Unveiling the Layers: An In-Depth Analysis of Bangalore's Health

Bangalore‟s health sector is on par with global standards with the best medical practitioners, state-of-the-art infrastructure, and technologically advanced equipment. Yet, it is always second to cities like Chennai and Mumbai. Bengaluru officially known as Bengaluru, is the capital of the Indian state of Karnataka. Bengaluru is sometimes referred to as the “Silicon Valley of India” (or “IT capital of India”) because of its role as the nation‟s leading information technology (IT) exporter. Bengaluru is the second fastest-growing major metropolis in India.

It is located in southern India on the Deccan Plateau. The healthcare scenario in Bengaluru city is a mix of plenty and scarcity. A number of government bodies and schemes provide health services. If all primary health facilities maintained by different government bodies were combined there are likely to be enough centres to 2 health care in Bengaluru city- need for a participatory, comprehensive health plan to meet the primary care needs of the population. The city is also host to autonomous institutions with high-caliber medical professionals such as the National Institute of Mental and Neuroscience and the Jayadevan Institute of Cardiology.

Government hospitals have a few advantages over private hospitals, which make them better and more efficient for patients. This includes their facilities being affordable in cost, which is an advantage for the masses, who cannot afford expensive treatments. The best doctors are majorly found in the southern part of India. Bengaluru has a few government hospitals that make them stand out from other private ones.

Bengaluru is a hub for medical tourism, with super-speciality hospitals boasting state-of-the-art treatment facilities. On the other hand, the communities that particularly need public health services, such as the urban poor and working classes, are unable to access them due to the shortage of medical staff, lack of medicines and diagnostic services, high levels of corruption and low sensitivity towards their needs. They end up using the private sector, which is an expensive option or postponing essential health care – an even more expensive option for which the individual, family and society pay a price. There have been cases of women delivering babies at home or in auto-rickshaws as they were turned away at Maternity Homes and did not have time to reach a secondary or tertiary institution, or the resources to get there. Tertiary care is expensive even in government hospitals due to bed charges, medicines and other expenses. The result is high levels of indebtedness and health indicators among the urban poor that are almost as bad as the rural poor. In order to make health care available to the weaker sections of society Bengaluru is dotted with numerous government hospitals. Most of the government hospitals in Bengaluru are run and managed by the municipal corporation of the city. The government hospitals in Bengaluru are usually multi-speciality hospitals that offer comprehensive medical care under a single roof.

The term Blockchain has been shaking the finance sector in particular, for a while now. Blockchain technology is frequently being described by words like „disruptive‟, „game changer‟ or „revolution‟. It is also viewed more as a foundational technology with the potential to create new foundations for global economic and social systems, than a disruptive technology. People from all over the world are working hard to find the best solutions concerning the development and testing of vaccines, preventing the spread of infection and quick identification of viral carriers since coronavirus is extremely contagious. In fact, blockchain potential use cases in healthcare vary accordingly to satisfy different requirements, such as data sharing, security, and data access. Other examples include blockchain platforms designed for clinical trials or precision medicine. In the current sense of epidemic management, the blockchain is evolving as a crucial technology solution in providing a transparent, reliable, and low-cost solution to facilitate successful decision-making, which could effectively result in contributing to quicker intervention during this crisis. Blockchain is now showing enough opportunities to become an integral part of fighting against COVID-19 as it would enable efficient tracking and monitoring solutions, ensure a transparent supply chain of vital products and donations, and secure payments. This is possible because blockchain comprises a chronologically ordered list of encrypted signatures, a secure distributed ledger containing permanent transaction records that are shared by all members in the network. Moreover, adopting blockchains and public ledgers maximizes cost savings by eliminating intermediaries that handle manual transactions. The prominent blockchain-based uses cases for combating the COVID-19 pandemic. Blockchain technology is capable of enhancing the healthcare sector in various areas that are affected by this outbreak, including improvements to clinical trials, managing supply chain operations, tracking donations, etc. it effectively responds to the pandemic, and a key territory of opportunity is in the assortment, accumulation, and access to information necessary for the tracking of the infection, deciphering trends, and administering research. Blockchain provides the possibility of guaranteeing data accuracy through its capability to verify and store immutable real-time data. The framework of Block chain acts as a base for new developing research while permitting organizations and associations to share their information with innovators, scientists, and researchers to test and incorporate this information into new devices and solutions. Utilizing a blockchain-fueled platform empowers compliance management, data proprietorship, and auditability to grant flexible sharing through different managerial levels. MiPasa, a worldwide scale control and correspondence system controlled by blockchain innovation, which assists with gathering, collating, and studying data about the virus‟s spread and containment, was launched by WHO while collaborating with significant innovation organizations and governments. MiPasa is an asset that has expectations to help public health officials, the scientific and business network, and people in general. The following benefits could be achieved by using blockchain technology in the healthcare system:

a) Robust Monitoring

One of the key things that the network management team of healthcare needs right now is overseeing, and powerful monitoring of all kinds of transactions. The feature that sets Blockchain apart from other healthcare management systems is that it documents all kinds of transactions in the form of a decentralized record. It is precise and transparent to the core which effectively saves time, effort, and cost, thus also saving the hassle of constant management.

b) Enhanced Collaboration

A big amount of success of any healthcare initiative depends largely on the people involved like third parties, professionals and researchers. Blockchain technology enhances the collaboration among these participants with the help of its distributed ledger technology through which they can provide deep insights and do group research.

As deliberated in the previous sections, the main issue that the healthcare industry is facing is the leakage of significant data and it being used for malicious means and for other vested interests. Another focus area is that the participants and parties involved in the database have access to the most updated and authentic patient data and diagnosis information. Blockchain is made up of the most advanced cryptographic aspects, which makes it immutable. That facilitates data authenticity accompanied by a digital signature, along with foolproof data security stabilizing the issues of security and trust.

d) Cost-Efficient Cures and Process Simplification

Smooth, streamlined, quality data sharing and distribution across all the key network participants and healthcare providers help in creating cost-effective treatments and sophisticated cures for numerous diseases. The fully organized step-by-step process documents transactions in the form of electronic health records, or EHRs which is an exclusively digital format. That not only increases the security aspect but simplifies complex processes such as billing and other procedures eliminating the need for multiple validations and middlemen who act on behalf of the other entities.

The scope of Blockchain in healthcare looks super up-and-coming and promising as it helps to solve some of the pressing issues afflicting the industry. As Blockchain is decentralized unlike the majority of the healthcare records that are centralized, we envision a progressive future. A future where the blockchain acts as an element of a system in which patients will become stewards of their own medical data, in place of relying on a central source. Of Course, the application of blockchain comes with its own set of technical challenges. The process and number of steps to record, find and get the data can be complex and numerous, but with the help of emerging technologies like Machine Learning and AI, these problems will get resolved eventually.

There are several technical and organizational challenges that constrain the use of blockchain technology in the healthcare industry. Have a look over some of these hurdles:

1. Uncertainty: The Blockchain concept is not widespread yet and there are only a few successful initiatives based on this modern technology at this time. That is a major hurdle because we don't have many successful blockchain models to follow which creates an uncertain situation.

2. Storage Capability: Blockchains within the healthcare industry will be composed of medical records, images, documents and lab reports which require a significant amount of storage space. Conceptually, every member included in the chain would have a complete copy of the full medical record of every individual in the U.S. and this volume could potentially exceed the storage capacity of current blockchain technology.

3. Data Ownership: Who will own the healthcare data? Who will grant permission to share it? That kind of structured department or process hasn't been established yet.

4. Cost: The cost of establishing and maintaining a healthcare blockchain is unknown yet and no one can seriously consider this technology without knowing about its expenses ahead of time.

5. Rules & Regulations: There are no rules available to address the use of blockchain in the healthcare industry. It is also uncertain as to how new policies regarding healthcare blockchain will conform to current privacy regulations like the HIPAA Act.

For operations to get executed successfully, a gas fee is required to be paid by stakeholders in the network. Hence, every line of code that is written in Solidity requires a certain amount of gas to get executed. Ethereum gas is the unit used to measure the computational effort required for transaction executions. Ethereum transactions incur two types of costs during their execution. First, execution cost is related to the costs of changing states in the contract and internal storage, while second is transaction cost, which includes the execution cost along with the cost of sending data such as contract deployment and transaction input cost.

This gas amount is calculated by considering both the gas price and gas limit, respectively. The former refers to the gas consumed in the contract, and the latter refers to the total gallons of gas placed inside the smart contract gas tank. Moreover, it should be noted that as the gas price increases, the rate of adding verified transactions to each block increases. Accordingly, this price is expected to increase during high network traffic as miners compete to add transactions in the blocks to receive transaction fees. The transaction and execution gases along with the corresponding transaction fees for deploying the contract and executing the major functions. The average gas price equal to 6 Gwei was obtained on April 10, 2020, according to the ETH Gas Station. This transaction fee was converted to US dollars at an Ether exchange rate of 1 ETH = 158.10 USD. We notice that the cost incurred by the stakeholders does not even exceed 5 USD. This implies that implementing the proposed solution is feasible and encourages cost savings for all stakeholders in the network.

We present and discuss the algorithms for implementing the blockchain-based COVID-19 tracking system that captures the working principles of our proposed solution leading to the development of the smart contract. The smart contracts were written in Solidity, which is a widely used language for Ethereum smart contracts. Compilation and execution of the contract were achieved through the use of Remix IDE, which is a browser-based compiler with an embedded debugger used for alerting and alarming the user with error notifications and warnings accordingly.

Firstly, oracles are assigned Ethereum addresses to be able to interact with the smart contracts as they act as a gateway between the blockchain platform and external data. This datum will comprise the statistics related to the number of infected and recovered cases and deaths obtained from reliable resources. This registration process is handled by the registration smart contract.

The aggregator smart contract has the additional functionality of the registration smart contract that is necessary to register oracles. Firstly, oracles are assigned Ethereum addresses to be able to interact with the smart contract as they act as a gateway between the blockchain platform and external data. This datum will comprise the statistics related to the number of infected and recovered cases and deaths obtained from reliable resources. Only trustworthy sources are used by registering oracles under the function to check whether the address is registered or not. If the oracle is not registered, then this function is responsible for registering the oracles by appending its Ethereum address to the list of the oracles of different resources. After the process of registration, the oracle is then given an initial credibility score of 80, which can later vary based on the data provided by this oracle. After the successful registration of oracles, they are now eligible to feed the smart contract with data extracted from online sources such as IHME and CDC using the function. Then, the process of data aggregation begins by incrementing the infected, recovered, and dead counts corresponding to that oracle.

Then, the submitted data are processed and grouped into clusters. It would ensure that the information submitted is verified by using a loop to go over each registered oracle. The clustering process takes place by comparing the input data with the data that already exists in the clusters. If the new data is similar to one of the available clusters, then the oracle is added to that particular cluster accordingly else a new cluster is created. Then, the appropriate cluster is chosen by selecting the cluster with the highest number of oracles. It should be noted that the credibility of oracles is also taken into account when selecting the cluster.

However, for this paper, the credibility value was fixed for simplification. Finally, the centroid of the trustworthy cluster will be found and used to update the ledger. Once the smart contract has aggregated the input from all oracles, the reputation of the oracles is to be updated. The input of those oracles is compared to the computed values of the infected, recovered, and deceased cases. The trustworthiness factor is computed, which is reflected in the change in the reputation scores of the oracle. If the oracle is within the most reputable cluster, it is considered a credible source of input, and its reputation increases. After many iterations, the most dependable oracles are given more weight when computing the final statistics. The code was then compiled successfully and tested in the Remix environment. It was observed that the functions were executed sequentially as expected.

Moreover, the code verified that only registered oracles were allowed to interact with the smart contract. We fed the data with information in which the code picked out the most trustworthy cluster based on the algorithm. This reinforces that the developed code works as intended. The full smart contract code can be found in the GitHub repository.

The sudden development of the COVID-19 pandemic has exposed the limitations of modern healthcare systems to handle public health emergencies. It is evident that adopting innovative technologies such as blockchain can help in effective planning operations and resource deployments. Blockchain technology can play an important role in the healthcare sector, such as improved clinical trial data management by reducing delays in regulatory approvals and streamlining the communication between diverse stakeholders of the supply chain, etc.

Moreover, the spread of misinformation has intensely increased during the outbreak, and existing platforms lack the ability to validate the authenticity of data, leading to public panic and irrational behaviour. Thus, developing a blockchain-based tracking system is important to ensure that the information received by the public and government agencies is reliable and trustworthy. In this paper, we review various blockchain applications and opportunities in combating the COVID-19 pandemic and develop a tracking system for the COVID-19 data collected from various external sources. We propose, implement, and evaluate a blockchain-based system using Ethereum smart contracts and oracles to track reported data related to the number of new cases, deaths, and recovered cases obtained from trusted sources. We present detailed algorithms that capture the interactions between stakeholders in the network. We present security analysis and the cost incurred by the stakeholders, and we highlight the challenges and future directions of our work. Our work demonstrates that the proposed solution is economically feasible and ensures data integrity, security, transparency, and data traceability among stakeholders. A blockchain-based tracking system for validating COVID-19 data from diverse sources to mitigate the spread of falsified or modified data. Our proposed blockchain-based solution promotes trust, transparency, and traceability and streamlines the communication between stakeholders in the network. Our proposed solution leverages Ethereum smart contracts and oracles and demonstrates the critical application of blockchain technology for COVID-19. The developed system would update the Apps and dashboards with real-time statistics as they become available, related to the number of confirmed cases, deaths, and recoveries. The presented system architecture, sequence diagram, and algorithms can be easily generalized for tracking various other infectious diseases. Our presented solution addresses the problems faced in the current pandemic crisis, such as miscommunication, data manipulation, and single point of failure. Furthermore, it mitigates malicious activities due to the inherent cryptography security features of blockchain technology. The smart contract code is made publicly available on GitHub. We present a detailed cost analysis to compute the transaction costs incurred by stakeholders when interacting with the smart contract. Furthermore, we present security analysis pertaining to integrity, accountability, authorization, non-repudiation, and resilience to common forms of cyberattacks. In future work, we aim to expand the smart contract functionalities and develop Apps to enable participants to interact with Ethereum smart contracts seamlessly. At first look, it looks like Bengaluru is overcrowded with public and private hospitals there is no scope for any new player to venture. Bengaluru is a startup paradise, a number of single speciality hospitals and various IT healthcare startups are born in Bengaluru. but the real scenario is together are different with a huge drain not only of Karnataka, but patients Tamilnadu also travel to Bengaluru to avail of healthcare facilities. Bengaluru is one of the most preferred destinations for medical tourism too. There is an acute requirement for the hospital beds as per WHO norms still 6,000 beds are required with respect to the population base at Bengaluru.