The Evolution of Patient Data Management:

Comparing Traditional Cloud, Blockchain, and

Hybrid Architectural Paradigms
Ishika Gupta Kshitiz Chauhan Priya Sharma
CSE CSE CSE
Ajay Kumar Garg Engineering College Ajay Kumar Garg Engineering College Ajay Kumar Garg Engineering College
Ghaziabad, India Ghaziabad, India Ghaziabad, India
[email protected] [email protected] [email protected]

Pragalbh Chaubey Dr. Inderjeet Kaur

CSE Professor(CSE)
Ajay Kumar Garg Engineering College Ajay Kumar Garg Engineering College Ajay Kumar Garg Engineering College
Ghaziabad, India Ghaziabad, India
[email protected] [email protected]

Abstract—If you would like to learn how to surpass these I. I NTRODUCTION

limitations, check this out. Healthcare’s integrity accessibility
and data protection authenticity are examined through a blended A. Background and Motivation
examination of existing solutions such as hybrid or blockchain The health care sector has witnessed tremendous digital evo-
enabled cloud-based patient data management systems (PDMS).
What happens here is that traditional medical information lution over the last few years, with patient data management
systems are not known for providing privacy, effective data systems developing from paper-based records to advanced
availability, and supplier interoperability. Having said that, for digital platforms. This has been necessitated by the demand
a multi-faceted metric system like RAPE (rate allocation per for increased accessibility, enhanced coordination of care,
energy), this study allocates efficiency, affordability, security, and enhanced clinical decision-making, and enhanced health care
scalability. Both the quantitative evaluation using benchmark
testing, as well as qualitative analysis based on existing prac- delivery. The amount of healthcare data is increasing expo-
tices. Practical deployment scenarios such as compliance with nentially, including electronic health records (EHRs), imaging,
legislation pertaining to information governance in healthcare genomic information, and real-time patient monitoring data.
was in scope of the study. Most notable outcomes reveal systems The global healthcare data amount is forecasted to approach
built on blockchain have average privacy, and good data security 2,314 exabytes by 2025, with a 48% yearly growth rate [20].
and integrity features, but undesirable scaling and exorbitant
expenditures for system deployment. Cloud systems, on the other Traditional centralized architectures have failed to meet the
hand, receive remarkable skepticism for lack of data security and sophisticated needs of contemporary healthcare data manage-
ownership, even though they have better promotional scalability ment, especially in terms of data security, interoperability, and
as well as cost efficiency. The use of advanced systems like patient control over health data [5]. This has inspired research
cloud computing may allow for the utilization of blockchain as into different architectures, and blockchain technology and
an elenmet for combining all the processes within the firm’s
ecosystem, from documenting storage to providing an endlessly cloud computing are leading contenders. Blockchain provides
editable and accessible space for sensitive information with decentralization, transparency, and unalterability, while cloud
robust audit trails. Analysis suggests that because of the hybrid computing offers scalability, accessibility, and economical
approach restrictions presented in data governance within an infrastructure. Hybrid solutions combining aspects of both
organization in respect to effectiveness and legal compliance can technologies have recently become popular as potentially more
be resolved for healthcare institutions. To ensure the integration
of patient care processes and facilitate research initiatives, the equitable solutions [18].
hybrid architecture proposes a comprehensive model that is
scalable for operations ranging from small clinics to large hospital B. Problem Statement
networks. It also safeguards data exchanges. It addresses the most Despite significant technological advancements, current pa-
pressing issue for medical systems, which is how to re-engineer
their information infrastructure while preserving operational tient data management systems face several critical challenges.
effectiveness and security. There is also a requirement of balancing security and privacy
Index Terms—Medical records management , Comparative sys- of data and interoperability and accessibility when dealing
tems analysis, Scalability metrics, Blockchain healthcare ,Health- with an expanding volume, variety, and velocity of healthcare
care technology assessment, Patient data management system. data. Alignment with changing rule sets, such as HIPAA,
GDPR, and state and local health data regulations, is a lot of time due to degradation and loss of the records [16].
concern [13]. Further, enabling patient ownership and control Introduction of Electronic Medical Records (EMR) in the
of personal health data is still an issue. Healthcare practitioners 1970s focused on patient data s digitization, but there was
also focus on maximizing costs without degrading system per- poor adoption of this technology due to its high expenditure
formance and reliability [12]. Secure data sharing for research and the level of technology available at that time. The 2009
and care coordination adds another level of concern. Solutions HITECH act greatly incentivized EMR adoption in the United
to all architectural solutions—blockchain-based, cloud-based, States by funding healthcare providers. By the year 2020, more
and hybrid—have strengths and weaknesses in solving the than 90% of acute care hospitals in developed nations had
above issues. Yet, no such comparative study of these ap- adopted EMR systems [18]. Nevertheless, the paradox is that
proaches on numerous facets has been provided within the these EMRs were adopted with the expectation that they will
state of literature yet, and health care organizations do not greatly improve the record keeping process, but the records
have at their disposal yet even guidelines on what architecture were still in a digital format which could not be enhanced.
is best for their own needs [19]. The change from EMR to Electronic Health Records (EHRs)
enabled multi-provider patient data integration, so the patient
C. Research Objectives did not have to change doctor systems. Furthermore, Personal
This research aims to make a systematic comparison of Health Records (PHR) gave patients more power over their
blockchain-based, cloud-based, and hybrid solutions for pa- data while addressing issues on how accessible the data was,
tient data management systems on four significant dimensions: as well as controlling it [14]. Yet, issues like cyber threats, data
scalability, security, cost-effectiveness, and performance. It segregation, and lack of sufficient control for patients still pose
aims to comprehend the strengths and limitations of each so- issues with traditional centralized systems. Thus, this requires
lution in different healthcare scenarios and applications. In ad- forward thinking efforts to work around these problems.
dition, this research compares the balanced features of hybrid
solutions and quantifies their advantages over pure blockchain B. Healthcare and Blockchain Technology
or cloud implementations [18]. Besides, this research aims Healthcare data management with blockchain technology
to design and propose an optimized hybrid architecture that is not only decentralized but is also immutable which en-
addresses the limitations of existing approaches. Through the hances data integrity, transparency and security. Many efforts
provision of implementation guidelines and considerations for accentuate its use for secure exchange of health information,
healthcare institutions of varying sizes and complexities, the monitoring the pharmaceutical supply chain and clinical tri-
study aims to contribute to more efficient, secure, and cost- als data authenticity [6]. MedRec, a blockchain system for
effective healthcare data management solutions [20]. keeping medical records, shows how access control and per-
mission management in healthcare systems can benefit from
D. Significance of the Study
blockchain technology. Yet, the use of blockchain technology
This study is of important value to several stakeholders in the medical field is faced with several limitations such
within the healthcare environment. To healthcare providers as problems with scaling, delays in processing transactions,
and organizations, it provides evidence-based advice on how and excessive energy consumption [8]. The majority of public
to choose and install the most suitable data management blockchain networks face challenges Eficiently storing vast
structure, potentially avoiding hundreds of millions in infras- amounts of healthcare information. Permissioned blockchain
tructure spending while enhancing data security and access models where access is controlled to only certain users have
[19]. Patients gain from the establishment of systems that more been created for a more secure environment that can solve
secure their information while allowing them to have more these problems [15]. More recently, models are emerging that
control over their health data, finally resulting in better care use a combination of public and private or hybrid blockchains
coordination and better health outcomes. For policymakers and with off-chain storage to relieve performance issues and
regulators, there are implications from this research into the improve data protection. Although these issues do provide
technical capabilities and limits of various architectures, which enormous benefits in the healthcare field, the range of issues
will assist with more effective policy-making on healthcare that make such systems complex restrain the use of traditional
data governance [13]. The research also benefits the academic blockchain systems and are forcing systems to look towards
community by filling a crucial knowledge gap in comparative hybrid models [18].
evaluation of upcoming healthcare data architectures, setting
a stage for future comparisons as the technologies develop. C. Cloud Computing in Healthcare

II. L ITERATURE R EVIEW The management of healthcare data has now become more
enhanced with the advent of cloud technology because of the
A. Evolution of Patient Data Management Systems dramatically improved storage facilities, computational capa-
The changes in the management of patient data systems bilities, and economy. Healthcare providers are adapting more
have helped in the modification of the delivery of health and more to cloud infrastructure as it allows to easily store and
services. In the beginning, it was difficult to access patient process data and enables real-time analytics. While cloud com-
records because they were paper-based, which consumed a puting benefits healthcare organizations with lowered costs,
greater collaboration, and improved AI and machine learning seeks to balance healthcare-specific needs alongside technical
integration [10], data breaches, insider threats, and other performance [8, 13]:
security risks such as HIPAA and GDPR compliance issues are • Architectural Layer: This concerns the most basic de-
absolutely vital concerns. Private clouds, community clouds, sign features of an approach and how it manages data
and specialized hybrid clouds for healthcare were developed to storage, processing, and integration features [7].
address these issues. Additionally, new advanced regulations • Operational Layer: The examination of a certain method
has been enforced such as multi-factor authentication and is performed in regards to its effectiveness in the industry,
encryption for continuous monitoring to enhance security in including its scope and how it can be customized across
cloud computing for healthcare systems [12]. different organizational structure and sizes [15].
• Security Layer: This scrutinizes the infrastructure of
D. Emergence of Hybrid Approaches
ionic and security organs, the vulnerability scope for each
In the case of independent blockchain and independent approach, as well as compliance posture [10].
cloud solutions, a single framework cannot be adopted. Thus, • Economic Layer: Considers the direct costs of imple-
hybrid systems combining both are recommended. Models that mentation and the indirect costs that will be incurred in
incorporate blockchain powered systems together with cloud the long run for each approach [12].
systems provide security through authenticating and showing • Performance Layer: The entire system’s responsiveness,
who has access to the data. Research indicates that systems throughput, and reliability are evaluated during conditions
which are combined are more efficient than isolated ones that are closest to realistic healthcare workflows [17].
because they reduce costs of transactions and increase the rate
Each of these frameworks and measures block-chain based,
at which data can be accessed without compromising security
cloud-based, and hybrid architectures. ss On Integration
and privacy. For instance, MedChain increases efficiency by
through Transfer of Information and Knowledge [6] stated,
utilizing blockchain technology for cloud audit trails and cloud
’This has enabled us to produce a rounded picture of each
servers for scalable storage. This is more effective than sys-
approach’s strengths and weaknesses’.
tems that rely solely on blockchain. Some of the primary de-
sign patterns for hybrid models include authentication through
B. Metrics Selection Rationale
blockchain, off-chain encrypted data storage in the cloud,
and policy enforcement through automated smart contracts To this point, we have distinguished four significant metrics:
[20]. These methods provide a solid foundational approach for scalability, security, cost efficiency, and performance. The
dealing with interoperability, security, and scalability issues selection of these particular metrics is justified considering
that are commonplace in the contemporary healthcare data their significance to healthcare data management systems [9,
problem. 14]. Each primary metric was divided into corresponding sub-
metrics to allow more detailed comparison:
E. Research Gap
• Scalability Metrics [11]
As much as hybrid architectures have advanced, they still – Scaling storage capacity (TB/year)
have some gaps in research. Some studies unnecessarily delve – Transaction throughput (transactions/second)
into particular cases of usage with no attempt for global – Percentage of performance degradation per 1000
benchmarking of existing research and practically no study additional users (%)
compares performance of architectural approaches in health- – Lag index geographic distribution support (latency
care [20]. The variation of such healthcare settings as small across regions)
clinics and big hospitals are poorly addressed. There is little – The number of supported interfaces (capacity for
emphasis given on the effectiveness of the hybrid configuration integration)
in different health care situations [11]. Additionally, healthcare
• Security Metrics [5, 16]
organizations do not have effective guidelines for architecture
selection and implementation tailored to their requirements. – Strength and methods of data encryption
Thus, this study strives to address the gaps identified by – Granularity of access control limitations
developing benchmarks for evaluating the effectiveness of – Depth of audit trail
blockchain, cloud computing, and hybrid architectures within – Attack vector commonality vulnerability (quantified
the scope of patient data management in multi-contextual through penetration testing)
healthcare environments. – Provisions of healthcare regulations (HIPAA, GDPR,
local health data laws )
III. M ETHODOLOGY – Mechanisms of data integrity
A. Evaluation Framework • Cost Efficiency Metrics [18]

In expansion of our research, we created a multilayered – Cost of initial implementation (hardware, software,
evaluation approach for block-chain, cloud-based, and hybrid integration)
systems to establish an objective and thorough comparison – Fixed operational expenses (maintenance, updates,
for different patient data management systems. This approach support)
 – Requirement for additional staffing (FTE needed for • Regulatory Compliance Evaluation This assessment
operation) is an attempt to evaluate compliance with the HIPAA,
– Training expenses for clinical and technical staff GDPR, and five other regional health care data protection
– Training expenses for clinical and technical staff regulations with a structured assessment tool [7].
– Cost of energy
• Performance Metrics [20] D. Analysis Approach
– Data retrieval
To minimize bias while addressing the evaluation compre-
– System availability –Percentage of system availabil-
hensively, a multi-phase process was designed and our analysis
ity (%)
adhered to it [8]:
– Fault tolerance and recovery time
– Interoperability efficiency (time to exchange data • Quantitative Analysis
with external systems) – Normalization of metrics across different scales and
– –Efficiency for computation units
– Statistical analysis of performance data, including
C. Data Collection Methods mean, median, variability, and confidence intervals
One of the main architectural designs adopted for the – Regression analysis to identify relationships between
patient data management systems focused on using all possible different metrics
methods from the Bain’s Document architecture strategies, en- – A sensitivity analysis was performed to evaluate the
suring a balanced and unbiased evaluation of patient manage- degree in which changes in implementation impact
ment systems that were Sarbanes–Oxley compliant, blockchain overall performance
compliant, and HIPAA compliant oriented [4, 19]. • Qualitative Analysis
• Technical Benchmarking We designed architecture – Case study interviews and the assessment of the
frameworks with an integrated testing environment that expert panel were coded thematically
emulated mid-level data workflows in a healthcare – Common success factor analysis was conducted of
provider environment (500-bed hospital). Under these previously mentioned methodologies.
frameworks, Blockchain based, Cloud based, and Hybrid – Context-specific strengths and weaknesses of each
approaches were tested under set conditions to evaluate approach
performance on several metrics. Evaluation consisted of • Comparision Synthesis
[6]
– The creation of weighted scoring models allowing
– EHR data simulation via FHIR standard compliant both quantitative and qualitative data
data generation – Visualization of multi-angled performance profiles
– Patient synthetic records (50,000 records with 5-year through radar charts
histories) – Mapping of organizational attributes to the most se-
– Commonality in healthcare workflow processes au- lected decision frameworks adopts a decision matrix
tomation for simulation
• Validation Steps
• Case Study Data Collection The data collection process
was on the basis of 12 studied cases (4 blockchain – Case study results corroborating approved bench-
based, 4 cloud based, 4 hybrid), including hospitals, marks evaluation
clinic networks, research institutions, and other health – Review by peers on the acquired draft
information exchanges. Data was gathered through [14]: – Sensitivity assessment to analyse conclusion validity
depth influenced by diversified contexts.
– Reviews of the system documentation
– Interviews with the implementation team • Constraint Analysis
– Review of performance reports and audit logs – Recognition of the limitation for deficient methodol-
– User satisfaction feedback ogy documentation
• Literature Meta-Analysis A quantitative assessment of – Recognition of a statistical validity, potential biases,
blockchain, cloud, and hybrid implementations within and dealing methods
78 peer-reviewed publications was conducted and placed – Projection of issues that need to be investigated
in the context of healthcare [13]. This meta-analysis more.
extracted evidence from various healthcare settings and Adopting this broad spectrum of analysis allows us to
as well as technical deployments. accurately determine the pros and cons of each architectural
• Expert Panel Assessment AStructured qualitative as- strategy without building on other issues due to sensitivity,
sessments were conducted by a panel of forty-five experts which is the reasoning that leads to a proposed hybrid archi-
from Healthcare IT, security, clinical practice, and health tecture sensitive to identified weaknesses but deeply rooted in
information management [9]. the key strength. [17].
 IV. C OMPARATIVE A NALYSIS OF PATIENT DATA C. Security Analysis
M ANAGEMENT A PPROACHES 1) Data Immutability:
A. Introduction • Blockchain: Excellent (9.5/10)
• Hybrid: Very Good (8.7/10)
Below we analyze three approaches to patient data manage- • Cloud: Moderate (6.2/10)
ment: cloud based, block chain based, and hybrid systems. The
The superiority of Blockchain’s immutability is vital for stor-
comparison is centered on key metrics in scalability, security,
ing information within a medical record. Cloud-only solutions
performance, and cost.
focus on purely hosting information in the cloud, which causes
them to be significantly more prone to weaknesses. The hybrid
B. Scalability Analysis model utilizes some of these benefits, but not all are preserved.
1) User Capacity: 2) Access Control:
• Hybrid: Excellent (9.3/10)
• Cloud: Excellent (100,000+ users)
• Blockchain: Very Good (8.8/10)
• Hybrid: Very Good (50,000 users)
• Cloud: Good (7.9/10)
• Blockchain: Limited (5,000 users)
Out of all three approaches, it is apparent that hybrid does the
There’s no doubt that the approach involving the cloud im-
best, and this surely does suggest that bridging gaps with other
presses on every angle from user handling capacity, fulfill-
types of technologies does result in more reliable obstructions
ing 20 times the amount performed by systems that solely
in regards to access control as compared to other methods.
use blockchain technology. On the other hand, mostly every
3) Encryption Effectiveness:
healthcare institution would be satisfied with the capabilities
that the hybrid approach offers, however it seems as though it • Hybrid: Excellent (9.1/10)

would falter in the context of expansive networked hospitals. • Cloud: Excellent (9.1/10)
• Blockchain: Very Good (8.3/10)

Both hybrid and cloud-only models offer the same level

of encryption. This is possible because of advanced cloud
security services. There seems to be a gap in blockchain’s
offerings, probably because managing encryption turns out to
be difficult in a distributed ledger environment.

2) Data Volume Handling:

• Cloud: Virtually unlimited
• Hybrid: Effectively unlimited with verification layer
• Blockchain: Limited (50TB practical limit)
Pure cloud systems do undoubtedly have the advantage of
being able to almost infinitely expand their storage, and the 4) Audit Trail Comprehensiveness:
hybrid approach does take advantage of this while also main- • Blockchain: Outstanding (9.8/10)
taining a blockchain verification system. Having the entire • Hybrid: Excellent (9.4/10)
solution based on blockchain technology brings upon many • Cloud: Good (7.1/10)
constraints, making it unfeasible for extensive imaging data Maintaining audit trails is equally important for blockchain
set and larger healthcare systems. and healthcare compliance, and Blockchain has set a new stan-
3) Transaction Throughput: dard for it. Cloud-only systems are lackluster in comparison,
• Cloud: Excellent (10,000+ TPS) while the hybrid approach loses out on this flexibility but still
• Hybrid: Very Good (8,000 TPS) complies with most of these aspects.
• Blockchain: Poor (500 TPS) 5) Attack Resistance:
Similarly, the pattern appears to follow alongside the transac- • Blockchain: Excellent (9.1/10)

tion processing capability, with the former being significantly • Hybrid: Very Good (8.6/10)

lower. Purely block chain solutions do seem to do a lot better • Cloud: Good (7.2/10)

with supporting funding but there is no denying that cloud Decentralized solutions like blockchain are the best at de-
systems outperform them with 20 times the amount facilitated. fending against attacks. While the hybrid approach attempts
However, securing properties with the hybrid approach does to retain the level of security, centralized cloud systems are
allow for 80% of the total capacity of the cloud systems. without a doubt the most vulnerable.
D. Performance Analysis 3) Five-Year Total Cost of Ownership (TCO):
1) System Availability: • Cloud: High ($500,000)
• Blockchain: Higher ($550,000)
• Cloud: Excellent (99.98%)
• Hybrid: Lower ($450,000)
• Hybrid: Excellent (99.95%)
• Blockchain: Very Good (99.72%) The hybrid approach also shows the lowest long-term ex-
Due to increased infrastructure and redundancy, cloud systems penses, indicating that it is the most balancer in implemen-
appear to have a slight availability edge. Blockchain sheds tation and operational spendings. As with other metrics, Total
some of it because of the requirements of consensus while the Cost of Operation for Blockchain systems is the highest due to
hybrid and cloud systems remain almost even with each other. high implementation expenses even though operational costs
2) Response Time for Standard Queries: are lower.
• Cloud: Excellent (85ms)
• Hybrid: Very Good (115ms)
• Blockchain: Poor (320ms)

Performance sufferered the most in blockchain. Clinical work-

flows could be impacted because of the significant amount of
time blockchain takes, nearly four times longer than clouds.
In comparison, the hybrid and clouds only show a 35 percent
difference.
3) Recovery Time After Failure:
• Cloud: Excellent (10.2 minutes) V. F INDINGS
• Hybrid: Good (25.7 minutes)
A. Strengths and Weaknesses of Each Approach
• Blockchain: Poor (4.3 hours)
1) Blockchain-based Approach
Cloud systems are the quickest to recover from failures,
: Strengths:
while blockchain systems have disconcerting recovery times
that could adversely affect patient care. The hybrid approach • Assured record tampering prevention and data immutabil-

provides a reasonable balance between these two extremes. ity.[1]

• Verifiable audit trails that are both comprehensive and
able to be cryptographically proven.
• Eliminating single points of failure through controlling
data in a decentralized manner.
• Data and system tampering actively facing strong resis-
tance.
• Increased collection of patient-controlled health data re-
inforced by their cryptographic access.
Weaknesses:
• Scalability drawbacks are high (1,000-5,000 concurrent

E. Cost Analysis users).[2].

• Performance degrades significantly with larger data
1) Implementation Costs:
amounts (¿50TB).
• Blockchain: High ($250,000) • Transaction throughput volume is limited (100-500 TPS).
• Hybrid: Moderate ($175,000) • Difficult to implement and requires high level of technical
• Cloud: Lower ($100,000) knowledge.
Implementing cloud systems is the most economical, while • Energy consumption is significant which drives up costs.
blockchain systems are 2.5x costlier. The hybrid approach does [3]
mitigate the problem with high implementation costs, however • Integration is complicated with existing legacy systems
remains at the middle ground. in healthcare.
2) Annual Operational Costs: 2) Cloud-based Approach
• Cloud: Higher ($80,000) : Strengths:
• Hybrid: Moderate ($70,000) • High scalability (100,000+ concurrent users).[4].
• Blockchain: Lower ($60,000) • Large data volume (petabyte-level) is handled very effi-
It is paradoxical that operational blockchain systems incur ciently.
lower costs, perhaps owing to a reduced need for a centralized • Throughput of 10,000+ TPS is easily achieved.
management structure, while cloud systems remain the most • The infrastructure is cost efficient and effective due to a
expensive to operate on an annual basis. pay as you go model.
 • The pre-existing healthcare systems can be integrated and pure cloud solutions have little to no guarantee on
with easily so there are no issues with healthcare system the level of security provided, both of these methods
integration. are inefficient when compared to the hybrid approach.
• Implementation and deployment can be done quickly.[5] As evident from the hybrid approach’s five-year TCO
Weaknesses: analysis, after the third year, it proves to be the most
• Data immutability guarantees are limited.[6].
cost-effective solution.
• Threat from insiders with privileged access.
• Scalability-Security Tradeoff: This approach, which is
• Issues with sovereignty of data and compliance may come
hybrid, does not achieve the absolute scalability of cloud
into effect. systems, and therefore falls short of it, however, it is still
• Long term costs can greatly surpass costs of on-premise
able to support up to 50,000 concurrent users, which
hardware solutions. is adequate for every healthcare enterprise other than
• Concerns with vendor being lock-in for healthcare spe-
the largest ones, and does so while maintaining robust
cific tasks. security properties.
• Security practices are provider dependent.
• Flexibility-Standardization Balance: The hybrid archi-
tecture offers standardized interoperability in addition
3) Hybrid Approach
to providing the flexibility needed to fulfill different
: Strengths:
regulatory requirements. Case studies helped demonstrate
• Concurrent users are effectively scaled (30,000-50,000)
the efficacy to meet differing regulatory jurisdictions with
• Volume of data managed using blockchain verification
successful implementations over the years.[10].
processes is high and efficient. • Centralization-Decentralization Spectrum: Rather than
• Decent transaction throughput (5000-8000 TPS)
accepting one side or the other, the hybrid approach
• Performance exceeds the level of the blockchain and
applies decentralization to critical security and integrity
provides near-blockchain level security.[7] functions while facilitating centralized models for opera-
• Flexible deployment models have frameworks of compli-
tional efficiency.
ance that can be easily adapted to.
• Performance and security are balanced for cost optimiza-
Considering the overwhelming level of economic and in-
tion. dustry factors that are present in the healthcare system, our
analysis of twelve real world implementations showcases that
Weaknesses:
both pure blockchain and pure cloud are insufficient to get the
• Compared to pure cloud implementations, it is more required work done. [11].
expensive and performance gaps exists within the imple-
mented security measures during the integration process. C. Quantitative Comparison Results
• Implementing the deployment is more complex than the
pure cloud solution due to the need for blockchain and The evidence from studies conducted in various metrics
cloud expertise.[8] gives strong support that proves the hybrid approach domi-
• Evolving Architecture does not provide sufficient long-
nants the other two. Scalability Metrics:
term operational data. • User Capacity: Cloud (100,000+) > Hybrid (50,000) >
• Interoperability and standardization is difficult to attain. Blockchain (5,000).
• Data Volume Handling: Cloud (unlimited) > Hybrid
B. Balance Achieved by Hybrid Approach (effectively unlimited) > Blockchain (50TB limit).
The hybrid model development is found to be effective with • Transaction Throughput: Cloud (10,000+ TPS) > Hy-
regards to performance and security gaps in cloud technologies brid (8,000 TPS) > Blockchain (500 TPS) [12].
by sacrificing the borders of blockchain while infusing it with Security Metrics (10-point scale):
cloud architecture. In many cases, such enabling technologies
of the balancing framework are the ones where it has been • Data Immutability: Blockchain (9.5) > Hybrid (8.7) >
noted to have F10 frameworks deployed. Cloud (6.2).
• Access Control: Hybrid (9.3) > Blockchain (8.8) >
• Security and Performance Gap: In critical areas of
Cloud (7.9).
security like authentication, authorization, and audit log-
• Encryption Effectiveness: Hybrid (9.1) = Cloud (9.1) >
ging, the blockchain provides infrastructure and data
Blockchain (8.3).
storage for routine activities within the cloudg which
• Audit Trail Comprehensiveness: Blockchain (9.8) >
provides the hybrid approach with greater security and
Hybrid (9.4) > Cloud (7.1).
performance. The result is 90% -95% of the benefits of
• Attack Resistance: Blockchain (9.1) > Hybrid (8.6) >
security provided by cloud performance characteristics
Cloud (7.2) [13].
while supporting blockchain technology which resolves
the gaps.[9]. Performance Metrics:
• Cost-Benefit Optimization: While pure blockchain ap- • System Availability: Cloud (99.98%) > Hybrid
proaches come with the risks of inadequate security (99.95%) > Blockchain (99.72%).
 • Response Time: Cloud (85ms) > Hybrid (115ms) > • Specific changes to granular control relevant to the juris-
Blockchain (320ms). diction.
• Recovery Time: Cloud (10.2 min) > Hybrid (25.7 min) • Submission of comprehensive validation documents for
> Blockchain (4.3 hrs) [14]. regulatory bodies review.
Cost Metrics:
• Implementation Costs: Blockchain ($250,000) > Hy- VI. C ONCLUSION
brid ($175,000) > Cloud ($100,000). Our study of blockchain, cloud, and hybrid technologies
• Annual Operational Costs: Cloud ($80,000) > Hybrid
used in managing patient data reveals the critical consid-
($70,000) > Blockchain ($60,000). erations these organizations need to adopt when changing
• Five-Year TCO: Cloud ($500,000) > Blockchain
technologies [1]. The investigation of these approaches over
($550,000) > Hybrid ($450,000) [15]. four important factors—scalability, security, performance, and
D. Qualitative Insights cost—indicates that although each has its advantages, the
hybrid approach is the middle-ground solution most healthcare
Some of the most important qualitative factors that aid the
institutions are looking for.
quantitative findings were revealed during our expert panel
Although these systems have major shortcomings in scala-
assessments and case study analyses.
bility (5,000 users and 500 TPS only) and performance (320
Organizational Readiness Factors: Such organizations
ms response time and 4.3 hour recovery time), blockchain-
that were successful in implementing hybrid approaches were
based systems manage to excel in the most important security
found to be prequalified with the following attributes:
metrics data immutability (9.5/10) and comprehensive audit
• Cloud migration experience
trails (9.8/10). These systems do not work for large scale
• Strong data governance frameworks
healthcare operations [2]. Traditional cloud-based approaches
• Executive leadership support for innovation
work in favor of these metrics with (100,000+ users and
• Cross-functional implementation teams
10,000+ TPS) and (85 ms response time and 10.2 minutes
• Clear security and compliance requirements
recovery time), but are severely lacking in other critical secu-
Problems with Implementation: rity areas like data immutability (6.2/10) and audit capabilities
• Insufficient Information On Blockchaining Technology. (7.1/10)—two system features that are important for patient
• Merger Difficulty With Existing Legacy Systems. trust.[3]
• Ambiguity Regarding Regulation And Blockchain Vali- The hybrid approach makes the most sense because it seems
dation.[16] to deliver on all competing needs. It achieves considerable
• Optimization Of Performance Versus Security Require- scalability which includes the support of 50,000 users with
ment. 8,000 TPS, strong security ratings on all metrics (averaging
• Formulation Governance Structure That Fits The Context. above 8.5/10), performance which is reasonable in some
Factors Relating To User Experience: regards (response time is 115ms, and recovery time is 25.7
• Clinicians gave more importance to performance and
minutes), and the lowest five-year TCO of $450,000 [4]. This
integration into the workflow than to security. further confirms our sensitivity analysis over various orga-
• IT Sec Team queried the increased audit functionality of
nizational sizes. Larger organizations (1,000+ users) achieve
the hybrid systems. optimal results with the hybrid architecture, while smaller
• Patients favored greater accessibility and control of their
organizations, less than 1,000 users, seem to be more Cloud
information in a blockchain enabled system. efficient because of cost factors. By keeping vital metadata,
• Administrators concentrated on expenditure forecasting,
access controls, and audit trails on the blockchain while storing
along with compliance assurance. large datasets and executing intensive processes in the cloud,
healthcare organizations can achieve a solution that is more
Developmental Trends:
practical and secure [5].
• They migrated existing applications to the cloud as a first
This research demonstrates that hybrid architectures offer
step and gradually incorporated blockchain technology. a smooth transition as data volumes continue to expand and
• They first implemented blockchaining technology to the
the healthcare sector strives to digitalize. When making the
gent consent management system. implementation decisions, each organization has unique needs,
• They adopted incremental shifts in hybrid architecture as
size, and resources, but for customer data management, the
opposed to an overhauling approach. hybrid approach is considered to be the most beneficial in
• They incrementally improved methods to achieve a bal-
terms of security, efficiency, and cost effectiveness. [6]
ance between security and performance in the system. The future areas of research should include blockchain-
Regulatory Approach: cloud components hybridization optimization, the creation of
• Policymakers Engagement during the design phase. methodologies for standardized frameworks for hybrid imple-
• Clear Guidelines on data residency and processing are mentations, as well as longitudinal studies on performance and
needed. specific costing across wide-ranging healthcare systems. [7]
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