International Journal of Medical Informatics 186 (2024) 105415 Available online 20 March 2024 1386-5056/© 2024 Elsevier B.V. All rights reserved. Healthcare 5.0: A secure and distributed network for system informatics in medical surgery Chenggang Wu a , Yuk Ming Tang b, c, * , Wei Ting Kuo b , Ho Tung Yip d , Ka Yin Chau c a Zhuhai City Polytechnic College of Marxism, Guangdong Province, China b Department of Industrial and Systems Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong c Faculty of Business, City University of Macau, Macau d The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong A R T I C L E INFO Keywords: Blockchain Healthcare 5.0 Orthopedic Surgery Electronic Health Records Hyperledger ABSTRACT Introduction: Health records serve not only as a database of a patient’s health history and treatment process but also as a crucial tool for doctors to diagnose and treat patients. However, the storage and sharing of these records are sensitive issues as they involve maintaining patient privacy and ensuring data transparency, security, and interoperability between different parties. Challenges to achieving these goals in the current surgical process can impact the allocation of medical resources and surgical outcomes. Methods: This article proposes a healthcare 5.0 framework for medical surgery that deploys a secure and distributed network using Blockchain to demonstrate transactions between different parties in the orthopedic surgery process. The proposed network uses the Hyperledger Composer platform for deployment, and a patient- doctor-supplier orthopedic surgery network is designed and implemented to enable the safe sharing of medical records. Results: A benchmarking tool was implemented for analyzing different scenarios of applying blockchain tech- nology to orthopedic surgery. The application of blockchain technology to orthopedic surgery presents a promising solution for data sharing and supply chain management in the feld. The integration of blockchain with cloud storage and hybrid encryption ensures secure and effcient storage of Electronic Health Record (EHR) and Personal Health Record (PHR) data. By leveraging the tamper-proof nature of blockchain and addressing concerns regarding centralized data storage, this scenario demonstrates enhanced security, improved access effciency, and privacy protection in medical data sharing. Conclusions: The article demonstrates the feasibility of using an IoT-based blockchain network in orthopedic surgery, which can reduce medical errors and improve data interoperability among different parties. This unique application of blockchain enables secure sharing of medical records, ensuring transparency, security, and interoperability. The network design may also be applicable to other surgeries and medical applications in the future. 1. Introduction Managing electronic healthcare records (EHRs) in a secure, effcient, and interoperable manner is a critical challenge in the healthcare in- dustry under a high-growth area with signifcant potential [1]. Tradi- tional centralized information systems used by hospitals restrict data sharing and patient control over their EHRs, limiting the effcient uti- lization of data [2]. Although virtual reality, artifcial intelligence, and information technologies have brought benefts to healthcare, the decentralized nature of patient data and limited data sharing hinder the effcient utilization of data [3,4,5,6]. In contrast, the implementation of blockchain networks offers a solution by decentralizing patient data and enabling secure transactions between different healthcare parties [7]. By leveraging blockchain’s distributed ledger technology, healthcare organizations can overcome the limitations of centralized systems, ensuring improved data accessibility and seamless data exchange. his advancement aligns with the Healthcare 5.0 paradigm, which utilizes Internet of Things (IoT) technologies in Industry 4.0, facilitating enhanced data sharing, privacy, security, and interoperability within the healthcare ecosystem [8,9]. * Corresponding author. E-mail address: yukming.tang@polyu.edu.hk (Y.M. Tang). Contents lists available at ScienceDirect International Journal of Medical Informatics journal homepage: www.elsevier.com/locate/ijmedinf https://doi.org/10.1016/j.ijmedinf.2024.105415 Received 26 August 2023; Received in revised form 30 January 2024; Accepted 16 March 2024