Blockchains may be considered a type of middleware, enabling collaboration across a network of participants, from individuals to multiple healthcare organizations.

A given blockchain network may consist of on-premises or cloud-based blockchain node deployments, or a hybrid. However, each of the nodes in a blockchain network must implement the same consensus algorithm and transact using the same consensus protocol in order to communicate with other blockchain nodes in the same blockchain network. Typically one blockchain platform, for example Ethereum Enterprise, will be used consistently across a given blockchain network, although the deployment of each Ethereum Enterprise blockchain node may vary, some on-premises and others in the cloud.

Deployment models for blockchain networks can leverage the existing, traditional models of system deployments, using on-premises environments or cloud-based environments, using either Platform-as-a-Service (PaaS) or Infrastructure-as-a-Service (IaaS) hosting models.

On-Premises Deployments

In a traditional on-premises deployment, a healthcare organization must procure hardware, install and configure software, maintain all updates and patching, and update network configurations to enable communications between the blockchain node in the DMZ and other blockchain nodes over the Internet.

Cloud-based PaaS Deployments

In a cloud-based, PaaS deployment model, the organization also must provide acquisition, configuration, and maintenance, but does not have to support the blockchain network within their data center, which presents some cost advantages in terms of computing use and lifecycle costs, as well as agility and scalability. As blockchains are used in production for mission critical use cases, availability becomes critical. Blockchain technology naturally helps improve availability with decentralization and no single point of failure. However, healthcare organizations must protect the availability of their blockchain nodes, which can be thought of as their on-ramps or off-ramps to the blockchain. Redundant nodes across availability zones with load balancing and automated failover can help with this. For healthcare organizations without data centers, or without multiple availability zones, cloud based deployment of nodes across availability zones can be a decision factor.

Cloud-based IaaS Deployments

For a cloud-based IaaS model, a healthcare organization may avoid the capital costs, delays, and maintenance of an on-premises deployment and transfer lifecycle costs to a cloud service provider, which enables them to create and host blockchain nodes as needed, and leverage the cloud’s security and availability. Cloud environments typically provide availability zones, load balancers, DDoS mitigations, and so forth that can be easily deployed, further simplifying and accelerating cloud deployment of blockchain nodes and enabling healthcare organizations to accelerate blockchain deployments, thus improving their focus on the business or application layer, and evolving and improving their blockchains.

It is important to note that blockchain technology is part of an ecosystem, and is not a standalone solution. Within this ecosystem a blockchain is integrated with enterprise systems. These enterprise systems also have various deployment models, and some may be deployed on-premises while others are cloud-based. However, for any enterprise systems that hold records referenced by the blockchain, it is important that such systems provide an externally accessible interface for retrieval of such information. If such systems are based in the cloud, this can be straightforward. However, if such enterprise systems are within the intranet of a healthcare organization, it will be necessary to provide an externally accessible interface, either in the DMZ of the healthcare organization, or in the cloud, and have this external interface integrated with the internal on-premises enterprise system.

The following architecture framework may be useful for constructing and evaluating blockchain solutions in healthcare.

Source: Healthcare Blockchain in the Cloud

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