Blockchain ledger
Distributed Ledger Technologies DLT such as Blockchain are a concept known to many people as the technology behind the cryptocurrency Bitcoin. But their potential to redefine how we do business and also redesign our business structures remains unclear to many. DLT are decentralized, digitally managed ledgers. By the capacity to distribute information with a high level of transparency and security, DLT have really refined the internet. Distributed Ledgers are basically a collaboration model which is based on an old idea: the cooperative system.
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What is Blockchain?
Personal Health Systems View all 5 Articles. Personal Health Records PHRs have the potential to give patients fine-grained, personalized and secure access to their own medical data and to enable self-management of care. Emergent trends around the use of Blockchain, or Distributed Ledger Technology, seem to offer solutions to some of the problems faced in enabling these technologies, especially to support issues consent, data exchange, and data access.
Our intention is to enable patient use of the data in order to support their care and to provide a strong consent mechanisms for sharing of data between different organizations and apps. Ledger of Me is based on around the principle that this combination of event-driven smart contracts, medical record data, and patient control is important for the adoption of blockchain-based solutions for the PHR.
The reference architecture we present can serve as the basis of a range of future blockchain-based medical application architectures. The opportunities presented by a predominantly digitized healthcare sector have begun to drive government policy and direction in the UK and elsewhere 1 — 3 ; stimulated the development of new health apps and validation needs 4 ; and led to advances in consumer hardware 5.
Despite this, visions of overarching transformation within the sector still struggle to gain traction 6. One of the main challenges facing digitized healthcare is that of enabling data sharing, or interoperability, between applications, data sources, and systems 7. Personal Health Record PHR , is a health record that can be accessed, and to some extent, controlled directly by the patient to whom that record belongs 8 , and requires such interoperability in order to actually deliver the more personalized care their concept promises.
However, the complex governance issues involved in protecting the very personal and private data that PHRs capture mean there is a clear need for more transparency in the areas of consent, anonymisation, and data ownership 9.
To achieve this healthcare systems need to balance complex system change against patient safety, evidence-based practice and validation processes. Patient expectations are changing. Citizens want a health system that adapts to their lifestyle and needs in the same way that banking and airlines have, while not always being aware of the inherent differences in how healthcare works, and the specific challenges of meeting the combined needs of the legal and ethical frameworks of both care and research Sharing of data, in particular, is seen as a huge challenge This is not solely because of the technical limitations, which are a part of problem, but also the need to meet complex information governance rules, organizational needs and priorities, public expectations of privacy for their health data, and even a distrust between different care boundaries These issues have, previously, limited data sharing and adoption of standards, and slowed the development of solutions that can be truly disruptive to the delivery of care.
Interest is growing amongst the research community in Distributed ledger technologies DLT and blockchain projects as solutions to these challenges 13 , These terms will be used interchangeably in this paper to refer to the general class of DLT. Whilst methodologies differ, most focus on the need to manage consent and permissions for the use of data These solutions are often described as personal health record systems as they are designed to put patients in charge of their own data, building on blockchain as a platform built to enforce the creation of trust and the management of identity.
These self-described PHR blockchain applications are now being developed using in order to test these solutions however it is still open for debate whether these solutions really fulfill the needs of a PHR, and if blockchain provides a useful platform or not.
This paper summarizes current blockchain development and reviews the specific use-case of blockchain-based PHR solutions, looking at the specific questions and shortfalls that these solutions have as healthcare applications.
In response to this we present a system design and reference architecture that responds to these shortfalls and presents a solution offering real transformation in digital health.
Traditional currencies need trusted third parties, usually governments and banks, to guarantee transactions, underwrite funds, and verify identity to prevent fraud. This can be a challenge on the internet where identity is difficult to guarantee, and so transactions cannot always be trusted. This is the question of how to achieve consensus amongst a group of peers where some members of the group are broadcasting potentially deliberately incorrect information, for example to double count payments into a bank account, or present a false identity.
Keys are used to digitally sign transactions on a blockchain. Although the ownership of the key can be considered anonymous, the identity itself is trustworthy.
The proof-of-work mechanism serves, in place of a trusted third party, to guarantee and secure the integrity of the system. This proof-of-work mechanism has however drawn criticism due to the immense amount of energy now consumed in providing this security Additional concerns exist around the quasi-anonymous nature of bitcoin transactions and its use in the facilitation of black-market transactions.
Building on the initial work to design a crypto-currency a new platform was started, called Ethereum Ethereum attaches a cost to undertake a computation based on the complexity of the contract and the amount of data to be stored, which is known as gas. When a transaction is completed there is an exchange of the ethereum currency, ether , to the agreed gas value which is given to the miner as well as the cost of the transaction itself. For example, management of complex supply chains and payment can now be more automated.
A visitor at a restaurant can order fish and be assured as to where it was caught, by which boat, when, and that it was stored at the correct temperature using internet-enabled thermometers 20 as the data is captured and recorded through smart contracts.
A range of socially minded projects have emerged from this technology, such as new models of identity for refugees in development with the UN to help people who have lost key identity papers and qualifications, and tracking pharmaceutical manufacturing and supply to reduce the potential for fraud Similarly, Hyperledger 22 a distributed ledger platform developed by IBM, released under an open source license, provides a set of tools and services that are able to meet the more complex demands of using blockchains in industry sectors other than banking.
Oracle services are application programming interfaces APIs that interact with software and data that is available separate to the blockchain, introducing an often required degree of explicit external trust into these systems.
For example, a service that managed payment for utilization of a cloud computing service would call for further detail from the service logs of the provider for service usage in order to calculate costs. A degree of Bitcoin's reliability and trust stems from it being hosted openly on public networks, and the transparent history of all transactions that this brings.
Ethereum is also a public network but it is possible to also establish a private solution, as can Hyperledger. This can be a benefit where data needs to remain private but organizations want the advantages of immutability and identity that blockchain provides — though justification of the use of such technology in intrinsically trusting environments can be difficult. In general blockchain brings benefit where there exists at least some degree of potential mistrust between peers on a given network.
Despite the hype, the last decade of blockchain development has seen tremendous internal growth but it has failed to be deliver transformational impact. There is now an acceptance that blockchain is less disruptive than it is foundational.
Rather than providing a mechanism for replacing existing ways of working directly, as the internet has done with banking, it provides the groundwork for future technology innovation and disruption. This has been compared to network protocol that underpins the internet Originally developed in the s, it was over a decade before the creation of the world-wide web, and a decade more before the emergence of internet-enabled companies such as Google.
Eleven solutions were found. Solutions that did not provide a whitepaper or details as to the features of the application were discounted, with five remaining for review. All of the solutions are in relatively early stages of development. All also focus on the perceived key benefit of blockchain to provide an audit of access to the data and to allow the patient to manage consent.
Management of consent and access to healthcare data has attracted the greatest attention as a potential target for blockchain-based applications, with an emphasis on the patient being provided with the ability to define rules for access to their health data. This need has been highlighted to both health professionals and the public in the wake of privacy concerns raised through projects such as the UK National Health Service NHS project Care.
Data 24 , which attempted to create a single, centralized repository of all patient data without clear guidance, consent or controls. Table 1 lists the solutions and key DLT features. Reviewing the documentation available for each of these solutions there are five common features that can be identified and described.
Health Data Is not Stored in the Chain. All of the solutions describe security of the data as a key benefit of using blockchain technology but none store personal health data in their implementation of blockchain. By only storing metadata MedRec stores basic information such as ownership and permission rather than the patient record being requested. Storing large amounts of data on a blockchain is recognized as expensive, both in financial and computational senses, due to the need to cryptographically sign data and encrypt it, to cover the token costs of data storage on a public chain and because of the replication requirements of a distributed data store.
As such the blockchains do not secure the data directly but is used as a gateway, or pointer, to external data stores, such as Guardtime's proprietary implementation, which links information on how the patient records have been used with the source In health this has to be balanced against other legal needs for health data but storing data within an immutable data store, even if held privately, could be challenged.
The nature of the integration to ensure that the source data is not tampered with is generally not described. In one case this is because it is considered out of scope and the responsibility of the data owner A suggested solution is to record a hash of the source data that is held off-chain, which can be used to check that the data has not been modified without an update to the chain Storing health data on a chain also creates other potential risks, especially on public chains.
As health data is not stored on the chain and a key feature of the technology is as a distributed ledger it is not surprising that the ability to create an immutable audit trail is an important benefit for all of the solutions. It is recognized that medical records have a legal basis and so blockchain solutions are offered as a key way of validating that the health record has not been altered.
To pass off a rewritten record as contemporaneous is a criminal offense and any retrospective changes have to be clearly marked, dated and signed, and the reason for such changes clearly documented.
Permissions and Consent to Access Data for Care. Consent to access a medical record for direct care is a subject that can vary in interpretation and legal requirements. In the UK the latest Caldicott report 30 suggests that consent for direct care is not needed, but this does not address the complex legal environment around the sharing of data between legal entities, whether hospitals or GP Practices, that also need to be agreed.
This is usually accomplished through data sharing agreements, but there are projects such as the Great North Care Record that suggest that consent should be the basis for all sharing of records. As the concept of care also extends to private sector providers, and companies providing health and well-being services and apps, the need for clear mechanisms becomes greater. As patients move between providers, their data becomes scattered across different organizations, losing easy access to past records.
For a patient to understand and consent to their record being used in different circumstances, for example to seek a second opinion from an overseas doctor not bound by the same information governance rules, there must be a platform for recording and managing that consent that is also independent and agnostic to the sources of data.
According to CareChain solutions other than blockchain are not viable, as they require either a platform able to communicate with every different electronic health record system in a standardized, point to point way, or for there to be a single, global solution for managing patient data, which is not likely to be adopted by all With strong identity management and the ability to manage permissions to access data through smart contracts, such as in Ethereum, or by the built-in permission system of Hyperledger Fabric, the patient can be put in charge of their data and, in doing so, get greater visibility, and insight into the data held about them.
Secondary uses and research based on medical record data is critical to ensuring that healthcare is delivered safely and that new insight into changes in population health can be identified and, if needed, managed and measured through large-scale intervention. Increasingly the value in real world evidence at a patient level is also recognized, for example in the GSK clinical trial in the UK, the Salford Lung Studies 34 , the connected patient medical records with a safety monitoring system and case report form for advanced analysis of potential adverse events.
While the need for consent for direct care purposes can be open for discussion that question of secondary uses is clearer. Although data can be anonymised and shared, it is increasingly recognized that the risks of re-identification are such that consent is the preferred mechanism for the use of medical records beyond direct care As the potential customers for this audience include large companies, such as pharmaceuticals and AI, this is identified as a potential revenue stream for blockchain platforms by allowing patients to provide permission to use the data, possibly in exchange for some form of token, backed by transparency as to how the data are being used.
These tokens can have a monetary value or be used in exchange for other healthcare services. Enabling Telehealth. Telehealth is growth area for healthcare which also brings increased challenges for quality of care, information security and integration of data. Linking health data with provenance is important for helping both clinicians and patients understand the quality of their data and how it can inform decisions about care.
For example, there is a difference in expectations and quality in data from validated medical devices as opposed to commercial fitness trackers and unvalidated health apps Blockchain platforms offer an opportunity to be able to link across different quality of sources in a way that is difficult to implement in existing EHRs. MedicalChain, DoveTail, and CareChain are explicitly designed to support integration with telehealth data, linked to example use cases around decentralized, collaborative care enabled through trustworthy use of data.
CareChain provide a CareConnect app that is designed to support this new care model based on blockchain for asynchronous care delivered in patient homes This is being tested with diabetic patients in the North of England.
These five features represent the current main themes of patient data and blockchain. Placing the patient at the center of their data sounds admirable, enabling them to share their data and even monetize it to support research.
However, the uptake and success of any blockchain-based solution will be determined by the value it offers to its users, whether patients or clinicians, exceeding existing tools and services.
Many healthcare solutions, blockchain or otherwise, fail to ask what is the real value proposition.
Distributed Ledger Technology (DLT)
We use cookies and other tracking technologies to improve your browsing experience on our site, show personalized content and targeted ads, analyze site traffic, and understand where our audiences come from. To learn more or opt-out, read our Cookie Policy. There are countless blockchain explainers in text, audio, and video around the web. Almost all of them are wrong because they start from a false premise. There is no universal definition of a blockchain, and there is widespread disagreement over which qualities are essential in order to call something a blockchain. The Bitcoin system is considered the first blockchain — the epiphany that launched the blockchain industry that proponents say will revolutionize money, government, and beyond.
Climate Ledger Initiative (CLI)
At the intersection of climate and blockchain technology. Highlighting the potential of blockchain technology in fighting climate change. CLI platform. Exchange of experience and joint learning. The CLI addresses policy and research questions and identifies specific innovation opportunities to contribute to climate change mitigation and adaptation and accelerate the implementation of the Paris Agreement by:. Extracting and documenting lessons learnt and making them publicly available in knowledge products and our flagship Navigating Report. The fourth edition of our report, Navigating Blockchain and Climate Action, will be launched on Tuesday 14th December The report highlights the experiences of using blockchain for climate action in Kenya, Peru, India and Chile.
Blockchain and Distributed Ledger Technologies DWG
The device will measure the data at the source of green energy production such as wind turbines, solar panels or hydropower and will record it securely into the blockchain to be used for decentralized applications. This initial solution is the cornerstone of all future energy services using blockchain, including energy traceability, peer-to-peer trading, crowdfunding, etc. The device will be able to connect different blockchains and several decentralized applications at the same time. As security is key to having trustworthy data, the device will include a Secure Element and an anti-tampering solution, combining ENGIE expertise in energy and Ledger expertise in security in blockchain environment.
Blockchain and Distributed Ledger Technology
This site uses cookies to deliver website functionality and analytics. If you would like to know more about the types of cookies we serve and how to change your cookie settings, please read our Cookie Notice. By clicking the "I accept" button, you consent to the use of these cookies. Ensuring equity, interoperability, transparency and trust in the governance of distributed ledger technology — and accelerating the necessary changes for this technology to reach its full potential. Blockchain, an early-stage technology enabling the decentralized and secure storage and transfer of information, could become a powerful tool for tracking and transactions that can minimize friction, reduce corruption, increase trust and empower users. While still nascent, cryptocurrencies built on distributed ledger technologies DLT have emerged as potential gateways to new wealth creation and disrupters across financial markets.
History of blockchain
Bitcoin pioneered decentralized infrastructure and Ethereum brought programmability. But earlier proof-of-work blockchains consume massive amounts of energy and process transactions slowly in order to achieve acceptable levels of security. Heavy bandwidth consumption by these technologies leads to expensive fees, even for a simple cryptocurrency transaction. The Hedera proof-of-stake public network, powered by hashgraph consensus, achieves the highest-grade of security possible ABFT , with blazing-fast transaction speeds and incredibly low bandwidth consumption. By combining high-throughput, low fees, and finality in seconds, Hedera leads the way for the future of public ledgers. Sharding to enable unlimited tps. For Hedera, the range is shown for transactions not requiring a transaction record but can receive a transaction receipt.
White paper – Distributed Ledger Technologies (DLT) and blockchain
Blockchain has great potential in providing an infrastructure for trusted, decentralised and disintermediated services beyond the financial sector. While the FinTech industry has been an early adopter because of its early use case of Bitcoin, blockchain is benefiting and has the potential to transform many other industries. It is considered a foundational technology that some compare to the rise of the Internet in the early 90s.
Its potential has been emphasised in , through the development of the blockchain which is a particular type of DLT on which the crypto-currency commonly referred to as Bitcoin still relies. Nowadays, the DLT is seen, by some, as the next step towards the digital transformation and may have a significant impact on the financial sector in the decade to come. Over the past few years, the CSSF has been increasingly solicited by financial and non-financial institutions, incumbents and start-ups, wishing to present a large diversity of applications and use-cases of DLT, in various sectors. The CSSF applies a principle of technology neutrality and acknowledges that innovative processes and technologies can contribute to the improvement of the provision of financial services.
Written by Thivanka Aluwihare. It's often explained as being a distributed ledger, which is the "true innovation of bitcoin". This is a half-truth, by itself the 'chain of blocks' does not give rise to any benefits of a blockchain system, such as 'immutability'. The Blockchain is a design pattern for creating decentralized systems that allow consensus without the need for third-party arbitration. When banks settle transactions, they use the central bank as a facilitator.
Scope: The IEEE Computer Society Blockchain and Distributed Ledger Standards Committee manages the development of standards within the area of blockchains and distributed ledgers, including standards for relevant data formats, the development and implementation of blockchains and distributed ledger systems, and for applications of blockchains and distributed ledgers to specific sectors, industries, and processes. The standard establishes data format requirements for a blockchain system s. The standard addresses the following attributes of the system, including but not limited to, data structure, data classification and its correlation , data element format, data type, identifier, and data length.
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