**3.3 Continuous patient monitoring with a patient-centric agent**

Internet of Things (IoT) applications in the modern healthcare system include devices, services, and wireless sensors that detect physiological signs with wearable or ingestible sensors that stream data to remote and often Cloud-based servers. Secure

**Figure 3.** *JTrack platform overview [1].*

*A Simulation Model of a Blockchain-Based Decentralized Patient Information Exchange… DOI: http://dx.doi.org/10.5772/intechopen.109591*

continuous monitoring of patients' physiological signs has the potential to augment traditional medical practice [7].

The process of integrating demographic, health record, and geographic location data with physiological data obtained from wearable or implantable medical devices (IMDs) is known as remote patient monitoring (RPM) [7].

The aggregation and indexing of huge streams of continuous data while maintaining patient privacy are one of the challenges of designing remote patient monitoring systems that are effective, efficient, and secure. One's personal space, which also includes the ability to control data and set others' access levels, is referred to as privacy [7].

In addition to operational environments, insiders and outsiders pose threats to healthcare information's confidentiality, integrity, and accessibility. By gaining unauthorized access to confidential data, insiders such as healthcare professionals and support staff, service providers and outsiders such as hackers pose a threat to the security of health information [7].

Unauthorized actions have the potential to alter patient information and even result in death. Patient and medical professional trust in the system can be damaged by privacy breach [7].

Health information systems can also be threatened by resource misuses such as personal use of systems and software disruption caused by viruses, worms, and malware. Threats to the confidentiality and integrity of patient data include communication infiltration, interception, embedded malicious code, and repudiation. The security of health information can also be compromised by accident, technical infrastructure failure, and operational errors [7].

These threats have not yet been addressed by existing RPM architectures, as described in the following section. As a result, RPM software and devices require architectures that provide increased attack protection [7].

Efforts to ensure privacy in RPM have been made in recent years; however, most approaches focus on a single link in the architecture that chains data from patient sensors to healthcare professionals through intermediary devices and servers [7]

An effective and efficient RPM needs to address issues of rapid storage at appropriate security levels, user authentication, access control, mobility management, and sustainability of patient health data [7].

In order to ensure that appropriate levels of the trade-off between effectiveness and privacy can be established for rapid, secure data storage and access, user authentication, role-based access, and sustainability, an advanced End-to-End eHealthcare architecture that addresses RPM healthcare data management issues has been developed. A Patient-Centric Agent for End-to-End data stream coordination and a Blockchain component for distributed data storage are key architectural features [7].

In [7], it was suggested that the inclusion of a Patient-Centric Agent (PCA) can decrease RPM challenges. The End-to-End data flow is inaccurate for the Patient-Centric Agent (PCA). The level of storage, security, and access required at any given time is determined by the PCA. The patient sensors and devices, Blockchain nodes, and healthcare service provider devices are all coordinated by the PCA. If a stream of data should be stored in a Blockchain, the PCA manages the process and determines whether it should. The PCA executes on a machine with mass memory limit and high handling power.

There are two levels to the proposed architecture. The data streaming and storage solution is provided by the lower tier, while the Healthcare Control Unit (HCU) manages the primary healthcare provider. **Figure 4** depicts six systems that make up

**Figure 4.** *The tier-based remote patient monitoring architecture [7].*

the lower tier. Patient Centric Agent (PCA), Blockchain, Healthcare Provider Agent (HPA), and Healthcare Provider's Wallet (HPW) are all examples of Body Area Sensor Network (BSN). In **Figure 4**, a Sensor Data Provider, such as a smartphone, connects BSN to the Patient-Centric Agent (PCA) [7].

The Healthcare Control Unit, the Cloud, and the Blockchain network are all connected to PCA. Medical services Supplier Specialist interfaces Blockchain, Medical care Control Unit, and Medical services Wallet at the medical services supplier end. The functional view of the architecture is shown in **Figure 5**, and the architecture is explained by the communication links that connect the various segments below. The architecture is built to handle a lot of patients at once [7].
