Blockchain technology in the secure sharing of data in health

JOÃO CARLOS FERREIRA

Professor  Iscte-Sintra

Researcher ISTAR-Iscte

ANA LÚCIA MARTINS

Professor Iscte Business School

Researcher BRU‑Iscte

Blockchain is a fundamental technology for the digital transition of the economy and society. It ensures that information and data transmission occur in secure conditions, respecting their integrity and, thus, creating trust among entities. Four ISTAR research units (ISTAR, BRU, CIES, and CIS) are involved in studies with applications in the health sector.

Blockchain is a term that is increasingly becoming part of our daily lives. What is it about?

João Carlos Ferreira (JCF) As Blockchain is an emerging technology, it is essential to raise awareness among companies and institutions about its potential.

In Portugal, Iscte pioneered blockchain training, presenting basic business-oriented concepts and applying Smart Contracts, which are automated processes. We have also held six summer schools in partnership with companies from various sectors. Under the RRP (Recovery and Resilience Plan), Iscte was the only institution that created a training offer and seminars on this technology. We covered 70 students, and the demand exceeded the supply.

What is the role of Blockchain in business?

JCF In digital business, trust is a weakness, as is the secure sharing of information and the need to find out who is on the other side doing the business (concept of digital identity). When we share information, we are never sure what will happen to it, nor who created it. Most of the Internet's problems stem from false information, which makes it difficult to hold anyone accountable, as it is challenging to verify the authenticity of the creator. Blockchain is a technology that allows for secure sharing. Behind the scenes of this technology is encryption that, through codes/keys, enables you to hide the message, keeping it only decipherable by those who have the right key. Information sharing often involves creating direct access to databases, which can lead to security breaches and increased vulnerability to attacks.

Blockchain solves everyday problems on the web. It allows for secure management of identities and creates an immutable record, ensuring a unique and trusted identity. This is especially relevant in high-value deals.

In education, for example, the certificate will no longer be on paper; it will be on the Blockchain. A recent example of this potential was the COVID-19 Digital Certificate, which anyone could present on their cell phone.

With Blockchain, if an organisation claims to be reputable, others will accept it, as we are in the process of sharing secure information

Ana Lúcia Martins (ALM) Essentially, the word "blockchain" itself conveys a great deal: a chain of blocks. The information is not stored in a central database but is dispersed across several databases. Blockchain simultaneously enables information to be shared among multiple entities and instils confidence in the customer. For example, if I want to know where a wine comes from, I don't consult the database since it is tamper able. I can go to jail for information, knowing it will be correct. If one of the entities seeks to tamper with the data, the others will learn how to identify this situation. This is especially important for branded products, as it helps combat counterfeiting.

Won't Blockchain be able to create a rift between the users of this technology and those who are excluded from it?

ALM We don't see it that way. Looking at management, for example, a supply chain works very much based on trust between the organisations that are part of it. Blockchain enables collaboration with entities that the chain itself does not know, but which have already been validated by an entity within the chain as trustworthy.

JCF When we need a loan, we go to a bank, and they ask us for a large set of documents and information. After a while, they asked if we were reputable. If we switch to another bank, we will have to repeat the entire process. With Blockchain, if an organisation claims to be reputable, others will accept it because we are sharing secure information. The advantage is that it enables connections between entities that do not trust each other. The technology allows businesses to manage public or private blockchains with greater confidence and security, tailored to their specific needs and requirements.

Where will this register be housed?

JCF It will be something to work on by areas. For example, the land registry of the house is now sometimes in several places. It is something done on paper, which is fallible. In Blockchain, a home is an asset allocated to an owner; the process is followed: it was mortgaged, not, etc. In other words, there is transparency of information. The Blockchain is a set of spatially distributed nodes, and each node replicates all the information.

Where are these nodes?

JCF They may be entities that have a computer and want to connect. A Land Registry Office may have a node. But it doesn't make sense for people at home to have a knot!

Can its security still be questioned if all technology involves codes, digital know-how, and human intervention?

JFC It is possible to question the security of any technology. Although Blockchain is highly secure due to its encryption and decentralised structure, human intervention introduces vulnerabilities that can compromise this security.

What are the mechanisms for monitoring the dissemination of misinformation, for example, in the supply chain?

JCF An entity that makes mistakes or practices misconduct will have its reputation permanently registered, moving from a local reputation to a global and transparent reputation. Blockchain facilitates these collaborative processes, allowing everyone to contribute to ensuring data integrity.

Are there experimental blockchain projects where the document or product carries all its information, or 'DNA,' behind it?

ALM Yes. There are pilot projects in supply chain, energy, health, sustainability, and transport, but we are at an early stage. Having this work with the respective number of nodes is a significant deal on a global scale. Both transactions and validation mechanisms are now very cumbersome.

Investment

JCF In the health area, if you do tests in a hospital, the results are stored there. When visiting another hospital, he is required to take the exams in a physical format. Blockchain aims to address this limitation, enabling quick and efficient access and sharing of information between different entities, regardless of their location.

What is ISTAR-Iscte's intervention in this research process?

JCF ISTAR has focused on health and training, creating content based on the experience accumulated in the last eight years. We held specialised seminars, short courses, and online training with about 120 participants, mostly from companies. At the end of October, the first credited course, with the curricular unit "Blockchain -- Fundamentals and Its Applications," was offered to 42 students. For the first time, we trained colleagues from other universities in the project consortium. In June, we held a workshop at the international MELECON conference, attended by approximately 200 participants from the scientific and business communities, during which we explained the relevance of Blockchain.

How has Iscte contributed to the study and application of this technology in the healthcare area?

JCF In the health area, we are focused on applying AI (artificial intelligence) and sharing information securely using digital wallets. A blockchain digital wallet is an application that enables you to securely store, send, and receive digital assets, including cryptocurrencies, tokens, and NFTs (non-fungible tokens). It works like a digital vault. In Artificial Intelligence, in collaboration with Santa Maria Hospital's Cardiology department, we are identifying patterns in data to generate alerts and classify MRIs, X-rays, and ultrasounds using neural networks, thereby replicating the knowledge of health professionals in digital form. The goal is to reduce your workload by creating a semi-automatic process where the human takes control of the information produced.

In this process, doesn't AI replace humans?

JCF AI does not replace humans; it frees them up for validation functions. We also have work in text, creating and analysing medical reports. Given their reasonability, we are reducing the time and moving the human element to the validator role. We made an experimental adaptation by uploading medical reports to the system and then created a model to extract names, ages, addresses, diseases, and prescribed medications from these reports. We are also developing tools to help doctors work more efficiently. For example, it is intended that the text automatically originates from the voice. With this process, health professionals save time and can serve more people. We are utilising AI extensively to enhance efficiency in healthcare, making it a valuable tool for boosting productivity. What AI does is perceive patterns and replicate them.

What is the relationship between Blockchain and AI?

JCF Blockchain enables data sharing, which AI then utilises. Thus, we can synergise with Blockchain to enhance greater sharing and AI to benefit from more shared data.

How do we ensure data-sharing protection using Blockchain?

JCF Access is always controlled by keys/codes, and blockchain technology allows for the management/control of access. Patients can choose what they want to share in healthcare, but their identities are unnecessary.

ALM Often, what matters is not the person themselves but the age group, the region where they live, the environment, and the information that can be shared. For a doctor, time is a highly precious and scarce resource. If we can have the report partially completed by AI and only need to review and adjust, we can process five patients per hour instead of four. If we can get you to use your time solely for direct service provision, we can enable you to provide a much better service. In the case of Blockchain, access to more information shared by other links in the network allows the patient's view to be more complete; with that, the quality of healthcare provided is improved.

Commonly, the idea of Blockchain is associated with Bitcoin. Where does this relationship come from?

JCF Yes, that's right; hence, training is needed. Digital currency is essential, but its technology allows us to go further, given the potential for securely sharing information, managing identities, and automating processes using Smart Contracts. Today, it is customary to have a business moulded around a rigid information system. Here, too, Blockchain is an asset, as it allows you to easily shape business processes by sharing information in a secure and immutable way. It is worth noting that, at the level of digital currency, security is inherent in the blockchain process; that is, I do not have to invest millions in security, unlike with current transaction systems. Thus, the cost of the transaction on the Blockchain is almost zero.

The complementarity that exists at Iscte, at the level of Schools and Research Units, allows for an integrated and differentiating capacity to offer

What are the advantages of Blockchain for management?

ALM A notable example is the use of frozen fish in a large food distribution chain in Portugal. The customer can read information about the fish using their mobile phone, learn where it came from, where it has been, and whether it has always been in suitable cold conditions. All the information is available to see the origin of the fish and the path it followed until it reached the point of sale. Knowing that the data is available conveys greater confidence in the safety of the purchase. This is already a competitive advantage for those who are in the market offering products. Technology emerges as a key factor in creating a competitive advantage.

The European Union has made a significant commitment to research. What are the advantages of the single market?

JCF Yes, the EU is betting on so-called disruptive technologies, which are gaining maturity. The EU needs cohesion and information sharing at the European level; Blockchain facilitates this process. Another important aspect is the digital identity, which must be unique and like the physical world. Blockchain enhances this application, and the EU supports this type of initiative in several areas, including health and education, with a need for standardised academic diplomas within the European space.

ALM A great advantage of this technology is that it provides transparency and, speaking in terms of the supply chain, it also gives visibility, an aspect that, in a free market, allows, for example, greater efficiency in resource planning and improved decision-making.

What was Iscte's commitment to developing projects by the end of 2025?

JCF The focus is on healthcare, where a team of 15 people combines the use of Artificial Intelligence and blockchain technology. Iscte, in close collaboration with BioGHP, is developing a digital wallet that centralises and standardises patients' clinical data, allowing them to be shared quickly and securely. We expect to present a proof of concept with accurate data in a small-scale pilot. This project aligns with the work carried out in collaboration with the European project XpanDH, where interoperability is one of the fundamental pillars.

In AI, Iscte has developed medical language models, including a Named Entity Recognition (NER) model in Portuguese. This model, trained on approximately 13 medical reports using Google's BERT as a basis, is now available. It enables the automatic extraction of information from medical reports, with practical applications such as patient triage and creating dashboards that present diagnoses, symptoms, prescribed medications, and the patient's progress. Relevant projects are also underway in disease classification based on medical images, utilising various technologies such as magnetic resonance imaging, X-rays, and ultrasounds. Through convolutional neural networks (CNNs), the system automatically analyses and classifies medical images, aiding in the diagnosis and treatment of various pathologies. Iscte has already published ten scientific articles related to this work and trained experts in AI applied to health.

ALM Iscte, with its several Schools on the same campus, has the possibility of creating a multidisciplinary offer. The blockchain area is no exception. We also had the curricular unit "Blockchain for Supply Chain Management," offered by Iscte Business School, which, due to its multidisciplinary nature, involved several professors, including those from the School of Technologies and Architecture.

What is BRU-Iscte's contribution to this project?

ALM Within the BRU, there are two strands. However, my contribution to this project is on two levels. First, we collaborate with the Cardiology Department at Santa Maria Hospital and the Santo António Hospital in Porto. We observe the entire process from the initial generation of information, analyse where it goes, what data exists, where there are difficulties in sharing and where this information can end up in the system and identify the necessary actions to overcome these difficulties. We assess the information flow needs, identify the problems, and initiate solutions to eliminate them, enabling ISTAR to share and make the information available. This technology will benefit people, including the community, all of us, and healthcare professionals. It aims to identify possible stakeholders with other needs. This is the second level I've reached with my team.

When faced with new projects, it is natural for people to be suspicious, but by getting to know them, they realise that potential and opportunities are born from them. This complementarity at Iscte, not only at the level of schools but also in research units, enables an integrated offer capacity that many other centres cannot match. We possess a range of distinct research skills, and this project is just one example of the cooperation that is possible. Thanks to the synergies, our research potential at ISCTE gives us a significant advantage.

Blockchain, in society's view