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A fragmentação dos dados de saúde constitui uma falha estrutural nos sistemas
nacionais de saúde. As redes de prestadores de cuidados evoluíram historicamente em
isolamento técnico. Portugal ilustra bem esta condição. Hospitais, centros de saúde
e outras unidades de especialidade utilizam sistemas de registo que não comunicam
entre si. Esta lacuna compromete de forma persistente tanto a segurança do doente
como a integridade dos dados.
Esta tese propõe, implementa e avalia o MedBlock, uma plataforma baseada
em blockchain com acesso permissionado, assente no Hyperledger Fabric. Esta framework
open-source e, mantida pela Linux Foundation, é orientada para ambientes
empresariais que requerem controlos de acesso, privacidade de dados e governação
dos mesmos. A plataforma foi concebida para colmatar estas deficiências mediante
a aplicação de uma tecnologia de registo distribuído e partilha segura de registos
eletrónicos de saúde. A plataforma foi avaliada face a três objetivos de segurança:
impedir a modificação não autorizada de registos, garantir a rastreabilidade de
cada evento de acesso a dados e aplicar a diferenciação de papéis entre doentes e
organizações de saúde. Os resultados confirmam o cumprimento destes objetivos. A
integridade dos registos é assegurada por mecanismos criptográficos, cada acesso
gera uma cadeia de auditoria imutável e o controlo de papéis é imposto pela própria
rede.
Este trabalho apresenta três contribuições distintas. Em primeiro lugar, produz
uma arquitetura de referência validada para a partilha de dados de saúde baseada
em blockchain, enquadrada nas exigências do RGPD e no contexto português. Em
segundo lugar, o protótipo MedBlock demonstra que a arquitetura é tecnicamente
concretizável e não apenas teoricamente coerente, o que constitui evidência funcional
da sua viabilidade. Em terceiro lugar, a implementação aborda barreiras concretas,
como a incerteza regulatória, a integração com sistemas mais antigos e a adoção
por parte dos profissionais de saúde.
No conjunto, estes resultados oferecem um modelo transferível: outros sistemas
nacionais de saúde que enfrentem infraestruturas fragmentadas e legislação rigorosa
em matéria de proteção de dados podem adaptar esta arquitetura e este roteiro sem
necessidade de partir do zero.
Healthcare data fragmentation remains a structural liability in national health systems. Provider networks have historically evolved in technical isolation. Portugal exemplifies this condition. Hospitals, primary care units, and other centres use record systems that do not communicate with one another. This gap places both patient safety and data integrity under persistent strain. This thesis proposes and evaluates MedBlock, a permissioned blockchain-based platform built on Hyperledger Fabric. This open-source framework, maintained by the Linux Foundation, is designed for enterprise environments that require access controls, data privacy, and configurable governance. The platform was conceived to address these deficiencies by applying distributed ledger technology to the secure sharing of electronic health records. The platform was evaluated against three security objectives: preventing unauthorised record modification, ensuring the traceability of every data access event, and enforcing role differentiation between patients and healthcare organisations. Evaluation results confirm that these objectives were met. Record integrity is ensured through cryptographic mechanisms, every access generates an immutable audit trail, and role control is enforced by the network itself. This work yields three distinct contributions. First, it produces a validated reference architecture for blockchain-based health data sharing, framed within the requirements of the GPDR and the Portuguese context. Second, the MedBlock prototype demonstrates that the architecture is technically realisable, not just theoretically sound, providing functional evidence of its feasibility. Third, the implementation addresses concrete barriers such as regulatory uncertainty, legacy system integration, and adoption by healthcare professionals. Collectively, these outputs offer a transferable model: other national health systems facing fragmented infrastructure and strict data protection legislation can adapt this architecture and roadmap without having to start from scratch.
Healthcare data fragmentation remains a structural liability in national health systems. Provider networks have historically evolved in technical isolation. Portugal exemplifies this condition. Hospitals, primary care units, and other centres use record systems that do not communicate with one another. This gap places both patient safety and data integrity under persistent strain. This thesis proposes and evaluates MedBlock, a permissioned blockchain-based platform built on Hyperledger Fabric. This open-source framework, maintained by the Linux Foundation, is designed for enterprise environments that require access controls, data privacy, and configurable governance. The platform was conceived to address these deficiencies by applying distributed ledger technology to the secure sharing of electronic health records. The platform was evaluated against three security objectives: preventing unauthorised record modification, ensuring the traceability of every data access event, and enforcing role differentiation between patients and healthcare organisations. Evaluation results confirm that these objectives were met. Record integrity is ensured through cryptographic mechanisms, every access generates an immutable audit trail, and role control is enforced by the network itself. This work yields three distinct contributions. First, it produces a validated reference architecture for blockchain-based health data sharing, framed within the requirements of the GPDR and the Portuguese context. Second, the MedBlock prototype demonstrates that the architecture is technically realisable, not just theoretically sound, providing functional evidence of its feasibility. Third, the implementation addresses concrete barriers such as regulatory uncertainty, legacy system integration, and adoption by healthcare professionals. Collectively, these outputs offer a transferable model: other national health systems facing fragmented infrastructure and strict data protection legislation can adapt this architecture and roadmap without having to start from scratch.
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Informática Forense Cibersegurança MedBlock Proteção de dados de saúde Saúde Empresa Framework Open-Source
