖𝑟𝑒𝑑 = 𝐸𝑓𝑓𝑜𝑟𝑡 𝐴𝑝𝑝𝑙𝑖𝑒𝑑 (𝐸𝐴) 𝐷𝑒𝑣𝑒𝑙𝑜𝑝𝑚𝑒𝑛𝑡 𝑇𝑖𝑚𝑒 (𝑑𝑡)
---- (3)
• The equations 1-3 provide cloud project effort and cost estimations based on block-points points which is the sum of
all workflows (WF) divided by the total number of blockchain process activities (P).
• Block Points = 0
𝑁
𝑊𝐹/ 0
𝑁
𝑃 X (Technical Complexity Factors (TCF)) X (Environmental Complexity Factors (ECF))
---- (4)
• TCF & ECF are useful factors for building a sustainable blockchain services.

51. Non-Functional Requirements for S3EF-SHBCAs
NFR4BC
Traceability
Interoperability
Scalability
Integrity
Confidentiality
Latency
Availability
Security
Performance
Throughput
Trust
Privacy
Khatter, K., DevanjaliRelan (2022) NFR for medical supply chain

52. BPMN Framework for Validating the Reference Architecture (REF4BD)
BPMN 2.0 modelling & simulation tools:
BonitaSoft 7.8, https://www.bonitasoft.com/
Visual Paradigm, https://www.visual-
paradigm.com/features/bpmn-diagram-and-tools/
Bizagi Studio,
https://www.bizagi.com/uk/products/bpm-suite/studio

55. Domain Classification for
Blockchain Applications
• To standardise BC application development
• To build sustainable BC applications
• To build reusable BC applications

56. Domain Classification for Blockchain Applications
Blockchain
Applications
Domain
Financial
Applications
Supply Chain
Management
Healthcare
Electronic Health
Record (EHR)
Smart Health
Imaging Services
Identity and Access
Management
E-Government (E-
Gov)
Land Registry
E-Health
Councils
E-Voting
Smart Energy and
Environment
Chosen Case
Study for this
research

58. Design Methods for Building dApps
Elaborate on
dApp
Requirements
with BC-SQUARE
Create Proof of
Concept (POC)
Select your Dapp
platform
Choose a
Blockchain Data
Structure
Design &
Implement
Blockchain and
Mapp onto
Reference
Architecture
Develop smart
contracts
Choose a front-
end framework
Start the testing
cycles

59. Design Method for S3EF-SHBCAs
• Designing a blockchain-based healthcare application requires a specific design method. The following steps
should be taken:
 Identify the use case: The first step is to identify the specific use case for the blockchain-based healthcare
application.
 Select the appropriate blockchain platform: The next step is to select the appropriate blockchain platform based
on the requirements of the use case.
 Choosing a suitable Blockchain Data Structures: Blockchain, GHOST, BlockDAG (directed acyclic graph),
Segregated witness
 Develop blockchain components (Service Component Model)
 Design the blockchain reference architecture: The blockchain architecture should be designed based on the
selected platform and the requirements of the use case.
 Design the smart contract: Smart contracts are self-executing contracts that execute automatically when certain
conditions are met. They are a critical component of blockchain-based applications and should be designed
carefully.

60. Service component models
cmp
IAuthentication
IAuthorization
IEncryption
ISignature IKeyManagement
IUserManagement
ITLS
ILogService
IInteroperablity
Security Services
IAuthentication
IAuthorization
IEncryption
ISignature IKeyManagement
IUserManagement
ITLS
ILogService
IInteroperablity
Generic &
reusable cloud
security
services
component
Large scale case study was
conducted using Amazon EC2
where application of CBSE
showed improved composability
with more than 100s cloud
service components
60

61. Blockchain
Service
Component
Design: Data
Processing
layer

62. Reference Architecture for Blockchain in S3EF-
SHBCAs
• A reference architecture is a blueprint for the architecture of a system. A reference architecture for
blockchain-based healthcare applications should include the following layers:
 Infrastructure layer: This layer includes the blockchain infrastructure, such as the nodes, the consensus
mechanism, and the data storage layer.
 Blockchain layer: This layer includes the blockchain protocol and the smart contract layer.
 Application layer: This layer includes the healthcare applications built on top of the blockchain layer.
 AI and IoT application layer: This layer includes the AI and IoT applications that can be integrated with the
blockchain-based healthcare applications to enable more advanced use cases.

63. Reference
Architecture for
Blockchain
Applications (REF-
ArcBC)
Blockchain Service Bus
Susta
inabl
e
Servi
ces
Sec
uri
ty
Lay
er

65. Building electronic health record (EHR) systems
using Ethereum programming language
• List of smart contracts that can be used for building electronic health record (EHR) systems using Ethereum programming language:
 Patient Registry Smart Contract: This contract can be used to store patient demographic information such as name, date of birth, gender, and
contact information. It can also be used to store other relevant information such as medical history and allergies.
 Electronic Health Record Smart Contract: This contract can be used to store patient health information such as diagnoses, medications, laboratory
test results, and imaging studies. It can also be used to track changes to the patient's health status over time.
 Consent Smart Contract: This contract can be used to manage patient consent for the use and sharing of their health information. It can be used to
record the patient's consent preferences and to manage access to their health information by healthcare providers and other authorized parties.
 Identity Smart Contract: This contract can be used to manage patient identity and authentication. It can be used to verify the patient's identity and
to ensure that only authorized users have access to their health information.
 Payment Smart Contract: This contract can be used to manage payments for healthcare services. It can be used to automatically process payments
for services rendered and to manage disputes between patients and healthcare providers.
 Prescription Smart Contract: This contract can be used to manage the prescription of medications. It can be used to track prescriptions, monitor
adherence to medication regimens, and manage refills.
 Medical Device Smart Contract: This contract can be used to manage the use and maintenance of medical devices. It can be used to track device
usage, monitor device performance, and manage device maintenance and repairs.
 EHR systems, biosensors, watches, smartphones, conversational interfaces and other instrumentation, software can tailor recommendations by
comparing patient data to other effective treatment pathways for similar cohorts

66. Efficient Generation of Real-World Data for Health Informatics (IBM Explorys Electronic
Health Record (EHR) Database)

67. Medicalchain
• Medicalchain uses blockchain technology to create a user-focused
electronic health record whilst maintaining a single true version of the
user’s data
• Medicalchain Dual Blockchain
• Hyperledger Fabric
• Ethereum and Smart Contracts
• Medicalchain as a Healthcare Platform
• Identity management using Civic: Identity fraud is a massive problem in
the world.
https://medicalchain.com/en/whitepaper/

68. Case Studies and Success
Stories in EHR
• IBM Watson Health
IBM has combined AI and blockchain to create secure,
interoperable EHR systems that provide insights into
patient data while maintaining data privacy.
• Medicalchain
Medicalchain utilizes blockchain technology to create a
secure, patient-controlled health record system that can
be accessed by authorized parties.
• https://medicalchain.com/en/

69. Reference Architecture (REF-ArcBC) Simulation for EHR

70. Resource
Utilization
The simulation shows it has taken
10.45 minutes to process 100 instances
of real-time data and service requests.

71. pragma solidity ^0.8.0;
contract PatientRegistry {
struct Patient {
uint256 id;
string name;
uint256 dateOfBirth;
string gender;
string contactInformation;
string medicalHistory;
string allergies;
}
uint256 public patientCount;
mapping(uint256 => Patient) public patients;
event PatientAdded(uint256 id, string name, uint256 dateOfBirth, string gender, string contactInformation);
function addPatient(string memory _name, uint256 _dateOfBirth, string memory _gender, string memory _contactInformation, string memory _medicalHistory, string
memory _allergies) public {
patientCount++;
patients[patientCount] = Patient(patientCount, _name, _dateOfBirth, _gender, _contactInformation, _medicalHistory, _allergies);
emit PatientAdded(patientCount, _name, _dateOfBirth, _gender, _contactInformation);
}
function getPatient(uint256 _id) public view returns (string memory, uint256, string memory, string memory, string memory, string memory) {
require(_id > 0 && _id <= patientCount, "Invalid patient ID");
Patient memory patient = patients[_id];
return (patient.name, patient.dateOfBirth, patient.gender, patient.contactInformation, patient.medicalHistory, patient.allergies);
}
}

73. Framework Evaluation Techniques for S3EF-SHBCAs
• Evaluation of frameworks for blockchain in healthcare applications can be done using various methods and
techniques. Here are some common evaluation methods and techniques that can be used:
1. Use case evaluation: Use cases provide a high-level view of how a blockchain-based healthcare application can be used in real-world scenarios.
Evaluating use cases can help assess the effectiveness of the blockchain solution in addressing specific healthcare challenges.
2. Technical evaluation: Technical evaluation involves assessing the blockchain-based healthcare application's technical aspects such as the underlying
blockchain technology, the security measures implemented, the data management approach, and the user interface. This evaluation can be done using
various methods, such as code review, security testing, and performance testing.
3. User evaluation: User evaluation involves assessing the blockchain-based healthcare application's usability and user experience. This evaluation can be
done using various techniques, such as user surveys, usability testing, and heuristic evaluations.
4. Economic evaluation: Economic evaluation involves assessing the economic viability of the blockchain-based healthcare application. This includes
assessing the cost of implementing and maintaining the blockchain solution and its potential benefits, such as improved efficiency and reduced costs.
5. Compliance evaluation: Compliance evaluation involves assessing the blockchain-based healthcare application's compliance with relevant regulations
and standards. This includes assessing compliance with regulations such as the Health Insurance Portability and Accountability Act (HIPAA) and the
General Data Protection Regulation (GDPR).
6. Interoperability evaluation: Interoperability evaluation involves assessing the blockchain-based healthcare application's ability to integrate with other
healthcare systems and technologies. This includes assessing compatibility with existing healthcare IT infrastructure and interoperability with other
blockchain-based healthcare applications.
7. Performance evaluation: Performance evaluation involves assessing the blockchain-based healthcare application's performance in terms of speed,
scalability, and reliability. This evaluation can be done using various techniques such as load testing, stress testing, and reliability testing.

74. Future Prospects
• Telemedicine and Remote Patient Monitoring
AI and blockchain can enhance telemedicine and remote patient
monitoring, making healthcare more accessible and efficient.
• Research Collaboration
Facilitating secure data sharing and collaboration among
researchers and institutions worldwide can accelerate medical
breakthroughs.
• Predictive Analytics
AI-powered predictive analytics can help in early disease
detection, reducing healthcare costs and improving patient
outcomes.

75. Key
points
and Q &
A
Need for a systematic & standardized approach to
developing & delivering blockchain applications
and evolution of Smart Healthcare 5.0
Requirements Engineering for S3EF-SHBCAs has
demonstrated developing secure & sustainable BC
Healthcare dApps
Reference architecture provides reusable,
standarised, and sustainable dApps in Healthcare
Need for research collaborations

76. • Haber, S. & Stornetta, W.S. J. Cryptology (1991) How to Time-Stamp a Digital Document, Journal of Cryptology, January 1991, Volume 3, Issue 2, pp 99–1113: 99. https://doi.org/10.1007/BF00196791
• https://azure.microsoft.com/en-us/solutions/blockchain/
• Xu, X (2017) A Taxonomy of Blockchain-Based Systems for Architecture Design, https://www.researchgate.net/publication/314213262
• http://www.r3cev.com/
• https://azure.microsoft.com/en-us/solutions/blockchain/
• http://www.ibm.com/blockchain/
• https://blog.ethereum.org/2016/01/15/privacy-on-the-blockchain/
• https://usa.visa.com/run-your-business/small-business-tools/retail.html
• Xu, X et. al (2017) A Taxonomy of Blockchain-Based Systems for Architecture Design, IEEE International Conference on Software Architecture (ICSA), April, Gothenburg, Sweden, DOI: 10.1109/ICSA.2017.33
• X. Xu, C. Pautasso, L. Zhu, V. Gramoli, A. Ponomarev, A. B. Tran, and S. Chen. The blockchain as a software connector. In WICSA, 2016
• Swan, M (2016) Blockchain: Blueprint for a New Economy, O’Reilly Media, 2015.
• Omohundro, S (2014) “Cryptocurrencies, Smart Contracts, and Artificial Intelligence,” AI Matters, vol. 1, no. 2, 2014, pp. 19–21.
• Bambara, J.J., and Allen, P.R (2018) Blockchain: A Practical Guide to Developing Business, Law, and Technology Solutions, McGraw Hill
• Daniel, F and Guida, L (2019) A Service-Oriented Perspective on Blockchain Smart Contracts, IEEE Internet Computing, January/February 2019
• Xia, Q et. Al (2017) BBDS: Blockchain-Based Data Sharing for Electronic Medical Records in Cloud Environments, MDPI Journal of Information 2017, 8, 44; doi:10.3390/info8020044, MDPI
• KHODADAD F, DASTJERDI A V, BUYYA R. IoT: an overview[M]. San Francisco: Margan Kaufmann, 2016.
• ASHTON K. That ‘IoT’ thing[J]. RFID journal, 2009, 22(7): 97-114.
• WANG X, ZHA X, NI W, et al. Survey on blockchain for IoT[J]. Computer Communications, 2019(107): 10-29.
• Perwej, Y., Parwej, F., Hassan, M. M. M., & Akhtar, N. (2019). The Internet-of-Things (IoT) Security: A Technological Perspective and Review. International Journal of Scientific Research in Computer Science, Engineering and Information Technology (IJSRCSEIT), ISSN, 2456-
3307.
• SHAO Q F, JIN C Q. Blockchain: architecture and research progress[J]. Chinese Journal of Computer, 2018, 41(5): 3-22.
• LI D, WEI J W. Theory, application fields and challenge of the blockchain technology[J]. Telecommunications Science, 2016, 32(12): 20-26.
• PAN J, YANG Z. Cybersecurity challenges and opportunities in the new edge computing+ IoT world[C]// The 2018 ACM International Workshop on Security in Software Defined Networks & Network Function Virtualization, Mar 19-21, 2018, Tempe, AZ, USA. NewYork: ACM
Press, 2018: 29-32.
• Ammar, A. et al. (2022) Literature Review: Blockchain-Oriented Software Characteristics and New Stream for Software Process Improvement, 2022 INTERNATIONAL CONFERENCE ON DECISION AID SCIENCES AND APPLICATIONS (DASA), March 2022, Chiangrai, THAILAND,
DOI: 10.1109/DASA54658.2022.9765124
• Khatter, K., DevanjaliRelan Non-functional requirements for blockchain enabled medical supply chain. Int J Syst Assur Eng Manag 13, 1219–1231 (2022). https://doi.org/10.1007/s13198-021-01418-y
• Marchesi, M (2018) An Agile Software Engineering Method to Design Blockchain Applications, Software Engineering Conference Russia (SECR 2018). Moscow, Russia, October 12-13, 2018, https://arxiv.org/ftp/arxiv/papers/1809/1809.09596.pdf
• Lallai, G. et al. (2020) Software Engineering for DApp Smart Contracts managing workers Contracts, https://www.researchgate.net/publication/340647768
References

77. References BC in Healthcare
"Blockchain in Healthcare: A Review, Applications and Challenges" by Kshetri, N. (2018). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6038899/
"Blockchain in Healthcare: A Systematic Literature Review, Synthesis and Future Research Directions" by Zhang, P., Schmidt, D. C., White, J., Lenz, G., & Rosenbloom, S. T. (2018).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6025219/
"Blockchain Technology: A Review of the Security and Privacy of Blockchain-Based Healthcare Systems" by Fernández-Alemán, J. L., Señor, I. C., Lozoya, P. Á. O., & Toval, A. (2019).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357056/
"Blockchain for Healthcare Data and Its Potential Use in Health IT and Health Care Related Research" by Halamka, J. D. (2017). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016039/
"Blockchain for Health Data and Its Potential Use in Health IT and Health Care Related Research" by Miron-Shatz, T., & Leshno, M. (2019).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459014/
"Blockchain Technology in Healthcare: A Comprehensive Review and Directions for Future Research" by Kuo, T. T., Kim, H. E., & Ohno-Machado, L. (2017).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5837657/
"Blockchain in Health Care: Hope or Hype?" by Coiera, E. (2018). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007653/
"A Blockchain-Based Approach for Secure Data Sharing in Healthcare Applications" by Al Omar, A. M., Atalla, M. A., & Al Ghamdi, M. A. (2019).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6784382/
"A Review of Blockchain Technology and Its Current Applications in Healthcare" by Zhang, P., Schmidt, D. C., & White, J. (2018).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6152273/
"Towards a Framework for Blockchain-Based Healthcare Applications" by O'Donnell, L., & Liu, J. (2019). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6960117/
Aggarwal, S. et al. (2019) Blockchain for smart communities: Applications, challenges and opportunities, Journal of Network and Computer Applications 144 (2019) 13–48
H. R. Chi, M. d. F. Domingues, H. Zhu, C. Li, K. Kojima and A. Radwan (2023), "Healthcare 5.0: In the Perspective of Consumer Internet-of-Things-Based Fog/Cloud Computing," in
IEEE Transactions on Consumer Electronics, doi: 10.1109/TCE.2023.3293993.