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Blockchain-Based Internet of Things

(B-IoT) Healthcare: Meta Review of its
Applications, Methods Networks,
Integration, and Security Protocols
MD MASUM BILLAH1 , MOHAMMAD MONIRUL ISLAM2 , SHEAK RASHED HAIDER NOORI3 ,
SYED AKHTER HOSSAIN4 , MOHAMMAD SHORIF UDDIN5*
1,2,3,4
Department of Computer Science & Engineering, Daffodil International University (e-mail: [email protected])
5
Department of Computer Science, Jahangirnagar University (e-mail: [email protected])
Corresponding author: Mohammad Shorif Uddin (e-mail: [email protected])

ABSTRACT The blockchain-based Internet of Things (B-IoT) employs peer networking technologies
to restrict physical object’s communication and interaction capabilities. This paper comprehensively
examines the latest advancements in blockchain healthcare systems, including an overview of state-of-
the-art technologies and recent developments. Key aspects of blockchain healthcare systems, applications,
methods, network technologies, security, challenges, and opportunities are reviewed. This review enumer-
ates all potential approaches and categorizes, evaluates, and summarizes the current Internet of Things
(IoT) blockchain healthcare techniques. In this context, a comprehensive discussion is provided regarding
applications, e-healthcare blockchain records, and blockchain in IoT healthcare. Blockchain networks are
explored to enhance security in healthcare applications within the context of IoT. The paper uses particular
keywords to search reputable journals and conference databases for academic outcomes. A screening
method was investigated to collect exclusively relevant articles. Furthermore, contributions and research
areas were carefully examined and distinguished. In the end, the study examines potential B-IoT healthcare
characteristics and highlights areas of undiscovered research as well as current research gaps. Finally, a
B-IoT healthcare security model is proposed.

INDEX TERMS IoT, Blockchain, Healtcare, Methods, Networks, Applications, Security

I. INTRODUCTION blockchain, which has the potential to link many computers.

Excessive maintenance and management expenditures are Consumer interest in blockchain technology development
the main problems facing modern healthcare systems [1]. is growing in the Internet of Things (IoT) [8]. The peer-
The healthcare system comprises many highly complex do- to-peer architecture involves network users who engage in
mains, including patients, doctors, researchers, practitioners, transactions and blockchain miners who facilitate the trans-
support staff, and management personnel [2]. Managing and actions on a decentralized ledger. The miners established
classifying patient data becomes a formidable task [3], [4]. a decentralized network of nodes to store the ledger us-
One major obstacle is the ineffective exchange of information ing cryptographic computations. Moreover, the blockchain
about healthcare across different healthcare domains [5]. ledger is established by consensus mechanisms, digital sig-
natures, and hash chains, ensuring reliable storage capacities.
Blockchain technology presents several promising solu-
Due to its advanced capabilities, blockchain provides several
tions for security concerns & the complexities of large-scale
services, including traceability, integrity, security, and non-
and diversified information in healthcare and medical facili-
repudiation. Data is kept in a publicly accessible and decen-
ties [6]. Blockchain is a network where peers interact directly
tralized manner, ensuring anonymity is maintained.
using a distributed and uncontrolled digital record [7]. A new
block that allows for safe data transfer between parties can Blockchain is used in the government, real estate, banking,
be created without requiring any transactions thanks to the finance industries, etc. Healthcare has recently begun to gar-

VOLUME 4, 2016 1
ner greater attention from researchers studying blockchain- at a few aspects of blockchain in the healthcare system. They
enabled applications, in contrast to banking and finance, do not detail the research themes, the main areas of healthcare
which have received more study. This study examines the where blockchain is used, specific blockchain applications,
viewpoints of researchers who have highlighted the capac- or the current blockchain-based healthcare systems. More
ity of blockchain technology to address existing challenges thorough information collection and representation of the
in healthcare applications, services, and market prospects earlier work in this field is required for future research.
within the healthcare system [9]. Contemporary review articles provide evaluations of current
In the world, patient data must be classified to avoid advancements in healthcare systems based on blockchain
privacy breaches and distributed to clinics and hospitals. technology, analyzing the advantages and disadvantages of
Data safety and security with a modern solution have the proposed solutions by researchers. An in-depth analysis
arisen in blockchain technology. Blockchain is a distributed of the body of literature is the goal of this project, which
ledger system that securely records transactions, ensuring also seeks to identify possible blockchain uses in healthcare
immutability. The term is derived from the practice of or- networks, applications, and data security. This study aims to
ganizing information into blocks. Every entity has a unique identify and tackle research obstacles in healthcare systems
hash identification. These blocks are then linked together, that use blockchain technology. The primary contribution of
each including the preceding block’s hash. This arrangement this study is a comprehensive analysis of relevant literature to
makes it difficult to conceal any modifications to a block synthesize knowledge on the use of blockchain technology in
since it would need to modify all other blocks in the chain. the healthcare sector across several disciplines [10].
The blockchain is an excellent repository for immutable The critical need for secure and tamper-proof healthcare
data when adding a new block. It is distributed to each data is highlighted, and the challenges of traditional cen-
participant or node in the network for verification. Nodes are tralized systems, which are vulnerable to breaches and data
compensated for their security efforts by receiving a reward manipulation, are compared. Blockchain is introduced as a
as a block. The potential of blockchain in healthcare is crucial solution that offers decentralized, immutable ledger technol-
to organize supply chains of verifiable origin and to prevent ogy, ensuring data integrity and privacy. The blockchain’s
the harmful impact of counterfeit monitoring of health data distributed nature facilitates seamless data sharing while
and devices in the general population. That represents the maintaining privacy and security standards. It enables pa-
use of blockchain in healthcare systems for the IoT. Figure tients to securely manage and share their medical records,
1 displays the graphic representations of IoT blockchain facilitating smoother interactions with healthcare providers
healthcare systems [8]. and promoting informed decision-making. Blockchain can
track the provenance of data, ensuring its authenticity and re-
liability, thereby accelerating the discovery of new treatments
[11].
The main differences between blockchain’s application
in healthcare and other domains are emphasized to provide
context for the unique challenges and opportunities within
IoT Personal Health Information (IoTPHI) and Electronic
Medical Records (EMRs). Blockchain solutions in health-
care must navigate regulatory requirements such as HIPAA,
GDPR, and FDA. There is a growing focus on patient-
centric care and empowering patients with greater control
over their health data. Blockchain applications in healthcare
address these unique challenges and regulatory requirements,
offering improved data security, interoperability, and patient
empowerment [12].
FIGURE 1: IoT blockchain healthcare systems [8]. This paper examines various blockchain healthcare re-
search studies and lists various healthcare blockchain sys-
Data security, network problems, and blockchain-based tems, technologies, applications, networks, security require-
healthcare approaches are gaining popularity in the research ments, and security challenges that the healthcare B-IoT will
and practical domains. Over the last decade, there has been need to overcome. A B-IoT system model is proposed. To
a sharp increase in research interest in blockchain-based that end, this study presents the following:.
healthcare systems. More thorough information collection • Cutting-edge technologies are employed in blockchain-
and documentation of past healthcare sector activities are based IoT (B-IoT) healthcare systems.
required in the modern era. Current developments in this field • Classify the existing IoT-based blockchain E-Healthcare
are summarized in recent review papers, which also point Record (EHR).
out the Benefits and drawbacks of the solutions proposed by • An extensive overview of healthcare applications on the
researchers. On the other hand, these review papers only look IoT that utilize blockchain technology.
2 VOLUME 4, 2016
 • An examination of conventional blockchain healthcare parency, security, and patient outcomes [13], [14]. In [15], we
methodologies and an in-depth discourse. propose a blockchain-based secure healthcare system design
• A concise overview of the current healthcare networks framework that improves security, privacy, and data sharing
that utilize the IoT and blockchain technology. while giving patients control over their health records, with
• Addressed comprehensive B-IoT healthcare security re- performance evaluation and a use-case scenario presented.
quirements and challenges. H. L. Pham et al. [16] propose a blockchain-based re-
• Designing a conceptual framework for a B-IoT system mote healthcare system to enhance patient data management
in the healthcare industry. and security. This system leverages blockchain and smart
• Finally, it tackles the comprehensive challenges of inte- contracts for the safe and open exchange of data among
grating blockchain and IoT technologies in the health- involved parties, enhancing the confidentiality and security of
care system. patient information. In [17] explored blockchain’s opportu-
The remaining papers are organized in the following order: nities, challenges, and future recommendations in healthcare
The related work on healthcare and blockchain is presented data management, highlighting its potential to enhance data
in Section II; Blockchain healthcare systems are described in sharing, privacy, and healthcare services while addressing
Section III; Section IV highlights the blockchain EHRs; and compliance, interoperability, and scalability issues.
Section V highlights blockchain in IoT healthcare. The appli- Griggs et al. [18], and M. Soni et al. [19], proposes a
cations are briefly described, and the IoT Blockchain Health- blockchain-based healthcare systems to solve data manage-
care Methods are analyzed in Section VI. Furthermore, in ment and privacy issues. Remote patient monitoring using
Section VII, different features of IoT healthcare blockchain smart contracts and blockchain. Healthchain is a privacy-
networks and blockchain healthcare security are represented protecting protocol that uses blockchain technology and
in Section VIII. Section IX discusses the proposed method cryptography. Both studies highlight blockchain’s potential
for blockchain healthcare; Section X explains the challenges in the healthcare industry to protect patient privacy and
of blockchain and IoT in healthcare systems; and Section XI strengthen data security. Privacy problems are addressed
concludes the work and includes suggestions for potential head-on in studies that look into the application of blockchain
areas of future research. technology in healthcare systems. They evaluate the use
of blockchain technology in healthcare management, data
II. RELATED WORKS exchange, and the distribution of medical supplies. Both
Blockchain technology is changing healthcare by bringing papers emphasize the potential of blockchain to enhance
traceable and dependable patient data management tech- patient privacy, security, and data sharing while proposing
niques. Blockchain is often understood as a distributed dig- cryptographic and privacy-preserving methods to address
ital ledger that records and authenticates transactions across privacy issues.
multiple computers. This technology has enormous potential A. Saha et al. [20], and E. J. De Aguiar et al. [21]
in healthcare to improve patient care, strengthen data secu- mentioned that the IoT has significantly changed patient care
rity, and streamline administrative tasks. The immutability and medical procedures by integrating intelligent gadgets,
and transparency of blockchain technology allow healthcare sensors, and cutting-edge data analytics. Real-time data from
systems to exchange patient records securely. Furthermore, wearables and medical equipment allows for remote patient
without jeopardizing privacy or needing permission from monitoring, prompt response when required, and the creation
third parties, the blockchain can securely transfer sensitive of tailored treatment regimens. The security and privacy of
data, such as clinical trial results or medical research. By medical data continue to be a significant challenge, even
reducing the possibility of fraud, increasing interoperabil- though IoT in healthcare can potentially improve patient out-
ity, and granting patients greater control over their medical comes and spur medical advances. As IoT develops further,
records, blockchain can improve healthcare efficiency and its uses in healthcare are anticipated to increase, revolution-
trust. in the medical field. A blockchain-based system that izing how healthcare services are provided and experienced
uses Practical Byzantine fault to protect the security, privacy and ultimately delivering a better future for all.
and interoperability of electronic health records (EHRs) is Ali et al. [20] proposed to enhance the security and trust-
improved by tolerance, role-based access control, and their worthiness of IoT blockchain networks in computer systems.
patient-centric approach, giving patients control over their They advocated for the implementation of a behavior moni-
health data [13]. The intermediate activity, patient record toring system and secure processing technology to ensure the
information, and patient data accessibility data are captured protection of blockchain programs and data.
by blockchain in the healthcare industry. [8]. A. Panarello et al. [22] IoT devices combined Attribute-
To ensure efficient implementation, a healthcare contract Based Encryption (ABE) and blockchain technology. By
management system utilizes blockchain technology, includ- leveraging ABE, data encryption can be based on user at-
ing Byzantine fault tolerance methods and smart contracts. tributes, enhancing privacy and security in a blockchain-
By automating the management of medical records, schedul- based IoT ecosystem. Different layers of IoT devices, in-
ing appointments, and patient registration, this system re- cluding machine learning, blockchain, and edge computing,
duces administrative burdens while improving efficacy, trans- have security risks across the IoT healthcare monitoring sys-
VOLUME 4, 2016 3
tems. In [23] systematically studied blockchain applications Proteção a Dados (LGPD) [28], the General Data Protection
in healthcare like data integrity and patient-centered care, Regulation (GDPR) [29], and the Health Insurance Porta-
including clinical trials—blockchain for securing medical bility and Accountability Act (HIPAA) [30] are essential in
IoT devices to protect patient information and transparent ensuring the protection of patient data privacy and confi-
data from unauthorized access. In [24] A comprehensive dentiality. The system relies on IoT technologies like sensor
security framework adaptable to diverse application areas networks and wearable devices. Reference [31] provides
and architectures emphasizes collaboration among various thorough information on how Wireless Body Area Networks
stakeholders to ensure the safety and privacy of IoT devices (WBANs) contribute to significantly advancing customized
and applications. treatment. The mentioned source includes Figure 2, which
Several academic journals discussing blockchain technol- WBANs use in the blockchain healthcare architecture [31].
ogy in IoT healthcare have been examined, comparing the
approaches taken by various authors. Subsequently, Section
III explores several IoT blockchain solutions in the healthcare
industry. Table 1 provides a concise overview of healthcare
technology from 2018 to 2024.
This study critically examines a range of literary journals
that specifically explore IoT healthcare systems, including
blockchain technology, highlighting the differences in the
methodologies used by these studies. Section III will now
concentrate on thoroughly examining the healthcare systems.

III. BLOCKCHAIN HEALTHCARE SYSTEMS

Healthcare systems could undergo many revolutions in
blockchain technology [25] by providing secure, transparent, FIGURE 2: WBANs of blockchain healthcare system.
and decentralized solutions. Here are some key aspects of
blockchain in healthcare: how patients are cared for directly Healthcare organizations can more easily confirm the
affects how healthcare data is managed, whether through credentials of their staff and partners thanks to the secure
medical records or in another way [26]. storage of healthcare providers’ credentials and licenses on
Blockchain uses encryption and decentralized storage to a blockchain. Blockchain can provide a unified and tamper-
guarantee data security and integrity. A blockchain can store proof health record for each patient, incorporating medical
patient records, clinical data, and other sensitive informa- history, diagnostic reports, treatment plans, and more. This
tion, lowering the risk of data breaches and illegal access can streamline patient care and reduce duplicate testing.
[25]. By establishing a standardized structure for data in- Blockchain can enhance telemedicine and remote monitoring
terchange, healthcare blockchains can assist in resolving the by securely storing and sharing patient data with healthcare
interoperability issue. This can make sharing medical records providers, enabling timely and accurate remote consultations
and information easier for various healthcare systems and and diagnoses [32]. While protecting patient privacy and
providers. More control over a patient’s health information data security, researchers can access anonymized patient
is possible. They can authorize or deny access to their data on a blockchain for studies and analytics. Blockchain
records, making communicating with medical professionals, technology can reduce administrative costs and errors by
researchers, or other trustworthy parties more straightforward streamlining and securing the billing and payment processes
while protecting their privacy. in the healthcare industry. The blockchain healthcare system
Blockchain can simplify clinical trials by securely storing encompasses exchanging health information, disseminating
and managing patient information, consent documents, and images, and managing logs. Figure 3 depicts the intricate
trial outcomes. This could improve the research process’s framework of blockchain systems in healthcare, as cited in
openness and credibility [25]. Blockchain technology can be [31].
used to track the manufacturing and distribution of pharma- The healthcare industry may benefit from several benefits
ceuticals, ensuring their validity and lowering the possibility of blockchain technology, as mentioned in the source [25].
of fake drugs reaching the market [27]. Blockchain can Nevertheless, it also presents distinct issues and concerns,
track medical equipment, supplies, and devices in addition to such as scalability, compliance with legislation, and interop-
drugs, enhancing efficiency and lowering the risk of coun- erability with existing systems. To effectively use the advan-
terfeit or substandard goods [25]. Blockchain technology tages of blockchain technology in the healthcare sector, it is
can improve the efficiency and transparency of managing crucial to engage in careful and detailed planning and foster
health insurance claims. Source [27] highlights that using collaboration among all parties involved. Table 2 presents a
smart contracts for automating claim validation and payment concise overview of the most recent progress in Blockchain
may effectively decrease occurrences of fraud and minimize Healthcare Systems.
administrative costs. In addition, rules such as Lei Geral de In the previous part, Blockchain Healthcare Systems were
4 VOLUME 4, 2016
 TABLE 1: Analyzing the technologies used in blockchain for healthcare systems between 2018 and 2024.

References Technologies Benefits Limitations

2018 • Smart contracts • Record-keeping and safety. • Adoption and Integration.
[16], [18], [19] • Safeguarding, privacy and data security. • Blockchain-Based Remote control.
2019 • Performance metrics • Patient privacy. • Energy-intensive, proof-of-work,
[15], [20] • Cryptographic techniques • Secure and transparent data. consensus mechanism.
• Evaluate the performance.
2020 • Role-Based Access Control (RBAC) • Security of EHR. • Scalability challenges.
[21], [22] • Smart contracts • Healthcare management. • Require significant adoption and integra-
• Transparency, distributed publicly tion efforts.
verifiable records. • Smart contracts complexity.
2021 • Role-Based Access Control (RBAC) • Enhance the efficiency of medical care. • Complex adaptations to blockchain.
[17] • Blockchain in healthcare.
2022 • Federated learning approach • Single storage location. • Data localization.
[90] • IoMT devices • Streamlined Processes. • Intrusion detection.
• Manage training
2023 • Decentralization • Protect data privacy. • Compliance with regulations.
[89] • Data Integrity
2024 • Data Integrity • Patient-Centric control. • Scalability.
[88] • Transparency • Enhanced Interoperability. • Cost of Implementation.
• Accountability

TABLE 2: Synopsis of advanced blockchain healthcare system developments.

Healthcare Systems Contributions Limitations

Data Security and Privacy Blockchain incorporate cryptographic techniques to • Scalability.
encrypt healthcare data,ensuring that it remains • Lack of data.
confidential and unreadable to unauthorized users. • Deletion centralization risks.
Interoperability Promote consistency and facilitate data exchange Adoption and network effects.
between disparate systems.
Patient Control Private keys grant them access to their records, ensuring Lost access to keys data migration.
data ownership and control.
Research and Clinical Trials Blockchain can manage and track patient consent for Scalability issues when handling the high volume of
participation in clinical trials. data generated in clinical trials include slower
transaction processing times and increased costs.
Drug Traceability Stakeholders can access real-time information about Requires the cooperation and adoption of various
the location, condition, and pharmaceutical products stakeholders.
ownership.
Telemedicine & Remote Monitoring IoT devices & wearables can collect real-time health Not acceptable for real-time telemedicine interactions.
data, which can be securely recorded on the blockchain.

IV. BLOCKCHAIN E-HEALTHCARE RECORD (EHR)

E-healthcare, often electronic healthcare, provides health-

care services and manages health-related data using digi-
tal technology and communication platforms. Conversely,
blockchain technology is a secure and decentralized digital
ledger, facilitating the transparent and immutable recording
of various transactions. In healthcare, blockchain finds its
utility in managing EHRs and handling data pertinent to
the industry. Blockchain technology may manage EHRs and
other medical records securely and effectively. Here is how it
FIGURE 3: Blockchain healthcare systems [31]. relates to electronic healthcare records. Using cryptographic
methods, blockchain technology guarantees the protection
and confidentiality of data. This method effectively reduces
the risk of data breaches and unauthorized access by securely
examined, and the most recent advancements in healthcare
storing patient information, with limited access granted only
technology were explored. Expanding on these technologies,
to authorized persons. Data sharing and interoperability prob-
Section IV will examine the techniques used in blockchain
lems might arise because healthcare providers often use
EHR.
different systems to store patient data. Blockchain technol-
ogy provides a standardized and secure framework for the
VOLUME 4, 2016 5
safe exchange of patient data across healthcare providers,
ensuring the integrity of the data. Figure 4 shows the EHR
systems [42].

FIGURE 5: E-Healthcare blockchain record system [87].

Healthcare Methods, investigating their diverse characteris-

tics. Section V will examine how blockchain is used in the
FIGURE 4: The system architecture of EHR [42]. context of healthcare applications.
The preceding section thoroughly analyzed and evaluated
The decentralized structure of blockchain technology as- IoT Blockchain Healthcare Methods, investigating their di-
sures that data cannot be changed or tampered with once verse characteristics. Section V will examine how blockchain
recorded. For medical records to remain accurate and reli- is used in the context of IoT healthcare.
able, this is essential. With blockchain, patients may have a
more significant say over who has access to their information V. BLOCKCHAIN IN IOT HEALTHCARE APPLICATIONS
and for what purposes. Patients can expressly agree to allow A. DATA SECURITY AND PRIVACY
certain healthcare professionals or researchers access their The use of blockchain and IoT in healthcare is exam-
medical records. Every transaction on a blockchain is visible ined, focusing on issues such as network design, consensus
and auditable, making tracing changes and access history mechanisms, and privacy-enhancing measures related to the
more straightforward. For regulatory compliance and ac- safety and privacy of healthcare data in IoT systems [18]. A
countability, this may be advantageous. Blockchain may sim- blockchain-based solution to ensure the authenticity and reli-
plify administrative procedures by offering a single source of ability of healthcare records is proposed [48]. A system based
truth for medical records. Reduced paperwork, managerial on the blockchain is specifically developed to provide the safe
mistakes, and overall operating expenses might result. and decentralised management of medical records, hence
Access to high-quality, trustworthy data may help with improving data security and dependability while maintaining
medical research thanks to blockchain’s safe and standard- the integrity of health information. This method employs a
ized data format. Data from many organizations may be an- decentralised record-keeping system that protects confiden-
alyzed by researchers while protecting patient privacy. Smart tial patient information from unauthorised entry, guarantee-
contracts, which are self-executing code integrated into a ing confidentiality, accuracy, and uninterrupted accessibility
blockchain, can optimise several operations in the health- [48]. HealthChain is a blockchain-based platform that fa-
care industry. These roles include accelerating the process- cilitates patient-driven interoperability in exchanging health
ing of insurance claims, overseeing appointment schedul- records. Patients are given greater control over their data
ing, and monitoring medications. Blockchain technology en- because of the decentralized architecture’s increased data se-
ables consumers to control their health data more efficiently, curity, privacy, and transparency [49]. Blockchain technology
guaranteeing its safe transmission across various healthcare addresses patient-centred healthcare data security, privacy,
providers and organisations. and interoperability issues. By allowing for encrypted data
Blockchain adoption for E-Healthcare records has many exchange between healthcare providers, blockchain-based
potential advantages, but there are also drawbacks, includ- platforms empower patients to take charge of their medical
ing legal restrictions, complex technological implementation, records [37].
and assuring data interoperability across various blockchain
platforms. Additionally, blockchain should be carefully con- B. MEDICAL SUPPLY CHAIN MANAGEMENT
sidered based on individual healthcare use cases and needs Efficiently overseeing medical supply chains is a crucial
since it is not a one-size-fits-all solution. The E-Healthcare component of healthcare management, involving coordinat-
blockchain record system is visualised in figure 5. ing, procuring, storing, distributing, and supervising medical
Table 3 provides an overview of the comparisons among equipment and materials. This method is essential for ensur-
EHR systems built on blockchain technology. The preceding ing the efficient and reliable delivery of healthcare services.
section thoroughly analyzed and evaluated IoT Blockchain In recent studies, blockchain’s potential benefits in healthcare
6 VOLUME 4, 2016
 TABLE 3: Comparison of blockchain-based EHR systems.

References Pros Cons Aim of the approach

[43] Patient-controlled records. Design-based only. Privacy-preserving blockchain-based healthcare intelligence.
[44] Share the network’s load. No schemes. Provide a safe healthcare system for a large-scale network.
[45] Mechanism of access control. Key management of scalability. Improve blockchain-based health record sharing that is safe,
effective, and efficient.
[46] Unchanged of the data ledger. Integrity and confidentiality. A cloud-based, attribute-based cryptosystem and blockchain-
powered secure electronic health record system.
[47] Incorporates the on-chain and off- Complex access control. Create a blockchain-based medical data-sharing.
chain storage verification methods
for security and privacy.

supply chain management include enhanced visibility, audi- blockchain’s immutability and decentralization [57]. In [58]
bility, and safety, emphasizing interoperability and standard- focuses on secure data exchange, while [59] aims to bolster
ization for successful implementation [50], [51]. Researchers security, interoperability, and data sharing in e-health systems
highlight advantages like data integrity, patient consent, and using blockchain technology.
transparency, emphasizing how blockchain can streamline
healthcare operations. Increased transparency, less counter- D. CLINICAL TRIALS AND RESEARCH
feit drug production, and more efficient inventory manage- Implementing advanced technologies like the IoT and
ment are advantages of implementing blockchain technology blockchain could bring substantial advantages to the health-
into healthcare supply chain management, as discussed in care industry. Clinical trials and other types of health-
[52]. Multiple research endeavours explore the intricacies care research benefit significantly from combining them.
of IoT and blockchain technology in managing healthcare Blockchain framework to enhance patient privacy during
supply chains, emphasizing the crucial need for privacy and informed consent in clinical trials [60]. Comprehensive anal-
security standards [53]. The healthcare supply chain sys- ysis conducted on IoT and blockchain applications in health-
tem utilizes blockchain technology, incorporating distributed care [61]. Blockchain-based clinical trial management sys-
ledger technology, smart contracts, and encryption to provide tems and potential blockchain technology applications [62].
secure data transmission and inventory management while The research highlights the capability of blockchain to boost
promoting openness and accountability [54]. These findings the security and transparency of patient data. It emphasizes
are crucial in enabling the extensive use of blockchain and improving data integrity and the protection of patient privacy
IoT in supply chain management across several industries. through the use of blockchain and IoT in clinical research and
healthcare environments [63]. Blockchain-based healthcare
C. INTEROPERABILITY AND DATA EXCHANGE systems bolster trust and data integrity in clinical trials.
Interconnection and information exchange are crucial com- Blockchain and IoT technology in healthcare ensure the
ponents of modern healthcare infrastructure, improving pa- secure transfer of EHRs, emphasizing confidentiality and
tient care, reducing errors, and enhancing healthcare ser- safety. This is particularly beneficial in clinical trials for data
vices’ effectiveness. This novel viewpoint tackles the diffi- interchange [64]. Figure 6 demonstrated the decentralized
culties associated with privacy, openness, and trust in health- blockchain architecture for the client application.
care data interchange. Integrating blockchain technology into
healthcare IoT frameworks is recommended to ensure the E. TELEMEDICINE AND REMOTE PATIENT
secure and transparent sharing of healthcare data within MONITORING
cloud-enabled IoT environments. This approach aims to Remote patient monitoring and telemedicine are healthcare
bolster data confidentiality, protection, and trustworthiness. practices that leverage digital technology to provide medical
Addressing privacy and security requires robust encryption services and monitor patients’ health remotely. These tech-
techniques to protect data at rest and in transit [55] to nologies hold the potential to transform healthcare delivery
ensure all sensitive healthcare data is encrypted to prevent by improving access, reducing costs, and enhancing pa-
unauthorized access. Implement multifactor authentication tient outcomes, making them components of modern health-
for users accessing healthcare data on blockchain platforms care systems. Blockchain-based telemedicine and electronic
to add an extra layer of security [56]. Private keys emphasize health record infrastructure enhance patient management,
secure and decentralized data sharing between IoT devices data security, and interoperability through IoT integration
and healthcare providers [24] to securely grant and revoke for remote health monitoring [65], [66]. The combination
access to their health data. A patient-centric blockchain- of blockchain’s immutability and IoT enables secure, high-
based health records-sharing system highlights the utility quality telemedicine services focusing on data privacy [67].
of blockchain for enhancing data exchange, interoperabil- Integrating blockchain and IoT in telemedicine emphasizes
ity, and security in healthcare IoT applications, leveraging data security, privacy, and audibility: remote health monitor-
VOLUME 4, 2016 7
ing, secure data storage on blockchain, and enhanced telecon- technology result in enhanced patient outcomes and a state-
sultations [68]. Challenges like scalability and trust are high- of-the-art healthcare system. However, stringent security pro-
lighted, with proposed solutions leveraging blockchain’s de- cedures are necessary to safeguard private medical informa-
centralized nature for secure communication, data integrity, tion. Future healthcare systems will likely rely heavily on
and access control [69]. Standardized protocols and efficient blockchain-edge computing.
data management are crucial for effective implementation,
offering insights into the blockchain [70], [71], and [33]. B. CLOUD COMPUTING
Table 4 shows the blockchain IoT health applications Cloud computing, IoT, and intelligent hospital information
overview. systems can collect and store a wide variety of patient records
in real time with the help of sensor technologies. SaaS,
PaaS, and IaaS are the three main services cloud technology
provides in the healthcare industry [38]. The present scenario
of cloud-based healthcare, particularly for storing health
records, offers a comprehensive insight into cloud technol-
ogy, as discussed in source [31]. Research [25], [27], and [32]
also explores the utilization of large databases for statistical
analysis and identifying patterns. These studies propose a ro-
bust cloud management framework for IoT-enabled e-health
systems, emphasizing efficiency, security, seamless integra-
tion, and predictive abilities in managing, processing, pro-
tecting, and complying with regulations. Medical facilities
that use this system see vast improvements in efficiency and
a decrease in the cost of treatment. The healthcare industry
FIGURE 6: Client application of decentralized blockchain has greatly benefited from combining cloud computing, IoT,
architecture [41]. and blockchain, allowing more effective data management,
analysis, and service delivery.
The section above surveys and examines IoT healthcare C. BIG DATA
applications and their features. In the following section, VI The capacity of big data within blockchain IoT healthcare
will review the blockchain and IoT blockchain healthcare systems to handle and analyze the vast volumes of data
methods. generated by connected devices and sensors is essential for
enhancing patient care [39]. Insights about patient behavior,
VI. IOT BLOCKCHAIN HEALTHCARE METHODS patterns, and health issues can be gleaned from the patient
A. EDGE COMPUTING data, allowing for more precise treatment plans [40]. En-
Radio Access Network (RAN) edge computing is a network hancing disease prediction and early identification, big data
architecture that strategically positions computers and stor- analytics in blockchain IoT also improves patient outcomes
age resources. Resource Preservation Net (RPN) system for through timely interventions. Better patient care is achieved
the healthcare sector that integrates edge computing with through greater operational efficiency, reduced waste, and
individualized clouds to develop PetriNet modelling [36]. To streamlined workflows to combine big data and IoT in health-
ensure the safe deployment of healthcare applications, the care facilities [41]. Table 5 presents an overview of the latest
process of upgrading wireless body area networks requires developments in healthcare blockchain technologies.
the use of mobile cloud computing and edge computing. In the previous section, several approaches to integrating
Reference [23] acknowledges that this improves healthcare IoT and blockchain technologies into the healthcare industry
quality while safeguarding patient confidentiality. Edge com- were examined. The next section, VII, will conduct a compre-
puting’s capacity to analyze data in real-time facilitates the hensive study that explicitly examines the incorporation of
development of systems capable of autonomously regulating blockchain technology into IoT healthcare networks within
physiological balance by enabling quick data processing the framework of e-healthcare.
and command execution. The intelligent healthcare frame-
work is investigating the potential of edge computing in VII. IOT HEALTHCARE BLOCKCHAIN NETWORKS
several domains, such as rural healthcare, patient-generated A. HEALTHCARE BLOCKCHAIN TOPOLOGY
health data, enhanced patient satisfaction, streamlined supply Robust encryption techniques protect health information dur-
chains, and cost reduction, as outlined in reference [37]. Edge ing transmission and while it is stored. The integrity of data is
computing in healthcare offers excellent promise for IoT- maintained through hashing and the use of digital signatures.
enabled devices by processing and analyzing data in real- Blockchain technology is crucial in verifying the origin and
time at the network’s periphery. The improved efficiency authenticity of pharmaceuticals, medical devices, and sup-
and accuracy in managing healthcare data using blockchain plies, preventing counterfeit products, and ensuring patient
8 VOLUME 4, 2016
 TABLE 4: Overview of the blockchain IoT health applications.

References Applications Benefits Limitations Blockchain Technology

[25] Electronic Health • Secures the data. • Availability, confidentiality, • Private blockchain.
Record (ERH) • Used patient’s data. and Transparency.
[40] Data security and • Enhanced data Security. • Scalability challenges. • Public blockchain.
orivacy • Prevent data privacy. • Interoperability issues. • Smart contracts.
• Decentralized storage.
• Sensors.
[47] Medical supply • Facilitated tracking • Interconnection. • Decentralized transparent, &
Chain management • Protection of private info. • Problems with regulation immutable nature.
• Efficient supply management. and the law. • Sensors and RFID tags.
[72] Clinical trials and • Centralized control & interference. • Computational overhead • Ethereum blockchains.
Research • Increased openness. and storage requirements. • Hyperledger fabric.
• Sharing information safely. • Interoperability. • Consortium blockchain.
• Automate streamlines data management. • Connected medical devices.
[73] Telemedicine and • Enables transparent & immutable • Blockchain interoperable • Sensor networks.
Remote patient recording of transactions. elite healthcare integration. • Hyperledger Fabric.
Monitoring • Blockchain enables accurate tracking • Blockchain must work on • Corda.
of medical supplies. scalability in the supply • Cloud-based platforms.
• Secure blockchain and IoT-encrypted chain of healthcare.
data transmission.
[80] Interoperability and • Safety improvements. • Scalability. • Hyperledger Fabric (HF).
Data exchange • Confidentiality of information • Regulatory challenges • Private blockchain.
availability. hinder blockchain IoT • Cloud computing.
• Authenticity and openness. adoption. • Smart contracts.

TABLE 5: Summary of state-of-art different healthcare blockchain technologies.

Technologies Contributions Limitations

Edge Computing • Enhancing security. • Reduced scalability.
• Decentralized and immutable ledger. • Computational resources compared to traditional data
• Edge devices can cryptographically sign data and transactions. centers.
Cloud Computing • Enhance data integrity and security in cloud • Running blockchain nodes and maintaining a blockchain
computing environment for health data. network can add to the operational costs of cloud
• Users can verify the integrity of data and computing environments.
transactions stored in the cloud. • Cloud storage and processing fees have the potential to
balloon over time.
Big Data • Health data can be securely recorded on the blockchain. • Compliance with data protection laws remains a complex
• Big data analytics tools can be applied to the vast challenge, especially when dealing with cross-border
amount of healthcare data stored on the blockchain. healthcare data.
Decentralization • Reducing the risk of single points of failure • Slower transaction speeds as the network grows.
and enhancing resilience.
Data Integrity • Reducing the risk of errors and inconsistencies. • Require significant computational power & energy con-
sumption.

safety. For IoT health blockchain network gateways and ser- adherence, is collected and transmitted by IoT devices. Edge
vice accesses, Internet Protocol (IP) and Global System for computing nodes are positioned near IoT devices, medical
Mobile Communications (GSM) are essential to keep medi- facilities, or patients’ premises. These nodes preprocess, fil-
cal data flow continuous. Similar theoretical frameworks for ter, and aggregate data from IoT devices to reduce latency
healthcare applications are discussed in references [82], [83], and optimize data before transmitting it to the blockchain
[84], and [85]. network.
In order to enhance the security of healthcare systems,
B. HEALTHCARE BLOCKCHAIN ARCHITECTURE it is advisable to use a consensus method such as Proof of
Designing a blockchain architecture for IoT health networks Authority (PoA) or Proof of Stake (PoS). Employ intelligent
entails organizing the layers and components to guarantee contracts to optimize procedures such as overseeing data ac-
safe, open, and effective health-related data management cessibility, handling insurance claims, and authorizing med-
from IoT devices. ical interventions. Utilise blockchain technology to securely
Numerous IoT health devices are included in different lay- store patient health information in an encrypted manner or
ers, including wearable fitness trackers, medical sensors, im- establish a connection between the blockchain and off-chain
plantable devices, and remote monitoring apparatus. Health- storage options to improve scalability and efficiency. The
related data, such as vital signs, patient activity, or medication blockchain network should include diverse nodes, including
VOLUME 4, 2016 9
IoT devices, that contribute to an all-encompassing health ties can see and change health authorizations. This will also
data network. Designated validators conduct transaction val- make it easier for the blockchain framework to connect to and
idation before adding them to the blockchain. Comprehen- share information with healthcare providers’ systems. Utilize
sive nodes store a complete and thorough account of the a decentralized blockchain platform in healthcare to im-
blockchain’s transaction history. prove several elements of healthcare administration, such as
Establish governance procedures and mechanisms to con- streamlined data management, patient records, supply chain
trol the blockchain network, such as validator selection and surveillance, billing procedures, and other related areas.
protocol updates. Protect sensitive health data using encryp- Table 6 represents the features and availability of IoT
tion, cryptography, and access control. Make it possible for Healthcare Topology.
EHRs, other data sources, and current healthcare systems to
TABLE 6: Strengths and simplicity of access of topology in
communicate. Web and mobile applications provide patient,
IoT healthcare systems.
healthcare provider, and authorized user interfaces. Patients
can manage consent, grant access to healthcare providers,
Healthcare Blockchain Features and Availability
and monitor their health data through the interfaces. A re- Topology
liable identity and access management system guarantee that Healthcare Blockchain Topology • Consortium Blockchain.
only vetted people or organizations can access patient data. • Data Privacy and Access Control.
• Security and Encryption.
Smart contracts manage patient consent and give patients • Scalability.
access to control over their data. Scalability solutions like • Data Validation and Verification.
sharding, sidechains, or state channels handle the massive • Auditability and Transparency.
Healthcare Blockchain • IoT Device Layer.
amount of health data produced by IoT devices. Architecture • Edge Computing Layer.
Blockchain’s transparent ledger makes all transactions and • Blockchain Network.
data access related to healthcare auditable and traceable. • User Interfaces and Applications.
• Auditability and Transparency.
With the help of the architecture in figure 7, IoT devices can Healthcare Blockchain Topology • Consortium Blockchain.
manage health data securely, transparently, and interoperable • Data Privacy and Access Control.
while still adhering to healthcare regulations and protecting • Security and Encryption.
• Scalability.
patient privacy. It uses blockchain technology to offer a • Data Validation and Verification.
decentralized, trust-based platform for managing healthcare • Auditability and Transparency.
data. Healthcare Blockchain Platform • Data Encryption and Security.
• Blockchain Technology.
• Identity and Access Management.
• Interoperability.

Several IoT healthcare topologies and architectures are

provided in the section above, which also examines IoT
healthcare blockchain networks. Section VIII will go over
IoT blockchain healthcare security in the following part.

VIII. IOT BLOCKCHAIN HEALTHCARE SECURITY

An extensive analysis was conducted on integrating
FIGURE 7: Architecture of blockchain [86]. blockchain with IoT, specifically emphasizing data gover-
nance, device management, and the challenges associated
with combining these technologies [16]. The research em-
C. HEALTHCARE BLOCKCHAIN PLATFORM phasized blockchain as a viable method to enhance security
Strong encryption methods safeguard health data both in and privacy in IoT setups [18]. This study investigated the
transit and at rest. Secure data is kept on the blockchain use of blockchain technology to protect data transferred by
or in off-chain storage solutions. The platform’s security IoT devices. It examined the structure, features, possible
should be evaluated to find and fix vulnerabilities. A suitable uses, and difficulties encountered in improving the security
blockchain platform technology, such as Ethereum, Hyper- of electronic gateway nodes [15].
ledger Fabric, or a specialized blockchain solution, complies
with healthcare data needs. Deploy a resilient consensus A. SECURITY REQUIREMENTS
mechanism designed explicitly for regulated network con- • Scalability: Scalability in blockchain healthcare is a
texts, such as Proof of Stake (PoS) or Proof of Authority difficult challenge but crucial for ensuring blockchain
(PoA). Create an extensive identity and access management technology can effectively handle the growing demands
system to verify the authenticity of all entities inside the of healthcare data and transactions. Careful planning,
network, such as persons, devices, and institutions. Enforce optimization, and adopting scalable solutions are es-
role-based access restrictions to ensure only authorized par- sential to achieving a scalable and efficient blockchain
10 VOLUME 4, 2016
 healthcare ecosystem [20]. Scalability is a critical con- impact of faults and failures in the system.
sideration in implementing blockchain technology in • Authentication: Authentication is crucial in the domain
healthcare, as it involves accommodating the increasing of the IoT healthcare blockchain since it verifies the
volume of data and transactions without compromising identities of users, devices, and enterprises involved in
system performance or efficiency. Scalability is essen- the blockchain network. Only authorized and trusted
tial in healthcare, where large volumes of patient data participants can access and perform actions on the
and complex transactions are involved [21]. healthcare blockchain. Digital certificates are issued by
• Confidentiality: Confidentiality is a necessary aspect a trusted Certificate Authority (CA) and contain the
of blockchain healthcare, where the privacy and se- entity’s public key [37]. Explore decentralized identity
curity of patient health information are of utmost im- solutions that give individuals control over their own
portance. Confidentiality in blockchain healthcare is a identities and credentials. It requires a combination of
multifaceted challenge that requires a combination of secure identity management, robust authentication pro-
technical, organizational, and regulatory measures to tocols, and compliance with regulatory requirements to
protect patient privacy and ensure health data security provide a safe and trusted environment for healthcare
[22]. Taking a holistic approach to confidentiality is transactions and data access [50].
essential, considering the entire data lifecycle and im- • Authorization: Role-Based Access Control (RBAC)
plementing appropriate safeguards at each stage. assigns specific roles to users, devices, and entities
• Integrity: Preserving data integrity in blockchain within the healthcare blockchain network. Define the
healthcare is vital for maintaining the trustworthiness permissions associated with each part to control what
of health records and ensuring that patient data remains actions they can perform. Secure APIs are used for
accurate and secure [74]. It requires a combination of interactions between IoT devices, healthcare systems,
technical measures, processes, and compliance with reg- and the blockchain. Implement robust API security mea-
ulatory standards to safeguard the integrity of healthcare sures to control and monitor access, including API keys,
data throughout its lifecycle on the blockchain. Employ OAuth 2.0 [51].
robust algorithms for the validation and verification of Healthcare IoT devices can range from wearable health
transactions. These consensus processes play a crucial trackers to medical sensors, and their numbers can be
role in guaranteeing the inclusion of only genuine and vast. Ensuring the secure and efficient integration of
unaltered data onto the blockchain. these devices into a blockchain network is critical for the
• Availability: In IoT healthcare blockchain, availability success of healthcare applications. Define each IoT de-
signifies consistent and reliable access to healthcare vice’s access control policies and permissions based on
systems, devices, and data, ensuring uninterrupted func- its identity and role. Real-time monitoring and alerting
tionality whenever required. High availability is critical systems to detect and respond to IoT device anomalies
in healthcare, where timely access to data and services or security breaches [52].
can have life-saving implications. Ensuring availability • A multi-protocol Network: A multi-protocol network
in IoT healthcare blockchain is crucial for maintaining in a blockchain healthcare system uses multiple com-
the continuous operation of critical healthcare systems, munication and data transfer protocols to enable various
especially when patient data and real-time monitoring components and entities within the healthcare system
are involved. A well-designed infrastructure with re- to interact efficiently and securely. This approach is
dundancy, monitoring, and recovery mechanisms is es- often necessary in complex healthcare environments
sential for meeting high availability requirements [48]. involving many devices, methods, and stakeholders.
Scalable systems can accommodate increasing numbers Implementing a multi-protocol network in a blockchain
of devices and users while maintaining consistent avail- healthcare system requires careful planning, standard-
ability. ized data formats, and strong security measures [53].
• Fault Tolerance: In the discipline of IoT healthcare The goal is to create an agile and resilient infrastructure
blockchain, fault tolerance pertains to the system’s abil- that supports the diverse needs of healthcare providers,
ity to perform correctly even in the presence of hardware patients, and IoT devices while ensuring the security and
failures, software faults, or unanticipated catastrophes. integrity of patient data.
Uninterrupted availability of patient data and services is • Information Disruptions: Interruptions in the IoT
crucial in healthcare environments. Specify SLAs with healthcare blockchain refer to disruptions or outages
service providers and partners that specify fault toler- in the system’s operation, which can have severe con-
ance and recovery expectations. Ensuring fault tolerance sequences in healthcare where real-time data access
in IoT healthcare blockchain is vital for maintaining the and critical patient information are involved. By im-
continuous operation of healthcare systems and safe- plementing redundancy, scalability, security measures,
guarding patient data [49]. A well-designed, redundant, and effective disaster recovery plans, healthcare orga-
and tested infrastructure, along with proper disaster nizations can minimize the impact of interruptions and
recovery and backup procedures, can help mitigate the ensure that critical healthcare services remain available
VOLUME 4, 2016 11
 and uninterrupted. Employ real-time monitoring and the domain. To guarantee security, integrity, and com-
alerting systems to detect issues promptly [54]. Mon- pliance, a blockchain healthcare system’s hazard model
itoring helps identify potential problems and enables entails the systematic assessment, identification, anal-
quick responses to minimize downtime. Interception in ysis, and management of potential risks and hazards.
a blockchain healthcare system refers to unauthorized Protecting patient data and upholding trust in healthcare
access or eavesdropping on the data and communica- blockchain solutions is necessary.
tions within the blockchain network. This kind of inter-
ference can compromise the security and privacy of pa- B. A TAXONOMY ATTACK
tient data, which is of utmost concern in healthcare [55]. Data accuracy and integrity are essential components of a
Modification in a blockchain healthcare system refers blockchain healthcare system. Attackers may try to com-
to any unauthorized or tampering of data or records promise patient records by inserting erroneous or malicious
stored on the blockchain. This activity can have severe data into the blockchain. Because it involves changing the
consequences in healthcare, as patient data integrity is categorization or classification of data, this kind of attack
paramount. In a blockchain-based healthcare system, may be called a "taxonomy attack." By altering the taxonomy
fabrication refers to the creation or modification of data, or metadata related to medical records, attackers may try
records, or transactions that contain false or fraudulent to confuse the healthcare system. This might result in in-
information [56]. This kind of activity can severely correct data classification or interpretation, affecting patient
impact the integrity of healthcare data, patient safety, care. Regularly evaluating and updating security measures
and the system’s overall trustworthiness. Maintaining is critical to safeguarding sensitive healthcare data within a
patient data integrity and ensuring the accuracy of med- blockchain system.
ical records require preventing and detecting fabrication Table 7 and 8 show the blockchain security require-
in a blockchain healthcare system. Sensitive healthcare ments and challenges of the IoT and the state-of-art of IoT
data must be protected with security measures, strict blockchain healthcare security and features, respectively.
access controls, and audibility features.
• Security Challenges: The blockchain-based healthcare TABLE 7: Security demands and hurdles in IoT for
system comes with unique security challenges due to blockchain.
health data’s sensitive and personal nature. Address-
ing these challenges is essential to maintaining data Security in Blockchain Healthcare Features
integrity, patient privacy, and the overall trustworthi- • Data Encryption.
• Device Authentication.
ness of the system. Computation restriction challenges SECURITY REQUIREMENTS • Access Control.
in a blockchain healthcare system refer to constraints • Data Integrity.
on computational resources, which can impact the • Network Segmentation.
• Data Privacy and Confidentiality.
performance and scalability of the system. Health- • Device Vulnerabilities.
care blockchains must deal with complicated data pro- SECURITY CHALLENGES • Supply Chain Security.
cessing, smart contracts, and cryptographic operations. • Interoperability Issues.
• Data Management Integration.
It can be hard to keep up with all these computa- • The first step is to identify and
tional needs—computational limitations in a blockchain categorize potential hazards.
healthcare system between security, scalability, and ef- HAZARD MODEL • Complies with healthcare
regulations and data protection.
ficiency [24]. The storage and retrieval of data and laws.
transactions within a blockchain healthcare system are • Robust data validation process.
restricted by memory limitations. Memory restrictions A TAXONOMY ATTACK • Continuously monitor the
can impact the blockchain’s performance, scalability, blockchain for any unusual or
suspicious data.
and overall functionality, especially in the healthcare
industry, where data storage needs can be significant.
For a blockchain healthcare system to be scalable and
perform well, memory issues must be resolved to pre- In Section IX, the authors introduce a model based
serve patient records’ long-term integrity [57]. Uncer- on blockchain architecture that they have researched. This
tainty challenges in a blockchain healthcare system refer model is accompanied by an exploration of security needs,
to issues and concerns related to the inherent uncer- obstacles, threat models, and types of attacks in IoT health-
tainties in healthcare data, processes, and regulatory care.
compliance [58]. Certain challenges in a blockchain
healthcare system require technological and organiza- IX. PROPOSED MODEL
tional solutions to ensure data accuracy, integrity, com- The primary goal of the proposed system is to reliably track
pliance, and patient trust. Addressing these challenges all of the most critical patient health and room condition
is essential for realizing the benefits of blockchain in metrics in real-time, regardless of whether or not Wi-Fi is
healthcare while managing the inherent complexities of available, using the blockchain structure. The system can
12 VOLUME 4, 2016
TABLE 8: Current trends and attributes in IoT healthcare data encryption before transmitting it to the cloud server. The
blockchain security. cloud server is responsible for data storage. Before presenta-
tion, the data decryption module decodes the encrypted data.
References IoT Blockchain Features Issue
Healthcare Security The interaction module represents the mobile application.
[75] Data encryption. End-to-End Encryption Figure 8 illustrates the overall architecture of the developed
Data-at-Rest Encryption. B-IoT system.
[76] Device authentication. Device identifiers for
authentication.
Data Processing Module: The sensing and data pro-
[77] Secure data transmission. Using protocols like cessing module gathers information about the patient and
HTTPS or MQTT with the room’s surroundings via sensors that convert analog or
TLS/SSL encryption.
digital signals from physiological and physical occurrences.
[78] Blockchain access Access controls and
Control. permissions based on user An ESP8266 Wi-Fi module or a SIM900A GSM module
roles and patient consent. transmits the acquired data to a cloud server; LCDs serve
[79] Data privacy and consent, Provide and revoke consent as the medical record; a buzzer and emergency button are
management. for data sharing.
[84] Data sharing, scalability, Blockchain-based smart part of the system for alerting people to danger; and so
and Quality of Service and secure healthcare on. This module then analyses the data it collects from the
(QoS). system (ssHealth) surroundings and the user’s physiological parameters and
scalability.
uploads it to a server in the cloud.
Data Security (Encryption) Module: The suggested so-
lution includes a crucial data security (Encryption) module
that plays a vital role in protecting the security and integrity
pinpoint the patient’s location in an emergency and issue a
of patient health data. At the same time, it is being sent
more robust and automated alert.
and stored. This module uses robust encryption techniques
The system integrates several technologies, but its two
to ensure that only authorised persons may access and utilize
main components are a wearable hardware gadget and a
the data, preventing unauthorised access to sensitive health
mobile app that displays the patient’s present and historical
information. State-of-the-art encryption methods encrypt pa-
medical history. The patient wearing the device may move
tient health data before transmitting it to the cloud server.
around under close supervision.
The module complies with secure communication protocols,
The sensors in the device collect data about the patient’s
strictly enforces access limits, and securely manages encryp-
body and environment, and encrypted data is sent to the
tion keys to safeguard data during transmission.
central processing unit using different blockchain paradigms
Data storage module: This module is responsible for
to protect the health data. The information sent to the mobile
gathering and storing the obtained data. The system depends
application from the server is also decrypted and stored in a
on a database that operates in real time and uses a Google
patient database. The system and the mobile app can identify
Firebase cloud server for backup. The real-time database
patient information anomalies and provide worrisome notifi-
receives data from the physical device. The system keeps the
cations that include the patient’s location. Figure ?? provides
health record in real-time, allowing for continuous patient
a schematic diagram to help you understand the system’s
monitoring. Updates are made every 7-8 seconds to ensure
general process.
an accurate and current health record. Nevertheless, the fre-
quency at which the gadget takes measurements may vary
A. SYSTEM DESIGN
depending on predetermined intervals.
The ability of a cloud to offer security, connect to real-time Data Decryption: Data Decryption Module, which safely
data with end-to-end encryption and decryption, and access decrypts the encrypted health data on the cloud server. Au-
performance data has significantly enhanced the proposed thorized healthcare professionals and individuals with active
system framework. This allows us to gather clinical insights encryption keys may retrieve the original health data in plain
from specific devices and ultimately improve patient out- text from this module. It guarantees data privacy by confirm-
comes, revolutionizing healthcare in collaboration with users. ing user identities using robust authentication procedures and
The five prominent system architecture and functionality obtaining encryption keys from a secure key management
modules are as follows: system. The decrypted data is securely sent to authorized
• Sensing and data processing. users to limit data exposure and guarantee secrecy. Monitor-
• Data security (Encryption). ing data access and ensuring responsibility are made more
• Data storage. accessible by comprehensive logging and auditing tools. Use
• Data decryption. encrypted communication and adhere to key management
• Interaction. practices to ensure high data security in accordance with data
The core concept of the suggested system is to provide round- protection laws.
the-clock online monitoring of patient’s health and room con- Interaction module: The mobile application receives
ditions. The sensing and data processing module symbolizes health data from the cloud server and displays it to authorized
the patient’s equipment. The data security module handles users. Users who are new to the system have the option to
VOLUME 4, 2016 13
 FIGURE 8: B-IoT system architecture for data security.

register as patients, guardians, or doctors. By signing in, they to revolutionize healthcare, offering improvements in data
may connect with the system and access a patient’s up-to-date security, interoperability, and real-time patient monitoring.
and past health records. While. The integration of blockchain and the IoT in health-
Problems arise while developing many of these apps and care shows great promise in enhancing data security, inter-
the services that support them. In Section X, the authors will operability, and patient well-being; its implementation poses
address the many problems and difficulties found during the several challenges that must be addressed for successful
review. Insights like these will help researchers, academics, deployment in the healthcare sector. This review of existing
chemists, healthcare stakeholders, doctors, and nurses move literature delves into the obstacles associated with utilizing
blockchain IoT healthcare forward. blockchain and IoT in healthcare and spotlights potential
solutions suggested in research articles [23], [34], [35], [36],
X. CHALLENGES OF BLOCKCHAIN HEALTHCARE [38], [81], [82], and [83].
Improvements in data security, interoperability, and patient
well-being may result from the healthcare industry’s use of A. TECHNICAL CHALLENGES
blockchain technology in conjunction with the IoT. However, There are worries about the scalability of the blockchain
specific challenges must be overcome for these technolo- infrastructure during data processing and storage due to the
gies to be successfully used in healthcare. In this article, large amounts of data produced by blockchain and the IoT. To
the challenges of using blockchain and IoT in healthcare address healthcare-related applications, it may be necessary
are examined, and possible solutions based on research are to enhance blockchain systems like Ethereum and Bitcoin
highlighted. Key challenges include scalability, interoper- due to their inherent restrictions, which limit the number of
ability, and data privacy concerns [34]. Addressing these transactions per second. Despite blockchain’s promise of an
challenges involves implementing standardized communi- immutable record, protecting the privacy of sensitive medical
cation protocols and enhancing data encryption techniques data is still an issue. In particular, striking a balance between
to improve data integration, device interoperability, and se- openness and data protection is paramount in the healthcare
curity [35]. IoT and blockchain technology applications in industry. Devices, protocols, and standards used by health-
healthcare concern data privacy, trust, and data provenance care networks may be different. Creating smooth interop-
to enhance data security, patient privacy, and regulatory com- erability between blockchain systems and IoT devices may
pliance in healthcare systems [36]. The issues of data authen- take time and slow widespread adoption. Blockchains require
ticity, resource-constrained devices, and consensus mecha- consensus mechanisms to validate transactions. The energy-
nisms propose a hybrid consensus algorithm to optimize intensive proof-of-work (PoW) used in many blockchains
resource usage and improve IoT device performance within can be impractical in healthcare. Finding energy-efficient
a blockchain network [57]. consensus mechanisms is a challenge. Real-time applica-
The combination of blockchain and IoT has the potential tions in healthcare require low-latency data transmission.
14 VOLUME 4, 2016
Blockchain’s inherent delay in transaction confirmation can TABLE 9: Difficulties of integrating blockchain and IoT in
pose challenges for applications requiring immediate action. healthcare.

Challenges Description
B. DEVELOPMENT CHALLENGES
Scalability Handling large data volumes efficiently on
Compliance with several regulatory frameworks, such as blockchain.
HIPAA in the US or GDPR in Europe, is essential when in- Data privacy and secu- Ensuring patient data privacy while leverag-
rity ing blockchain’s security.
tegrating blockchain and IoT systems into the healthcare in- Interoperability Integrating diverse IoT devices and
dustry, subject to tight restrictions. Finding a middle ground blockchain platforms seamlessly.
between complying with these standards and maintaining the Consensus mechanisms Finding energy-efficient consensus methods
benefits of blockchain and IoT takes a lot of work. Ensur- suitable for healthcare.
Latency Addressing delays in transaction confirma-
ing data consistency and standardisation across healthcare tion for real-time applications.
providers and IoT devices is essential for meaningful data Regulatory compliance Complying with healthcare regulations like
exchange. Achieving this standardisation can be challenging HIPAA or GDPR.
Data standardization Establishing consistent data formats across
due to the diverse systems used. Healthcare organizations systems and devices.
must allocate substantial resources towards infrastructure, Cost of implementation Overcoming financial barriers associated
training, and development to implement blockchain and IoT with infrastructure and training.
Skills gap Developing a skilled workforce proficient in
technologies. When faced with the financial obstacles posed both blockchain and IoT.
by new technologies, smaller healthcare facilities may need Patient consent Managing and respecting patient consent in
support. More blockchain and IoT specialists are needed in decentralized systems.
Data ownership Clarifying data ownership and access rights
the healthcare sector. Building and educating a skilled staff among stakeholders.
capable of managing these technologies may be challenging. Network reliability Ensuring consistent network connectivity,
especially in remote areas.
C. OTHER CHALLENGES Resistance to change Addressing the healthcare industry’s hesi-
tance to adopt new technologies.
Managing patient consent and providing them with control
over their data in a blockchain-based system can be complex.
Striking the right balance between patient empowerment and
data access is a challenge. Determining data ownership and
access rights in a decentralized system can be contentious. XI. CONCLUSIONS
Patients, healthcare providers, and other stakeholders may In B-IoT, the combination of blockchain technology with the
have conflicting interests. IoT devices depend on network IoT, is a fascinating new area that might have far-reaching
connectivity, and any disruptions can impact data collection effects on healthcare systems. By making it impossible to
and transmission. Ensuring network reliability in remote alter without authorization, blockchain technology claims to
or underserved areas can be challenging. The healthcare guarantee the authenticity and reliability of medical records.
industry is known for its conservative approach to adopt- Incorporating the IoT into healthcare can establish a robust
ing new technologies. Convincing stakeholders to embrace framework for safeguarding healthcare data and ensuring its
blockchain and IoT solutions can take a lot of work. integrity. This encompasses the secure storage and accessibil-
Integrating blockchain and IoT in healthcare presents im- ity of patient records, medical device information, and data
mense potential for data security, interoperability, and real- related to the drug supply chain. The decentralized nature of
time monitoring. However, this transformative journey faces blockchain technology facilitates secure data sharing among
significant hurdles. Technical issues include scalability, data healthcare professionals, fostering collaboration and elevat-
privacy, and interoperability. Development challenges en- ing the quality of patient care. The healthcare industry oper-
compass regulatory compliance, data standardization, and ates under rigorous regulations, demanding strict adherence
cost implications. Meanwhile, patient consent, data own- to data protection and privacy standards when implementing
ership, and network reliability pose complex non-technical bIoT systems. Achieving compliance can often be a com-
challenges. Resistance to change within the healthcare indus- plex and multifaceted process. One notable challenge lies in
try remains a persistent obstacle. Despite these challenges, scaling the blockchain network to accommodate the substan-
collaborative efforts among technology providers, healthcare tial volume of data generated within the healthcare sector.
institutions, and regulators are essential to unlocking the pro- The implementation and maintenance of bIoT solutions may
found benefits of this technological convergence for a more involve significant expenses. Healthcare institutions and or-
efficient and secure healthcare landscape. Table 9 illustrates ganizations might hesitate to embrace emerging technology
the difficulties of integrating Blockchain and IoT within the due to financial considerations and concerns regarding data
healthcare domain. security. While bIoT technology has the potential to enhance
The above-mentioned challenges will contribute to ad- data privacy, it also raises questions about the degree of
vancing the B-IoT healthcare industry. Subsequently, the control patients and healthcare providers have over personal
conclusion and current advancements in B-IoT healthcare health data. Integrating healthcare, Blockchain technology,
will be discussed and reviewed in Section XI. and the IoT presents a promising path toward a healthcare
VOLUME 4, 2016 15
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