Received 20 December 2022, accepted 4 January 2023, date of publication 12 January 2023, date of current version 19 January 2023. Digital Object Identifier 10.1109/ACCESS.2023.3236505 Blockchain for Healthcare Management Systems: A Survey on Interoperability and Security EDGAR R. DULCE VILLARREAL 1,2 , JOSE GARCÍA-ALONSO 3 , (Member, IEEE), ENRIQUE MOGUEL 4 , AND JULIO ARIEL HURTADO ALEGRÍA 1 1 Facultad de Electrónica y telecomunicaciones, Universidad del Cauca, Popayán 190003, Colombia 2 Escuela de Ciencias Básicas Tecnología e Ingeniería, Universidad Nacional Abierta y a Distancia (UNAD), Pasto 110110, Colombia 3 Department of Computer and Telematic Systems Engineering, Universidad de Extremadura, 10004 Badajoz, Spain 4 CénitS–COMPUTAEX, Extremadura Supercomputing, Technological Innovation and Research Center, 10004 Cáceres, Spain Corresponding author: Edgar R. Dulce Villarreal (edgardv@unicauca.edu.co) This work was supported in part by the Spanish Ministry of Science and Innovation under Project PID2021-124054OB-C31; and in part by the Regional Ministry of Economy, Science and Digital Agenda under Grant GR21133. ABSTRACT n recent years it has been shown that the secure exchange of medical information significantly benefits people’s life quality, improving their care and treatment. The interoperability of the entire healthcare ecosystem is a constant challenge, and even more, with all the risks posed to the security of healthcare information. Blockchain technology is emerging as one of the main alternatives when it comes to finding a balance in the healthcare ecosystem. However, the constant development of new Blockchain technologies and the evolution of healthcare systems make it difficult to find established proposals. From an architectural point of view, the design of blockchain-based solutions requires trade-offs e.g. security and interoperability. This paper focuses on two main objectives, in the first one, it was carried out a Systematic Literature Review for exploring architectural mechanisms used to support the interoperability and security of Blockchain-based Health Management Systems. Taking into account of results, a series of scenarios were generated where these mechanisms can be used along with their context, issues, and various architectural concerns (interoperability and security). In the second objective, a high-level architecture and its validation were proposed through an experiment for the whole process of developing a Domain Specific Language, using the Model Driven Engineering methodology for specific Smart Contracts. INDEX TERMS Blockchain, DSL, health, interoperability, MDE, model, security, smart contracts, software architecture. I. INTRODUCTION In today’s globalized world, where the percentage of univer- sal health coverage is only 50%. It is necessary for everyone to have access to quality health services (diagnosis, treatment, and prevention) in an efficient, safe, and transparent man- ner [1]. For this purpose, technologies that increase the cover- age and quality of hospital services are being developed every day, and without them, medical centers would be inefficient and lose credibility [2]. The large healthcare ecosystem includes several inter- connected stakeholders with different and sometimes The associate editor coordinating the review of this manuscript and approving it for publication was Taehong Kim . competing needs. The healthcare environment involves a high degree of comprehensive and reliable information exchange between stakeholders [3]. However, this information is highly fragmented and distributed in multiple non-integrated data storage systems, making it impossible to have adequate information to support the care process and decision-making. This occurs because each medical center manages health information in an isolated and centralized way, causing health personnel to have a small history of the patient’s entire life, which leads to errors in diagnosis and treatment. Likewise, having centralized information presents multiple informa- tion risks. This is highlighted by [4], which mentions that healthcare is one of the sectors most vulnerable to cyberat- tacks. Denial-of-service (DoS) attacks can occur to indispose VOLUME 11, 2023 This work is licensed under a Creative Commons Attribution 4.0 License. For more information, see https://creativecommons.org/licenses/by/4.0/ 5629