{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T19:49:36Z","timestamp":1777060176869,"version":"3.51.4"},"reference-count":69,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2020,1,15]],"date-time":"2020-01-15T00:00:00Z","timestamp":1579046400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["61872038"],"award-info":[{"award-number":["61872038"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["61471035"],"award-info":[{"award-number":["61471035"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012226","name":"Fundamental Research Funds for the Central Universities","doi-asserted-by":"publisher","award":["FRF-BD-18-016A"],"award-info":[{"award-number":["FRF-BD-18-016A"]}],"id":[{"id":"10.13039\/501100012226","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Electronic healthcare (eHealth) identity management (IdM) is a pivotal feature in the eHealth system. Distributed ledger technology (DLT) is an emerging technology that can achieve agreements of transactional data states in a decentralized way. Building identity management systems using Blockchain can enable patients to fully control their own identity and provide increased confidence in data immutability and availability. This paper presents the state of the art of decentralized identity management using Blockchain and highlights the possible opportunities for adopting the decentralized identity management approaches for future health identity systems. First, we summarize eHealth identity management scenarios. Furthermore, we investigate the existing decentralized identity management solutions and present decentralized identity models. In addition, we discuss the current decentralized identity projects and identify new challenges based on the existing solutions and the limitations when applying it to healthcare as a particular use case.<\/jats:p>","DOI":"10.3390\/s20020483","type":"journal-article","created":{"date-parts":[[2020,1,17]],"date-time":"2020-01-17T04:14:41Z","timestamp":1579234481000},"page":"483","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":83,"title":["Distributed Ledger Technology for eHealth Identity Privacy: State of The Art and Future Perspective"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6356-563X","authenticated-orcid":false,"given":"Mohammed Amine","family":"Bouras","sequence":"first","affiliation":[{"name":"The School of Computer and Communication Engineering, University of Science and Technology, Beijing 100083, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7783-5183","authenticated-orcid":false,"given":"Qinghua","family":"Lu","sequence":"additional","affiliation":[{"name":"The Commonwealth Scientific and Industrial Research Organisation (CSIRO) Data 61, Eveleigh NSW 2015, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9656-5801","authenticated-orcid":false,"given":"Fan","family":"Zhang","sequence":"additional","affiliation":[{"name":"The School of Computer and Communication Engineering, University of Science and Technology, Beijing 100083, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yueliang","family":"Wan","sequence":"additional","affiliation":[{"name":"Run Technologies Company, Ltd., Beijing 100192, China"},{"name":"Beijing Engineering Research Center for Cyberspace Data Analysis and Applications, Beijing 100083, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4834-9442","authenticated-orcid":false,"given":"Tao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Key Lab of Information Network Security, Ministry of Public Security, Shanghai 200031, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6413-193X","authenticated-orcid":false,"given":"Huansheng","family":"Ning","sequence":"additional","affiliation":[{"name":"The School of Computer and Communication Engineering, University of Science and Technology, Beijing 100083, China"},{"name":"Beijing Engineering Research Center for Cyberspace Data Analysis and Applications, Beijing 100083, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,1,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/S1386-5056(03)00131-X","article-title":"Evaluation of health information systems\u2014Problems and challenges","volume":"71","author":"Ammenwerth","year":"2003","journal-title":"Int. J. Med. Inform."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.is.2014.05.004","article-title":"Collaborative and secure sharing of healthcare data in multi-clouds","volume":"48","author":"Fabian","year":"2015","journal-title":"Inf. Syst."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1109\/MCOM.2012.6194388","article-title":"Research challenges in computation, communication, and context awareness for ubiquitous healthcare","volume":"50","author":"Viswanathan","year":"2012","journal-title":"IEEE Commun. Mag."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1145\/2994581","article-title":"Blockchain beyond bitcoin","volume":"59","author":"Underwood","year":"2016","journal-title":"Commun. ACM"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.cosrev.2018.10.002","article-title":"A survey on essential components of a self-sovereign identity","volume":"30","author":"Gayvoronskaya","year":"2018","journal-title":"Comput. Sci. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1109\/SURV.2012.072412.00129","article-title":"A survey on identity management for the future network","volume":"15","author":"Torres","year":"2013","journal-title":"IEEE Commun. Surv. Tutor."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Ning, H., Liu, X., Ye, X., Zhang, J.H.W., and Daneshmand, M. (2019). Edge computing based ID and nID combined identification and resolution scheme in IoT. IEEE Internet Things J.","DOI":"10.1109\/JIOT.2019.2911564"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1109\/MTAS.2004.1337889","article-title":"Digital identity","volume":"23","author":"Camp","year":"2004","journal-title":"IEEE Technol. Soc. Mag."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/S1363-4127(04)00014-7","article-title":"Privacy-enhancing identity management","volume":"9","author":"Hansen","year":"2004","journal-title":"Inf. Secur. Tech. Rep."},{"key":"ref_10","unstructured":"Bertino, E., Paci, F., and Shang, N. (2009, January 16\u201319). Digital identity protection-concepts and issues. Proceedings of the 4th International Conference on Availability, Reliability and Security, Fukuoka, Japan."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Ning, H., Ye, X., Bouras, M.A., Wei, D., and Daneshmand, M. (2018). General Cyberspace: Cyberspace and Cyber-enabled Spaces. IEEE Internet Things J.","DOI":"10.1109\/JIOT.2018.2815535"},{"key":"ref_12","unstructured":"Cao, Y., and Yang, L. (2010, January 17\u201319). A survey of identity management technology. Proceedings of the 2010 IEEE International Conference on Information Theory and Information Security (ICITIS), Beijing, China."},{"key":"ref_13","unstructured":"Myllyniemi, A. (2020, January 15). Identity Management Systems: A Comparison of Current Solutions. Available online: https:\/\/pdfs.semanticscholar.org\/3043\/9b6e5dd36d390a7f2e78b7812a1d39d066ce.pdf."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Mills, D.C., Wang, K., Malone, B., Ravi, A., Marquardt, J., Badev, A.I., Brezinski, T., Fahy, L., Liao, K., and Kargenian, V. (2016). Distributed ledger technology in payments, clearing, and settlement. FEDS Work. Pap.","DOI":"10.17016\/FEDS.2016.095"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1002\/jsc.2148","article-title":"Distributed ledger technology: Applications and implications","volume":"26","author":"Maull","year":"2017","journal-title":"Strateg. Chang."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1109\/MCC.2017.3791019","article-title":"Blockchain standards for compliance and trust","volume":"4","author":"Anjum","year":"2017","journal-title":"IEEE Cloud Comput."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Xu, X., Weber, I., Staples, M., Zhu, L., Bosch, J., Bass, L., Pautasso, C., and Rimba, P. (2017, January 3\u20137). A taxonomy of blockchain-based systems for architecture design. Proceedings of the2017 IEEE International Conference on Software Architecture (ICSA), Gothenburg, Sweden.","DOI":"10.1109\/ICSA.2017.33"},{"key":"ref_18","first-page":"653","article-title":"A survey of blockchain security issues and challenges","volume":"19","author":"Lin","year":"2017","journal-title":"IJ Netw. Secur."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"11","DOI":"10.22213\/2410-9304-2018-1-11-14","article-title":"Review of blockchain technology: Types of blockchain and their application","volume":"16","author":"Andreev","year":"2018","journal-title":"Intellekt. Sist. Proizv."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Deshpande, A., Stewart, K., Lepetit, L., and Gunashekar, S. (2017). Distributed Ledger Technologies\/Blockchain: Challenges, Opportunities and the Prospects for Standards, The British Standards Institution (BSI). Overview Report.","DOI":"10.7249\/RR2223"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1109\/MITP.2017.3051335","article-title":"Can blockchain strengthen the internet of things?","volume":"19","author":"Kshetri","year":"2017","journal-title":"IT Prof."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"28203","DOI":"10.1109\/ACCESS.2018.2837650","article-title":"A new transitively closed undirected graph authentication scheme for blockchain-based identity management systems","volume":"6","author":"Lin","year":"2018","journal-title":"IEEE Access"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2274","DOI":"10.1109\/ACCESS.2017.2782733","article-title":"BIDaaS: Blockchain based ID as a service","volume":"6","author":"Lee","year":"2017","journal-title":"IEEE Access"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Alsayed Kassem, J., Sayeed, S., Marco-Gisbert, H., Pervez, Z., and Dahal, K. (2019). DNS-IdM: A blockchain identity management system to secure personal data sharing in a network. Appl. Sci., 9.","DOI":"10.3390\/app9152953"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.18517\/ijaseit.8.4-2.6838","article-title":"Blockchain technology the identity management and authentication service disruptor: A survey","volume":"8","author":"Lim","year":"2018","journal-title":"Int. J. Adv. Sci. Eng. Inf. Technol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Zhu, X., and Badr, Y. (August, January 30). A Survey on Blockchain-based Identity Management Systems for the Internet of Things. Proceedings of the 2018 IEEE International Conference on Internet of Things (iThings) and IEEE Green Computing and Communications (GreenCom) and IEEE Cyber, Physical and Social Computing (CPSCom) and IEEE Smart Data (SmartData), Halifax, NS, Canada.","DOI":"10.1109\/Cybermatics_2018.2018.00263"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Pashalidis, A., and Mitchell, C.J. (2003, January 9\u201311). A taxonomy of single sign-on systems. Proceedings of the Australasian Conference on Information Security and Privacy, Wollongong, Australia.","DOI":"10.1007\/3-540-45067-X_22"},{"key":"ref_28","first-page":"99","article-title":"Trust requirements in identity management","volume":"Volume 44","author":"Fabre","year":"2005","journal-title":"Proceedings of the 2005 Australasian Workshop on Grid Computing and e-Research"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Huang, J., and Nicol, D. (2009, January 14\u201316). A calculus of trust and its application to PKI and identity management. Proceedings of the 8th Symposium on Identity and Trust on the Internet (IDtrust \u201909), Association for Computing Machinery, New York, NY, USA.","DOI":"10.1145\/1527017.1527021"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1109\/35.312841","article-title":"Kerberos: An authentication service for computer networks","volume":"32","author":"Neuman","year":"1994","journal-title":"IEEE Commun. Mag."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"493","DOI":"10.3233\/JCS-2007-15502","article-title":"User centricity: A taxonomy and open issues","volume":"15","author":"Camenisch","year":"2007","journal-title":"J. Comput. Secur."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1109\/MC.2005.408","article-title":"Federated identity management","volume":"38","author":"Shim","year":"2005","journal-title":"Computer"},{"key":"ref_33","unstructured":"Hughes, J., and Maler, E. (2005). Security Assertion Markup Language (saml) v2.0 Technical Overview, OASIS. OASIS SSTC Working Draft sstc-saml-tech-overview-2.0-draft-08."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Alsaleh, M., and Adams, C. (2006, January 28\u201330). Enhancing consumer privacy in the liberty alliance identity federation and web services frameworks. Proceedings of the International Workshop on Privacy Enhancing Technologies, Cambridge, UK.","DOI":"10.1007\/11957454_4"},{"key":"ref_35","first-page":"12","article-title":"Federated security: The shibboleth approach","volume":"27","author":"Morgan","year":"2004","journal-title":"Educ. Q."},{"key":"ref_36","unstructured":"Cameron, K. (2005). The Laws of Identity, Microsoft Corp."},{"key":"ref_37","unstructured":"Respect Network Corporation (2019, October 17). Respect Trust Framework. Available online: https:\/\/www.oixnet.org\/registry\/respect-network\/."},{"key":"ref_38","unstructured":"W3C Group (2019, October 17). Decentralized Identifiers (DIDs) v0.11. Available online: https:\/\/w3c-ccg.github.io\/did-spec\/."},{"key":"ref_39","unstructured":"Christopher, A. (2019, October 22). The Path to Self-Sovereign Identity. Available online: http:\/\/www.lifewithalacrity.com\/2016\/04\/the-path-to-self-soverereign-identity.html."},{"key":"ref_40","unstructured":"Ritz, D., Althauser, C., and Wilson, K. (2020, January 11). Connecting Health Information Systems for Better Health-Leveraging. Seattle: Joint Learning Network for Universal Health Coverage. eBook. Available online: https:\/\/jln1.pressbooks.com\/."},{"key":"ref_41","unstructured":"W3C Group (2019, October 17). Verifiable Claims Use Cases. Available online: https:\/\/www.w3.org\/TR\/verifiable-claims-use-cases\/."},{"key":"ref_42","unstructured":"Domenech, M.C., Comunello, E., and Wangham, M.S. (2014, January 15\u201318). Identity management in e-Health: A case study of web of things application using OpenID connect. Proceedings of the 2014 IEEE 16th International Conference on e-Health Networking, Applications and Services (Healthcom), Natal, Brazil."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1504\/IJIEM.2010.035624","article-title":"Information security and privacy in healthcare: Current state of research","volume":"6","author":"Appari","year":"2010","journal-title":"Int. J. Internet Enterp. Manag."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Mahmoud, R., Yousuf, T., Aloul, F., and Zualkernan, I. (2015, January 14\u201316). Internet of things (IoT) security: Current status, challenges and prospective measures. Proceedings of the 2015 10th International Conference for Internet Technology and Secured Transactions (ICITST), London, UK.","DOI":"10.1109\/ICITST.2015.7412116"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1108\/LHS-04-2014-0032","article-title":"The medical leadership challenge in healthcare is an identity challenge","volume":"28","author":"Andersson","year":"2015","journal-title":"Leadersh. Health Serv."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Zyskind, G., and Nathan, O. (2015, January 21\u201322). Decentralizing privacy: Using blockchain to protect personal data. Proceedings of the Security and Privacy Workshops (SPW), San Jose, CA, USA.","DOI":"10.1109\/SPW.2015.27"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Dunphy, P., and Petitcolas, F.A. (2018). A first look at identity management schemes on the blockchain. arXiv.","DOI":"10.1109\/MSP.2018.3111247"},{"key":"ref_48","unstructured":"Lundkvist, C., Heck, R., Torstensson, J., Mitton, Z., and Sena, M. (2019, October 08). Uport: A Platform for Self-Sovereign Identity. Available online: http:\/\/blockchainlab.com\/pdf\/uPort_whitepaper_DRAFT20161020.pdf."},{"key":"ref_49","unstructured":"Sovrin Foundation (2018). Sovrin: A Protocol and Token for Self- Sovereign Identity and Decentralized Trust, Sovrin Foundation. Whitepaper."},{"key":"ref_50","unstructured":"Identity.com Inc (2020, January 11). Decentralized Identity Verification Ecosystem. Available online: https:\/\/www.identity.com\/."},{"key":"ref_51","unstructured":"Blockstack, Inc (2019, October 15). Blockstack. Available online: https:\/\/blockstack.org\/."},{"key":"ref_52","unstructured":"Thekey, Inc (2019, October 15). Thekey. Available online: https:\/\/www.thekey.vip\/."},{"key":"ref_53","unstructured":"Selfkey (2019, October 15). SelfKey Identity Ecosystem. Available online: https:\/\/selfkey.org\/."},{"key":"ref_54","unstructured":"UniquID Inc (2019, October 15). Blockchain Identity and Access Management. Available online: https:\/\/uniquid.com\/."},{"key":"ref_55","unstructured":"ShoCard (2019, October 17). ShoCard: The Premier Blockchain-Based Mobile Identity Platform. Available online: https:\/\/shocard.com\/."},{"key":"ref_56","unstructured":"SecureKey Technologies (2019, October 15). Verified.Me. Available online: https:\/\/verified.me\/."},{"key":"ref_57","unstructured":"Decentralized Identity Foundation (2019, October 15). The Rising Tide of Decentralized Identity\u2014Decentralized Identity Foundation. Available online: https:\/\/medium.com\/decentralized-identity\/the-rising-tide-of-decentralized-identity-2e163e4ec663."},{"key":"ref_58","unstructured":"Cambridge Blockchain (2019, October 15). Identity Compliance Solutions. Available online: https:\/\/www.cambridge-blockchain.com\/."},{"key":"ref_59","unstructured":"uPort Inc (2019, October 15). uPort.me. Available online: https:\/\/www.uport.me\/."},{"key":"ref_60","unstructured":"Sovrin Foundation (2019, October 15). Sovrin Identity. Available online: https:\/\/sovrin.org\/."},{"key":"ref_61","unstructured":"Evernym, Inc (2019, October 15). Evernym. Available online: https:\/\/www.evernym.com\/."},{"key":"ref_62","unstructured":"NEO, Inc (2019, October 15). NEO Smart Economy. Available online: https:\/\/neo.org\/."},{"key":"ref_63","unstructured":"Garfinkel, S. (1995). PGP: Pretty Good Privacy, O\u2019Reilly Media, Inc."},{"key":"ref_64","unstructured":"(2019, October 15). DIF. Decentralized identity Foundation. Available online: https:\/\/identity.foundation\/."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1109\/MSP.2008.49","article-title":"The seven flaws of identity management: Usability and security challenges","volume":"6","author":"Dhamija","year":"2008","journal-title":"IEEE Secur. Priv."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1109\/MSP.2006.94","article-title":"Introduction to identity management risk metrics","volume":"4","author":"Peterson","year":"2006","journal-title":"IEEE Secur. Priv."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Geyer, F., Kinkelin, H., Leppelsack, H., Liebald, S., Scholz, D., Carle, G., and Schupke, D. (2019, January 18\u201321). Performance perspective on private distributed ledger technologies for industrial networks. Proceedings of the 2019 International Conference on Networked Systems (NetSys), M\u00fcnchen, Germany.","DOI":"10.1109\/NetSys.2019.8854512"},{"key":"ref_68","unstructured":"Wang, R., Ye, K., and Xu, C.Z. (2019, January 14\u201317). Performance benchmarking and optimization for blockchain systems: A survey. Proceedings of the International Conference on Blockchain, Seoul, Korea."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Hileman, G., and Rauchs, M. (2017). Global Blockchain Benchmarking Study, Cambridge Centre for Alternative Finance, University of Cambridge.","DOI":"10.2139\/ssrn.3040224"}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/20\/2\/483\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:43:03Z","timestamp":1760362983000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/20\/2\/483"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1,15]]},"references-count":69,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2020,1]]}},"alternative-id":["s20020483"],"URL":"https:\/\/doi.org\/10.3390\/s20020483","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1,15]]}}}