I
AE
S In
t
er
na
t
io
na
l J
o
urna
l o
f
Art
if
icia
l In
t
ellig
ence
(
I
J
-
AI
)
Vo
l.
15
,
No
.
1
,
Feb
r
u
ar
y
20
26
,
p
p
.
310
~
321
I
SS
N:
2
2
5
2
-
8
9
3
8
,
DOI
: 1
0
.
1
1
5
9
1
/ijai.v
15
.i
1
.
p
p
3
1
0
-
3
2
1
310
J
o
ur
na
l ho
m
ep
a
g
e
:
h
ttp
:
//ij
a
i
.
ia
esco
r
e.
co
m
Secure and
int
erop
erab
le ele
ctronic
health r
ecord e
x
c
ha
ng
e
using
blockcha
in
a
nd ECD
H
E
-
ba
se
d acces
s co
ntrol
K
rish
na
P
ra
s
a
d Na
ra
s
im
ha
Ra
o
,
Selv
a
n
Chin
na
iy
a
n
S
c
h
o
o
l
o
f
C
o
m
p
u
t
e
r
S
c
i
e
n
c
e
a
n
d
E
n
g
i
n
e
e
r
i
n
g
,
R
e
v
a
U
n
i
v
e
r
si
t
y
,
B
e
n
g
a
l
u
r
u
,
I
n
d
i
a
Art
icle
I
nfo
AB
S
T
RAC
T
A
r
ticle
his
to
r
y:
R
ec
eiv
ed
May
23
,
2
0
2
5
R
ev
is
ed
Dec
28
,
2
0
2
5
Acc
ep
ted
J
an
10
,
2
0
2
6
El
e
c
tro
n
ic
h
e
a
lt
h
re
c
o
r
d
s
(EHRs)
a
c
t
a
s
c
o
m
p
re
h
e
n
siv
e
re
c
o
rd
s
o
f
h
e
a
lt
h
-
re
late
d
tran
sa
c
ti
o
n
s
a
n
d
e
ss
e
n
ti
a
l
re
so
u
rc
e
s
o
f
d
a
ta
in
th
e
h
e
a
lt
h
c
a
re
se
c
to
r.
Ho
we
v
e
r,
th
e
in
teg
ri
ty
a
n
d
se
c
u
rit
y
p
r
o
b
lem
s
o
f
EHR
c
o
n
t
i
n
u
e
to
b
e
in
flex
i
b
le.
T
h
e
a
rc
h
it
e
c
tu
re
o
f
b
l
o
c
k
c
h
a
in
-
e
n
a
b
led
EHR
a
d
d
re
ss
e
s
th
e
issu
e
s
o
f
in
te
g
rit
y
e
fficie
n
t
ly
.
Th
is
p
a
p
e
r
d
e
v
e
lo
p
e
d
t
h
e
d
e
c
e
n
tralize
d
p
a
ti
e
n
t
-
c
e
n
tri
c
h
e
a
lt
h
c
a
re
d
a
ta
m
a
n
a
g
e
m
e
n
t
(P
CHD
M
)
sy
ste
m
u
si
n
g
b
lo
c
k
c
h
a
in
-
e
n
a
b
led
EHR
a
rc
h
it
e
c
tu
re
fo
r
a
d
d
re
ss
in
g
p
ro
b
lem
s
with
a
c
c
e
s
s
c
o
n
tro
l
,
re
c
o
rd
p
ri
v
a
c
y
a
n
d
d
a
ta
c
o
n
fid
e
n
t
i
a
li
ty
.
T
h
is
fra
m
e
wo
rk
p
lac
e
s
th
e
p
a
ti
e
n
t
a
t
th
e
c
o
n
tr
o
l
c
e
n
ter,
e
n
s
u
rin
g
se
c
u
re
sto
ra
g
e
o
f
EHR
re
c
o
rd
s
a
n
d
o
b
tai
n
in
g
e
fficie
n
t
d
a
ta
m
a
n
a
g
e
m
e
n
t
th
ro
u
g
h
t
h
e
in
teg
ra
ti
o
n
o
f
b
l
o
c
k
c
h
a
in
a
n
d
in
terp
lan
e
tar
y
fil
e
sy
ste
m
(IP
F
S
)
.
To
p
re
v
e
n
t
a
c
c
e
ss
b
y
u
n
a
u
th
o
ri
z
e
d
u
se
rs,
th
e
p
r
o
p
o
se
d
e
ll
i
p
ti
c
c
u
r
v
e
Diffie
-
He
ll
m
a
n
e
p
h
e
m
e
ra
l
(ECDHE)
m
e
c
h
a
n
ism
in
c
o
rp
o
ra
tes
sm
a
rt
c
o
n
trac
t
-
e
n
a
b
led
a
c
c
e
ss
c
o
n
tro
l
f
o
r
m
a
n
a
g
in
g
EHR
tran
sa
c
ti
o
n
s
a
n
d
e
n
f
o
rc
in
g
a
c
c
e
s
s
stra
teg
ies
.
Th
is
a
rc
h
it
e
c
tu
re
in
c
o
rp
o
ra
tes
h
y
p
e
rle
d
g
e
r
fa
b
ric
e
n
d
o
rse
m
e
n
t
p
o
li
c
ies
(HFRP
)
to
a
d
d
re
ss
sc
a
lab
il
it
y
p
ro
b
lem
s
wh
il
e
p
re
se
rv
in
g
p
a
ti
e
n
t
p
riv
a
c
y
a
n
d
se
c
u
ri
n
g
m
e
d
ica
l
d
a
ta.
Th
e
d
e
v
e
lo
p
e
d
m
e
th
o
d
se
c
u
re
s
th
e
E
HR
d
a
ta
a
n
d
fa
c
il
it
a
tes
th
e
d
a
ta
e
x
c
h
a
n
g
e
a
c
ro
ss
h
e
tero
g
e
n
e
o
u
s
h
e
a
lt
h
c
a
re
p
latfo
rm
s,
e
n
su
r
in
g
sta
n
d
a
r
d
c
o
m
m
u
n
ica
ti
o
n
a
m
o
n
g
d
iffere
n
t
EHR
sy
ste
m
s.
Th
e
a
rc
h
it
e
c
tu
re
i
s
a
ss
e
ss
e
d
with
p
a
ra
m
e
ters
o
f
ti
m
e
fo
r
b
l
o
c
k
c
re
a
ti
o
n
,
t
h
e
c
o
m
p
u
tatio
n
a
l
o
v
e
rh
e
a
d
o
f
tran
sa
c
ti
o
n
wit
h
e
n
c
r
y
p
ti
o
n
k
e
y
si
z
e
a
n
d
EHR
u
p
l
o
a
d
a
n
d
d
o
wn
l
o
a
d
ti
m
e
.
K
ey
w
o
r
d
s
:
Acc
ess
co
n
tr
o
l
B
lo
ck
ch
ain
-
b
ased
HE
R
E
lectr
o
n
ic
h
ea
lth
r
ec
o
r
d
s
HFR
P
I
n
ter
p
lan
etar
y
f
ile
s
y
s
tem
Patien
t p
r
iv
ac
y
Patien
t
-
ce
n
tr
ic
h
ea
lth
-
ca
r
e
d
a
ta
m
an
ag
em
en
t
T
h
is i
s
a
n
o
p
e
n
a
c
c
e
ss
a
rticle
u
n
d
e
r th
e
CC B
Y
-
SA
li
c
e
n
se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
Kr
is
h
n
a
Pra
s
ad
Nar
asimh
a
R
ao
Sch
o
o
l o
f
C
o
m
p
u
ter
Scien
ce
a
n
d
E
n
g
in
ee
r
in
g
,
R
ev
a
Un
iv
er
s
ity
B
en
g
alu
r
u
,
I
n
d
ia
E
m
ail: r
2
0
p
cs0
9
@
cit.
r
ev
a.
e
d
u
.
in
1.
I
NT
RO
D
UCT
I
O
N
Hea
lth
d
ata
is
g
en
er
ally
s
to
r
e
d
in
d
atab
ases
,
wh
ich
m
a
k
es
it
v
u
ln
er
ab
le
to
t
h
ef
t
an
d
tam
p
er
in
g
[
1
]
.
T
h
er
ef
o
r
e,
th
e
h
ea
lth
ca
r
e
d
ata
r
eq
u
ir
e
d
to
b
e
s
av
e
d
elec
tr
o
n
ically
f
o
r
r
em
o
v
in
g
is
s
u
es
to
ex
ch
an
g
e
th
e
d
ata
an
d
v
is
u
aliza
tio
n
o
f
d
ata
b
etw
ee
n
h
ea
lth
ca
r
e
p
r
o
v
i
d
er
s
[
2
]
.
A
h
u
g
e
am
o
u
n
t o
f
elec
tr
o
n
ic
h
ea
lth
r
ec
o
r
d
s
(
E
HR
)
d
ev
elo
p
e
d
as
d
i
g
ital
h
ea
lth
ca
r
e
p
r
o
ce
s
s
[
3
]
.
T
h
e
r
ap
id
ad
o
p
tio
n
o
f
E
HR
d
e
m
an
d
s
u
n
p
a
r
alleled
d
ata
s
ec
u
r
ity
i
n
h
ea
lth
ca
r
e
in
d
u
s
tr
y
[
4
]
.
Ad
d
itio
n
ally
,
th
e
lim
itatio
n
s
d
r
awn
b
y
C
OVI
D
-
1
9
o
n
r
em
o
t
e
p
r
o
ce
s
s
h
av
e
an
im
p
o
r
tan
ce
o
f
s
ec
u
r
ity
b
r
ea
k
s
,
p
ar
ticu
lar
l
y
in
s
itu
atio
n
s
wh
er
e
co
n
f
id
en
tial
p
atien
t
in
f
o
r
m
atio
n
is
p
r
o
ce
s
s
ed
o
n
lin
e
f
o
r
tr
an
s
m
is
s
io
n
[
5
]
.
Mo
r
eo
v
er
,
p
atien
ts
f
ac
e
r
is
k
s
d
u
e
to
th
e
p
o
ten
tial
ex
p
o
s
u
r
e
o
f
th
eir
p
er
s
o
n
al
h
ea
lth
in
f
o
r
m
atio
n
[
6
]
.
T
h
e
u
s
e
o
f
a
p
atien
t’
s
p
er
s
o
n
al
in
f
o
r
m
atio
n
f
o
r
v
a
r
io
u
s
s
ec
o
n
d
a
r
y
p
u
r
p
o
s
es
with
o
u
t
th
eir
co
n
s
en
t sig
n
if
ican
tly
co
m
p
r
o
m
is
es p
atien
t p
r
i
v
ac
y
[
7
]
.
Ap
ar
t
f
r
o
m
i
n
f
o
r
m
atio
n
s
ec
u
r
i
ty
,
p
atien
ts
ar
e
allo
wed
to
p
r
o
f
it
f
in
an
cially
f
r
o
m
s
h
ar
in
g
t
h
eir
h
ea
lth
d
ata.
T
h
er
ef
o
r
e,
s
y
s
tem
th
at
en
s
u
r
es
s
ec
u
r
e
E
HR
s
to
r
ag
e
an
d
im
p
lem
e
n
ts
an
ap
p
r
o
v
e
d
r
etr
iev
al
alg
o
r
it
h
m
with
p
atien
t
co
n
tr
o
l
an
d
in
ce
n
t
iv
e
m
ec
h
a
n
is
m
s
is
th
e
s
o
lu
tio
n
f
o
r
th
ese
is
s
u
es
[
8
]
.
T
h
e
b
lo
ck
ch
ain
-
b
ased
E
HR
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Ar
tif
I
n
tell
I
SS
N:
2252
-
8
9
3
8
S
ec
u
r
e
a
n
d
in
tero
p
era
b
le
elec
tr
o
n
ic
h
ea
lth
r
ec
o
r
d
ex
ch
a
n
g
e
u
s
in
g
… (
K
r
is
h
n
a
P
r
a
s
a
d
N
a
r
a
s
imh
a
R
a
o
)
311
s
y
s
tem
en
s
u
r
es
s
ec
u
r
e
s
to
r
ag
e
o
f
p
atien
t
d
ata,
wh
ile
its
s
m
ar
t
co
n
tr
ac
t
-
d
e
p
en
d
e
n
t
m
eth
o
d
en
ab
les
s
ec
u
r
e
ex
ch
an
g
e
o
f
r
ec
o
r
d
s
b
etwe
en
au
th
en
ticated
u
s
er
s
[
9
]
.
T
h
e
a
u
d
it
tr
ail
t
r
ac
k
in
g
tr
an
s
ac
tio
n
s
o
n
th
e
b
lo
c
k
ch
ain
p
r
o
v
id
es
o
p
p
o
r
tu
n
ities
to
in
ce
n
tiv
ize
d
ata
s
h
ar
in
g
f
o
r
p
atie
n
ts
[
1
0
]
.
T
h
o
u
g
h
b
lo
c
k
ch
ain
-
b
ased
s
y
s
tem
o
f
f
er
s
h
ig
h
r
ec
o
r
d
s
to
r
ag
e
,
as
well
as
o
f
f
er
s
ex
p
en
s
iv
e
s
o
lu
tio
n
s
[
1
1
]
.
T
h
er
ef
o
r
e,
th
e
b
lo
ck
c
h
ain
-
b
ased
s
y
s
tem
is
d
ev
elo
p
e
d
with
in
ter
p
lan
etar
y
f
ile
s
y
s
tem
(
I
PF
S)
f
o
r
o
r
i
g
in
al
s
to
r
ag
e
r
ec
o
r
d
s
[
1
2
]
.
I
t
is
a
co
s
t
-
ef
f
ec
tiv
e
s
o
lu
tio
n
f
o
r
E
HR
s
to
r
ag
e
r
e
q
u
ir
em
en
ts
b
u
t
m
o
r
eo
v
er
s
u
f
f
er
s
f
r
o
m
th
e
c
o
m
p
lex
ity
o
f
th
e
alg
o
r
ith
m
o
f
m
ap
p
in
g
d
ata
r
ec
o
r
d
s
f
o
r
tr
an
s
ac
tio
n
s
[
1
3
]
.
Dev
elo
p
in
g
b
l
o
ck
ch
ai
n
-
b
ased
ap
p
licatio
n
s
f
o
r
p
atien
ts
an
d
p
r
o
v
id
er
s
h
as
th
e
ca
p
a
b
ilit
y
o
f
m
itig
atin
g
in
ter
o
p
er
a
b
ilit
y
b
ar
r
ier
s
am
o
n
g
c
o
m
m
er
cial
E
HR
s
y
s
tem
s
.
T
h
ese
ap
p
licatio
n
s
en
ab
le
p
atien
ts
to
h
av
e
co
m
p
lete
co
n
tr
o
l
o
v
e
r
th
eir
h
e
alth
ca
r
e
r
ec
o
r
d
s
,
g
r
an
tin
g
p
er
m
is
s
io
n
to
p
r
o
v
id
e
r
s
to
s
h
ar
e
d
ata
as
n
ee
d
ed
[
1
4
]
,
[
1
5
]
.
I
n
th
is
m
a
n
u
s
cr
ip
t,
in
t
eg
r
ated
d
esig
n
o
f
p
atien
t
-
ce
n
tr
ic,
s
ec
u
r
e
an
d
in
ter
o
p
er
a
b
le
E
HR
ex
ch
an
g
e
f
r
am
ewo
r
k
.
Par
ticu
lar
ly
,
d
ev
e
lo
p
ed
a
f
iv
e
-
p
h
ase
in
ter
o
p
e
r
a
b
ilit
y
ar
ch
itectu
r
e
wh
ich
in
co
r
p
o
r
ates
h
ea
lth
lev
el
s
ev
en
-
f
ast
h
ea
lth
ca
r
e
r
eso
u
r
c
es
(
HL
7
-
FHI
R
)
s
tan
d
ar
d
izati
o
n
,
s
m
ar
t
co
n
t
r
ac
t
-
en
ab
le
d
r
eg
is
tr
ies
an
d
cr
o
s
s
-
ch
ain
d
ata
ex
c
h
an
g
e
b
y
wr
ap
p
er
tr
an
s
ac
tio
n
s
.
Mo
r
eo
v
e
r
,
in
teg
r
atio
n
o
f
ellip
tic
cu
r
v
e
Dif
f
ie
-
Hellm
an
ep
h
em
er
al
(
E
C
DHE
)
with
d
y
n
am
ic,
r
o
le
-
b
ased
ac
ce
s
s
co
n
tr
o
l
(
R
B
AC
)
an
d
s
ess
i
o
n
-
lev
el
en
c
r
y
p
tio
n
in
tr
o
d
u
ce
d
m
u
lti
-
lay
e
r
ed
s
ec
u
r
ity
m
ec
h
an
is
m
f
o
r
r
ea
l
-
tim
e,
c
o
n
s
en
t
-
b
ased
E
HR
s
h
ar
in
g
.
So
n
k
am
b
le
et
a
l
.
[
1
6
]
s
u
g
g
e
s
ted
th
e
d
ec
en
tr
alize
d
p
atien
t
-
ce
n
ter
ed
h
ea
lth
ca
r
e
d
ata
m
a
n
ag
em
en
t
(
PC
HDM
)
alo
n
g
b
lo
ck
ch
ain
-
e
n
ab
led
E
HR
f
o
r
h
an
d
lin
g
th
e
ch
allen
g
es
o
f
ac
ce
s
s
co
n
tr
o
l,
r
ec
o
r
d
p
r
iv
ac
y
an
d
co
n
f
id
en
tiality
.
Fo
r
c
o
n
tr
o
llin
g
u
n
au
th
o
r
ized
u
s
er
s
,
d
ev
elo
p
ed
s
ec
u
r
e
p
ass
wo
r
d
au
t
h
en
ti
ca
tio
n
-
en
ab
led
k
ey
ex
ch
an
g
e
(
SP
AKE
)
in
tr
o
d
u
ce
d
th
e
s
m
ar
t
co
n
tr
ac
t
-
en
ab
led
ac
ce
s
s
co
n
tr
o
l
f
o
r
th
e
tr
an
s
ac
tio
n
o
f
E
HR
an
d
ac
ce
s
s
s
tr
ateg
ies.
Díaz
an
d
K
asch
el
[
1
7
]
p
r
esen
ted
th
e
E
H
R
m
an
ag
em
en
t
m
eth
o
d
d
e
p
en
d
in
g
o
n
en
titi
es,
an
d
u
s
er
r
o
les
a
n
d
in
tr
o
d
u
ce
d
h
y
p
er
led
g
er
f
a
b
r
ic
in
d
o
u
b
le
-
c
h
an
n
el
co
n
f
ig
u
r
atio
n
.
Her
e,
p
r
esen
ted
p
r
o
to
ty
p
e
im
p
lem
en
ted
in
h
y
p
e
r
led
g
er
f
ab
r
ic
b
y
s
in
g
le
an
d
d
o
u
b
le
-
ch
an
n
el
co
n
f
i
g
u
r
atio
n
.
T
h
e
p
r
esen
ted
alg
o
r
ith
m
p
r
o
v
id
es
a
s
o
lu
tio
n
lik
e
th
e
h
y
p
e
r
led
g
er
f
ab
r
ic
p
latf
o
r
m
,
wh
ich
p
r
o
v
i
d
es
an
alter
n
at
iv
e
f
o
r
ad
d
r
ess
in
g
s
ca
lab
ilit
y
ch
allen
g
es
an
d
f
o
r
p
r
ev
en
tin
g
th
e
p
r
iv
ac
y
o
f
th
e
p
atien
t
an
d
th
e
s
ec
u
r
ity
o
f
m
e
d
ical
in
f
o
r
m
atio
n
.
Mh
am
d
i
et
a
l.
[
1
8
]
in
tr
o
d
u
ce
d
th
e
SEM
R
Ach
ain
d
ev
ic
e
d
ep
en
d
in
g
ac
ce
s
s
co
n
t
r
o
l
an
d
s
m
ar
t
co
n
tr
ac
t
alg
o
r
ith
m
.
T
h
e
ac
ce
s
s
co
n
tr
o
l
m
ec
h
a
n
is
m
s
lik
e
R
B
AC
an
d
attr
ib
u
te
-
B
AC
(
AB
AC
)
wer
e
u
s
ed
i
n
th
is
ap
p
r
o
ac
h
.
B
y
u
s
in
g
b
lo
ck
c
h
ain
as
s
ec
u
r
e
d
is
tr
ib
u
ted
led
g
er
an
d
ac
ce
s
s
co
n
tr
o
l
m
ec
h
an
is
m
,
th
e
s
y
s
tem
g
iv
es
s
tak
eh
o
ld
er
s
with
tr
an
s
p
ar
e
n
c
y
,
cr
ed
ib
ilit
y
,
im
m
u
tab
ilit
y
an
d
tr
u
s
two
r
th
in
ess
.
Am
an
at
et
a
l
.
[
1
9
]
in
tr
o
d
u
ce
d
th
e
ar
ch
itectu
r
e
d
ep
en
d
ed
o
n
b
lo
ck
c
h
ain
tec
h
n
o
lo
g
y
wh
ic
h
au
th
en
ticated
a
u
s
er
id
en
tity
b
y
p
r
o
o
f
o
f
s
tak
e
(
POS)
cr
y
p
to
g
r
ap
h
ic
m
ec
h
an
is
m
an
d
s
ec
u
r
e
h
ash
alg
o
r
ith
m
(
SHA2
5
6
)
f
o
r
s
ec
u
r
i
n
g
th
e
s
h
ar
in
g
o
f
E
HR
b
etwe
en
v
ar
io
u
s
elec
tr
o
n
ic
h
ea
lth
ca
r
e
d
e
v
ices.
Sam
m
eta
an
d
Par
th
ib
an
[
2
0
]
im
p
lem
en
ted
t
h
e
h
y
p
er
led
g
e
r
b
lo
c
k
ch
ain
e
n
ab
led
s
ec
u
r
e
m
e
d
ical
d
ata
m
a
n
ag
em
en
t
with
d
ee
p
lear
n
in
g
e
n
ab
led
d
iag
n
o
s
is
(
HB
E
SDM
-
DL
D)
m
eth
o
d
.
I
m
p
lem
en
ted
m
et
h
o
d
in
v
o
l
v
ed
d
if
f
er
en
t
p
h
ases
lik
e
en
cr
y
p
tio
n
,
g
en
e
r
atio
n
o
f
o
p
tim
u
m
k
ey
,
h
y
p
er
led
g
er
b
lo
ck
ch
ain
-
en
a
b
led
s
ec
u
r
ed
d
ata
m
an
ag
em
en
t
an
d
d
iag
n
o
s
is
.
T
o
en
h
an
ce
th
e
e
f
f
ec
tiv
en
ess
o
f
a
Simo
n
alg
o
r
i
th
m
,
th
e
g
r
o
u
p
teac
h
in
g
o
p
ti
m
izatio
n
alg
o
r
ith
m
(
GT
OA)
was
em
p
lo
y
ed
to
g
en
er
ate
a
b
est
k
ey
o
f
a
Simo
n
alg
o
r
ith
m
.
Kau
r
et
a
l
.
[
2
1
]
p
r
esen
ted
a
n
o
v
el
s
ec
u
r
ity
f
r
am
ewo
r
k
th
at
co
m
b
in
ed
b
lo
ck
ch
ai
n
an
d
s
o
f
twar
e
-
d
ef
in
ed
n
etwo
r
k
(
SDN)
alg
o
r
ith
m
s
,
ze
r
o
-
tr
u
s
t
(
Z
T
)
f
o
r
a
d
d
r
ess
in
g
t
h
e
is
s
u
es
in
laten
cy
-
s
en
s
itiv
e
h
ea
lth
ca
r
e
en
v
ir
o
n
m
en
ts
.
T
h
e
p
r
esen
te
d
m
eth
o
d
e
n
h
an
ce
d
s
ec
u
r
ity
b
y
in
teg
r
atin
g
an
im
m
u
tab
le
tr
a
n
s
ac
tio
n
lo
g
,
e
n
s
u
r
in
g
d
ata
in
teg
r
ity
,
an
d
tr
ac
ea
b
ilit
y
,
wh
ile
s
u
p
p
o
r
tin
g
d
y
n
am
ic
n
etwo
r
k
c
o
n
f
ig
u
r
atio
n
s
.
Selv
ar
aj
et
a
l
.
[
2
2
]
s
u
g
g
ested
t
h
e
ef
f
ec
tiv
e
a
d
ap
tiv
e
f
ea
tu
r
e
c
en
tr
ic
p
o
ly
n
o
m
ial
(
AFC
P)
d
at
a
s
ec
u
r
ity
m
eth
o
d
.
T
h
e
s
u
g
g
ested
m
eth
o
d
is
ad
ap
ted
to
en
s
u
r
e
s
ec
u
r
ity
f
o
r
all
ty
p
es
o
f
d
ata.
T
h
e
s
u
g
g
ested
s
ch
em
e
ca
teg
o
r
ized
E
HR
d
ata
f
ea
tu
r
es
in
to
v
ar
io
u
s
class
e
s
d
ep
en
d
in
g
o
n
th
e
s
ig
n
if
ican
ce
id
en
ti
f
ied
f
r
o
m
th
e
d
ata.
T
h
e
m
eth
o
d
e
n
f
o
r
ce
d
a
h
ea
lt
h
y
tr
u
s
t
ac
ce
s
s
r
estrictio
n
to
r
estrict
m
alicio
u
s
ac
ce
s
s
.
N
atar
ajan
et
a
l
.
[
2
3
]
in
tr
o
d
u
ce
d
th
e
s
ec
u
r
ed
p
atie
n
t
lo
g
in
cr
e
d
en
tial
s
y
s
tem
(
PLCS
)
to
E
HR
d
ata
ex
c
h
an
g
e
in
clu
d
in
g
b
lo
c
k
en
cr
y
p
tio
n
with
a
s
y
m
m
etr
ic
an
d
asy
m
m
etr
ic
m
ec
h
an
is
m
f
o
r
h
o
s
p
ital
s
er
v
er
s
an
d
p
at
ien
ts
.
Mo
r
eo
v
er
,
a
q
u
an
tu
m
s
ec
u
r
e
t
r
u
s
t
p
r
o
to
c
o
l
(
QSTP)
was
co
m
b
in
ed
to
im
p
r
o
v
e
tr
u
s
t
an
d
s
ec
u
r
ity
a
m
o
n
g
p
atien
ts
an
d
h
o
s
p
itals
,
en
s
u
r
in
g
d
ata
s
ec
u
r
i
ty
an
d
co
n
f
i
d
en
tiality
.
T
h
o
u
g
h
ex
is
tin
g
HE
R
m
an
ag
e
m
en
t
s
y
s
tem
s
s
u
f
f
er
s
f
r
o
m
cr
itical
is
s
u
es
r
elate
d
to
d
ata
p
r
iv
ac
y
,
u
n
au
th
o
r
ized
ac
ce
s
s
,
lack
o
f
p
atie
n
t
co
n
tr
o
l
an
d
lim
i
ted
in
ter
o
p
er
ab
ilit
y
ac
r
o
s
s
h
eter
o
g
e
n
eo
u
s
p
latf
o
r
m
s
.
T
r
ad
itio
n
al
b
lo
c
k
c
h
ain
s
o
lu
tio
n
s
,
b
en
ef
icial
i
n
s
ec
u
r
ity
an
d
au
d
itab
ilit
y
s
till
f
ac
es
ch
allen
g
es
in
s
ca
lab
ilit
y
,
s
ec
u
r
e
k
ey
ex
ch
a
n
g
e
a
n
d
ef
f
ec
tiv
e
o
f
f
-
ch
ain
d
ata
s
to
r
a
g
e.
Ad
d
itio
n
ally
,
m
an
y
ex
is
tin
g
alg
o
r
ith
m
s
lack
s
o
f
u
n
if
ied
f
r
am
ewo
r
k
th
at
s
im
u
ltan
eo
u
s
ly
en
s
u
r
es
s
ec
u
r
e
ac
ce
s
s
co
n
tr
o
l,
p
atien
t
-
ce
n
tr
ic
d
ata
o
wn
er
s
h
ip
an
d
s
ea
m
less
in
ter
o
p
er
ab
ilit
y
ac
r
o
s
s
m
u
ltip
le
b
lo
ck
c
h
ain
n
e
two
r
k
s
.
T
h
e
m
ain
o
b
jectiv
e
o
f
th
is
m
an
u
s
cr
ip
t
is
to
d
ev
elo
p
th
e
b
l
o
ck
ch
ain
-
e
n
ab
led
,
p
atien
t
-
ce
n
tr
ic
E
H
R
d
ata
ex
ch
an
g
e
f
r
am
ewo
r
k
wh
ich
co
m
b
in
es
E
C
DHE
f
o
r
s
ec
u
r
e
k
e
y
ex
ch
a
n
g
e,
I
PF
S
f
o
r
s
ca
lab
le
o
f
f
-
c
h
ain
s
to
r
ag
e
an
d
h
y
p
er
led
g
e
r
f
ab
r
i
c
f
o
r
p
er
m
is
s
io
n
ed
b
lo
ck
c
h
ai
n
ac
ce
s
s
.
T
h
e
d
e
v
elo
p
ed
alg
o
r
ith
m
aim
s
to
en
s
u
r
e
d
y
n
am
ic,
R
B
AC
b
y
s
m
ar
t
co
n
tr
ac
ts
,
en
s
u
r
es
p
atien
t
au
th
o
r
izatio
n
in
ev
er
y
p
h
ase
an
d
e
n
ab
les
s
ec
u
r
e
an
d
in
ter
o
p
er
a
b
le
d
ata
s
h
ar
in
g
ac
r
o
s
s
d
if
f
er
en
t
h
ea
lth
c
ar
e
en
tit
ies
u
s
in
g
HL
7
-
FHI
R
s
tan
d
ar
d
s
an
d
cr
o
s
s
-
ch
ain
co
m
m
u
n
icatio
n
p
r
o
to
co
ls
.
T
h
e
s
ig
n
if
ican
t
c
o
n
tr
ib
u
tio
n
s
o
f
t
h
is
m
an
u
s
cr
ip
t
a
r
e
d
e
s
cr
ib
ed
as
f
o
llo
ws:
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
9
3
8
I
n
t J Ar
tif
I
n
tell
,
Vo
l.
15
,
No
.
1
,
Feb
r
u
ar
y
20
26
:
310
-
3
2
1
312
d
ev
elo
p
e
d
th
e
b
l
o
ck
ch
ain
-
en
a
b
led
E
HR
ar
ch
itectu
r
e
alo
n
g
with
o
n
-
ch
ain
tr
an
s
ac
tio
n
s
an
d
o
f
f
-
ch
ain
s
to
r
a
g
e.
Dev
elo
p
ed
E
C
DHE
alg
o
r
ith
m
f
o
r
s
ec
u
r
e
s
m
ar
t
-
co
n
tr
ac
t
en
ab
led
ac
ce
s
s
co
n
tr
o
l
f
o
r
in
tr
o
d
u
ce
th
e
p
atien
t
ce
n
tr
ical
co
n
tr
o
l
o
n
E
HR
d
a
ta.
T
h
e
h
y
p
er
le
d
g
er
f
ab
r
ic
e
n
d
o
r
s
em
en
t
p
o
licie
s
(
HFR
P)
r
ely
o
n
o
n
-
ch
ai
n
tr
an
s
ac
tio
n
s
,
wh
ile
an
I
PF
S is
u
s
ed
o
n
o
f
f
-
c
h
ain
s
to
r
ag
e
o
f
E
HR
d
ata.
T
h
is
p
ap
er
is
s
y
s
tem
ized
as
f
o
llo
ws:
s
ec
tio
n
2
g
iv
es
d
etai
ls
o
f
a
d
ev
elo
p
e
d
alg
o
r
ith
m
.
Sectio
n
3
g
iv
es th
e
r
esu
lts
an
d
d
is
cu
s
s
io
n
o
f
th
e
p
r
o
p
o
s
ed
m
o
d
el.
T
h
e
co
n
clu
s
io
n
o
f
th
is
r
esear
ch
is
g
iv
en
in
s
ec
tio
n
4
.
2.
P
RO
P
O
SE
D
M
E
T
H
O
D
T
h
e
r
ap
id
ev
o
lu
tio
n
o
f
h
ea
lt
h
ca
r
e
is
d
r
iv
en
b
y
im
p
r
o
v
ed
p
atien
t
ca
r
e
s
er
v
ices.
T
h
e
E
HR
s
ar
e
n
u
m
er
ically
s
av
ed
r
ec
o
r
d
s
co
n
tain
in
g
h
ea
lth
ca
r
e
r
ele
v
an
ce
d
ata.
T
h
e
h
ea
lth
ca
r
e
in
f
o
r
m
ati
o
n
is
s
im
p
ly
s
h
ar
ed
o
v
er
d
if
f
er
en
t
h
ea
lth
ca
r
e
p
r
o
v
id
er
s
b
ec
au
s
e
o
f
E
HR
.
T
h
is
en
h
an
ce
s
h
ea
lth
ca
r
e
b
y
o
f
f
er
i
n
g
ac
cu
r
ate
h
ea
lth
r
ec
o
r
d
s
(
HR
)
in
s
itu
atio
n
s
.
Ho
wev
er
,
d
ev
ice
p
r
iv
ac
y
an
d
s
ec
u
r
ity
p
r
o
tectio
n
ar
e
ch
allen
g
in
g
to
m
ain
tain
.
B
lo
ck
ch
ain
h
as
em
er
g
ed
as
a
p
r
ac
tical
tech
n
o
lo
g
y
th
at
is
ex
p
an
d
in
g
ac
r
o
s
s
v
ar
io
u
s
in
d
u
s
tr
ies.
Giv
en
th
e
n
ee
d
o
n
p
atien
t
-
ce
n
tr
ic
s
y
s
tem
s
an
d
an
in
teg
r
atio
n
o
f
d
if
f
er
e
n
t
s
y
s
tem
s
,
b
lo
ck
ch
ain
h
as
s
ig
n
if
ican
t
p
o
te
n
tial
in
h
ea
lth
in
f
o
r
m
atio
n
.
T
h
is
p
a
p
er
,
p
r
im
ar
ily
f
o
cu
s
es
o
n
b
l
o
ck
ch
ain
-
e
n
ab
led
h
ea
lth
ca
r
e
d
ata
m
an
ag
e
m
en
t,
em
p
h
asizin
g
an
e
x
ch
an
g
e
o
f
E
HR
d
ata
am
o
n
g
h
ea
lth
ca
r
e
p
r
o
v
id
e
r
s
an
d
r
esear
ch
a
n
aly
s
es.
T
h
e
d
ev
elo
p
e
d
m
eth
o
d
s
ec
u
r
es
a
E
HR
d
ata
an
d
f
ac
ilit
ates
th
e
d
ata
ex
c
h
a
n
g
e
ac
r
o
s
s
h
eter
o
g
en
e
o
u
s
h
e
alth
ca
r
e
p
latf
o
r
m
s
,
en
s
u
r
in
g
s
tan
d
ar
d
c
o
m
m
u
n
icatio
n
am
o
n
g
d
i
f
f
er
en
t
E
HR
s
y
s
tem
s
.
Fig
u
r
e
1
r
ep
r
esen
ts
th
e
p
r
o
ce
s
s
o
f
b
lo
ck
ch
ain
-
en
ab
led
d
ata
ex
c
h
an
g
e
f
o
r
E
HR
.
Data
o
wn
er
is
a
p
atien
t
an
d
it
co
n
tain
s
o
wn
er
s
h
i
p
ac
r
o
s
s
its
h
ea
lth
d
ata.
I
t
ca
n
b
e
s
h
ar
e
d
if
r
eq
u
i
r
ed
.
T
h
e
p
atien
t
au
th
o
r
izatio
n
is
p
r
o
ce
s
s
ed
with
th
e
E
C
DHE
ac
ce
s
s
co
n
tr
o
l
m
ec
h
an
is
m
b
y
u
tili
zin
g
s
m
ar
t
co
n
tr
ac
ts
.
Patien
ts
ar
e
au
t
h
o
r
i
ze
d
to
g
r
an
t
h
ea
lth
ca
r
e
p
r
o
v
i
d
er
s
ac
ce
s
s
to
th
eir
E
HR
s
,
wh
ich
ar
e
s
h
ar
ed
b
y
p
r
o
v
id
e
r
s
with
p
atien
t’
s
p
e
r
m
is
s
io
n
.
T
h
e
h
ash
es
o
f
HE
R
an
d
m
ain
attr
ib
u
tes
ar
e
s
av
ed
o
n
a
b
l
o
ck
ch
ain
an
d
o
r
ig
in
al
d
ata
in
a
f
o
r
m
at
o
f
d
o
cu
m
en
t
is
s
av
ed
o
n
I
PF
S.
T
h
er
ef
o
r
e
,
th
e
ar
ticle
aim
s
to
c
r
ea
te
p
atien
t
-
ce
n
tr
ic
E
HR
s
y
s
tem
.
T
h
e
ch
allen
g
in
g
p
r
o
b
lem
is
to
en
s
u
r
e
ac
ce
s
s
co
n
tr
o
l
an
d
d
ata
p
r
i
v
ac
y
wh
i
ch
is
ac
ce
s
s
ed
an
d
s
h
ar
ed
.
Dev
elo
p
ed
s
o
lu
tio
n
p
r
ev
en
ts
p
atien
t
p
r
iv
ac
y
o
n
E
HR
s
b
y
th
e
h
ea
lth
ca
r
e
d
ata
-
s
h
a
r
in
g
p
r
o
ce
s
s
wh
ich
in
v
o
lv
es
th
e
r
estrictio
n
o
f
a
cc
ess
an
d
d
ata
en
cr
y
p
tio
n
.
Ad
d
itio
n
ally
,
an
in
-
d
ep
th
an
aly
s
is
o
f
p
r
iv
ac
y
,
in
f
o
r
m
atio
n
s
ec
u
r
ity
an
d
r
eq
u
i
r
em
en
ts
o
f
ac
ce
s
s
co
n
tr
o
l o
n
b
lo
ck
ch
ain
-
b
ased
s
ec
u
r
ity
is
co
n
d
u
cted
.
2
.
1
.
Da
t
a
s
t
o
r
a
g
e
o
f
elec
t
ro
n
ic
hea
lt
h r
ec
o
rd
T
h
e
m
ain
aim
is
to
d
e
v
elo
p
an
ap
p
r
o
ac
h
to
s
to
r
e
p
o
r
tio
n
s
o
f
E
HR
o
n
b
lo
ck
c
h
ain
,
in
co
r
p
o
r
atin
g
s
tan
d
ar
d
s
lik
e
HL
7
-
FHI
R
d
at
a
s
tan
d
ar
d
f
o
r
b
lo
ck
c
h
ain
-
b
as
ed
d
ata
s
to
r
ag
e.
T
h
is
e
n
ab
led
u
s
to
k
ee
p
tr
ac
k
o
f
d
ata
ab
o
u
t
th
e
p
atien
t
o
n
HE
R
wh
ich
f
o
llo
ws
HL
7
-
FHI
R
s
tan
d
ar
d
.
T
h
e
r
ef
o
r
e
,
th
e
HL
7
g
iv
es
a
co
m
p
lete
an
aly
s
is
o
f
p
r
o
p
e
r
E
HR
h
a
n
d
lin
g
.
Patien
t
ce
n
tr
ic
h
ea
lth
-
ca
r
e
d
ata
m
an
ag
e
m
en
t
(
PC
DH
M)
is
th
e
d
ev
elo
p
ed
s
o
lu
tio
n
f
o
r
t
h
e
is
s
u
e.
T
h
is
s
y
s
tem
is
d
ev
elo
p
ed
u
s
in
g
I
PF
S,
a
p
e
r
m
is
s
io
n
ed
d
ec
e
n
tr
aliz
ed
s
to
r
ag
e
s
o
lu
tio
n
d
ep
en
d
e
n
t
o
n
h
y
p
er
led
g
er
f
a
b
r
ic
wh
ich
s
av
es
h
ea
lth
d
ata
wi
th
an
o
w
n
er
’
s
co
n
s
en
t.
T
h
e
cr
y
p
to
g
r
a
p
h
ic
p
u
b
lic
k
ey
en
cr
y
p
tio
n
m
ec
h
an
is
m
is
tak
en
f
o
r
e
n
cr
y
p
tin
g
I
PF
S d
ata
f
o
r
estab
lis
h
in
g
th
e
E
HR
b
lo
c
k
ch
ain
d
e
v
ice.
I
n
a
h
ea
lth
ch
ain
s
tr
u
ctu
r
e
m
eth
o
d
,
th
e
B
y
za
n
tin
e
f
a
u
lt
to
ler
a
n
ce
(
B
FT)
is
u
s
ed
f
o
r
ch
o
o
s
in
g
an
d
i
d
en
tify
in
g
b
lo
ck
s
to
in
clu
d
e
i
n
a
b
lo
c
k
c
h
ain
.
Fig
u
r
e
1
r
ep
r
esen
ts
th
e
p
r
o
ce
s
s
o
f
b
lo
c
k
ch
ain
-
b
ased
d
ata
ex
ch
an
g
e
f
o
r
E
HR
an
d
th
e
Fig
u
r
e
2
r
ep
r
esen
ts
th
e
ar
ch
itectu
r
e
o
f
in
ter
o
p
e
r
ab
ilit
y
p
r
o
ce
s
s
.
Fig
u
r
e
1
.
Pro
ce
s
s
o
f
b
lo
ck
c
h
ai
n
-
en
ab
led
d
ata
ex
c
h
an
g
e
f
o
r
E
HR
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Ar
tif
I
n
tell
I
SS
N:
2252
-
8
9
3
8
S
ec
u
r
e
a
n
d
in
tero
p
era
b
le
elec
tr
o
n
ic
h
ea
lth
r
ec
o
r
d
ex
ch
a
n
g
e
u
s
in
g
… (
K
r
is
h
n
a
P
r
a
s
a
d
N
a
r
a
s
imh
a
R
a
o
)
313
Fig
u
r
e
2
.
Ar
c
h
itectu
r
e
o
f
in
ter
o
p
er
ab
ilit
y
2
.
1
.
1
.
I
nte
ro
pera
bil
it
y
s
t
ruct
ure
T
o
o
b
tain
in
ter
o
p
er
ab
ilit
y
,
th
e
E
HR
s
f
o
llo
w
th
e
g
e
n
er
al
s
tan
d
ar
d
.
T
h
e
HL
7
-
FHI
R
en
s
u
r
ed
th
at
E
HR
d
ata
was
s
tr
u
ctu
r
ed
an
d
ac
ce
s
s
ib
le
ac
r
o
s
s
v
ar
io
u
s
b
lo
ck
ch
ain
p
latf
o
r
m
s
.
T
h
e
HL
7
-
FHI
R
en
ab
les
s
ec
u
r
e
d
ata
q
u
er
ies
an
d
r
etr
iev
als
ac
r
o
s
s
h
o
s
p
itals
.
T
h
is
en
s
u
r
es
th
e
co
m
p
atib
ilit
y
am
o
n
g
h
y
p
e
r
led
g
er
f
ab
r
ic
an
d
o
th
e
r
b
lo
ck
ch
ain
b
ased
h
ea
lth
ca
r
e
s
y
s
tem
s
[
2
4
]
,
[
2
5
]
.
Fig
u
r
e
2
r
ep
r
esen
ts
th
e
ar
ch
itectu
r
e
o
f
t
h
e
in
ter
o
p
e
r
ab
ilit
y
m
eth
o
d
.
T
h
is
in
clu
d
es
th
e
in
ter
m
ed
iate
co
n
tr
ac
t
wh
ich
i
n
clu
d
es
a
n
am
e,
n
etwo
r
k
an
d
ad
d
r
ess
o
f
ev
er
y
h
o
s
p
ital
co
n
tr
ac
t.
W
h
ile
Ho
s
p
ital
1
n
ee
d
s
ac
ce
s
s
to
in
f
o
r
m
atio
n
f
r
o
m
Ho
s
p
ital
2
,
th
e
f
o
llo
win
g
s
tep
s
wer
e
f
o
llo
wed
.
‒
Switch
to
in
-
b
etwe
en
co
n
tr
ac
t
n
etwo
r
k
.
‒
R
etr
iev
es n
etwo
r
k
an
d
a
d
d
r
ess
o
n
Ho
s
p
ital
2
.
‒
Switch
to
a
n
etwo
r
k
in
Ho
s
p
ital
2
.
‒
R
etr
iev
es c
o
m
p
o
n
en
ts
f
r
o
m
a
co
n
tr
ac
t o
f
Ho
s
p
ital
2
.
‒
R
etu
r
n
to
an
ac
tu
al
co
n
tr
ac
t
n
etwo
r
k
an
d
r
e
v
er
t
in
f
o
r
m
ati
o
n
.
T
h
is
p
r
o
ce
d
u
r
e
p
e
r
m
its
to
s
ec
u
r
ity
an
d
co
n
tr
o
l o
f
d
ata
s
h
ar
i
n
g
am
o
n
g
v
ar
io
u
s
co
n
t
r
ac
ts
o
f
th
e
h
o
s
p
it
al.
2
.
1
.
2
.
Cro
s
s
-
cha
in inte
ro
pera
bil
it
y
T
h
is
m
eth
o
d
allo
wed
th
e
u
s
er
s
to
d
ir
ec
t
ex
ch
an
g
e
ass
is
t
s
am
o
n
g
v
ar
io
u
s
b
lo
ck
c
h
ain
s
with
o
u
t
r
eq
u
ir
in
g
in
ter
m
e
d
iates.
T
h
e
wr
ap
p
ed
t
o
k
en
s
in
a
s
in
g
le
b
l
o
ck
ch
ain
a
r
e
wr
ap
p
ed
to
d
ev
e
lo
p
th
e
illu
s
tr
atio
n
i
n
d
if
f
er
en
t
b
l
o
ck
ch
ain
s
an
d
e
n
ab
le
its
u
tili
za
tio
n
in
v
ar
io
u
s
ec
o
s
y
s
tem
s
.
I
n
d
iv
id
u
al
b
lo
ck
ch
ain
s
ca
lled
s
id
ec
h
ain
s
ar
e
in
teg
r
ated
with
th
e
p
r
im
ar
y
b
lo
c
k
ch
ain
,
allo
ws
d
ef
in
ed
task
s
to
b
e
p
r
o
ce
s
s
ed
o
n
a
s
id
ec
h
ain
wh
en
m
ain
tain
in
g
in
teg
r
atio
n
with
a
p
r
im
ar
y
ch
ain
.
S
m
ar
t
co
n
tr
ac
ts
ac
t
as
b
r
id
g
es
am
o
n
g
v
ar
i
o
u
s
b
lo
ck
ch
ain
s
,
f
ac
ilit
atin
g
a
tr
a
n
s
m
is
s
io
n
o
f
in
f
o
r
m
atio
n
a
n
d
ass
is
tin
g
in
th
eir
i
n
ter
ac
tio
n
s
.
T
h
is
p
latf
o
r
m
is
d
ev
elo
p
e
d
with
attr
ib
u
tes
o
f
cr
o
s
s
-
ch
ain
in
ter
o
p
er
ab
ilit
y
allo
ws
s
ev
er
al
b
lo
ck
c
h
ain
s
to
b
e
i
n
teg
r
ated
in
to
h
u
g
e
n
etwo
r
k
s
.
T
h
is
i
n
ter
o
p
e
r
ab
ilit
y
en
ab
le
d
u
tili
za
tio
n
o
f
s
p
ec
ialized
attr
ib
u
tes
f
r
o
m
v
ar
io
u
s
b
lo
ck
c
h
ain
s
in
t
h
e
s
p
ec
if
ied
ec
o
s
y
s
tem
.
Ass
et
s
m
o
v
e
s
ea
m
less
ly
am
o
n
g
b
lo
c
k
ch
ain
s
,
en
ab
lin
g
m
u
ch
m
o
r
e
ef
f
ec
tiv
e
u
s
ag
e
an
d
tr
ad
in
g
.
I
n
te
r
o
p
er
a
b
ilit
y
s
u
p
p
o
r
ts
th
e
ea
s
e
o
f
co
n
g
esti
o
n
o
n
o
n
e
b
lo
c
k
ch
ain
th
r
o
u
g
h
d
is
tr
ib
u
tes
th
e
tr
an
s
ac
tio
n
s
o
v
er
m
u
ltip
le
ch
ain
s
.
T
h
is
in
ter
o
p
e
r
ab
ilit
y
h
el
p
s
th
e
co
llab
o
r
atio
n
am
o
n
g
v
ar
io
u
s
p
r
o
jects
an
d
p
latf
o
r
m
s
.
T
h
is
in
ter
o
p
er
ab
ilit
y
p
lay
s
a
n
ess
en
tial
p
ar
t
in
m
itig
atin
g
th
e
d
r
awb
ac
k
s
o
f
i
s
o
lated
b
lo
ck
c
h
ain
s
an
d
d
e
v
elo
p
in
g
th
e
m
u
ch
in
ter
r
elate
d
an
d
ad
ap
tab
le
b
lo
c
k
ch
ain
.
Fig
u
r
e
3
r
ep
r
esen
ts
t
h
e
ar
ch
itectu
r
e
o
f
cr
o
s
s
-
ch
ain
in
ter
o
p
er
ab
ilit
y
p
r
o
ce
s
s
.
Fig
u
r
e
3
.
Ar
c
h
itectu
r
e
o
f
cr
o
s
s
-
ch
ain
in
ter
o
p
er
ab
ilit
y
T
h
e
ec
o
s
y
s
tem
o
f
b
lo
ck
ch
ai
n
co
n
tin
u
es
to
v
alid
ate,
an
d
s
o
lu
tio
n
s
o
n
cr
o
s
s
-
ch
ain
c
o
m
m
u
n
i
ca
tio
n
an
d
in
f
o
r
m
atio
n
s
h
ar
in
g
a
r
e
ess
en
tial
to
o
b
tain
m
ajo
r
s
p
r
ea
d
ad
o
p
tio
n
an
d
f
u
lly
r
ea
lizin
g
a
s
ig
n
if
ica
n
ce
o
n
d
ec
en
tr
alize
d
tech
n
iq
u
es.
Fig
u
r
e
3
r
ep
r
esen
ts
th
e
ar
ch
itectu
r
e
o
f
cr
o
s
s
-
ch
ain
i
n
ter
o
p
e
r
ab
il
ity
.
I
n
ter
o
p
er
ab
ilit
y
o
f
th
e
p
r
o
p
o
s
ed
b
lo
ck
c
h
ain
-
en
ab
led
E
HR
s
y
s
tem
,
o
b
tain
e
d
b
y
ad
o
p
tin
g
th
e
HL
7
-
FHI
R
s
tan
d
ar
d
s
f
o
r
e
n
s
u
r
in
g
d
ata
co
n
s
is
ten
cy
a
n
d
ac
ce
s
s
ib
ilit
y
ac
r
o
s
s
d
if
f
er
e
n
t
h
ea
lth
ca
r
e
p
latf
o
r
m
s
.
T
h
e
in
ter
o
p
er
ab
il
ity
s
tr
u
ctu
r
e
o
f
t
h
e
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
9
3
8
I
n
t J Ar
tif
I
n
tell
,
Vo
l.
15
,
No
.
1
,
Feb
r
u
ar
y
20
26
:
310
-
3
2
1
314
s
y
s
tem
en
ab
les
s
ec
u
r
e
an
d
s
tr
u
ctu
r
ed
q
u
er
ies
am
o
n
g
h
o
s
p
it
als,
en
s
u
r
in
g
th
at
E
HR
s
ar
e
h
an
d
led
c
o
n
s
is
ten
tly
.
Ad
d
itio
n
ally
,
cr
o
s
s
-
ch
ain
in
te
r
o
p
er
a
b
ilit
y
allo
ws
d
ir
ec
t
d
ata
ex
ch
an
g
e
am
o
n
g
v
ar
io
u
s
b
lo
ck
ch
ain
s
with
o
u
t
r
ely
in
g
o
n
in
ter
m
ed
iates,
u
tili
zin
g
b
r
id
g
e
s
m
ar
t
co
n
tr
ac
ts
an
d
wr
ap
p
ed
to
k
en
s
.
T
h
is
in
t
eg
r
atio
n
f
ac
ilit
ates
b
lo
ck
ch
ain
f
ea
tu
r
es,
im
p
r
o
v
es
co
llab
o
r
atio
n
am
o
n
g
h
ea
l
th
ca
r
e
p
r
o
v
id
er
s
an
d
h
elp
s
o
v
er
co
m
e
n
etwo
r
k
co
n
g
esti
o
n
.
Hen
ce
,
th
ese
m
ec
h
an
is
m
s
ar
e
m
u
ch
m
o
r
e
ad
ap
tab
le
an
d
r
eliab
le
f
o
r
d
ig
ital
h
ea
lth
ca
r
e
in
f
r
astru
ctu
r
e.
I
n
ter
o
p
er
ab
ilit
y
in
b
lo
c
k
ch
ain
-
e
n
ab
led
h
ea
lth
ca
r
e
d
ata
ex
ch
an
g
e
is
s
ig
n
i
f
ican
t
f
o
r
e
n
s
u
r
in
g
s
ea
m
less
co
m
m
u
n
icatio
n
am
o
n
g
v
ar
i
o
u
s
en
titi
es
lik
e
h
o
s
p
it
als,
d
iag
n
o
s
tic
ce
n
ter
s
an
d
in
s
u
r
an
ce
p
r
o
v
id
er
s
.
T
h
is
r
esear
ch
in
tr
o
d
u
ce
d
th
e
f
iv
e
-
s
tag
e
in
ter
o
p
er
ab
ilit
y
f
r
a
m
ewo
r
k
wh
ich
f
ac
ilit
ates
ef
f
ec
tiv
e
an
d
s
ec
u
r
e
d
ata
ex
ch
an
g
e
am
o
n
g
b
lo
c
k
ch
ain
n
etwo
r
k
s
.
i)
Stag
e
1
:
d
ata
s
tan
d
ar
d
izatio
n
—
in
in
itial
p
h
ase
in
clu
d
es
s
tan
d
ar
d
izin
g
th
e
p
atien
t
d
ata
b
y
HL
7
-
FHI
R
f
r
am
ewo
r
k
,
wh
ich
en
a
b
les
s
t
r
u
ctu
r
ed
a
n
d
in
ter
p
r
etab
le
E
HR
.
T
h
is
en
s
u
r
ed
th
at
v
ar
io
u
s
h
ea
lth
ca
r
e
s
y
s
tem
s
ex
ch
an
g
e
an
d
p
r
o
ce
s
s
d
ata
with
o
u
t c
o
m
p
atib
ilit
y
p
r
o
b
lem
s
.
ii)
Stag
e
2
:
s
m
ar
t
co
n
tr
ac
t
—
en
ab
led
r
eg
is
tr
y
f
o
r
in
ter
o
p
er
a
b
ilit
y
-
th
e
in
ter
o
p
er
ab
ilit
y
s
m
ar
t
c
o
n
tr
ast
(
I
SC
)
is
d
ep
lo
y
e
d
to
b
e
co
n
s
id
er
e
d
a
s
a
r
eg
is
tr
y
th
at
h
a
n
d
les
m
e
tad
ata
o
f
p
a
r
ticip
atin
g
h
o
s
p
itals
.
R
eg
is
tr
y
in
clu
d
es:
‒
Ho
s
p
ital id
en
tifie
r
s
:
b
lo
ck
ch
ai
n
ad
d
r
ess
es.
‒
Sm
ar
t c
o
n
tr
ac
t I
Ds
:
to
q
u
er
y
t
h
e
m
ed
ical
r
ec
o
r
d
s
.
‒
Acc
ess
p
ar
am
eter
s
:
f
o
r
d
ata
r
etr
iev
al
r
eq
u
ests
.
W
h
en
Ho
s
p
ital
1
r
eq
u
ests
th
e
p
atien
ts
’
d
ata
f
r
o
m
Ho
s
p
ital
2
,
I
SC
v
er
if
ies cr
ed
e
n
tials
an
d
f
o
r
war
d
s
a
r
eq
u
est.
iii)
Stag
e
3
:
s
ec
u
r
e
r
eq
u
est
an
d
r
e
tr
iev
al
p
r
o
ce
s
s
—
af
ter
I
SC
v
er
if
ies
a
r
eq
u
est,
th
e
d
ata
ex
c
h
a
n
g
e
p
r
o
ce
s
s
is
g
iv
en
as f
o
llo
ws.
‒
Ho
s
p
ital A
s
en
d
s
th
e
q
u
er
y
t
o
I
SC
with
th
e
p
atien
t I
D
an
d
n
e
ed
ed
m
ed
ical
r
e
q
u
ests
.
‒
I
SC
f
o
r
war
d
s
a
r
eq
u
est to
th
e
s
m
ar
t c
o
n
tr
ac
t o
f
Ho
s
p
ital
2.
‒
Ho
s
p
ital
2
co
m
p
u
tes ac
ce
s
s
co
n
tr
o
l m
ec
h
a
n
is
m
s
f
o
r
v
e
r
if
y
in
g
th
e
au
th
e
n
ticity
o
f
r
eq
u
ester
s
.
‒
W
h
eth
er
v
er
if
ied
,
th
e
r
eq
u
ested
E
HR
is
en
cr
y
p
ted
an
d
tr
an
s
m
itted
b
ac
k
to
Ho
s
p
ital
1
th
r
o
u
g
h
th
e
b
lo
ck
ch
ain
n
etwo
r
k
.
iv
)
Stag
e
4
:
cr
o
s
s
-
ch
ain
in
ter
o
p
er
ab
ilit
y
b
y
wr
ap
p
er
tr
a
n
s
ac
tio
n
s
—
wh
er
e
v
ar
io
u
s
b
lo
ck
ch
ain
n
etwo
r
k
s
ar
e
in
v
o
lv
ed
,
th
e
cr
o
s
s
-
ch
ain
co
m
m
u
n
icatio
n
p
r
o
to
c
o
l is u
tili
ze
d
.
‒
T
h
e
r
eq
u
ested
d
ata
is
h
ash
ed
a
n
d
lo
ck
e
d
in
th
e
o
r
ig
in
b
lo
ck
c
h
ain
.
‒
T
h
e
wr
ap
p
e
d
to
k
e
n
r
ep
r
esen
ts
d
ata
th
at
is
p
r
o
d
u
ce
d
a
n
d
s
en
t
to
th
e
d
esire
d
b
lo
ck
ch
ai
n
.
‒
R
ec
eiv
in
g
h
o
s
p
ital r
ed
ee
m
s
a
wr
ap
p
ed
to
k
en
to
s
ec
u
r
ely
ac
c
ess
th
e
ac
tu
al
d
ata.
v)
Stag
e
5
:
s
ec
u
r
e
d
ata
d
ec
r
y
p
ti
o
n
an
d
ac
ce
s
s
—
r
ec
eiv
in
g
an
en
cr
y
p
ted
E
HR
,
Ho
s
p
ital
1
d
ec
r
y
p
ts
d
ata
b
y
E
C
DHE
k
ey
ex
ch
an
g
e.
T
h
is
e
n
s
u
r
es e
n
d
-
to
-
en
d
s
ec
u
r
ity
an
d
p
r
ev
en
ts
u
n
au
th
o
r
ized
ac
ce
s
s
.
2
.
2
.
H
y
perledg
er
f
a
bric
blo
c
k
cha
in
I
n
th
is
p
ap
er
,
th
e
u
s
er
s
h
o
u
ld
r
eg
is
ter
to
u
tili
ze
p
er
m
is
s
io
n
-
r
elied
h
y
p
er
le
d
g
er
b
lo
c
k
ch
ai
n
n
etwo
r
k
.
Me
ch
an
is
m
o
f
ac
ce
s
s
co
n
tr
o
l
an
d
m
o
d
el
o
n
h
y
p
er
led
g
e
r
is
u
tili
ze
d
f
o
r
m
an
ag
in
g
th
e
p
er
m
is
s
io
n
in
th
e
n
etwo
r
k
.
I
t
is
th
e
d
is
tr
ib
u
ted
led
g
er
s
o
lu
tio
n
f
r
am
ewo
r
k
,
t
h
at
o
f
f
er
s
g
r
ea
t
lev
els
o
f
r
o
b
u
s
tn
ess
,
ad
ap
tab
ilit
y
,
co
n
f
id
en
tiality
,
a
n
d
s
ca
lab
ilit
y
.
T
h
is
is
s
u
p
p
o
r
ted
th
r
o
u
g
h
a
m
o
d
u
la
r
s
tr
u
ctu
r
e.
As
an
o
u
tco
m
e,
th
e
clo
s
ed
b
lo
ck
ch
ain
is
n
ee
d
ed
,
th
at
m
ain
tain
th
e
n
ee
d
e
d
p
r
i
v
ac
y
.
Hy
p
er
led
g
e
r
f
ab
r
ic
h
elp
s
m
u
ltip
le
au
th
o
r
izatio
n
lay
er
s
,
allo
win
g
in
f
o
r
m
atio
n
o
wn
er
s
to
co
n
tr
o
l
p
o
r
ti
o
n
o
f
its
in
f
o
r
m
atio
n
is
ac
ce
s
s
ib
le.
T
h
is
m
ak
es
a
g
o
o
d
ch
o
ice
o
n
m
a
n
ag
in
g
ac
ce
s
s
o
n
h
ea
lth
ca
r
e
r
ec
o
r
d
s
.
Sm
ar
t
co
n
tr
ac
t
n
eg
o
tiatio
n
s
f
o
llo
w
ed
r
u
les
o
n
s
m
ar
t
co
n
tr
ac
t
s
to
r
ag
e.
Patien
t
-
ce
n
ter
ed
h
ea
lth
ca
r
e
d
ata
m
an
ag
em
en
t
ac
ce
s
s
co
n
tr
o
l
u
s
in
g
s
m
ar
t
co
n
tr
ac
t
(
PC
HDM
A
C
-
SC
)
is
a
f
r
a
m
ewo
r
k
d
ev
elo
p
ed
t
o
c
h
ain
co
d
e
o
n
a
R
B
AC
alg
o
r
ith
m
.
Dep
en
d
in
g
o
n
p
r
e
-
d
eter
m
i
n
ed
p
ar
ticip
an
ts
,
t
h
e
p
er
m
is
s
io
n
ed
b
lo
ck
c
h
ain
ass
ig
n
s
h
y
p
er
led
g
er
f
ab
r
ic
f
o
r
ef
f
icien
tly
s
h
ar
e
h
ea
lth
d
ata
with
o
u
t
r
ely
in
g
o
n
o
n
e
au
th
o
r
ity
.
Hy
p
er
led
g
e
r
f
ab
r
ic
em
p
lo
y
s
a
B
FT
co
m
p
r
o
m
is
es
p
r
o
to
c
o
l,
en
ab
lin
g
co
n
s
en
s
u
s
with
o
u
t
th
e
n
ee
d
f
o
r
n
ativ
e
c
r
y
p
to
c
u
r
r
en
cy
.
T
h
e
I
PF
S
o
b
jects
ar
e
u
tili
ze
d
to
r
ep
licate
th
r
o
u
g
h
g
r
ap
h
tr
ee
ar
c
h
itectu
r
e
ca
lled
as
Me
r
k
le
d
ir
ec
ted
ac
y
clic,
ac
t
as
a
s
tate
d
ata
s
o
u
r
c
e
to
a
h
y
p
er
le
d
g
er
b
lo
ck
ch
ain
.
T
h
e
o
f
f
-
ch
ai
n
an
d
o
n
-
ch
ain
b
lo
c
k
ch
ain
s
ar
e
d
esig
n
ed
to
s
to
r
e
HR
s
an
d
u
s
e
I
PF
S.
T
h
e
p
r
ec
is
e
ac
ce
s
s
co
n
tr
o
l
s
y
s
tem
i
s
d
esi
g
n
ed
wh
ich
u
s
es
th
e
h
y
p
er
le
d
g
er
b
lo
ck
c
h
ain
an
d
PC
HDM
AC
-
SC
p
r
o
to
co
l
f
o
r
av
o
id
in
g
th
e
attac
k
in
g
with
o
u
t
p
atien
t p
er
m
is
s
io
n
.
2
.
3
.
P
a
t
ient
-
ce
nte
re
d hea
lt
hca
re
da
t
a
m
a
na
g
e
m
ent
s
y
s
t
e
m
T
h
is
s
y
s
tem
ar
ch
itectu
r
e
u
tili
ze
s
th
r
ee
p
ee
r
n
o
d
es
f
o
r
d
ev
elo
p
in
g
t
h
e
web
ap
p
s
f
o
r
o
n
e
o
r
g
an
izatio
n
,
u
tili
zin
g
h
y
p
er
led
g
er
c
r
ea
to
r
u
s
er
p
er
m
is
s
io
n
b
lo
ck
ch
ai
n
d
ep
e
n
d
ed
o
n
h
y
p
er
le
d
g
er
f
ab
r
ic.
Or
g
an
izatio
n
u
tili
ze
s
th
r
ee
p
ee
r
n
o
d
es;
o
n
e
ac
ts
as
v
alid
atio
n
o
n
th
e
p
ee
r
n
o
d
e
a
n
d
n
ex
t
ac
t
as
o
r
d
er
i
n
g
n
o
d
e
to
r
e
g
is
ter
s
tak
eh
o
ld
er
s
.
Mu
lti
-
p
ee
r
s
ac
c
ess
a
s
im
ilar
d
ata
s
o
u
r
ce
in
th
e
s
y
s
tem
,
wh
ich
is
ac
h
iev
e
d
th
r
o
u
g
h
I
PF
S
to
d
is
tr
ib
u
te
d
ata
s
to
r
ag
e.
B
lo
ck
ch
ain
c
o
n
n
ec
tiv
it
y
is
s
u
p
p
o
r
ted
b
y
c
o
m
p
o
n
en
ts
lik
e
in
f
o
r
m
atio
n
ce
r
tific
ate
au
th
o
r
ity
,
s
m
ar
t c
o
n
tr
ac
ts
,
th
e
m
em
b
er
s
h
ip
s
er
v
ice
p
r
o
v
id
er
(
MSP)
an
d
o
r
d
e
r
ed
n
o
d
es.
Mu
l
ti p
ee
r
s
d
is
tr
ib
u
ted
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Ar
tif
I
n
tell
I
SS
N:
2252
-
8
9
3
8
S
ec
u
r
e
a
n
d
in
tero
p
era
b
le
elec
tr
o
n
ic
h
ea
lth
r
ec
o
r
d
ex
ch
a
n
g
e
u
s
in
g
… (
K
r
is
h
n
a
P
r
a
s
a
d
N
a
r
a
s
imh
a
R
a
o
)
315
ac
r
o
s
s
d
if
f
er
en
t
lo
ca
tio
n
s
an
d
m
ac
h
in
es
to
ev
alu
ate
s
y
s
tem
s
ca
lab
ilit
y
.
T
h
is
ar
ch
itectu
r
e
en
ab
les
s
m
ar
t
co
n
tr
ac
ts
to
ac
ce
s
s
th
e
led
g
e
r
,
with
m
u
ltip
le
p
ee
r
s
d
is
tr
ib
u
ted
ac
r
o
s
s
d
if
f
er
en
t
lo
ca
tio
n
s
an
d
m
ac
h
in
es
to
ev
alu
ate
s
y
s
tem
s
ca
lab
ilit
y
.
T
h
ese
p
ee
r
n
o
d
es
ar
e
in
teg
r
ate
d
in
to
an
ap
p
licatio
n
,
u
tili
ze
s
s
m
ar
t
co
n
tr
ac
ts
o
n
u
p
d
atin
g
a
led
g
e
r
.
T
h
e
s
y
s
tem
co
n
s
is
ts
o
f
th
r
ee
p
ee
r
n
o
d
es
p
ee
r
n
o
d
e
0
(
PE0
)
,
p
ee
r
n
o
d
e
1
(
PE1
)
an
d
p
ee
r
n
o
d
e
2
(
PE2
)
ev
er
y
o
n
e
m
ain
tain
i
n
g
c
o
p
ies
o
n
led
g
er
a
n
d
s
m
ar
t
co
n
tr
ac
ts
.
T
h
e
o
n
e
ch
an
n
el
in
h
y
p
er
led
g
er
co
m
p
o
s
er
m
ad
e
th
e
p
ee
r
tr
an
s
m
is
s
io
n
f
e
asib
le.
T
h
is
n
etwo
r
k
d
ev
el
o
p
s
th
e
tr
an
s
ac
tio
n
an
d
s
en
d
s
th
a
t
to
PE0
,
PE1
,
an
d
PE2
.
T
h
e
p
ee
r
in
s
tall
ch
ain
n
o
d
es
d
ep
en
d
ed
o
n
tr
a
n
s
ac
tio
n
ex
ec
u
tio
n
.
Fo
r
co
m
m
u
n
icatio
n
with
p
ee
r
s
,
an
ap
p
licatio
n
ass
ig
n
s
ch
ain
co
d
e
s
wh
ile
r
eq
u
esti
n
g
o
r
m
o
d
if
y
i
n
g
a
le
d
g
er
.
HR
ch
ain
n
etwo
r
k
en
ab
le
d
b
lo
c
k
s
in
a
b
lo
ck
ch
ain
f
o
r
d
is
p
lay
in
g
th
e
h
ash
v
alu
es
as
m
o
d
if
ied
i
n
h
is
to
r
y
wh
ich
m
ad
e
f
o
r
a
f
r
am
ewo
r
k
.
B
lo
ck
in
led
g
er
,
wh
ic
h
co
r
r
esp
o
n
d
s
to
th
e
p
atien
t’
s
h
ea
lth
r
ec
o
r
d
,
m
ajo
r
ly
c
o
n
s
is
ts
o
f
tr
an
s
ac
tio
n
s
(
)
,
p
r
esen
t
tr
an
s
ac
tio
n
is
r
ep
r
esen
ted
as
ℎ
(
)
an
d
h
ash
o
f
p
ast
tr
an
s
ac
tio
n
s
is
r
ep
r
esen
ted
as
ℎ
(
)
.
B
y
u
s
in
g
t
h
e
(
)
,
b
lo
ck
wo
r
k
lo
ad
is
d
eter
m
in
ed
,
an
d
its
m
ath
em
atica
l
f
o
r
m
u
la
is
g
iv
en
as
(
1
)
.
T
h
e
E
H
R
in
clu
d
es
d
etails
lik
e
d
iag
n
o
s
ed
d
is
ea
s
e,
r
ec
o
m
m
e
n
d
atio
n
o
f
a
d
o
ct
o
r
,
ad
d
r
ess
,
p
o
s
itio
n
,
I
D
o
f
th
e
h
o
s
p
ital,
p
atien
t
p
r
o
f
ile,
f
u
r
th
er
r
ev
iew
n
o
tes,
d
o
cto
r
n
a
m
e,
m
ed
icin
e
,
an
d
s
ca
n
an
d
test
im
ag
e
r
ep
o
r
ts
.
PC
HDM
co
n
s
id
er
s
a
f
o
llo
win
g
s
tak
eh
o
ld
er
to
ac
c
o
u
n
t
.
(
)
=
(
)
+
ℎ
(
)
+
ℎ
(
)
(
1
)
R
ec
o
r
d
o
wn
er
—
HR
s
b
elo
n
g
to
p
atien
ts
.
PC
HDM
AC
-
SC
a
g
r
ee
m
en
t
is
s
ig
n
ed
th
r
o
u
g
h
t
h
e
p
atien
t
an
d
s
av
ed
o
n
a
h
y
p
e
r
led
g
er
b
l
o
ck
ch
ain
.
Patien
ts
co
n
tr
o
l
ac
ce
s
s
p
er
m
is
s
io
n
f
o
r
v
iewin
g
its
h
ea
lth
ca
r
e
r
ep
o
r
ts
b
y
h
ea
lth
ca
r
e
r
ec
o
r
d
ch
ai
n
n
et
wo
r
k
s
,
with
ea
ch
PC
HDM
AC
-
SC
d
eter
m
in
in
g
ac
ce
s
s
b
ased
o
n
its
co
n
tex
t.
Data
u
p
lo
ad
er
—
f
o
r
d
ata
u
p
lo
ad
er
s
.
T
h
e
p
r
i
m
ar
y
r
esp
o
n
s
ib
ilit
y
is
to
u
p
lo
ad
p
atien
t
h
ea
l
th
d
ata
b
y
en
cr
y
p
tin
g
th
e
clin
ical
in
f
o
r
m
atio
n
o
f
a
f
f
ec
ted
in
d
iv
id
u
a
ls
an
d
ad
d
in
g
it
to
I
PF
S
n
e
two
r
k
.
T
h
e
i
n
itial
tr
an
s
ac
tio
n
s
ar
e
th
en
a
u
th
o
r
ize
d
o
n
a
b
lo
ck
c
h
ain
.
Data
u
s
er
s
—
p
ar
ties
in
ter
ested
in
o
b
tain
i
n
g
clin
ical
o
r
h
e
alth
in
f
o
r
m
atio
n
ab
o
u
t
p
atie
n
ts
,
s
u
ch
as
p
h
y
s
ician
s
,
in
s
u
r
an
ce
co
m
p
a
n
ies,
h
o
s
p
itals
,
an
d
r
esear
ch
e
r
s
ar
e
r
ep
r
esen
te
d
as
d
ata
c
u
s
to
m
er
s
with
in
th
e
d
ata
u
s
er
ca
teg
o
r
y
.
An
ac
ce
s
s
co
n
tr
o
l
m
ec
h
an
is
m
is
o
f
f
er
e
d
b
a
s
ed
o
n
r
o
les.
T
h
is
m
ec
h
a
n
is
m
allo
ws
p
atien
ts
to
p
r
o
v
id
e
ac
ce
s
s
r
ig
h
ts
f
o
r
d
ata
u
s
er
s
th
r
o
u
g
h
PC
HSMA
C
-
SC
.
2
.
4
.
Da
t
a
encr
y
ptio
n
C
r
y
p
to
g
r
ap
h
ic
alg
o
r
ith
m
s
lik
e
p
ar
in
g
-
e
n
ab
led
c
r
y
p
to
g
r
ap
h
y
,
s
ec
u
r
e
cr
y
p
to
g
r
a
p
h
y
alg
o
r
ith
m
s
lik
e
p
r
o
x
y
r
e
-
e
n
cr
y
p
tio
n
a
n
d
p
u
b
lic
k
ey
c
r
y
p
t
o
g
r
ap
h
y
o
f
f
e
r
co
n
f
id
e
n
tiality
an
d
in
teg
r
it
y
f
o
r
b
lo
c
k
ch
ain
in
f
o
r
m
atio
n
.
T
h
e
p
atien
ts
an
d
d
o
cto
r
s
h
av
e
in
ter
ac
tio
n
wh
en
ac
ce
s
s
it
s
H
R
s
,
d
o
cto
r
s
g
iv
e
I
PF
S
H
R
s
an
d
n
ex
t
r
eq
u
est
f
o
r
ac
ce
s
s
in
g
th
e
r
ec
o
r
d
s
.
T
h
is
ap
p
r
o
ac
h
en
ab
les
r
eq
u
est
-
en
ab
led
,
p
atien
t
-
ce
n
tr
ic
v
iew
o
f
r
ec
o
r
d
s
,
r
ath
er
th
a
n
d
is
clo
s
in
g
a
p
ati
en
t’
s
en
tire
in
f
o
r
m
atio
n
.
Ses
s
io
n
k
ey
is
en
cr
y
p
ted
an
d
s
av
ed
,
e
n
ab
lin
g
a
p
atien
t
-
ce
n
tr
ic
v
iew
o
f
r
ec
o
r
d
s
o
n
I
PF
S.
T
h
is
k
ey
is
n
ee
d
ed
f
o
r
r
etr
ie
v
in
g
r
ec
o
r
d
s
f
o
r
p
a
r
ticu
lar
s
ess
io
n
.
B
o
th
a
s
ess
io
n
k
ey
an
d
en
c
r
y
p
ted
p
atien
t
-
ce
n
tr
ic
v
iews
ar
e
s
h
ar
ed
with
p
atien
ts
an
d
d
o
cto
r
s
.
Per
s
p
ec
tiv
e
o
f
p
atien
t
-
ce
n
tr
ic
an
d
is
d
ec
r
y
p
ted
th
r
o
u
g
h
d
o
cto
r
s
to
u
p
d
ate
p
atien
t H
R
.
T
h
e
p
atien
t i
s
in
f
o
r
m
ed
to
f
o
llo
w
an
u
p
d
ate
o
f
I
PF
S
r
ec
o
r
d
.
T
h
e
v
iew
o
f
p
atien
t
-
ce
n
tr
ic
an
d
is
a
u
to
m
atica
lly
elim
in
ated
wh
ile
HR
is
co
m
m
itted
th
r
o
u
g
h
a
p
atien
t.
HR
ac
ce
s
s
is
p
r
o
s
cr
ib
ed
f
o
r
s
tak
eh
o
l
d
er
s
t
ill
a
co
n
s
en
t
o
f
p
atien
t
is
p
r
o
v
id
ed
.
T
h
is
m
eth
o
d
p
r
ev
en
ts
p
atien
t
p
r
iv
ac
y
.
Data
h
ash
v
alu
e
is
s
af
ely
s
av
ed
o
n
th
e
h
y
p
er
led
g
e
r
b
lo
ck
c
h
ain
u
s
in
g
s
m
ar
t
ch
ain
co
d
e,
wh
ich
p
r
o
ce
s
s
es
it
in
th
e
s
y
s
tem
’
s
b
ac
k
en
d
.
As
a
n
o
u
tco
m
e
,
th
e
led
g
e
r
in
f
o
r
m
s
th
e
p
atien
t
af
ter
u
p
d
atin
g
th
e
r
ec
o
r
d
s
s
u
cc
ess
f
u
lly
.
2
.
5
.
I
nte
rpla
net
a
ry
f
ile
s
y
s
t
em
I
PF
S
is
d
ec
en
tr
alize
d
s
to
r
ag
e
p
r
o
to
co
l,
em
p
lo
y
s
a
s
p
ec
if
ic
h
ash
v
alu
e,
d
e
p
en
d
i
n
g
o
n
th
e
co
n
ten
t
o
f
th
e
f
ile.
T
h
is
allo
ws
f
o
r
th
e
s
h
ar
in
g
an
d
p
e
r
m
an
en
t
s
to
r
ag
e
o
f
d
if
f
er
e
n
t
f
ile
ty
p
es
u
s
in
g
h
ash
v
alu
es.
T
h
is
p
r
o
ce
s
s
allo
ws
th
e
u
s
er
s
to
id
en
tify
th
eir
f
iles
.
Mo
r
e
o
v
er
,
d
ata
ar
e
ef
f
ec
tiv
ely
p
r
o
tecte
d
f
r
o
m
s
av
in
g
twice,
an
d
th
at
co
n
s
u
m
es
s
to
r
ag
e
s
p
ac
e
th
r
o
u
g
h
u
tili
zin
g
a
d
ed
u
p
l
icatio
n
m
eth
o
d
o
n
I
PF
S.
Her
e
,
a
I
PF
S
is
u
tili
ze
d
f
o
r
s
to
r
in
g
th
e
E
HR
.
T
h
is
is
th
e
p
r
im
a
r
y
b
en
ef
it
o
f
I
PF
S
to
ac
ce
s
s
th
at
in
s
tead
o
f
p
o
s
itio
n
-
b
ased
a
d
d
r
ess
in
g
.
T
h
e
I
PF
A
allo
ws
th
e
d
is
tr
ib
u
tio
n
o
f
lar
g
e
am
o
u
n
ts
o
f
in
f
o
r
m
atio
n
with
o
u
t
d
u
p
licatio
n
,
wh
ich
m
i
n
im
izes
s
to
r
ag
e
n
ee
d
s
an
d
b
a
n
d
wid
th
co
s
ts
.
T
h
is
en
h
an
ce
s
th
e
d
o
wn
lo
ad
r
ates
o
f
r
ec
o
r
d
s
.
T
h
e
I
P
FS
is
th
e
im
m
u
tab
le
s
to
r
ag
e
m
ec
h
an
is
m
an
d
th
e
h
a
s
h
v
alu
e
o
f
I
PF
S
ca
n
’
t
b
e
m
o
d
if
ied
.
Fig
u
r
e
4
r
ep
r
esen
ts
th
e
o
v
er
all
tr
an
s
ac
tio
n
o
f
b
lo
c
k
ch
ain
-
e
n
ab
led
E
HR
d
ata
u
s
in
g
I
PF
S.
2
.
6
.
P
a
t
ient
-
ce
nte
re
d hea
lt
hca
re
da
t
a
m
a
na
g
e
m
ent
a
cc
es
s
co
ntr
o
l
-
s
m
a
rt
c
o
ntr
a
ct
Do
cto
r
r
e
q
u
ests
th
e
p
er
m
is
s
io
n
f
r
o
m
p
atien
ts
to
ac
ce
s
s
th
e
p
atien
t’
s
I
PF
S
HR
.
T
h
e
R
B
AC
p
er
m
is
s
io
n
eith
er
allo
ws
o
r
d
en
ies
th
e
r
eq
u
est
f
o
r
au
th
o
r
ized
u
s
er
s
.
Af
ter
g
ettin
g
th
e
p
er
m
is
s
io
n
o
f
t
h
e
p
atien
t,
th
e
d
o
cto
r
d
ev
elo
p
s
,
an
d
wr
ites
an
d
r
ea
d
s
th
e
r
ec
o
r
d
s
o
f
p
atien
ts
.
Patien
t
co
m
m
its
th
eir
r
ec
o
r
d
a
f
ter
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
9
3
8
I
n
t J Ar
tif
I
n
tell
,
Vo
l.
15
,
No
.
1
,
Feb
r
u
ar
y
20
26
:
310
-
3
2
1
316
th
e
wr
itin
g
p
r
o
ce
s
s
to
h
av
e
p
e
r
m
an
en
t
s
to
r
ag
e.
Patien
t
-
ce
n
tr
ic
HR
s
ar
e
ac
ce
s
s
ed
th
r
o
u
g
h
v
ar
io
u
s
s
tak
eh
o
ld
er
s
lik
e
in
s
u
r
an
ce
ag
en
ts
,
r
esear
ch
er
s
,
an
d
p
h
ar
m
ac
is
ts
in
h
ea
l
th
ca
r
e
ch
ain
ar
ch
itectu
r
e
f
o
r
s
ess
io
n
s
.
Acc
e
s
s
is
g
r
an
ted
o
n
l
y
if
th
e
o
wn
er
s
h
ip
an
d
o
b
ject
I
D
m
atch
a
p
atien
t.
HR
o
f
a
p
atien
t
is
u
p
d
ated
th
r
o
u
g
h
lab
o
r
ato
r
y
tech
n
ician
with
a
co
n
s
en
t
d
o
ct
o
r
an
d
p
atien
t.
Hy
p
e
r
led
g
er
f
a
b
r
ic
b
lo
ck
c
h
ain
m
an
a
g
es
ac
ce
s
s
co
n
tr
o
l,
p
r
iv
ac
y
ag
r
ee
m
en
ts
,
an
d
p
o
licies
wh
i
ch
ar
e
en
f
o
r
ce
d
th
r
o
u
g
h
a
c
er
tific
ate
au
th
o
r
ity
.
So
m
e
s
ettin
g
s
ar
e
f
o
llo
wed
th
r
o
u
g
h
th
e
tech
n
iq
u
e
d
escr
ib
ed
as f
o
llo
ws
:
i)
T
h
e
id
en
tity
o
n
ev
e
r
y
s
tak
eh
o
l
d
er
g
r
a
n
ted
ac
ce
s
s
is
d
ef
in
ed
t
h
r
o
u
g
h
an
ac
ce
s
s
co
n
tr
o
l p
o
licy
.
ii)
Au
th
o
r
ized
v
alu
e
is
em
p
lo
y
ed
th
r
o
u
g
h
s
y
s
tem
f
o
r
r
e
s
o
u
r
ce
s
,
ac
tio
n
k
in
d
s
,
s
tak
eh
o
ld
er
s
,
an
d
en
v
ir
o
n
m
en
t f
ea
tu
r
es a
f
ter
o
b
tain
in
g
p
atien
ts
'
ap
p
r
o
v
al.
T
h
er
e
ar
e
th
r
ee
lay
e
r
s
o
n
p
r
iv
ac
y
i
n
th
e
s
y
s
tem
:
‒
Ph
ase
1
:
o
n
ly
p
atien
ts
v
iew
its
HR
.
‒
Ph
ase
2
:
th
e
au
th
o
r
ized
s
tak
eh
o
ld
er
s
h
av
e
ac
ce
s
s
f
o
r
HR
.
‒
Ph
ase
3
:
th
e
au
th
o
r
ized
p
atien
t
ca
r
etak
er
ac
ce
s
s
es th
e
HR
in
th
e
em
er
g
e
n
cy
.
Patien
ts
h
an
d
le
its
in
f
o
r
m
ati
o
n
p
r
iv
ac
y
th
r
o
u
g
h
a
d
ju
s
tin
g
th
e
p
r
iv
ac
y
p
h
ase
.
A
u
t
h
o
r
iz
in
g
ac
ce
s
s
b
ef
o
r
e
s
u
b
m
itti
n
g
it
to
au
th
o
r
ized
E
HR
u
s
er
s
.
T
h
e
m
eth
o
d
is
s
tr
u
ctu
r
ed
in
tier
s
to
ac
co
m
m
o
d
ate
ch
a
n
g
in
g
co
n
d
itio
n
s
.
Fig
u
r
e
4
.
Ov
e
r
all
tr
an
s
ac
tio
n
o
f
b
lo
ck
c
h
ain
-
en
a
b
led
E
HR
d
at
a
u
s
in
g
I
PF
S
2
.
7
.
E
llip
t
ic
curv
e
Dif
f
ie
-
H
el
lm
a
n e
ph
em
er
a
l
E
C
DHE
is
a
k
ey
ex
ch
a
n
g
e
tech
n
iq
u
e
u
tili
ze
d
b
etwe
en
cli
en
t
an
d
s
er
v
er
,
r
esu
ltin
g
in
p
r
e
-
d
ef
in
e
d
s
ec
r
et
s
h
ar
ed
b
y
p
ar
ties
.
I
n
h
a
n
d
s
h
ak
e,
o
n
ce
clien
t
an
d
s
er
v
er
ag
r
ee
in
cip
h
er
s
u
ite
a
n
d
cu
r
v
e
to
b
e
u
s
ed
,
b
o
th
p
ar
ties
estab
lis
h
a
co
m
m
o
n
p
a
r
am
eter
d
o
m
ain
.
T
h
ese
in
cl
u
d
e
th
e
f
o
llo
win
g
v
alu
es.
–
is
p
r
im
a
n
u
m
b
er
r
e
p
r
esen
ted
o
n
f
ield
.
–
is
cu
r
v
e
eq
u
atio
n
p
a
r
am
eter
.
–
(
,
)
is
b
ase
p
o
in
t c
o
o
r
d
in
ates
.
–
is
o
r
d
er
o
f
,
r
ep
r
esen
ted
as a
s
m
all
in
teg
er
o
n
=
0
.
–
ℎ
is
co
-
f
ac
to
r
T
h
e
p
r
o
ce
s
s
o
f
p
r
e
-
d
e
f
in
ed
s
ec
r
et
ar
r
an
g
em
en
t
is
d
escr
ib
e
d
as
f
o
llo
ws.
Me
an
w
h
ile,
th
e
E
C
DHE
p
r
o
ce
s
s
is
s
h
o
wn
in
Alg
o
r
ith
m
1
.
–
Ser
v
er
s
elec
ts
r
an
d
o
m
n
u
m
b
e
r
(
0
<
<
)
.
Nex
t,
a
s
er
v
er
m
ea
s
u
r
es
an
d
s
en
d
th
at
to
a
clien
t.
–
C
lien
t selec
t
s
r
an
d
o
m
n
u
m
b
er
′
(
0
<
′
<
)
.
C
lien
t m
ea
s
u
r
es
′
an
d
s
en
d
th
at
to
a
s
er
v
er
.
–
C
lien
t
an
d
s
er
v
er
,
af
ter
ac
q
u
i
r
in
g
ep
h
em
er
al
i
n
f
o
r
m
atio
n
a
n
d
′
,
m
ea
s
u
r
es
a
s
ec
r
et
o
f
th
e
p
r
e
-
d
ef
i
n
ed
=
′
=
′
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Ar
tif
I
n
tell
I
SS
N:
2252
-
8
9
3
8
S
ec
u
r
e
a
n
d
in
tero
p
era
b
le
elec
tr
o
n
ic
h
ea
lth
r
ec
o
r
d
ex
ch
a
n
g
e
u
s
in
g
… (
K
r
is
h
n
a
P
r
a
s
a
d
N
a
r
a
s
imh
a
R
a
o
)
317
Alg
o
r
ith
m
1
.
Pro
ce
s
s
o
f
E
C
DHE
i)
W
h
en
th
e
v
alid
u
s
er
r
eq
u
ests
t
h
e
ac
ce
s
s
to
p
atien
t’
s
h
er
,
th
e
s
ec
u
r
e
k
ey
is
estab
li
s
h
ed
f
o
r
en
cr
y
p
tin
g
th
e
co
m
m
u
n
icatio
n
.
ii)
T
h
e
E
C
DHE
en
ab
le
d
b
o
th
th
e
p
atien
t
a
n
d
h
ea
lth
ca
r
e
p
r
o
v
id
er
f
o
r
s
ec
u
r
ely
g
en
er
ate
th
e
s
h
ar
ed
s
ec
r
et
k
ey
with
o
u
t tr
a
n
s
f
er
r
in
g
th
at
a
cr
o
s
s
th
e
n
etwo
r
k
.
iii)
Af
ter
estab
lis
h
in
g
th
e
s
h
ar
ed
k
ey
,
th
e
E
HR
d
ata
is
en
cr
y
p
ted
b
ef
o
r
e
t
h
e
tr
an
s
m
is
s
io
n
.
iv
)
W
h
eth
er
th
e
attac
k
er
in
ter
ce
p
t
s
en
cr
y
p
ted
d
ata,
it c
an
’
t
d
ec
r
y
p
t th
at
with
o
u
t p
r
iv
ate
k
ey
s
.
v)
Nex
t,
th
e
s
m
ar
t c
o
n
tr
ac
t
v
er
if
i
es th
e
u
s
er
au
th
o
r
izatio
n
b
ef
o
r
e
allo
win
g
ac
ce
s
s
to
HE
R
d
ata.
v
i)
On
ce
th
e
v
alid
u
s
er
is
au
th
en
ti
ca
ted
,
E
C
DHE
estab
lis
h
es th
e
s
ec
u
r
ed
co
m
m
u
n
icatio
n
c
h
an
n
el.
2
.
8
.
Acc
ess
co
ntr
o
l a
nd
s
ec
ure
da
t
a
s
ha
ring
T
h
e
ac
ce
s
s
co
n
tr
o
l
is
th
e
ess
e
n
tial
d
ev
ice
f
o
r
h
an
d
lin
g
th
e
E
HR
d
ata
an
d
p
r
ev
en
ti
n
g
its
p
r
iv
ac
y
an
d
s
ec
u
r
ity
.
T
h
e
r
u
les
an
d
id
en
tif
ier
s
o
f
s
m
ar
t
co
n
tr
ac
t
ar
e
m
an
ag
ed
th
r
o
u
g
h
b
lo
c
k
ch
ain
-
en
ab
led
co
n
tr
o
ller
th
at
en
s
u
r
ed
p
s
eu
d
o
with
in
f
r
am
e
wo
r
k
.
E
th
e
r
eu
m
co
n
tain
s
n
u
m
er
o
u
s
f
ea
tu
r
es
lik
e
ca
p
ab
ilit
y
f
o
r
u
tili
zin
g
th
e
s
m
ar
t
co
n
tr
ac
t
.
T
h
e
b
lo
ck
c
h
ain
s
m
ar
t
co
n
tr
ac
t
s
u
p
p
o
r
ts
th
e
u
s
er
in
u
s
in
g
its
ac
ce
s
s
p
r
iv
ileg
es.
As
an
o
u
tco
m
e
,
th
e
r
is
k
o
f
r
ev
ea
lin
g
co
n
f
i
d
en
tial
m
ed
ical
in
f
o
r
m
atio
n
is
m
i
n
im
ized
.
T
h
e
b
lo
ck
c
h
ain
en
s
u
r
es
th
at
th
e
E
H
R
s
ca
n
’
t
m
o
d
if
ied
a
r
b
itra
r
ily
.
T
h
e
tr
an
s
f
er
o
f
s
ec
u
r
ed
d
ata
is
ca
r
r
ied
o
u
t
au
to
m
atica
lly
th
r
o
u
g
h
ac
ce
s
s
p
er
m
is
s
io
n
o
f
p
atien
ts
u
tili
zin
g
th
e
s
m
ar
t
co
n
tr
ac
t
b
lo
ck
ch
ai
n
.
T
h
e
s
ig
n
atu
r
e
alg
o
r
ith
m
en
s
u
r
ed
th
e
s
ec
u
r
e
d
ata
tr
an
s
f
er
.
T
h
ese
d
ec
en
tr
alize
d
s
y
s
tem
o
f
f
er
s
t
h
e
p
r
o
tectio
n
o
f
p
atien
t
-
ce
n
tr
ic
p
r
i
v
ac
y
to
s
eg
m
en
tatio
n
o
f
E
HR
in
f
o
r
m
atio
n
an
d
ca
u
s
es
ac
ce
s
s
ed
co
n
s
tr
ain
ts
.
T
h
ese
d
ev
ices
im
p
lem
en
t
k
ey
-
e
n
ab
led
ac
ce
s
s
co
n
tr
o
l
to
s
ec
u
r
e
tr
an
s
ac
tio
n
s
o
f
E
HR
u
s
in
g
E
C
DHE
,
with
ac
ce
s
s
r
es
tr
ictio
n
s
d
ef
in
ed
in
s
m
ar
t c
o
n
tr
ac
t
.
E
H
R
s
ar
e
en
cr
y
p
ted
b
y
a
p
u
b
lic
k
e
y
o
n
p
atien
ts
an
d
f
ile
s
h
ar
in
g
is
h
an
d
led
t
h
r
o
u
g
h
p
atien
ts
.
Hea
lth
ca
r
e
p
r
o
v
id
er
s
s
ec
u
r
ely
ac
ce
s
s
ed
E
HR
s
f
r
o
m
r
em
o
te
g
iv
er
s
o
n
d
em
an
d
in
g
u
tili
zin
g
clo
u
d
co
m
p
u
tin
g
,
tim
e
v
ar
ia
n
ce
,
p
o
s
itio
n
.
Secu
r
e
m
ed
ica
l
s
o
u
r
ce
s
h
ar
in
g
wh
ich
co
n
tain
s
m
ess
ag
e
au
th
en
ticatio
n
,
is
f
a
cilitated
th
r
o
u
g
h
p
r
iv
ate
cl
o
u
d
en
v
ir
o
n
m
en
ts
.
T
h
e
d
ev
elo
p
e
d
s
y
s
tem
ad
d
r
ess
es
th
e
k
ey
th
r
ea
ts
lik
e
Sy
b
il
attac
k
s
ar
e
m
itig
ated
b
y
u
s
in
g
p
er
m
is
s
io
n
ed
h
y
p
er
led
g
er
f
ab
r
ic
b
l
o
ck
ch
ai
n
,
wh
e
r
e
e
n
tire
n
o
d
es
a
r
e
a
u
th
en
ticated
t
h
r
o
u
g
h
MSP.
Key
co
m
p
r
o
m
is
e
is
h
an
d
led
b
y
E
C
DHE
p
r
o
to
co
l,
th
at
en
s
u
r
es
f
o
r
wa
r
d
s
ec
r
ec
y
th
r
o
u
g
h
ep
h
em
er
al
k
ey
p
ai
r
s
f
o
r
e
v
er
y
s
ess
io
n
.
R
ep
lay
attac
k
s
ar
e
p
r
e
v
en
ted
th
r
o
u
g
h
in
clu
d
in
g
tim
estam
p
v
alid
atio
n
in
s
m
ar
t
c
o
n
tr
ac
ts
,
r
ejec
ts
r
e
u
s
ed
o
r
d
elay
ed
m
ess
ag
es.
Alg
o
r
ith
m
f
o
r
E
C
DHE
p
r
o
to
co
l
with
s
m
ar
t
co
n
t
r
ac
t
-
b
ased
ac
c
ess
co
n
tr
o
l
,
in
clu
d
e
d
th
e
s
tep
-
by
-
s
tep
alg
o
r
ith
m
as sh
o
wn
in
Alg
o
r
ith
m
2
.
Alg
o
r
ith
m
2
.
E
C
DHE
p
r
o
to
co
l w
ith
s
m
ar
t c
o
n
tr
ac
t
-
b
ased
ac
ce
s
s
co
n
tr
o
l
i)
E
C
DHE
k
ey
ex
ch
an
g
e
alg
o
r
ith
m
—
th
e
g
en
er
atio
n
o
f
ep
h
em
er
al
k
ey
p
air
s
b
y
b
o
th
p
ar
ties
,
s
h
ar
ed
s
ec
r
et
d
er
iv
atio
n
,
a
n
d
e
n
cr
y
p
tio
n
o
f
E
HR
d
ata.
ii)
Sm
ar
t
co
n
tr
ac
t
ac
ce
s
s
co
n
tr
o
l
f
lo
w
—
d
etailed
h
o
w
p
atien
t
c
o
n
s
en
t,
r
o
le
-
b
ased
p
e
r
m
is
s
io
n
s
an
d
r
eq
u
est
v
alid
atio
n
ar
e
e
n
f
o
r
c
ed
b
y
ch
a
in
co
d
e
o
n
h
y
p
er
led
g
er
f
a
b
r
ic
.
iii)
Secu
r
e
E
HR
R
etr
iev
al
p
r
o
ce
s
s
—
d
escr
ib
es
h
o
w
en
c
r
y
p
ted
d
a
ta
is
r
etr
iev
ed
f
r
o
m
I
PF
S
an
d
d
ec
r
y
p
ted
b
y
s
ess
io
n
k
ey
estab
lis
h
ed
th
r
o
u
g
h
E
C
DHE
.
3.
E
XP
E
R
I
M
E
N
T
A
L
ANA
L
Y
SI
S
T
h
e
p
er
f
o
r
m
an
ce
o
f
th
e
d
ev
e
lo
p
ed
HFR
P
-
E
C
DHE
alg
o
r
ith
m
is
s
im
u
lated
in
a
clo
u
d
en
v
ir
o
n
m
e
n
t
with
th
e
r
eq
u
ir
e
d
co
n
f
ig
u
r
atio
n
o
f
a
n
i5
p
r
o
ce
s
s
o
r
,
8
GB
R
AM
an
d
W
in
d
o
ws 1
0
(
6
4
-
b
it).
T
h
e
u
p
lo
a
d
in
g
tim
e,
d
o
wn
lo
ad
in
g
tim
e,
ex
ec
u
tio
n
tim
e,
co
m
p
u
tatio
n
al
o
v
e
r
h
ea
d
an
d
th
r
o
u
g
h
p
u
t
ar
e
th
e
m
e
tr
ics
co
n
s
id
er
ed
to
ev
alu
ate
th
e
p
e
r
f
o
r
m
an
ce
o
f
th
e
d
ev
el
o
p
ed
HFR
P
-
E
C
DHE
alg
o
r
ith
m
.
T
h
e
e
v
alu
atio
n
an
d
v
alid
atio
n
o
f
HFR
P
-
E
C
DHE
alg
o
r
ith
m
is
d
escr
ib
ed
as f
o
llo
ws
.
I
n
p
r
o
p
o
s
ed
HFR
P
-
E
C
DHE
s
y
s
tem
,
k
ey
s
izes
ar
e
v
ar
ied
t
o
ev
alu
ate
its
im
p
ac
t
o
n
co
m
p
u
tatio
n
al
o
v
er
h
ea
d
an
d
e
x
ec
u
tio
n
.
E
n
cr
y
p
tio
n
k
ey
len
g
t
h
is
co
n
s
id
er
ed
f
o
r
m
1
6
,
6
4
,
1
2
8
,
2
5
6
,
a
n
d
5
1
2
b
its
.
E
x
p
er
im
en
tal
r
esu
lts
s
h
o
w
th
at
as
th
e
k
ey
s
ize
in
cr
ea
s
es,
b
o
th
co
m
p
u
tatio
n
al
o
v
er
h
ea
d
an
d
ex
ec
u
tio
n
tim
e
also
in
cr
ea
s
es
d
u
e
to
h
ig
h
co
m
p
lex
ity
in
v
o
lv
es
in
en
cr
y
p
tio
n
an
d
k
ey
ex
c
h
an
g
e
p
r
o
ce
s
s
es.
T
ab
le
1
r
ep
r
esen
ts
th
e
ev
alu
atio
n
o
f
co
m
p
u
tatio
n
o
v
e
r
h
ea
d
,
ex
ec
u
tio
n
tim
e
an
d
th
r
o
u
g
h
p
u
t
u
s
in
g
d
if
f
e
r
e
n
t
k
ey
en
cr
y
p
tio
n
alg
o
r
ith
m
s
.
Her
e
,
th
e
ex
is
tin
g
alg
o
r
ith
m
s
lik
e
E
C
DH,
ellip
tic
cu
r
v
e
in
teg
r
ated
en
cr
y
p
tio
n
s
ch
em
e
(
E
C
I
E
S)
an
d
DHE
ar
e
s
im
u
lated
b
ase
d
o
n
p
r
o
p
o
s
ed
HFR
P
-
E
C
DH
E
s
im
u
latio
n
p
ar
a
m
eter
s
.
Fig
u
r
e
5
r
ep
r
esen
ts
an
u
p
lo
ad
tim
e
an
d
d
o
wn
lo
a
d
ti
m
e
wh
en
a
n
in
f
o
r
m
atio
n
s
ize
v
ar
ied
f
r
o
m
2
0
t
o
1
0
0
M
B
.
W
h
ile
d
ata
s
ize
m
ax
im
izes,
u
p
lo
a
d
an
d
d
o
wn
l
o
ad
tim
e
in
cr
ea
s
es.
B
u
t,
a
r
at
e
o
f
r
is
e
in
d
o
wn
lo
a
d
tim
e
is
g
r
ea
ter
th
an
u
p
l
o
ad
tim
e
wh
en
a
b
lo
c
k
s
ize
is
in
cr
ea
s
ed
.
Fig
u
r
e
6
r
ep
r
esen
ts
co
m
p
u
tat
io
n
al
tim
e
with
v
ar
io
u
s
k
ey
s
izes.
T
h
e
ev
alu
atio
n
is
d
o
n
e
b
ased
o
n
v
ar
io
u
s
k
ey
s
izes
lik
e
1
6
,
6
4
,
1
2
8
,
2
5
6
,
a
n
d
5
1
2
b
its
,
tim
e
co
n
s
u
m
ed
f
o
r
en
cr
y
p
tin
g
t
h
e
r
e
co
r
d
an
d
u
p
lo
a
d
in
g
th
at
in
to
b
lo
ck
ch
ain
.
T
h
is
is
clea
r
th
at
th
e
co
m
p
u
tatio
n
al
tim
e
in
cr
ea
s
ed
wh
en
k
ey
len
g
th
was
in
cr
ea
s
ed
.
Ho
wev
er
,
it
n
ee
d
s
a
d
d
itio
n
al
co
m
p
u
tatio
n
tim
e,
as
lo
n
g
e
r
k
ey
s
p
r
o
v
id
e
h
ig
h
e
r
s
ec
u
r
i
ty
ag
ain
s
t
attac
k
s
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
9
3
8
I
n
t J Ar
tif
I
n
tell
,
Vo
l.
15
,
No
.
1
,
Feb
r
u
ar
y
20
26
:
310
-
3
2
1
318
Fig
u
r
e
7
r
ep
r
esen
ts
th
e
ex
ec
u
tio
n
tim
e
with
v
ar
io
u
s
k
ey
s
izes.
T
h
e
ev
alu
atio
n
is
d
o
n
e
b
a
s
ed
o
n
v
ar
io
u
s
k
e
y
s
izes
lik
e
1
6
,
6
4
,
1
2
8
,
2
5
6
an
d
5
1
2
b
its
,
th
e
tim
e
c
o
n
s
u
m
e
d
f
o
r
ex
ec
u
tin
g
th
e
wh
o
le
p
r
o
ce
s
s
.
T
h
is
is
clea
r
th
at
th
e
ex
ec
u
tio
n
tim
e
in
cr
ea
s
ed
wh
en
th
e
k
e
y
len
g
t
h
was in
cr
e
ased
.
Fig
u
r
e
8
th
e
u
p
lo
a
d
in
g
a
n
d
d
o
wn
lo
ad
in
g
tim
e
o
f
I
PF
S
E
HR
d
ata
is
r
ep
r
esen
ted
.
I
t
in
clu
d
es
th
e
s
ize
o
f
d
ata
an
d
th
e
u
p
lo
a
d
in
g
an
d
d
o
w
n
lo
ad
in
g
d
u
r
atio
n
o
f
E
HR
d
ata.
Her
e,
th
e
d
ata
s
ize
i
s
v
ar
ied
f
r
o
m
2
0
to
1
0
0
MB.
As
s
h
o
wn
in
Fig
u
r
e
9
,
as
d
ata
s
ize
o
f
E
HR
m
ax
im
izes,
tim
e
r
eq
u
ir
ed
f
o
r
u
p
lo
a
d
an
d
d
o
wn
l
o
ad
d
ata
also
m
ax
im
izes.
Fig
u
r
e
9
s
h
o
ws
th
at
th
e
tr
an
s
ac
tio
n
t
h
r
o
u
g
h
p
u
t
is
r
ep
r
esen
ted
w
h
ich
is
h
o
w
m
a
n
y
tr
an
s
ac
tio
n
s
is
v
alid
ated
an
d
p
r
o
ce
s
s
ed
p
er
s
ec
o
n
d
.
T
h
e
b
lo
ck
ch
ain
b
atch
tr
a
n
s
ac
tio
n
th
r
o
u
g
h
p
u
t
o
u
tco
m
es
ar
e
o
b
s
er
v
ed
u
n
d
er
m
u
lti
-
en
d
o
r
s
em
en
t
p
o
licies
an
d
s
en
t
r
ates
o
f
tr
an
s
ac
tio
n
s
.
As
th
e
s
en
t
r
ate
o
f
b
lo
ck
ch
ai
n
b
atch
tr
an
s
ac
tio
n
in
cr
ea
s
es,
m
ea
n
th
r
o
u
g
h
p
u
t
also
in
cr
ea
s
es
f
o
r
1
-
of
-
an
y
,
2
-
of
-
an
y
an
d
3
-
of
-
an
y
en
d
o
r
s
em
en
t
p
o
licies.
Fro
m
th
e
Fig
u
r
e
6
,
m
ea
n
tr
an
s
ac
tio
n
th
r
o
u
g
h
p
u
t
m
in
im
izes
wh
ile
th
e
b
lo
ck
ch
ain
s
y
s
tem
m
ax
im
izes
th
e
am
o
u
n
t o
f
p
ee
r
s
in
th
e
e
n
d
o
r
s
em
en
t p
r
o
ce
s
s
.
Fig
u
r
e
1
0
s
h
o
ws
th
e
p
er
f
o
r
m
an
ce
o
f
th
e
d
ev
elo
p
ed
HF
R
P
-
E
C
D
HE
alg
o
r
ith
m
is
ev
a
lu
ated
with
d
if
f
er
en
t
co
n
v
en
tio
n
al
alg
o
r
it
h
m
s
in
ter
m
s
o
f
c
o
m
p
u
tatio
n
o
v
er
h
ea
d
(
m
s
)
,
ex
ec
u
tio
n
tim
e
(
s
)
,
an
d
th
r
o
u
g
h
p
u
t
(
tp
s
)
.
T
h
e
co
n
v
en
tio
n
al
m
ec
h
an
is
m
s
lik
e
ellip
tic
cu
r
v
e
cr
y
p
to
g
r
ap
h
y
(
E
C
C
)
,
r
iv
est
Sh
a
m
ir
Ad
lem
an
(
R
SA)
an
d
b
lo
wf
is
h
in
ter
m
s
o
f
co
m
p
u
tatio
n
o
v
er
h
ea
d
(
m
s
)
,
e
x
ec
u
tio
n
tim
e
(
s
)
,
an
d
th
r
o
u
g
h
p
u
t
(
tp
s
)
.
C
o
m
p
ar
e
d
to
co
n
v
en
tio
n
al
alg
o
r
ith
m
s
,
th
e
d
ev
elo
p
e
d
HFR
P
-
E
C
DHE
alg
o
r
ith
m
o
b
tain
e
d
h
ig
h
th
r
o
u
g
h
p
u
t
an
d
co
n
s
u
m
e
d
less
ex
ec
u
tio
n
tim
e
an
d
c
o
m
p
u
tatio
n
al
o
v
er
h
ea
d
.
T
ab
le
1
.
E
v
alu
atio
n
o
f
HFR
P
-
E
C
DHE
with
d
if
f
er
en
t e
n
cr
y
p
tio
n
alg
o
r
ith
m
s
M
e
t
r
i
c
s
M
e
t
h
o
d
s
F
i
l
e
si
z
e
i
n
M
B
20
30
40
C
o
m
p
u
t
a
t
i
o
n
o
v
e
r
h
e
a
d
(
ms)
EC
D
H
1
.
9
2
.
0
2
.
5
EC
I
ES
1
.
3
1
.
5
1
.
9
DHE
0
.
9
1
.
1
1
.
4
P
r
o
p
o
se
d
H
F
R
P
-
E
C
D
H
E
0
.
4
0
.
7
0
.
9
Ex
e
c
u
t
i
o
n
t
i
m
e
(
s)
EC
D
H
36
39
43
EC
I
ES
32
35
38
DHE
27
29
34
P
r
o
p
o
se
d
H
F
R
P
-
E
C
D
H
E
22
26
31
Th
r
o
u
g
h
p
u
t
(
t
p
s)
EC
D
H
26
30
35
EC
I
ES
22
27
31
DHE
18
23
28
P
r
o
p
o
se
d
H
F
R
P
-
E
C
D
H
E
15
19
23
Fig
u
r
e
5
.
Up
l
o
ad
in
g
an
d
d
o
wn
lo
ad
in
g
tim
e
Fig
u
r
e
6
.
Key
s
ize
v
s
co
m
p
u
ta
tio
n
al
o
v
er
h
ea
d
Fig
u
r
e
7
.
Key
s
ize
v
s
ex
ec
u
tio
n
tim
e
Fig
u
r
e
8
.
I
PF
S u
p
lo
a
d
in
g
a
n
d
d
o
wn
lo
ad
in
g
o
f
E
HR
d
ata
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Ar
tif
I
n
tell
I
SS
N:
2252
-
8
9
3
8
S
ec
u
r
e
a
n
d
in
tero
p
era
b
le
elec
tr
o
n
ic
h
ea
lth
r
ec
o
r
d
ex
ch
a
n
g
e
u
s
in
g
… (
K
r
is
h
n
a
P
r
a
s
a
d
N
a
r
a
s
imh
a
R
a
o
)
319
Fig
u
r
e
9
.
Per
f
o
r
m
an
c
e
o
f
t
h
r
o
u
g
h
p
u
t
Fig
u
r
e
1
0
.
E
v
alu
atio
n
with
ex
i
s
tin
g
alg
o
r
ith
m
s
3
.
1
.
Co
m
pa
ra
t
iv
e
a
na
ly
s
is
I
n
th
is
s
ec
tio
n
,
th
e
p
e
r
f
o
r
m
an
ce
o
f
th
e
d
ev
elo
p
e
d
HFR
P
-
E
C
DHE
alg
o
r
ith
m
is
s
im
u
lated
b
ased
o
n
ex
is
tin
g
alg
o
r
ith
m
s
a
n
d
c
o
m
p
ar
ed
to
it.
T
h
e
ex
is
tin
g
alg
o
r
i
th
m
s
lik
e
SP
AKE
[
1
6
]
an
d
s
ca
lab
le
b
lo
ck
c
h
ain
b
ased
E
HR
m
an
ag
em
en
t
[
1
7
]
with
d
if
f
er
en
t p
er
f
o
r
m
an
ce
m
e
tr
ics
ar
e
co
m
p
ar
e
d
in
th
is
s
ec
tio
n
.
T
ab
le
2
s
h
o
ws
th
e
p
er
f
o
r
m
an
ce
o
f
th
e
d
ev
el
o
p
ed
HFR
P
-
E
C
DHE
alg
o
r
ith
m
is
co
m
p
ar
ed
with
SP
AKE
[
1
6
]
m
et
h
o
d
with
m
etr
ics
o
f
u
p
lo
ad
in
g
an
d
d
o
wn
lo
ad
in
g
tim
e
b
y
v
ar
y
in
g
th
e
f
ile
s
ize
f
r
o
m
2
0
to
4
0
MB.
T
ab
le
3
s
h
o
ws
th
e
p
er
f
o
r
m
an
ce
o
f
th
e
d
e
v
elo
p
e
d
HFR
P
-
E
C
DHE
alg
o
r
ith
m
is
co
m
p
ar
ed
with
th
e
SP
AKE
[
1
6
]
m
et
h
o
d
wit
h
m
etr
ics
o
f
co
m
p
u
tatio
n
al
o
v
er
h
ea
d
b
y
co
n
s
id
er
in
g
k
e
y
s
izes
o
f
1
6
,
6
4
,
1
2
8
,
2
5
6
a
n
d
5
1
2
b
its
.
T
ab
le
4
s
h
o
ws
th
e
p
er
f
o
r
m
an
ce
o
f
th
e
d
ev
elo
p
ed
HFR
P
-
E
C
DHE
alg
o
r
ith
m
with
m
etr
ics
o
f
laten
cy
a
n
d
t
h
r
o
u
g
h
p
u
t
in
ter
m
s
o
f
s
u
cc
ess
f
u
l tr
an
s
ac
tio
n
s
p
er
s
p
ec
if
ied
s
en
t r
ate.
T
ab
le
2
.
C
o
m
p
a
r
is
o
n
with
SP
AKE
[
1
6
]
in
ter
m
s
o
f
u
p
lo
ad
i
n
g
an
d
d
o
wn
l
o
ad
in
g
tim
e
M
e
t
r
i
c
s
M
e
t
h
o
d
s
F
i
l
e
si
z
e
i
n
M
B
20
30
40
U
p
l
o
a
d
i
n
g
t
i
me
S
P
A
K
E
[
1
6
]
18
20
27
P
r
o
p
o
se
d
H
F
R
P
-
E
C
D
H
E
15
17
21
D
o
w
n
l
o
a
d
i
n
g
t
i
m
e
S
P
A
K
E
[
1
6
]
20
22
32
P
r
o
p
o
se
d
H
F
R
P
-
E
C
D
H
E
17
20
26
T
ab
le
3
.
C
o
m
p
a
r
is
o
n
with
SP
AKE
[
1
6
]
in
ter
m
s
o
f
c
o
m
p
u
ta
tio
n
al
o
v
er
h
ea
d
M
e
t
h
o
d
s
C
o
m
p
u
t
a
t
i
o
n
a
l
o
v
e
r
h
e
a
d
(
ms)
1
6
b
i
t
s
6
4
b
i
t
s
1
2
8
b
i
t
s
2
5
6
b
i
t
s
5
1
2
b
i
t
s
S
P
A
K
E
[
1
6
]
0
.
6
0
.
8
0
.
9
1
.
5
2
.
4
P
r
o
p
o
se
d
H
F
R
P
-
E
C
D
H
E
0
.
4
0
.
6
0
.
7
1
.
1
2
.
0
T
a
b
l
e
4
.
C
o
m
p
a
r
is
o
n
w
i
t
h
s
c
ala
b
l
e
b
l
o
c
k
c
h
a
i
n
b
a
s
e
d
E
HR
m
an
a
g
e
m
e
n
t
[
1
7
]
i
n
t
e
r
m
s
o
f
l
a
te
n
c
y
a
n
d
t
h
r
o
u
g
h
p
u
t
M
e
t
r
i
c
s
M
e
t
h
o
d
s
S
u
c
c
e
ssf
u
l
t
r
a
n
sac
t
i
o
n
s
p
e
r
s
p
e
c
i
f
i
e
d
s
e
n
t
r
a
t
e
9
9
7
1
0
0
0
1
0
0
0
1
0
0
0
La
t
e
n
c
y
(
s)
S
c
a
l
a
b
l
e
b
l
o
c
k
c
h
a
i
n
b
a
s
e
d
EH
R
ma
n
a
g
e
m
e
n
t
[
1
7
]
0
.
1
5
0
.
1
7
0
.
2
4
0
.
4
4
P
r
o
p
o
se
d
H
F
R
P
-
E
C
D
H
E
0
.
1
2
0
.
1
5
0
.
1
9
0
.
3
5
Th
r
o
u
g
h
p
u
t
(
t
p
s)
S
c
a
l
a
b
l
e
b
l
o
c
k
c
h
a
i
n
b
a
s
e
d
EH
R
ma
n
a
g
e
m
e
n
t
[
1
7
]
2
5
.
0
5
0
.
0
9
4
.
4
1
8
6
.
2
P
r
o
p
o
se
d
H
F
R
P
-
E
C
D
H
E
2
8
.
0
3
7
.
2
7
8
.
3
1
2
3
.
7
4.
CO
NCLU
SI
O
N
T
h
e
b
l
o
c
k
c
h
ai
n
is
a
s
i
g
n
i
f
i
ca
n
t
tec
h
n
o
l
o
g
y
t
o
d
e
p
l
o
y
t
h
e
d
i
g
it
al
h
e
alt
h
-
c
ar
e
s
y
s
te
m
b
e
ca
u
s
e
th
at
ad
d
r
ess
es
th
e
is
s
u
es
w
it
h
ac
ce
s
s
c
o
n
t
r
o
l
f
o
r
E
HR
d
a
ta
.
B
y
u
t
ilizi
n
g
I
PF
S,
th
is
a
r
ti
cle
d
e
v
e
l
o
p
e
d
a
PC
HD
M
-
DL
s
y
s
tem
,
wh
ich
m
a
n
ag
es
ac
ce
s
s
to
E
HR
d
ata.
B
lo
ck
ch
ain
s
m
ar
t
co
n
tr
ac
ts
ass
is
t
u
s
er
s
b
y
u
t
ilizin
g
th
eir
a
cc
ess
r
ig
h
ts
.
B
y
,
th
e
E
C
DHE
tech
n
iq
u
e
is
p
r
o
p
o
s
ed
to
s
ec
u
r
e
th
e
tr
an
s
ac
tio
n
s
o
f
E
HR
d
ata.
T
h
e
ar
ch
itectu
r
e
en
ab
les
ac
ce
s
s
co
n
tr
o
l
f
o
r
p
ati
en
t
-
ce
n
tr
ic
E
HR
s
u
s
in
g
th
e
E
C
DHE
en
cr
y
p
tio
n
tech
n
iq
u
e.
I
t
is
ev
alu
ated
with
m
etr
ics
o
f
tim
e
f
o
r
b
lo
ck
cr
e
atio
n
,
th
e
co
m
p
u
tatio
n
al
o
v
er
h
ea
d
o
f
t
r
an
s
ac
tio
n
with
en
cr
y
p
tio
n
k
e
y
s
ize
an
d
u
p
lo
ad
a
n
d
d
o
wn
lo
a
d
tim
e
f
o
r
E
HR
s
ize.
Dev
elo
p
ed
m
eth
o
d
s
ec
u
r
es
th
e
E
HR
d
ata
an
d
f
ac
ilit
ates
th
e
d
ata
ex
ch
an
g
e
ac
r
o
s
s
h
eter
o
g
en
eo
u
s
h
ea
lth
ca
r
e
p
latf
o
r
m
s
,
en
s
u
r
in
g
s
tan
d
ar
d
co
m
m
u
n
icatio
n
am
o
n
g
d
if
f
er
e
n
t
E
HR
s
y
s
tem
s
.
T
h
e
p
r
o
p
o
s
ed
ar
ch
itectu
r
e
r
esu
lted
in
s
ec
u
r
e
E
HR
tr
an
s
ac
tio
n
s
th
at
ar
e
m
an
ag
ed
t
h
r
o
u
g
h
t
h
e
R
B
A
C
m
ec
h
an
is
m
f
o
r
d
ata
o
wn
er
s
(
p
atien
ts
)
.
T
h
e
cr
o
s
s
-
c
h
ain
E
HR
ex
c
h
an
g
e
,
d
em
o
n
s
tr
ates
f
u
n
ctio
n
s
o
f
Evaluation Warning : The document was created with Spire.PDF for Python.