Blockchain technology and raft consensus for secure physician prescriptions and improved diagnoses in electronic healthcare systems

In this section, the proposed consensus approach among doctors using the RAFT algorithm is explained, which provides more security and reliability between patients and doctors.

The Raft consensus algorithm is favored for medical documents and doctors’ consensus due to its simplicity, reliability, and fault tolerance. Unlike more complex algorithms, Raft is designed for easier implementation and comprehension, making it accessible to healthcare professionals who may not have specialized technical knowledge. Its strong consistency guarantees that all nodes agree on the state of data, crucial for accurate medical records and doctors’ decisions. Raft’s fault tolerance capabilities ensure system reliability, crucial in healthcare where uninterrupted access to data is vital. Additionally, Raft’s adaptability to permissioned networks aligns well with the controlled environment of healthcare organizations, allowing for efficient consensus among trusted parties without the complexities of permissionless networks. Overall, Raft’s simplicity, reliability, and adaptability make it a preferred choice for ensuring consensus in medical settings. Table 2 compares different consensus methods.

System architecture

The initial stage of the proposed method’s architecture is visually depicted in Fig. 1. This pioneering approach introduces a state-of-the-art method for delivering medical and healthcare services while promoting consensus among specialized physicians. Each participating physician has the opportunity to contribute their expert assessment of a patient’s diagnosis, considering the patient’s comprehensive medical and treatment history, as well as the diagnosis provided by the treating physician. The patient is ultimately prescribed the diagnosis with the highest consensus among the medical experts, and all versions of prescriptions are securely stored within immutable blocks, ensuring the prevention of any unauthorized alterations.

Consensus steps

Step 1 Choosing the Treating Physician

Phase 1-1: Registration of Physicians in the System.

Each physician, during the registration process in the system, enters their personal and professional information (medical credentials). The system verifies the accuracy of the physician’s information through validation. The result of the validation process is communicated to the individual in the form of a message.

Phase 2-1: Patient Registration in the System.

Every patient is required to complete their registration in the system by providing their personal information. The system then verifies the accuracy and authenticity of the provided data through a validation process.

It is noteworthy that patients, when engaging with any physician and undergoing their treatment process, have the opportunity to share their feedback on the diagnosis, the physician’s approach, and other aspects of the interaction, regardless of the final outcome. All these valuable opinions are recorded in the system, allowing it to calculate an average rating and rank physicians accordingly. The average user ratings provided by patients in the system serve as a significant parameter for the statistical ranking of physicians.

Phase 3-1: Choosing the Attending Physician by the Patient.

After logging into the system, the patient indicates the medical specialty they would like to pursue. Next, the system shows the patient a list of licensed doctors from which they can choose their favorite medical professional. The patient selects a candidate from the list to serve as their treating physician. The rankings that other patients have given in the physician evaluation are also displayed to help the patient make an informed choice. In the suggested algorithm, the chosen doctor takes the lead position. The patient informs the chosen healthcare practitioner about their ailment or condition after choosing the attending physician.

Step 2 Formation of Blocks.

Phase 1-2: Submission of the patient’s medical record to the treating physician by the patient.

Once the patient chooses the treating physician, they send a request to access their medical records, and upon the patient’s confirmation, they forward their medical history to the selected physician.

Phase 2-2: Choosing Physicians to Participate in Consensus.

Once the treating physician reviews the patient’s medical records and their statements, they submit a request through the system to select other physicians for participation in the consensus process, as shown in Fig. 2. Subsequently, the system presents a list of eligible physicians to the treating physician, who can then send them invitations to join the consensus based on their respective specialties. The treating physician has the flexibility to invite a specific number of physicians to participate in the consensus.

The treating physician initiates the request for selecting doctors to participate in the consensus.

The selection of additional physicians will be carried out by the system using the following formula.

Weighted Sum Formula for specialist selection:

The selection of participating physicians in the consensus is based on the weighted sum of two criteria. This parameter is denoted as C_i for the ith physician in this article and is computed as Eq. (1). One of the criteria (S_1i for physician i) is the average ratings of users, i.e., patients, regarding their interactions with the physician i and the effectiveness of the treatment process.

The second criterion denoted as S_2i, is the degree of agreement of the ith physician’s decisions with other physicians. This criterion is measured using the kappa index, which is computed as Eq. (2). The higher the level of agreement, the higher the physician’s ranking.

In which \(P_ij\left(A\right)\) is the actual proportion of agreements between physicians i and j, \(P_ij\left(E\right)\) is the probability of causal agreement and N is the total number of physicians. Also, in Eq. (1),\(\alpha\) is the weighting parameter and can be according to the coordinator preferences.

Phase 3-2: The treating physician (leader) submits their comments and the medical records.

The treating physician, who also assumes the role of the leader, examines the patient’s medical records, provides their assessment, and records it in a block. After that, as shown in Fig. 3, Subsequently, the block is sent to other physicians for verification, with each of them having a copy of the block. The selection of the treating physician by the patient and the consensus among other physicians are facilitated using the proposed method based on the Raft algorithm.

Sending a copy of the diagnostic version to the doctors participating in the consensus.

Phase 4-2: Voting.

Other physicians, after reviewing the patient’s medical records and the medical issue, express their opinions and cast their votes (yes/no) in the log. If the treating physician’s opinion receives a majority of votes, it will be approved. However, if it gets rejected, the entire consensus process must be repeated with a new leader.

Benefits of Using Blockchain: Since the system is connected to the blockchain network, all of these activities will be securely recorded in the blockchain. This ensures that no physician or individual can manipulate or delete their opinions or diagnoses. The significance of this lies in the fact that any incorrect or inaccurate diagnosis by a physician could lead to further issues for the patient, causing complications and potentially allowing the physician to avoid accountability by altering previous instructions or prescriptions in their favor.

To prevent such tampering and enhance the accountability of physicians for their diagnoses, all opinions and diagnoses must be faithfully recorded in blockchain blocks. This way, in case of any problems arising from incorrect diagnoses, the patient can easily trace and investigate the matter. Furthermore, the consensus among physicians ensures that if any medical aspect has been overlooked or not adequately addressed in the patient’s medical records, it can be thoroughly reviewed during the consensus process. This empowers the patient to pursue a better and more reliable path towards recovery.