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8.5 BLOCKCHAIN CHALLENGES AND SOLUTIONS FOR HEALTHCARE 217

private blockchain technology. For any sensitive decision, doctors can gain consent from the patient’s
community and family. A medical team from several locations can cooperate to take any clinical trials
without any trust issue.

8.4.10 ONLINE ACCESS TO LONGITUDINAL DATA BY PATIENT
Blockchain provides a double layer secured platform for managing online medical records. The main
advantage of this is that the patient can do this without the involvement of third parties. Broderson et al.
[74] mentioned three key capabilities of this technology, which makes blockchain a strong clinical data
management tool. Firstly, blockchain is capable of developing a trusted health database. Secondly,
blockchain is capable of creating a network among data owners and processing with anonymity. Fi-
nally, before any decision, automatic consents are also available.

8.4.11 OFF-CHAIN DATA STORAGE DUE TO PRIVACY AND DATA SIZE
Due to restriction on personal data privacy, off-chain data storage facilities are gaining popularity. Gen-
erally, blockchain is unable to store huge amounts of data due to its decentralized architecture. On the
contrary, healthcare and biological data are naturally massive in numbers. In order to solve this issue,
off-chain data storage backed by data hashing has become a good option. The next section will provide
a detailed description of this.

8.5 BLOCKCHAIN CHALLENGES AND SOLUTIONS FOR HEALTHCARE
BIG DATA
Challenges: Although advantages and opportunities exist with blockchain technology, there are still a
few fundamental drawbacks that create some domain-specific challenges. Storage, scalability, modi-
fication, privacy and regulations are four key challenges that this technology faces in healthcare
big data.
Storage: Healthcare and medical records produce an enormous amount of EMR and sensor data
from patients and wearable IoT devices. On the contrary, blockchain architecture supports very limited
on-chain data storage. Blockchain’s decentralized and hashed architecture has too high a cost for data
storing. Similarly, blockchain data access, management, and operations can also be costly if the data
size is bigger. Therefore, blockchain applications must be designed keeping this factor in mind.
Modification: On the one side, blockchain characteristics of data immutability secure the system
but on the other side, it gives no option for data modification and deletion and data modification and
changes are unavoidable. Either we need to create a new block by consensus from all nodes or generate
a new chain. These two methods are costly and not feasible. Therefore, blockchain application devel-
opment must be in such a way that data modification need is lowest.
Scalability: Due to the decentralized architecture, the scalability issue is less serious. However,
private clinics, healthcare centers, rural hospitals, enterprise research organizations, insurance compa-
nies, individual patients, and IoT startups etc. have millions of users with different infrastructure. It is
highly unlikely that all of them are capable of maintaining the same blockchain decentralized archi-
tecture. Blockchain technology also needs a higher computation power, which demands higher