A Blockchain-Based E-Healthcare System With Provenance Awareness

Efficient sharing of comprehensive and relevant electronic health records (EHRs) is critical for precise disease research and high-quality, timely diagnoses. Recently, blockchain-based EHR sharing solutions have addressed issues such as single points of failure and data silos. However, decentralized solutions still face challenges in efficiently tracking and sharing dispersed and correlated medical records. Patients, lacking professional medical knowledge, struggle to construct and maintain the lineage of their overall medical records, leading to inefficient and insecure sharing of correlated EHRs with trusted doctors. Doctors from various departments also struggle to access the most relevant EHRs necessary for a precise understanding of patients' medical histories. This study introduces a blockchain-based EHR system with provenance awareness, collecting data provenance to document traceable patient histories, facilitate rapid authorizations for correlated EHRs in a lineage, and conduct post-authorization audits. Designing a DAG-like data structure, the system efficiently stores the EHR provenance on blockchain and optimizes provenance-specific search. The system introduces a dedicated EHR authorization layer to facilitate dynamic authorization propagation along with the EHR provenance path. Harnessing Nash equilibrium principles, the system establishes an honesty-driven auditing mechanism to scrutinize doctors' data access provenance and the intricate journey of patient health records. We developed a prototype using Ethereum blockchain smart contracts, verifying the feasibility of our model. The prototype successfully integrates data provenance, operates at expected costs, enhances user-friendliness, and improves access control efficiency.