The utility of Enterprise-grade Blockchain Databases with MongoDB in Healthcare

Dr. Adam Tabriz

A practical approach towards Decentralized, secured Medical Records while sustaining Scalability

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Blockchain technology or a decentralized distributed digital ledger system (Figure 1) is a configuration that stores transactional records, known as the blocks. It merely holds the data in quite a lot of databases, known as the "chain," in a network connected through peer-to-peer nodes. It contrasts with the traditional centralized databases that store the complete information in a single server run by a single administrator. On the other hand, by nature, Blockchain can't rely on a single administrator; thus, it has the potential to fundamentally transform relations across almost every industry, from media and entertainment to logistics and supply chain, medicines, and patient care. The key to using cases across all sectors is the elimination of resistance.

The blockchain trend is merely following a route defined by earlier technological revolutions. For instance, In the 1990s, the Internet's adoption eliminated discord from the composition and dispersion of information. The 2000s marked the era when mass adoption of open-source software wiped out resistance from developers retrieving the building blocks to produce new applications. And In the early 2010s, mass adoption of cloud computing and distributed systems removed the tension from amassing and scaling data center infrastructure while freeing enterprises from expensive, legacy technology stacks. Today we are moving towards mass adoption of blockchain technologies.

Benefits of Blockchain in Healthcare

The utility of distributed digital ledger is too many, with substantial capacity to improve data security and the accessibility of medical records, bringing transparency to financial operations, decreasing patient care complexity, and reducing the amount of administrative friction.

The blockchain trend has the potential to eliminate friction along three primary vital paths. These include facilitating "Control," "Trust," and "Value."

Multiple entities can share control over a document or a process using Blockchain technology. A fully public blockchain network acts much the same way as the public health system.

In other words, individual participants work in consortiums within which all parties, even competitors, can more easily share health data infrastructure to benefit all patients. A single enterprise, by itself, even if not vast enough, can reduce risk by having multiple systems, administrators share control of that organization's Information technology support.

In the blockchain model, created data and information are deemed permanent. Thus, it produces highly tamper-resistant audit trails throughout the chain of the healthcare delivery system. Blockchain creates a single source of immutable truth, which is sufficient to establish trust within the network of stakeholders.

Using a distributed ledger system, we can issue and transfer assets without dependence on a central entity. For example, you own hence can share your information at an address with anyone you wish if one holds the private key or token at that address. The latter concept applies to almost any digital or physical asset scenario.

Blockchain utility within the Framework of Healthcare Enterprise Solutions

The blockchain characteristics of decentralization, immutability, and assets have inspired innovators. It has provided them an additional tool to evaluate real-world & enterprise Information Technology systems and their applications. Still, "blockchain" is treated by most people as a term, assuming one solid prototype of the system, such as Bitcoin. However, the utility of Blockchain is going beyond a monolithic phenomenon into an environment that embraces various hybrid models, as will be discussed later.

Healthcare is a highly information-rich industry. Furthermore, it is a riddled ocean of valuable yet private data. Blockchain scenarios where data is operational and deployed within enterprise solutions have several benefits.

First of all, Enterprise solutions are familiar as it is a similar model to regular application deployments. Furthermore, it's more manageable for the enterprise to reflect on privacy and regulatory compliance by caching the data within its walls. Finally, developers can instantly progress on their blockchain implementation while still participating in often slower evolving consortium-based passageways.

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Figure 1 Adapted from White Paper; Building Enterprise-Grade Blockchain Databases with MongoDB; 2017

Blockchain Deployment Architecture

The deployment of Blockchain at enterprise scale is foreseeable along the spectrum (Figure 2) from one hundred percent centralized to a full-fledged decentralized system. The centralized stack is where a single entity controls each part of the application infrastructure and concomitantly powers all modern Health Information Technology systems. MongoDB, a cross-platform document-oriented database program and a NoSQL database scheme, has recently emerged as a leading database in these distributed systems classes.

In partly decentralized applications, one can add in just enough blockchain technology as necessary to entertain some of the benefits offered by Blockchain, i.e., control, trust, and value. While doing that, the remaining application infrastructure relics are centralized to sustain scalability, ease deployment.

Figure 2 Adapted from White Paper; Building Enterprise-Grade Blockchain Databases with MongoDB; 2017

Blockchain Database Deployment Scenarios and their Limitations

A modern enterprise Information Technology stack; can be anything from centralized systems to fully decentralized methods and anything partly decentralized arrangements in between. But each encompasses its particular advantages and limitations.

There is a dedicated application infrastructure for decentralized processing called "Smart Contracts," empowering the system to execute automatically, control, or document legally pertinent events and actions according to the terms of a contract or an agreement. But it also comes with trade-offs that other enterprise's counterparts don't face. The most important of the limitations is that the decentralized system comes with much lower scalability. The reality is that complete decentralization is not practical for many enterprise-grade blockchain endeavors.

The sweet spot for enterprise blockchain usage over the next several years is in partly-decentralized applications.
But The key windfalls are audit trails and trailing who-owns-what!

It is essential to give every user the capacity to act as their tier if we implement a "decentralized" blockchain system. (Figure 3 Right) But by doing that, they also need to make sure that they do not lose that key. If they fail to do so, their data is in danger. And they will lose access to the information forever.

Some Blockchain solutions consume great energy. Blockchain technology uses the Proof-of-Work consensus algorithm that relies on the miners to do the work. It incentivizes miners to solve complicated mathematical problems. High energy consumption is what makes these complex mathematical problems not so ideal for the real world.

Blockchain is not a circulated computing system, meaning it data banks on nodes to function correctly. The quality of the nodes determines the quality of the Blockchain. It means that it is not a distributed computing system where the network doesn't depend on its involvement and participation. In comparison, a distributed computing system works to ensure that they verify the transactions according to the rules, ensure that they record them, and warrant that they have the transactional history for each operation. Each of these actions is Blockchain, but there is a lack of synergy, mutual contribution, and synchrony.

Advances in Query handling in Enterprise Solutions

The most advanced databases today offer rich querying, scale to enterprises. That includes the healthcare industry, which often requires a controlled yet scalable environment while maintaining data sovereignty and individual data ownership. Querying is a requirement for a database. It serves a range of applications that need to consume data stored in the Blockchain for operational and analytical tasks. On the other hand, the scale includes high capacity, high output, low latency, and the ability to improve performance as we add more hardware. Data partitioning, or" sharding," is a prerequisite to horizontal scale-out so that each hardware node is only storing a subset of the data and Handling a fraction of requests.

Amid the overwhelming system requirements of healthcare information technology, centralized databases like MongoDB are realized to offer comprehensive querying and scale, which today's Blockchain fails to provide.

So, what is MongoDB

Healthcare enterprise solutions, mainly if intended to self-sustain amid increasing interoperability and implementation of technologies such as wearable devices, in that case, the demand for a highly flexible and scalable data environment. MongoDB offers such flexibility to a Health IT infrastructure, especially for a decentralized climate within the controlled setting.

MongoDB is an open-source, non-relational database management system (DBMS). (Figure 3 Left) It utilizes flexible documents instead of tables and rows to process and store various forms of data. In contrast to the SQL solution, a NoSQL solution, MongoDB offers an elastic data storage model that permits users to store and query in many forms with affluence. That simplifies database management for developers and creates a highly scalable environment for cross-platform requisitions and services.

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Figure 3 Adapted from White Paper; Building Enterprise-Grade Blockchain Databases with MongoDB; 2017

MongoDB utilizes a dynamic representation that provides users with flexibility when creating data records and querying file collections through MongoDB aggregation. It also enhances analyzing large amounts of information in a short period. MongoDB documents or groups of manuscripts are the basic units of data. They are formatted as Binary Javascript Object Notation or JSON. These documents typically store numerous types of data distributed across multiple systems.

Comparing currently available databases, including MongoDB and MySQL, it can be hard to choose a healthcare enterprise's right solution without clearly defining the network's mission. For example, MySQL uses a structured query language to access stored data by which schemas are used to create database structures, utilizing tables to standardize data types so that values are searchable and queried adequately. A developed solution like MySQL is helpful for various situations, including applications, website databases, and commercial artifact management. Because of its inflexible nature, MySQL is preferable to MongoDB when data integrity and isolation are necessary, such as handling transactional data. MongoDB's less-restrictive format and higher performance make it a better choice on the other end of the spectrum, mainly when availability and speed are fundamental interests. It is also noteworthy; various databases have been previously used in combination with great success.

Blockchains in the Information Technology (IT) Stack

Generally speaking, there are four distinct layers of IT stacks within the Blockchain system. That includes the Internet, Blockchain protocol, Application layer, and User experience.

As one would expect, there would be no Blockchain without the Internet, as any digital distributed ledger system requires a global network of interconnected devices or nodes, such as computers, smartphones, Internet of Things (IoT) devices, etc. Concomitantly they all must rely on the Internet Protocol Suite (TCP/IP) that defines how data should be packed, addressed, transmitted, routed, and received.

The blockchain protocol operates on the Internet through those peer-to-peer network nodes that execute the protocol, completing transactions based on a cryptographic algorithm on identical copies of the distributed ledger of these transactions hosted on these P2P machine's networks. As already outlined, the protocol establishes an open, private, immutable, shared and trusted public ledger of transactions, not controlled by a single entity.

The Application Layer was initially developed on the 'native' blockchain protocol for most of its existence, i.e., it was initially the Bitcoin. However, recent changes introduced in forks led to a Decentralized Autonomous Organization (DAO). DAOs allowed people to contribute to economic value development through cryptographic tokens created in an open, translucent network short of the need for formal contracts or agreements. Hereafter, Ethereum leads the innovation into developing a custom-built public blockchain that executes smart contracts applications that run as programmed on a P2P network that is not subject to fraud, interference, or downtime.

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For the User Experience, the blockchain stack's underlying technology layers have supported applications in our day-to-day activities. We will increasingly witness the continued growth of DAPPs accessed by specialized dApp browsers on our device of choice.

One of the significant obstacles facing the medical community, physicians, mainly, is the user experience's unfriendliness. At most parts, that is the upshot of the complexity of use-cases associated with medical practice and the medical community's dissociation from their technology validation process. It is prudent to assume that proper Blockchain protocols and smart contracts would enhance users' productivity in the healthcare system.

Refuting Blockchain Database gaps with MongoDB

Amid remaining challenges on executing full-stack Blockchain systems and the nature of unpredictability the novel system can encompass, it is reasonable to utilize a system that possesses the best of two environments. That is Using MongoDB and Blockchain DAPP.

The question arises; what is the best scenario, and which data should be stored and managed centrally or the other way around.

When considering Blockchain Database Deployment Scenarios, two dynamic parts affect deployment determinations. First, we need to determine whether the intended blockchain database for deployment will be within an "enterprise" or a "consortium." Once we decide, the next question is, "do we need that blockchain data to be "operational"? Meaning; if it is directly going to be used by clients or there will be an intermediary centralized Database. (Figure 4)

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Figure 4 Adapted from White Paper; Building Enterprise-Grade Blockchain Databases with MongoDB; 2017

Operational data attributes to data from existing, non-blockchain business processes, some of which are stored in the blockchain database but are not directly accessed by clients.

The said factors drive to four possible deployment scenarios:

  • Deployment scenario 1: blockchain data is operational; deployed within the enterprise.
  • Deployment scenario 2: blockchain data is not operational; deployed within the enterprise.
  • Deployment scenario 3: blockchain data is operational; deployed within a consortium.
  • Deployment scenario 4: blockchain data is not operational; deployed within a consortium.
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Scenario 1 Adapted from White Paper; Building Enterprise-Grade Blockchain Databases with MongoDB; 20
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Scenario 2 Adapted from White Paper; Building Enterprise-Grade Blockchain Databases with MongoDB; 20
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Scenario 3 Adapted from White Paper; Building Enterprise-Grade Blockchain Databases with MongoDB; 20
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Scenario 4 Adapted from White Paper; Building Enterprise-Grade Blockchain Databases with MongoDB; 20

Deployment Within-enterprises is familiar ground for all technologists, thus making the system we intend to work on- a convenient method. It's also more comfortable for the enterprise to reason about privacy and regulatory compliance if all the data is maintained within its partitions. Assuredly, engineers can make fast progress on their blockchain implementation while still participating in often slower evolving consortium-based methods.

If we intend to maintain deployment within the enterprise (instead of the consortium), then the blockchain data will not be used directly by users. Instead, there are MongoDB instances that will be centrally controlled. These instances send data to and from the blockchain database. Users access these instances rather than the blockchain database. In other words, users only use blockchain data via mediators. Engineers typically use the latter scenario for its propensity to be faster to modify and convenient to develop.

The main objective behind building a consortium is decentralization, where no single entity controls the database infrastructure. That creates collaborative infrastructure, increasing immutability due to a single truth source extending beyond a single organization. It also does that by raising the tangibility of claimed or transferred assets within the system. That is of such significance that Blockchain technology allows even regular competitors to work together because a shared infrastructure can simplify the information technology domain and unlock business opportunities higher in the value concatenation.

The privacy concerns arising with the consortium scenario is a new concern for the developers.

In healthcare, users generally covet to keep their data private and only open read permissions to other entities on an as-needed basis. In fact, for 21st-century citizens, the latter is a matter of legality rather than an option. For instance, data protection requirements are that users who wish to issue an asset have more fine-grained control on how that asset can propagate to other owners. However, the constraints in the scenario above fall on to co-admins as well. There should be a way for co-admin one to commit a client-style to write to the database, where co-admin two cannot see the data load.

One would use scenario 4 to benefit a consortium, like shared resources, and the benefits of non-operational blockchain data such as speed, convenience, and privacy.

In the healthcare environment where value-based medical services are on the rise, speed, scalability, and privacy are necessary; that is even more crucial when the trending promises point towards individual patient sovereignty and ensuring their right to data ownership.

Although many of the scenarios mentioned above may suit modern medical practice, maintaining the centrality of operations while ensuring one hundred percent consortium on the individual data may be the wisest of all scenarios. That provided the utility of a robust and flexible database system such as MongoDB.

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MongoDB meeting the demands of Blockchain in the Healthcare Domain

Healthcare is an extremely vulnerable industry for hacking and abuse. For the reason that it possesses an unlimited volume of valuable information. Cybercrime Hacking is one typical example of an external hacker accessing an organization's network to obtain unauthorized entree to sensitive patient information. It typically jolts with the hacker spear-phishing another user in an organization, consequently clicking by that user on a malicious link and leading to a drive-by download of malware providing admission to delicate patient data.

Even in insider fates or workarounds, a user executes a well-intentioned action that results in unauthorized access to sensitive patient information. Or a Business Associates, a third-party organization contracted by your party, experiences a breach event involving unauthorized access to delicate patient data. The latter is worth mentioning further, wherein the patient information affected originates from the organization, which was previously shared for the third-party organization fulfilling its contractual obligations. Blockchain helps overcome such adversities. Or else in malicious insiders or fraud, Blockchain blocks an operator who intends to perform a hostile action that results in unlawful access to delicate patient information. That could be valid in the case of a disgruntled worker committing fraud. Likewise, Blockchain prevents insider inquisitive staff from accessing the records of patients of your organization without any legitimate need to do so.

By espousing Blockchain with MongoDB, one can take advantage of a distributed architecture database platform that powers the next generation of blockchain databases and enterprise applications. There is an added benefit of recording value exchanges; the core database's integrity needs to enforce data veracity while providing several controls to implement such guarantees.

#Blockchain #MongoDB #Healthcare #Technology #Data

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Adam Tabriz is a Physician, Writer, Entrepreneur, and public health policy, expert. He is an advocate for Personal liberty. The combination of his experience and expertise underlines his passion for advocating true “Personalized Healthcare” and “Healthcare without Borders.” His favorite slogan is: “Peace of mind would come to all people through the universal respect for the basic human rights of everyone”

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