Decentralized Identity Management for E-Health Applications: State-of-the-Art and Guidance for Future Work

Abstract

Background: The increasing usage of various online services requires an efficient digital identity management approach. Unfortunately, the original Internet protocols were not designed with built-in identity management, which creates challenges related to privacy, security, and usability. Thereis an increasing concern regarding the management of these sensitive data in the society, who have access to it and where it is stored. Blockchain technology can, potentially offer a secure solution to address this problem, in a decentralized manner without any centralized authority. This is of importance for e-health services where the patient and the healthcare provider often are required toprove their identity. Blockchain technology can be utilized for creating digital identities and make themanagement of those identities easier, giving a higher degree of control to the user than what current solutions offer. It can be used for creating a digital identity on the blockchain, making it easier to manage for individuals and entities, giving them greater control over who has their personal in-formation and how they handle it, and it could be utilized to create a higher degree of trust andsecurity to e-health applications.
 Objective The aim of this research work is to review the state-of-the- art regarding blockchain-based decentralized identity management for healthcare applications. Based on this summary, we provide a viewpoint on how blockchain-based decentralized identity frameworks couldbe utilized for virtualized healthcare applications.
 Method This research has applied a scoping, semi-systematic review approach to summarize thestate-of-the-art. Included identity management systems were evaluated based on seven criteria:Autonomy, Authority, Availability, Approval, Confidentiality, Tenacity and Interoperability ResultsSeven blockchain-based identity management systems were included and evaluated in this work:These include solutions built with Ethereum, Hyperledger Indy, Hyperledger Fabric, Hedera andSovrin blockchains.
 Conclusion Digital identity management is crucial for virtual healthcare. Decentralized identity management for healthcare purposes is currently being explored, both in academia and the private sector. More work is needed with the aim to improve the efficiency of current DIM solutions and to fully understand what technical frameworks are best suited for e-health applications.

The Implementation of Federated Digital Identifiers in Health Care: Rapid Review

“…Today, patients who receive care from different organizations access their personal health information through multiple patient portals, and this information is stored separately without one place to organize or process the information [2]. Contributing to this fragmented system is the use of decentralized identities, which require patients to create, verify, and remember multiple usernames and passwords for the services owned and controlled by multiple distinct entities [3]. Although having unique electronic credentials may be perceived by some as being more secure, users are prone to creating the same logins and passwords for multiple applications in a "do-it-yourself" password management strategy, which negates the perceived increase in security [4].…”

“…This ultimately impacts the quality of the user experience. To mitigate this issue, federated identity management solutions are being introduced into health care from other sectors to improve the interoperability of health care data among institutions [3]. These solutions use federated digital identifiers (FDIs) as part of the identity proofing process, which involves binding a user with their credentials (such as a driver's license) and using that information for the authentication process [4].…”