International Journal of Innovative Technology and Exploring Engineering (IJITEE) ISSN: 2278-3075 (Online), Volume-12 Issue-1, December 2022 1 Published By: Blue Eyes Intelligence Engineering and Sciences Publication (BEIESP) © Copyright: All rights reserved. Retrieval Number: 100.1/ijitee.A93591212122 DOI: 10.35940/ijitee.A9359.1212122 Journal Website: www.ijitee.org Abstract: Digitalization has become a crucial part of healthcare 4.0 by transforming systems such as electronic health records (EHR), electronic medical records (EMR), and electronic personal medical records (ePHR). Healthcare 4.0 is derived from industry 4.0 and aims to enhance collaboration, virtualization, coherence, and convergence, which helps transform modern healthcare into more personalized and predictive. Healthcare 4.0 also aims to develop digital enablers which will support coordination among various stakeholders and seamless information flow in the patient journey towards wellbeing. These systems enhance patient care through the timely sharing of patient data across different providers globally. Timely sharing helps, but it also makes the electronic system vulnerable to alteration and breaches. In healthcare, blockchain application is widely used in various areas, such as health information exchange, pharmaceutical counterfeit, clinical trials, health supply chain management, patient data management, insurance claims, and product recall in case of adverse events. This research paper aims to identify how blockchain technology can help enhance the privacy and security of electronic health record systems. This paper discusses various blockchain-based systems, which provide a more efficient and secure option than client-server architecture-based traditional EHR systems. Keywords: Healthcare, Digitalization, EHR, Blockchain, Sustainability. I. INTRODUCTION Healthcare 4.0 is derived from industry 4.0. Various digital enablers, such as cloud computing, machine learning, and artificial intelligence, were used to build the blockchain-based system to support real-time access to patient's clinical data. Industry 4.0 represents the industrial revolution and aims to integrate the physical system with information, process, and operational technology. Fig. 1. Evolution of health care system (Li & Carayon, 2021) [7]. Manuscript received on 15 November 2022 | Revised Manuscript received on 18 November 2022 | Manuscript Accepted on 15 December 2022 | Manuscript published on 30 December 2022. * Correspondence Author Dr. Manish Shashi*, College of Management, Walden University, Minneapolis, MN, USA. Email: manish.shashi@gmail.com © The Authors. Published by Blue Eyes Intelligence Engineering and Sciences Publication (BEIESP). This is an open access article under the CC-BY-NC-ND license http://creativecommons.org/licenses/by-nc-nd/4.0/. As depicted in fig.1, plenty of research and development work were already done in healthcare 3.0 pertaining to digitalization of EHR. Healthcare 4.0 is more like optimizing the effort and bringing humans, including patients, providers, and third parties such as clinics, insurance, and pharmacies, to the center of smart and connected healthcare. It is critical to consider their characteristics, abilities, needs, and constraints while designing and implementing interconnected and smart healthcare systems [7]. An electronic health record (EHR) contains the results of clinical and administrative encounters between a provider (physician, nurse, telephone triage nurse, and others) and a patient that occur during episodes of patient care [11]. Physicians can make prompt, smarter, and more efficient decisions with informed knowledge of a patient’s health history, such as previous diagnoses, treatments, and tests. It will also be cost-effective and may save the cost of repeated tests and maximize the value of services delivered to patients. Most medical data transmission is still through mail or fax due to the lack of trusted and secure infrastructure and the mandatory requirement of privacy and sensitivity. Security and privacy are the utmost critical factors in healthcare. Privacy refers to persons having the right to allow or disclose personal information to others, forcing providers and authorities to create agreed policies and procedures [16]. EHR can be utilized and maliciously exploited in two different ways. External agents like marketers can exploit patients' data for malicious purposes. EHR can also help make or break a diagnosis, such as avoiding injecting any substance a patient is allergic to. Safeguarding privacy includes access control of patients’ information, security of patient data from unauthorized users, and the modification and destruction of stored data [16]. Blockchain holds great promise in healthcare and is believed to have more potential applications than any industry besides the financial industry. Blockchain is a list of records linked together using cryptography, a secure communication technique that allows only the sender and intended recipient of a message to view its contents [3]. Each block is unique, consisting of a specific algorithm of the previous block, transaction data, and timestamp [15]. Because a block is a byproduct of the previous block, data cannot be modified, allowing transactions to be recorded factually and with better security [15]. Blockchain allows users to have complete control of data and privacy without a central point of control, thus making it highly cost-effective and efficient for building applications for sharing EHR data [3]. Leveraging Blockchain-Based Electronic Health Record Systems in Healthcare 4.0 Manish Shashi