Cluster Computing

https://doi.org/10.1007/s10586-024-04357-y (0123456789().,-volV)
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IoT-based eHealth using blockchain technology: a survey

Aya H. Allam1 • Ibrahim Gomaa2 • Hala H. Zayed1,3 • Mohamed Taha1

Received: 26 October 2023 / Revised: 13 January 2024 / Accepted: 10 February 2024

 The Author(s) 2024

Abstract
The eHealth sector has witnessed significant growth due to technological advancements, facilitating care delivery in
patients’ homes and moving away from traditional hospital settings. Blockchain and the Internet of Things (IoT) play
pivotal roles in enhancing healthcare services, offering features such as remote patient monitoring, streamlined electronic
medical record (EMR) management, drug traceability, and effective disease control, particularly during events like the
COVID-19 pandemic. The growing utilization of IoT devices brings about security challenges, including concerns related
to data integrity and device authentication. This paper proposes the integration of blockchain technology as a robust
solution. Leveraging its decentralized and tamper-resistant features, blockchain establishes trust among diverse IoT
devices, ensuring the integrity of IoT data. Additionally, smart contracts enhance device authentication, fortifying overall
security by addressing vulnerabilities associated with centralization. Regarding the management of eHealth, this survey
begins with an overview of the industry, highlighting IoT-related challenges in healthcare. It explores various IoT
applications in eHealth and discusses how blockchain can effectively address obstacles in healthcare management through
IoT. Notably, the paper provides insights into examining consensus algorithm parameters within blockchain systems,
clarifying the methodology used to assess and optimize these critical components. The survey extends to a thorough review
of existing research on integrating blockchain-based IoT in eHealth. Finally, it presents an overview of challenges and
potential solutions for implementing blockchain-based IoT in the eHealth sector. This comprehensive survey aims to
empower stakeholders by providing insights to enhance patient care in this dynamic and evolving field.

Keywords IoT
Healthcare
Blockchain
Security
COVID-19

1 Introduction

Today, global healthcare spending could exceed $10 tril-

lion [1]. Healthcare is a vital field that impacts the global
population and plays an important role in the advancement
of nations. As a result, eHealth systems have contributed
& Aya H. Allam greatly to most government initiatives worldwide, and
[email protected]
industry spending increased by 4.1% per year globally
Ibrahim Gomaa between 2017 and 2021 [2].
[email protected]
IoT technology has greatly impacted the healthcare
Hala H. Zayed sector and led to significant growth in recent years. The
[email protected]
eHealth industry has been significantly improved by inte-
Mohamed Taha grating IoT into various applications such as EMR man-
[email protected]
agement, disease prediction, remote patient monitoring,
1
Computer Science Department, Faculty of Computer and and drug traceability [3]. In healthcare systems, data col-
Artificial Intelligence, Benha University, Benha, Egypt lected by IoT sensors play a critical role [4]. Remote
2
National Telecommunication Institute (NTI), Cairo, Egypt patient monitoring is very prevalent these days, and pro-
3
Faculty of Engineering, Egypt University of Informatics, tecting the privacy of enormous volumes of data is a major
Cairo, Egypt challenge with such systems [5]. These issues can be

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solved with several technologies, such as Mobile Edge associated with healthcare, IoT, and Blockchain, all
Computing (MEC), Fog Computing, and Blockchain [6]. included in this survey.
Blockchain technology is being explored as a potential
solution for addressing security challenges. This has led to
1.2 Contributions and comparisons to other
increased interest in using blockchain to safeguard sensi-
survey articles
tive data [3]. Integration of IoT-based eHealth systems
using blockchain technology is presented in lots of
In this survey, we assessed the adoption of Blockchain in
research, and many challenges are faced in this integration.
an IoT-based eHealth system Besides, we will emphasize
This article reviews and analyzes integration frameworks
the importance of blockchain in such a system and describe
of Blockchain-based IoT in the healthcare industry.
how the scientific community views the future of block-
Moreover, the work also identifies key challenges that
chain–IoT healthcare integration. To achieve our goals, we
impede blockchain adoption in healthcare applications
reviewed modern research and studies focusing on the most
utilizing IoT architectures.
common challenges surrounding the use of Blockchain and
IoT in eHealth applications. Table 1 summarizes the key
1.1 Search methodology
findings and contributions of previous comprehensive
surveys that have examined the integration of IoT and
This study delves into blockchain-based research papers
blockchain in eHealth systems. In our research evaluation,
Related to Healthcare, IoT, and Blockchain published
we highlighted the breakdown of the studies into various
between 2015 and 2023.
components and noted several key observations. Figure 2
shows the paper’s contributions.
1.1.1 Search strategy
The survey’s primary contributions include:
The search space for this study was defined by utilizing • A detailed examination of the value of eHealth systems,
various scientific databases, including Google Scholar, offering insights into their importance and potential
ResearchGate, IEEE, Science Direct, Elsevier, Springer, impact in the healthcare domain (Sect. 2).
ACM, MDPI, Wiley, and Hindawi. • An enhanced understanding of IoT, including a brief
overview and exploration of its challenges, aiding
1.1.2 Search criteria readers in grasping complexities in IoT implementation
in healthcare (Sect. 3).
To achieve a comprehensive understanding of the subject • An investigation into IoT rules (Sect. 4), providing
and address the research questions, specialized search guidance for comprehending regulatory frameworks
keywords were employed. The selected papers were iden- governing IoT, especially in healthcare applications,
tified using the search keywords (‘‘HER’’ OR ‘‘Healthcare’’ optimizing IoT utilization in the sector.
OR ‘‘EMR’’ OR ‘‘Electronic Health Record’’ OR ‘‘Elec- • A comprehensive overview of Blockchain technology
tronic Medical Record’’) AND (‘‘IoT’’ OR ‘‘Internet of and its applications (Sect. 5), offering valuable insights
Things’’) AND ‘‘Blockchain.’’ into the role of blockchain in enhancing healthcare
systems.
1.1.3 Paper selection process • Discussion of recent research efforts in integrating IoT
with Blockchain in healthcare (Sect. 6), providing a
Following the defined search strategy and criteria as shown snapshot of the current state, advancements, and
in Fig. 1, the paper selection process proceeded in the challenges in this evolving field.
following steps: • Exploring contributions and limitations of recent
research in IoT-based healthcare integrated with
• Step 1: Initial collection involved gathering papers
blockchain (Sect. 7).
based on their titles and keywords, accumulating 300
papers. The ultimate purpose of the survey is to familiarize
• Step 2: Subsequent refinement comprised removing researchers with the relevance of IoT in the eHealth
duplicates and focusing on the abstract and conclusion industry and the challenges that arise from it. The survey
sections. After this step, 150 papers remained. enables readers to make informed judgments about incor-
• Step 3: In the final step, a thorough examination of the porating blockchains into their IoT-focused healthcare
entire content of each paper was undertaken, and any practices by studying future trends and offering solutions.
unsuitable ones were excluded. This meticulous process
led to the ultimate selection of 110 papers specifically

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Fig. 1 PRISMA Chart for paper selection process

Table 1 Recent survey comparisons

References Years Blockchain IoT Healthcare application Security Privacy Data management Scalability

[7] 2019 X 4 X 4 X X X
[8] 2020 4 4 X 4 4 X X
[9] 2020 4 X 4 4 4 X X
[10] 2019 4 4 X 4 4 4 X
[11] 2020 4 X 4 4 X X X
[12] 2022 4 4 X 4 4 X X
Our survey 2023 4 4 4 4 4 4 4

1.3 Paper organization 2 eHealth

The structure of the paper is as follows: the value of the eHealth is extremely important for public health and
eHealth system is discussed in Sect. 2. Section 3 provides a medical treatment. It is estimated that advancements in
brief on the IoT and the difficulties it faces. In Sect. 4, IoT health and medical care can increase life expectancy by
rules are investigated to assist in better comprehending the several years. They may even greatly enhance the quality
many healthcare applications that employ IoT. Section 5 of life and functional abilities [13].
presents the blockchain overview and its applications. eHealth is the treatment, amelioration, and diagnosis of
Section 6 discusses recent research in IoT integrated with injuries and mental disabilities in people and the
Blockchain in healthcare. Section 7 shows the contribu- improvement of their health. eHealth is provided by doc-
tions and limitations in recent research in IoT based on tors, pharmacists, dentists, nurses, optometrists, psycholo-
healthcare integrated with blockchain. Section 8 concludes gists, midwives, audiologists, and others.
the paper and future directions. eHealth [14] (Electronic Health) refers to how infor-
mation technology may improve patient health and the
healthcare system. Experts expect that this area of health-
care will continue to expand since technology has helped
minimize wait times and some of the responsibilities
placed on medical personnel. During the COVID-19 epi-
demic, eHealth has been immensely popular since it has

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Fig. 2 Paper contributions

allowed healthcare providers to provide front-line medical Various forms of data, like Personal Health Records
treatments to patients despite the closure of local surgical (PHR), enable individuals to take charge of their health
facilities and hospital departments. information despite facing security concerns during data
A study conducted by [15], which surveyed 398 transfer. Electronic Medical Records (EMR) concentrate
healthcare professionals, found that telemedicine usage is on medical histories within a specific practice, encounter-
expected to remain at a high-level post-pandemic, with ing challenges in interoperability. Electronic Health
over 20% of patient appointments being handled through Records (EHR) offer a comprehensive overview across
telemedicine. This represents a significant increase from healthcare providers, sharing similar interoperability con-
the pre-pandemic usage of 2% and possibly as high as 61% cerns. Common issues encompass difficulties in data
during the pandemic. Figure 3 depicts the percentage of exchange, security vulnerabilities, and the potential for
patient appointments in the United States that were done Unauthorized access. In the IoT healthcare landscape, a
via telemedicine before, during, and after COVID-19. The combination of these records is employed, presenting
integration of IoT technology is revolutionizing conven- security challenges during data transfer that necessitate
tional healthcare systems, particularly through the moni- robust measures for maintaining data integrity and inter-
toring of patient behavior. Within healthcare systems, data operability [16]. This transformative impact extends to
collected by IoT sensors plays a pivotal role [4]. patient care, where IoT solutions may mitigate the need for

Fig. 3 April 2020, patient

appointments, and telemedicine
before, during, and after
COVID-19 [15]

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emergency department visits or hospital stays, proving patient’s state, providing healthcare providers valuable
particularly advantageous for individuals with mobility information to help manage and treat their condition [25].
challenges, even enhancing convenience in utilizing public From 2016 to 2025, in [24], Fig. 6 depicts the expected
transportation [17]. size of the IoT in the eHealth industry. In 2016, eHealth-
related IoT sales reached about 24 billion dollars, with
estimates indicating that by 2025, the previous number
3 Internet of Things (IoTs) would rise to more than 135 billion dollars. It demonstrates
the value of IoT in the eHealth industry. Implementing IoT
IoT is attracting significant attention from researchers and in healthcare has several benefits, including:
academics due to its ability to introduce new services and
• Data collection errors reduction.
solutions across various applications [19, 20]. IoT seam-
• Patient care Improvement.
lessly connects various ‘‘things’’ (devices) to create an IoT
• Enhancing the management of hospital resources.
network infrastructure where communication, processing,
and sensing activities are carried out without human By automating data collection and analysis, IoT can help
intervention [21]. According to (‘‘IoT devices installed improve the accuracy and speed of healthcare delivery
base worldwide 2015–2025 | Statista,’’ n.d.), by 2025, the while enabling more efficient resource use.
total number of IoT-connected things (devices) in use will Despite IoT-based eHealth benefits, some obstacles need
reach 75 billion devices. to be overcome. One of these obstacles is the management
Figure 4 demonstrates the rapid expansion of IoT-con- of information. As information plays a critical role in the
nected devices. The IoT industry is projected to experience decision-making process for patient care, the massive data
significant revenue growth, increasing from $892 billion in volume generated by IoT devices may be overwhelming.
a device in 2018 to approximately $4 trillion in devices by By 2025, based on the IDC (International Data Corpora-
2025. The IoT applications including Healthcare, Smart tion), 41.6 billion IoT devices will be in use, generating
Cities, Environments, Grids, Retail, Farming, and many 79.4 Zettabytes of data, which must be collected, stored,
more [22]. Figure 5 shows the IoT’s history, current, and and analyzed securely and efficiently to be useful in
future architecture. The gadgets will not only be connected healthcare (‘‘The Growth in Connected IoT Devices is
to the epidemic [15]. Expected to Generate 79.4 ZB of Data in 2025, According
SIoT is the concept of social IoT that is becoming more to a New IDC Forecast | TelecomTV,’’ n.d.). This massive
prevalent. It allows various social networking users to unstructured data must be handled in a real-time way.
connect to devices via SIoT, enabling them to share the IoT Processing, data collection, and interpretation need a huge
devices in public over the internet. Therefore, SIoT creates amount of computing, network, and storage resources. The
new ways for people to communicate and interact with monitoring data must be synced and evaluated on time so
each other and with connected devices [23]. the treating physician can make suitable and informed
IoT will bring innovation to many aspects of our modern decisions.
society, both at home and in the workplace. Among them, IoT security challenges revolve around ensuring data
the healthcare industry is a strong challenger. Real-time confidentiality, integrity, and availability (CIA) [26].
patient monitoring can be made possible with IoT, which is Confidentiality concerns involve protecting sensitive
particularly important for individuals with chronic dis- information from unauthorized access ensuring that only
eases. This allows instant and continuous monitoring of the authorized parties can access and interpret the data

Fig. 4 IoT-connected devices in

use worldwide from 2015 to
2025 [18]

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Fig. 5 Different architecture of

IoT [23]

Fig. 6 IoT in the healthcare

industry [24]

generated by IoT devices. Integrity focuses on maintaining 4 Healthcare IoT applications

the accuracy and reliability of the data, preventing any
unauthorized tampering or alterations. Availability is cru- The Internet of Things enables sensor integration into
cial for IoT devices’ continuous and reliable operation, physical components that collect health data such as heart
requiring measures to prevent disruptions or denial of rate, vital signs, blood pressure, and body temperature.
service attacks. IoT systems’ diverse and interconnected These components will be connected to the internet
nature intensifies these challenges, necessitating robust through a different gateway and deliver real-time eHealth
security measures to mitigate potential risks and vulnera- information to various authorities (analysis laboratories,
bilities in this rapidly expanding and interconnected land- rays, ambulances, hospitals, etc.(. Recent research has
scape. Additionally, the diversity of IoT devices and suggested that this information can be analyzed and inter-
systems presents challenges for interoperability, especially preted using ML (Machine Learning) algorithms, which
as IoT is increasingly being used in large-scale projects can then be used to diagnose and treat illnesses and provide
such as smart cities where many kinds of devices and proactive forecasts in some situations. This can lead to
systems need to communicate seamlessly. There is no more accurate and efficient healthcare, enabling healthcare
widely agreed-upon standard to follow [27]. The lack of providers to make better-informed decisions about patient
standardization among IoT devices can make implement- care. Currently, several healthcare applications [2] use IoT
ing successful IoT systems in healthcare challenging. One medical devices, as shown in Fig. 7 and Table 2.
of the possible solutions to this problem is to use Block-
chain. It can help to solve interoperability issues by cre- 4.1 Remotely monitoring patients
ating a secure, decentralized network that can share data
across different devices and systems. Additionally, block- The patient’s remote monitoring refers to the use of tech-
chain can help to improve security by supporting a secure nology to collect and transmit patient data for analysis and
and tamper-proof way to save and transfer sensitive patient review by healthcare providers, allowing for remote mon-
data. Therefore, blockchain technology is still relatively itoring of patients. Entity management healthcare system
new, and its potential in IoT healthcare applications is still prototype proposed to utilize eHealth sensors to gather
being explored [6]. patient’s data and exchange it with the entity. The system

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includes various sensors such as ECG to monitor the 4.3 Tracking of patients
heart’s muscle activity, BTS, accelerometers, and envi-
ronmental sensors [28]. Another eHealth system employed In [34], Alzimio is a mobile application designed to help
ECG equipment to observe heart rhythm and use the individuals with dementia, autism, and Alzheimer’s disease
k-nearest neighbor method to diagnose cardiac arrhythmias by utilizing geofencing and activity-based notifications.
[29]. A third proposed eHealth system is an IoT-based real- The app has been shown to effectively detect activities with
time system using MQTT (Message Queuing Telemetry an accuracy rate of over 95% and minimal delay using
Transport) for remotely monitoring patients’ systems, various threshold-based algorithms, such as ‘‘max-in-win-
which aims to ensure the integrity of real-time ECG data dow,’’ which results in fewer than 30 s.
[30]. Moreover, an IoT-based eHealth system for soldiers was
proposed, using a heart rate and other sensors for tracking
4.2 The prediction of diseases and monitoring [35].

In [31] the proposed healthcare system is a mobile appli- 4.4 Coronavirus (COVID-19)
cation using cloud and IoT networks to observe and
anticipate critical illnesses. It uses the UCI Repository In [36] a system for detecting and monitoring COVID-19
dataset and medical sensors to develop a systematic was developed, utilizing wearable sensors and mobile
approach for identifying and forecasting diabetes and applications to gather current symptom information.
related medical data. A novel classification technique Machine learning techniques were applied to analyze a
called the Fuzzy Rule-based Neural Classifier is presented dataset of 14,251 COVID-19 cases to identify potential
to determine the illness and its severity. Furthermore, Al- virus cases.
Makhadmeh et al. proposed an eHealth system that com- In [37] an IoT architecture was proposed to detect the
bines the Internet of Things and neural networks to know infected person. Smart sensors and IoT are being used to
heart properties from previous studies and forecast most measure and record body signs. Individuals’ temperatures
heart illnesses. The authors used the University of Cali- aid in identifying those who are affected. In addition, it
fornia Irvine (UCI) dataset and MATLAB tool to calculate assists in maintaining social distance. Healthcare systems
the system’s efficiency, and the suggested method had a incorporating IoT technology can improve decision-mak-
99.03% accuracy with an 8.5-s time complexity [32]. ing by utilizing cloud computing and data analysis.
In [33], the Authors proposed an eHealth system to Authors [38] demonstrated an IoT-based method for
discover chronic kidney illness. Their approach resulted in preventing COVID-19 in the workplace. Instead of using a
categorization with a prediction accuracy of 97.75%. They manual biometric system, they recommended using face
also plan to use feature selection and clustering approaches recognition. They also recommended using non-contact
to enhance the model performance. infrared sensors to monitor people’s body temperatures and
alert authorities when they exceeded a certain level.
Authors [39] proposed a method for early detection of
COVID-19 illness using IoT and AI technology to reduce
direct communication with infected patients. The system
utilizes various advanced eHealth sensors, such as a pulse
sensor, heat monitoring, and others. These technologies can
work independently without human intervention.
In their work [40] authors proposed an architecture that
combines SDN and NFV technologies, proposing an IoT-
SDN model with multiple controllers to manage automated
industrial systems during the COVID-19 pandemic.
Emphasizing the heightened dependence on the internet
and cloud-based activities in the current global scenario,
the system aims to provide substantial automation while
ensuring security and privacy in networking. It enhances
the efficiency and reliability of Industry 4.0 applications,
thereby effective pandemic management. The model sup-
ports intelligent and smart industry practices, encourages
social distancing, and aligns with Industry 4.0 principles.
Fig. 7 Healthcare IoT applications

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Table 2 Different healthcare applications that used IoT

Papers Types Years Sensors Contribution Implemented Future work
in hardware/
simulated

[28] Remote monitoring 2016 ECG A prototype has been developed that Implemented Add new health sensors
of patients BTS (Body utilizes an eHealth sensor to gather Appropriate
Temperature patient data and transmit it, allowing Communication
Sensor) for the simultaneous monitoring of bandwidth
multiple patients
[29] Remote monitoring 2020 ECG sensor ECG equipment to observe the heart Implemented the use of wearable
of patients rhythm devices
Fog technology is utilized to decrease Utilizing a variety of
delays in data transmission by keeping additional data mining
patient information on local devices techniques
rather than sending it to the cloud
[30] Remote monitoring 2020 ECG sensor This system reduces the need for Implemented Adding more eHealth
of patients patients to travel, particularly those sensors
living in rural or suburban areas, thus Improving performance
decreasing travel time and costs by decreasing jitter
delay and removing
noise signal
[31] Disease Prediction 2018 Medical dataset Developed a mobile healthcare app Simulated Using various security
utilizing cloud technology and the IoT mechanisms to improve
to track, detect, and diagnose critical medical data security
health issues on cloud databases
[32] Disease Prediction 2019 Wearable watch Enhancing the detection rate of heart Simulated Enhancing the
conditions by utilizing a vast amount diagnosing procedure
of data. Decreasing the complexity of for medical diseases
analyzing heart disease and ensuring a with IoT
low rate of incorrect classification Utilizing effective
when predicting heart data feature selection
approaches and optimal
methodologies
[33] Disease Prediction 2020 CKD dataset Data is collected utilizing IoT devices Not specified Different feature
That is linked to the individual selection and clustering
approaches must be
To increase the data quality, do pre-
used to enhance the
process operations
model
The LR model was used by combining
the LR and Adam Optimization
models
On the tested CKD dataset, the
classification model had a prediction
accuracy of 97.75%
[34] Patient Tracking 2016 Android phone A mobile application that employs Simulated A bigger range of
geofencing and alarms triggered by users/patients should be
specific activities to assist individuals evaluated
with dementia, autism, and Need to implement on
Alzheimer’s different platforms
[35] Patient Tracking 2017 Pulse rate An IoT-based system for monitoring and Implemented Added several sensors to
Oxygen tracking the health of soldiers could provide more tracking
Analyzer include wearables or sensors that services
Sensor gather vital signs data and send it to a
central command center for real-time
Temperature
monitoring. Location tracking would
enable quick response in case of lost or
injured soldiers and prevent soldiers
from going missing in action. The
system could also facilitate
communication among soldiers during
emergencies

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Table 2 (continued)
Papers Types Years Sensors Contribution Implemented Future work
in hardware/
simulated

[36] COVID-19 2020 COVID-19 Proposed frameworks reduce the effect Not specified Need to evaluate the real
Pandemic cases dataset of infectious illnesses and death rates system
This approach would also allow for
improved follow-up on patients who
have recovered
[37] COVID-19 2020 ITS (Infrared Using smart sensors to detect and record Proposed Need to evaluate the real
Pandemic Thermometer body temperatures can help identify framework system
Sensor) individuals who may be sick and need
Smart watch medical attention. This technology can
also assist in maintaining social
Optical and IP
distancing by monitoring and alerting
Camera
individuals if they come into proximity
with others
[38] COVID-19 2020 Camera The work that is suggested to ensure the Implemented We must set up
Pandemic Non-contact health and safety of its employees or portable system devices
infrared members to verify an individual
sensor is health
[39] COVID-19 2021 Pulse sensor To eliminate direct interaction with Implemented Test cases will be
Pandemic Thermal patients, assist clinicians in detecting required for accurate
monitoring the Coronavirus remotely evaluation
Blood sensors

The significance of IoT has been growing recently, health-related metrics. The continuous and real-time data
especially with the advent of COVID-19. As such, the streams produced by these sensors result in large volumes
value of IoT will be further examined as follows: of data, commonly called big data. While big data offers
numerous advantages in healthcare, such as predictive
• IoT ensures that all data is considered when making
analytics and early detection of health issues, handling and
better patient decisions. Fully interactive technology
processing such vast amounts of data can be resource-in-
and networked health options reinforce and improve
tensive and complex. As an alternative approach,
treatment efficacy.
researchers and healthcare practitioners also leverage
• Advanced IoT technology enhances emergency care
datasets that may not fall into the big data category but are
and makes it more efficient.
still valuable for analysis [31, 33, 36]. These datasets may
• Advanced medical technology encourages individuals
be more manageable in size and easier to work with, pro-
to take their drugs as prescribed. On-time delivery and
viding meaningful insights without the same level of
other vital health IoT have been shown to increase
computational demands as big data analysis.
patient care comfort.
As shown in Fig. 8, several problems exist in eHealth
• IoT enables doctors to consult with experts from all
based IoT, including:
around the world on complex issues.
• Doctors can use a variety of sophisticated sensors and • Keeping data secure and private is the most challenging
technology to assist them in their work. With ease, task since the daily data acquired is so huge [41].
check the patient’s health and internal sentiments • Overusing medical devices might generate network
[28–30, 32, 38, 39]. congestion and poor data transfer speeds.
In the utilization of sensors in healthcare settings has led Obtaining IoT devices remains a huge challenge [6].
to a substantial increase in data generation. These sensors, Blockchain technology presents a solution to these issues,
integrated into various medical devices and wearable and we will explore the different types of blockchains and
technologies, continuously collect and monitor patient their features in the next section. Additionally, we will
information, including vital signs, activity levels, and other

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Fig. 8 Challenges of IoT in

healthcare

discuss the advantages of using blockchain in healthcare centralized systems by utilizing the processing power
and the consensus methods that are employed in healthcare. of communication devices. Unlike centralized sys-
tems which require extensive hardware and software,
blockchain’s distributed nature obviates the need for
5 Blockchain technology a centralized server [47].
The features of using blockchain in medical eHealth
The term ‘‘Blockchain’’ was first coined by [42] to describe
such as:
the technology behind the digital currency Bitcoin.
Blockchain technology is a distributed and peer-to-peer 1. Patients may submit records to anybody without
network in which all transaction records are distributed worrying about data corruption or manipulation since
across all nodes. the blockchain is immutable and traceable.
Three types of blockchains have been identified: public, 2. A medical record created and uploaded to the
private, and consortium, which are used to connect dif- blockchain will work similarly to be safe.
ferent organizations and promote cooperation among the 3. Patients can have some say in how their medical
parties involved. Like private blockchains, consortium information is used and shared by the research
blockchains do not have transaction costs, and publishing institutions. Any entity needing medical information
new blocks is not computationally expensive. However, it about a patient may use the blockchain to obtain the
doesn’t provide complete decentralization and censorship required authorization.
resistance; it still provides auditability and reduces the 4. A reward mechanism can also motivate the patient’s
transaction processing time [43]. positive behavior. For example, they can earn tokens
The following are blockchain technology’s key features: for following a care plan or being healthy. They can
also be compensated with tokens for providing data for
(1) Decentralization centralized networks incur
clinical trials and research.
expenses and have performance limitations. In
5. Because of the type of product they handle, pharma-
contrast, blockchain-based infrastructures allow for
ceutical firms must have a highly secure supply chain.
transactions between two nodes without a central
Pharmaceuticals are often stolen from the supply chain
organization needing to keep track of data or
and sold illegally to various customers. Furthermore,
authorize transactions.
counterfeit pharmaceuticals alone cost these businesses
(2) Immutability the blockchain is censorship-resistant
roughly $200 billion every year. A transparent
and difficult to tamper with because all peers agree
blockchain will assist these firms in enabling close
upon all new updates through decentralized consen-
tracking of medications back to their place of origin,
sus algorithms.
(3) Transparency unlike centralized systems, where the
central server has complete control over everything,
blockchain technology provides a high degree of
transparency because all peers have entry to all
transaction information that has ever occurred in
their network [44].
(4) Security using the public key system and the
consensus mechanism makes the blockchain resistant
to various attacks. Additionally, blockchain elimi-
nates a single point of failure, making it more secure
than centralized systems [45].
(5) Anonymity blockchain technology allows for anon-
ymity by protecting users’ privacy using anonymous
identities on the shared distributed ledger [46].
(6) Cost blockchain technology can significantly lower
costs associated with setup and maintaining
Fig. 9 Types of nodes in the blockchain

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therefore reducing the incidence of counterfeit medi- algorithm has the potential to foster a high-quality
cation. As shown in Fig. 9, Full and lightweight nodes eHealth service.
are different types of nodes that may be used for 5. Proof of Significance (PoI) it is a step forward from
blockchain-based operations. The blockchain net- PoS. It considers the balance of nodes as well as the
work’s nodes oversee mining, data storage, block reputation of nodes. It’s a more efficient network. It
generation, block validation, cryptocurrency purchas- is suggested to be used for eHealth care services
ing and distribution, and information distribution since doctors’ reputations may be used to help people
among peers. make decisions.
6. Practical Byzantine Fault Tolerance (PBFT) this
Research on consensus algorithms has been a prevalent
algorithm is more efficient and superior to PoW and
topic for the past 30 years, even before the creation of
PoS, making it suitable for private blockchain use. It
blockchain technology. Reference [48] give a summary of
also has a low tolerance for malicious nodes. The
some of the early work in distributed systems consensus.
aim is to apply this protocol to influence the use of
Consensus algorithms play a vital role in the functioning of
eHealth services.
blockchain technology. They are designed to securely
7. Byzantine Fault Tolerance Delegated (dBFT) is a
update and maintain replicated shared states across all
step forward from PBFT. Nodes are chosen from
peers in the network. By using consensus methods, the
different nodes as a result, it appears that eHealthcare
blockchain can ensure that all copies of the shared state
services are gaining popularity.
agree and synchronize at any given moment, a key aspect
8. Proof of Capacity (PoC) this is a step forward from
of the blockchain’s state machine replication system.
Proof of Work (PoW). It will most likely need to
According to [49] and [50], deterministic consensus cannot
store a large amount of data to mine the next. Other
tolerate errors in completely asynchronous communication
nodes block it. It is incompatible with the Internet of
models. Therefore, partial synchrony assumptions and
Things. We also advise against using it for health-
maximum latency limits for propagating transactions are
related purposes services.
necessary [51]. In previous work on consensus procedures,
9. Proof of Activity (PoA) this approach combines PoW
the building elements that went into establishing ‘‘Decen-
and PoS to validate transactions. The process starts
tralized’’ consensus algorithms utilized in blockchain net-
with PoW, and then a group of validators performs
works included cryptography and partial synchronous, as
PoS to place the transaction in the Miner’s header.
well as predecessor designs and suggestions of digital
However, due to its high latency, PoA is not
currency [52, 53].
suitable for Internet of Things (IoT) applications
There are many forms of decentralized blockchain
and, therefore, is not an appropriate choice for
consensus algorithms currently in use, as well as their
eHealth.
applicability for IoT networks, particularly in the supply of
10. Proof of Burn (PoB) this is the process of transfer-
healthcare services as follows [54]:
ring bitcoin to an address that cannot be recovered.
1. Proof of Work (PoW): PoW requires high network Burned coins give a miner a higher priority in terms
bandwidth, making it unsuitable for IoT applications. of mining. Because it is dependent on the presence of
However, it is widely used in various platforms, so it a monetary framework, it is ideal for cryptocurrency
is likely to be incorporated into healthcare services. implementation but terrible for IoT. It is unsuit-
2. Proof of Stake (PoS): In this algorithm, the next able for eHealth-related applications due to its
block is mined by selecting a node through a lottery random burning technique.
or random selection process. It is considered the 11. Proof of Elapsed Time (PoET) Intel proposed a low-
most democratic system available. This mechanism energy alternative to Proof of Work (PoW). It uses a
may be a viable solution for eHealth application random wait time to select the winning miner and is
submissions due to its democratic nature. considered IoT-friendly due to the use of trusted
3. Delegated Proof of Stake (DPoS): is democratically execution environments such as Intel’s Software
representative. It speeds up transactions but comes at Guard Extension (SGX). However, it is highly
a higher price in terms of centralization. There is a specialized for SGX-based environments and may
procedure for identifying rogue delegates and voting not be suitable for eHealth.
them out. As a result, it has great potential for use in 12. The Stellar Consensus Protocol (SCP) is an advance-
eHealthcare settings. ment from the Practical Byzantine Fault Tolerance
4. Leased Proof of Stake (LPoS) LPoS enables low- (PBFT) algorithm. It comprises two parts: the
balance nodes to participate in a lease contract. This nomination protocol and the ballot protocol. It is
well-suited for low-latency microfinance services.

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Therefore, SCP may be a suitable option for a 6 IoT-based healthcare using blockchain
decentralized application (dAPP) developer to use
when creating a healthcare service. In this section, we evaluated the integration of Blockchain
The comprehensive evaluation of consensus algorithms into an IoT-based eHealth system. Additionally, we will
in the realm of blockchain technology involves an in-depth highlight the significance of blockchain within this system
analysis based on a multitude of critical parameters. These and explain the scientific community’s perspective on the
essential factors, encompassing blockchain type, transac- future integration of blockchain and IoT in healthcare. To
tion rate, scalability, adversary tolerance model, experi- achieve our goals, we conducted a thorough review of
mental setup, latency, throughput, bandwidth, recent research and studies. Initially, we discussed the
communication model, communication complexity, and importance of blockchain in IoT applications, presenting
attack finality, collectively serve as crucial metrics for a related work in this domain. Following that, we delved into
nuanced comparison. This extensive set of parameters the impact of this integration in healthcare applications and
forms the foundation for assessing various consensus presented key research findings in this evolving field.
algorithms, providing insights into their strengths and
weaknesses within the dynamic landscape of blockchain 6.1 Integrating blockchain with IoT
technology.
In the comparative study of recently proposed algo- IoT systems encounter various challenges, including
rithms [55, 56], such as Proof of Work (PoW), Proof of interoperability issues, resource constraints, and security
Stake (PoS), Delegated Proof of Stake (DPoS), Leased vulnerabilities. Blockchain emerges as a powerful solution
Proof of Stake (LPoS), Proof of Significance (PoI), Prac- by introducing a decentralized and tamper-evident ledger
tical Byzantine Fault Tolerance (PBFT), Byzantine Fault that significantly enhances the confidentiality, integrity,
Tolerance Delegated (dBFT), Proof of Capacity (PoC), and availability (CIA) of data within IoT networks. The
Proof of Activity (PoA), Proof of Burn (PoB), Proof of distributed and consensus-driven nature of blockchain
Elapsed Time (PoET), and the Stellar Consensus Protocol ensures the integrity of IoT data, making tampering highly
(SCP), distinctive attributes emerge, significantly influ- resistant and fostering trust in the information generated by
encing their suitability for diverse blockchain applications. connected devices. Its cryptographic techniques improve
For example, PoW, commonly associated with public confidentiality by encrypting data during transmission and
blockchains, showcases medium to high transaction rates storage, restricting access to authorized entities. Moreover,
but exhibits moderate scalability. Despite resilience to the decentralized structure of blockchain strengthens
Sybil attacks, PoW is susceptible to 51% attacks, requiring availability, ensuring continuous operation despite poten-
substantial computational power and resulting in moderate tial node failures or attacks. These features fortify the
latency and throughput with elevated bandwidth require- security of IoT systems and establish a robust foundation
ments. Conversely, PoS, applicable to both public and for transparent, trustworthy, and resilient data management
private blockchains, offers higher scalability with lower across interconnected devices. A comparative analysis of
computational demands, albeit vulnerable to Long-Range the features and capabilities of both IoT and blockchain
attacks. DPoS introduces governance layers, reducing technologies provides valuable insights into their synergies
latency and enhancing throughput, while LPoS maintains and distinctions, Table 3 presents a comparison of these
similar characteristics with a slightly lower throughput. features and capabilities [8].
The adaptability of PoI is highlighted, offering transaction Furthermore, integrating blockchain technology into IoT
rates and scalability in the medium range, with perfor- systems can improve their scalability and stability. The
mance contingent on the chosen significance metric. PBFT distributed nature of blockchain allows for distributed data
and dBFT, tailored for private blockchains, exhibit high saving and processing, which can support many devices
transaction rates, moderate scalability, and resilience to a and transactions [57]. In comparison to existing IoT solu-
limited number of malicious nodes. Each consensus algo- tions, blockchain provides the following possible benefits
rithm introduces unique trade-offs, underscoring the as shown in Table 4 [58].
importance of considering specific application require-
ments and network conditions during their selection. 6.1.1 The blockchain of things architecture

In [58], an architecture was proposed to integrate IoT with

Blockchain. This architecture has two advantages:
• it provides an abstraction from IoT’s lower levels,

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Table 3 Comparison between IoT and Blockchain algorithm more suitable for IoT in [59] proposed that PoS,
Parameters IoT Blockchain
DPoS, and LPoS are partially compliant with IoT, but
PoET is more supported and compliant with IoT.
Privacy X 4
Security X 4 6.1.2 Related work of IoT with Blockchain
Latency X 4
Scalability X 4 Many studies have touted blockchain technology as the
Resources Restricted Consumed answer to addressing confidentiality and safety concerns in
Scalability 4 X the IoT structure [60]. The article introduces the security
System Structure Centralized Decentralized problems that arise in IoT systems, specifically focusing on
the layers of IoT systems. The authors also survey recent
solutions to these security problems and propose that
blockchain technology could be a practical way to address
• it offers consumers services based on blockchain these challenges. Reference [61] reviewed IoT and indus-
technology. trial IoT (IIoT) concerns and classified them according to
their susceptibility. Then, to address some of the security
There are five sublayers in the blockchain, as shown in challenges, he proposed blockchain technology. They also
Table 5. The overlay network is a part of the network sub- discussed some of the issues that blockchain presents
layer in IoT systems. It comprises digital or tangible links concerning IoT.
connecting the nodes in the communication networks that Similarly, Reference [62] the authors evaluated various
form the foundation, which can be cabled or Wi-Fi. The security measures for IoT and identified a lack of datasets
overlay network creates a logical topology on the physical as a concern among academics and practitioners. They
connection’s infrastructure, allowing the nodes to com- proposed utilizing blockchain to establish a safe environ-
municate and exchange data. It serves as the communica- ment for exchanging IoT datasets while acknowledging
tion backbone of the IoT structure, enabling the devices to some difficulties associated with implementing this tech-
link and interact. The architecture of IoT-based connection nology. Furthermore, Reference [63] the authors created a
is depicted in Table 6, along with comparisons of related blockchain-based IoT framework that aims to provide a
protocols. confidential and safe system while minimizing the techni-
In the consensus sublayer, there are many different cal burden of blockchain [64]. Also examine the ability of
consensus algorithms. Still, we need to choose a consensus blockchain technology to analyze the IoT system’s security

Table 4 Solutions for IoT problems using Blockchain

IoT problem Solution using Blockchain

Poor interoperability IoT data is being transformed and stored in blockchains

P2P overlay network, which enables ubiquitous internet access, blockchains are built
Security Blockchain uses cryptography techniques and digital signatures such as the Elliptic curve
Using some blockchain technologies to improve security in IoT, such as a smart contract
Traceability and Blockchain is traceable
reliability
Resource Constraints Using lightweight nodes that can verify a transaction’s trustworthiness without downloading or storing the entire
blockchain
Failure point Blockchain enables individuals and entities to communicate and transact in a distributed way without needing a
centralized authority to manage the flow of information and transactions
Scalability The blockchain can be leveraged to create a scalable solution that can manage a large number of IoT devices due to its
ability to share and validate data across a network of participants
Flexibility The technology of Blockchain, using various open-source solutions, allows for a flexible setting in which a variety of
IoT devices can operate by providing a distributed platform that provides secure and transparent communication
between them
Costs The decentralized design of blockchain technology ensures that data transfer and exchange are more secure, as it
reduces the risk of a failure point. This also eliminates costly investments in servers with advanced software and
hardware capabilities

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Table 5 Blockchain layers used in IoT

Blockchain layers Description

Data sub-layer Blockchain uses asymmetric cryptographic algorithms and hash functions to get data from lower-level IoT
(Internet of Things) devices, such as those in the perception layer, and secure that data by encrypting it and
adding a digital signature, providing an additional layer of security and integrity to the data transferred
Network sub-layer Responsible for communicating between nodes (wired or wireless communication)
Consensus sub-layer In this layer, implement consensus algorithms as explained in the blockchain section
Incentive sub-layer In this blockchain layer, participants who contribute to the distributed consensus mechanism, such as through
mining, should be rewarded for their efforts in maintaining and validating the network
Service sub-layer Industries such as manufacturing, logistics, supply chains, food and agriculture, and utilities, among others, could
benefit from implementing blockchain-based services, as they support a safe, transparent, and tamper-proof way
of managing transactions and data

Table 6 Network
Protocol Standards Bandwidth Range Cost
communication protocols
Wi-Fi 100? Mbps 25–50 m Low
Cellular 5G: 50 Mbps, 4G: 15 Mbps, 3G: 4 Mbps 1–5 km Medium
Bluetooth 25 Mbps 50–100 m Very low
LPWAN (NB-IoT) 200 kbps 1 m to 10 km Medium
Satellite 50 Mbps Anywhere Very high

needs and how combining the IoT with blockchain might exhibits improved average throughput, energy utilization,
solve these problems [7]. The authors gave an overview of and overall end-to-end delay compared to a traditional
the security issues and risks in IoT applications and dis- Blockchain approaches. Blockchain approaches. In [68],
cussed various solutions that are being developed to the author presented a distributed model for smart cities
enhance trust in these systems. Four specific solutions, FC incorporating Blockchain, Software-Defined Networking
(fog computing), EC (edge computing), blockchain, and (SDN), and Network Function Virtualization (NFV). A key
ML (machine learning), were presented as ways to improve contribution is an energy-optimized cluster head selection
security in IoT. The overall subject of IoT security was also algorithm designed for efficient procedures. The SDN
examined. controller oversees IoT device activities, and Blockchain is
Furthermore, Reference [65] reviewed IoT security employed for detecting and mitigating cyber-attacks in IoT
challenges before suggesting the blockchain as a potential networks. Experimental results demonstrate the superiority
solution to these problems. They also talked about how IoT of the proposed architecture over existing ones, such as
and blockchain may work together. Furthermore, Refer- Core and DistArch-SCNet. The presented model exhibits
ence [66] the authors presented a smart contract as a improved throughput, response time, gas consumption, and
solution to address confidentiality and security issues in communication overhead, leading to notable enhancements
IoT systems and enable safe interactions between IoT in overall system performance [69].
devices. By utilizing blockchain technology, their approach The study provided an overview of using blockchain
enables decentralization of access control, authentication, technology to address safety and confidentiality concerns
and payments. Furthermore, in their work [67] the authors on the Internet of Things and presented the advantages and
introduced an optimized and comprehensive framework for potential drawbacks of integrating blockchain-based IoT.
resource management within a Blockchain-enabled soft- Similarly, Reference [70] gave a study to establish the
ware-defined Internet of Things (IoTs) ecosystem. The specifications for developing an IoT identity management
framework incorporates a novel cluster-head selection system. They then advocated combining blockchain with
algorithm and a distributed flow-rule verification tech- the IoT to create a more efficient identity management
nique, ensuring network consistency and security. The system to deliver more confidence and effectiveness. Fur-
proposed Blockchain-enabled SDN-IoT architecture thermore, Reference [71] presented a blockchain-based

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integrated IoT infrastructure to protect the integrity of medication adherence, and other health-related informa-
sensing data. Their platform allowed end-users and devices tion. This information is then transferred to a blockchain
to monitor and control each other in real-time. The results network, which is decentralized and secure. The informa-
showed that their technology might be a suitable fit for IoT tion is saved on the blockchain, which provides an
devices with limited resources. Furthermore, Reference immutable ledger of all transactions.
[72] the framework proposed using Ethereum for less- Smart contracts and rules can be used to define how the
power IoT devices to address power consumption issues data is used and shared. For example, a smart contract
during communication, transaction verification, and secu- could be used to ensure that only authorized healthcare
rity. Blockchain was suggested to enhance access control providers have access to the patient’s information. Rules
efficiency and effectiveness [73]. For example, I presented can be set up to govern how the data is used, such as who
an access management system based on the blockchain to can access it and for what purposes. Healthcare providers
address confidentiality and security issues in IoT systems. can access the data on the blockchain network if they are
As a decentralized access manager, they used blockchain to authorized to do so. This can help improve patient care, as
make access decisions [75]. providers can access real-time data about their patients’
The author also proposed using blockchain to create a health status.
decentralized control paradigm for Internet of Things sys- Overall, blockchain technology can be very helpful for
tems. They believed this could increase the efficiency of IoT-based healthcare systems, as it provides:
handling access management in IoT solutions. Further-
(1) Secure Data Sharing blockchain technology provides
more, Zhang et al. (2019) the author proposed an access
a secure and decentralized way to store and share
control mechanism based on a smart contract system that
data. Patient data is encrypted and stored on a
utilizes several ACCs (access control contracts).
distributed ledger, which authorized healthcare
The cost-effective use of blockchain technology has
providers can access. This ensures that patient data
been proposed to enhance the security and confidentiality
is secure and cannot be tampered with or accessed by
of healthcare data [77]. One way to utilize blockchain is to
unauthorized parties.
improve the confidentiality of health information by
(2) Improved Interoperability blockchain technology
implementing a pseudonym-based encryption system,
can help to improve interoperability between differ-
known as PBE-DA, for electronic health records. Addi-
ent healthcare systems. Data stored on a blockchain
tionally, blockchain can serve as a bridge between medical
can be accessed by different healthcare providers,
systems and the Internet of Things health devices. In
regardless of the system they are using. This can help
addition Mishra and Tyagi (2019) suggested a solution to
to ensure that patient data is available to providers
use blockchain technology to produce an intrusion detec-
when and where they need it.
tion system for IoT that can detect unauthorized entry and
(3) Enhanced Data Privacy blockchain technology can
analyze connection activity. They applied their suggestion
help to protect patient data privacy. Data stored on a
to protect patient data in the healthcare industry. Table 7
blockchain is encrypted and can only be accessed by
also includes current studies on blockchain and IoT inte-
authorized parties. Patients can control who has
gration (Fig. 10).
access to their data and can revoke access at any
The study presents the statistical data of the reviewed
time.
publications by relevant fields and the role of blockchain in
various IoT solutions, with many of the articles focusing on The following literature highlights the objectives of
utilizing blockchain in eHealth (Uddin et al. 2021). As blockchain-based IoT in healthcare. Literature work can be
recent researchers are interested in healthcare, the next categorized into different domains, each contributing
section reviews the state of the arts related to IoT-based unique perspectives and solutions to enhance healthcare
healthcare by blockchain. through technological innovation.

6.2 IoT-based healthcare using blockchain 6.2.1 Digital healthcare systems

The sensitivity of healthcare information requires strict Author [79] proposed a novel protocol, ‘‘Blockchain-en-
privacy measures. The execution of blockchain in eHealth abled IoMT Authenticated Key Exchange’’ (B-IAKE), this
can address these concerns, enhance service efficiency, and work establishes a distributed environment within the
facilitate the shift towards decentralized eHealth systems. Internet of Medical Things (IoMT). By leveraging Hyper-
Here is an example of how blockchain can benefit IoT- ledger Fabric and smart contracts, it eliminates the need for
based healthcare systems. It can be represented in Fig. 11. a central trusted entity, ensuring secure access to IoMT-
IoT devices collect patient data, such as vital signs, generated data.

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Table 7 Current studies on

Papers Survey Framework Security Privacy Healthcare papers
blockchain and IoT integration
[7] 4 X 4 X X
[60] 4 X 4 X X
[61] 4 X 4 X X
[62] 4 X 4 X X
[74] X 4 4 X X
[64] 4 X 4 X X
[65] 4 X 4 X X
[66] X X 4 4 X
[69] 4 X 4 X X
[70] 4 X 4 4 X
[71] X 4 X X X
[72] X 4 4 4 X
[73] X 4 4 4 X
[75] X 4 4 X X
[76] X 4 4 X X
[77] X 4 X 4 4
[78] X X 4 X 4

[80] addressing challenges associated with the COVID-19

pandemic, this research delves into the design of IoT and
Blockchain systems. The proposed architecture, although
not explicitly detailed, contributes solutions proven to be
effective in various scenarios. In [81] authors presented a
blockchain-enabled Internet of Medical Things (IoMT)
system, this study focuses on confidentiality issues. The
architectural layers include a device, EC, blockchain net-
work, and data analytics, with an emphasis on combating
challenges related to COVID-19. In [82] authors Intro-
duced a telemedical laboratory service, this work employs
Fig. 10 Using BCs in various IoT applications
Cloud Computing, Blockchain, and IoT layers. Clinical
tests conducted on patients using IoT medical equipment
6.2.2 Fighting COVID-19 are communicated instantly, showcasing a distributed
approach to healthcare. Authors [83] proposed a zero-
In [3] integrating cognitive computing, IoT, and Block- knowledge blockchain architecture for Bahrain’s IoT smart
chain, authors proposed a comprehensive healthcare solu- cities, this study addresses the secure sharing of health
tion to manage the effects of the COVID-19 epidemic. The information. The architecture involves user layers, data
architecture spans network, IoT/Blockchain/AI layers, query layers, data structure layers, and existing database
employing smart contracts for effective coordination. In infrastructure layers.

Fig. 11 Diagram of blockchain for IoT-based healthcare

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6.2.3 Patient monitoring cities in Bahrain, ensuring secure health information

sharing. Patient monitoring solutions presented in
In [84] authors utilized Hyperledger, this work employed [85, 86, 89] highlight various aspects, such as federated
blockchain for secure data storage in patient monitoring. learning, private smart healthcare architecture, and proof of
The proposed architecture involves IoT sensing and gate- concept with enhanced homomorphic encryption. Each
way layers, ensuring tamper-proof storage of medical study brings its unique approach to leveraging blockchain
sensor data. Authors [85] focused on a mobile crowd- in healthcare, contributing to the evolving landscape of
sourcing system for diabetes research, this study integrates IoT-based healthcare applications.
local users, remote users, and mHealth fog services. Con- In Table 9 compares the limitations of the discussed
tinuous Glucose Monitoring (CGM) devices connected to frameworks. While some frameworks exhibit strengths in
the IoT form the basis of patient monitoring [86]. decentralization, scalability, and security, others may fall
Proposing a patient monitoring architecture with sensor short in certain aspects, such as energy consumption, reli-
networks, blockchain cloud networks, and user interfaces, ability, and anonymity. The variations in these attributes
this work emphasizes federated learning and smart con- emphasize the trade-offs inherent in designing blockchain-
tracts for secure and private healthcare. based healthcare systems.
In Table 10 summarizes the contributions of various
6.2.4 Drug transportation healthcare applications utilizing IoT. Each study addresses
specific challenges in healthcare, ranging from secure key
In [87] the context of pharmaceutical supply chain man- exchange [79] and COVID-19 management [3, 81] to drug
agement, this study implements a blockchain system. The transportation [87] and patient monitoring [85, 86, 89].
architecture involves sensor and blockchain layers, These contributions collectively advance the understanding
demonstrating efficiency in transaction latency and energy and implementation of blockchain and IoT in healthcare,
consumption. providing valuable insights into diverse applications and
potential improvements for future developments.
6.2.5 IoT applications in healthcare

Authors [88] Introduced a multiagent system architecture 7 Open research issues and future
utilizing private, distributed blockchain, this work focuses challenges
on lightweight and secure solutions for Internet of Things
(IoTs) systems in healthcare. Blockchain technology is still in its early stages, but it has
In Table 8 provides an overview of various healthcare the potential to be powerful. As a result, despite its many
applications utilizing blockchain technology. Notably, the benefits, it is confronting several development obstacles, as
applications cover diverse aspects of healthcare, ranging well as in terms of IoT adoption in healthcare. Overcoming
from patient monitoring to fighting COVID-19. The pro- these challenges can be categorized into eight main cate-
posed architectures, consensus algorithms, and platforms gories, as demonstrated in Fig. 12. To summarize these
employed differ across studies. In the digital healthcare challenges and provide potential solutions, we have
system proposed in [79], a novel protocol named ‘‘Block- included Table 11, which outlines each challenge and
chain-enabled IoMT Authenticated Key Exchange’’ (B- suggests an algorithm to address it.
IAKE) is introduced, leveraging Hyperledger Fabric.
Similarly, in [3], a solution integrating cognitive comput- 7.1 Limited resources
ing, IoT, and blockchain is proposed for managing the
impact of COVID-19. The patient monitoring system in IoT devices frequently have limited resources, such as
[84] utilizes Hyperledger, emphasizing secure data storage limited computational power, storage, battery life, and
through blockchain. The study [87] focuses on drug network connectivity. In contrast, blockchain’s centralized
transportation, implementing a hardware-based blockchain consensus processes often require significant computa-
system with AES-128 encryption and SHA-256. moreover, tional resources and energy. For instance, the PoW mech-
the IoT applications in healthcare proposed in [88] intro- anism utilized in Bitcoin has been shown to consume a
duce a multiagent system architecture with a lightweight large amount of energy [57]. Because of this, low-power
consensus algorithm and Diffie–Hellman key exchange. IoT devices may be unable to handle consensus processes
Frameworks proposed in [80–82] address fighting COVID- requiring a significant amount of energy. Additionally, the
19, each introducing distinct architectures and platforms large amount of information in blockchains makes imple-
(e.g., Ethereum, Hyperledger). Furthermore, Reference menting them fully on IoT devices infeasible. As of
[83] proposes a zero-knowledge blockchain for IoT smart September 2018, the Bitcoin blockchain has grown to

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Table 8 Comparison between frameworks in IoT-based healthcare using blockchain

References Years Application type Layers Hardware Consensus Attributes Platforms
implementation algorithm

[79] 2023 Digital healthcare Not specified Proposed architecture Not specified Smart contract Hyperledger
system
[3] 2022 Fighting COVID-19 Network Layer Proposed architecture Not specified Smart contract Proposed by
IoT/ author
Blockchain/
Ai Layer
Applications
Layer
[84] 2022 Patient Monitoring IoT sensing Hyperledger Permissioned Smart contract Hyperledger
Layer consensus caliper
IoT gateway algorithm
Layer
[90] 2019 Patient Trackability Not specified NS2 Not specified SHA-256 Proposed by
author
[87] 2021 Drug transportation Sensor Layer Implemented in PoAh [58] AES-128 Proposed by
Blockchain hardware Encryption author
Layer algorithm
SHA-256
[88] 2021 IoT Applications Local Proposed architecture Lightweight Diffie–Hellman Private
(healthcare) Blockchain consensus Key exchange blockchain
Manager algorithm algorithm
Fog Blockchain asymmetric
Manager algorithm
Cloud
Blockchain
Manager
[80] 2020 Fighting COVID-19 Not specified Proposed architecture Not specified Not specified Proposed by
author
[81] 2020 Fighting COVID-19 Device Layer Proposed architecture Not specified Asymmetric Proposed by
EC (edge encryption/ author
computing) decryption
Layer smart contracts
Blockchain
network
Layer
Data analytics
Layer
[82] 2020 Fighting COVID-19 Cloud Ethereum POW Smart contract Ethereum
computing
Layer
Blockchain
Layer
IoT Layer

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Table 8 (continued)
References Years Application type Layers Hardware Consensus Attributes Platforms
implementation algorithm

[83] 2021 Fighting COVID-19 User Layer Ethereum POW Smart-contract Ethereum
Data query SHA256
Layer
Data structure
Layer
Existing
database
infrastructure
Layer
[85] 2019 Patient Monitoring Local users Ethereum OrbitDB, POW Smart contract Ethereum
Remote users Android, ARMbian GlucoCoin
mHealth fog
service
[86] 2022 Patient Monitoring Sensor network Proposed architecture Not specified Federated learning. Proposed by
blockchain smart contracts author
cloud
network
User interfaces
(monitories)
[89] 2022 Digital healthcare Not specified Hyperledger Fabric proof of Enhanced Hyperledger
system PyCharm concept homomorphic Fabric
encryption
(EHE), smart
contracts

Table 9 Comparison between limitations in different research

References Reliability Decentralization Scalability Anonymity Security Privacy Energy consumption

[79] X 4 4 X 4 X X
[3] 4 4 4 4 4 4 X
[84] X 4 X X 4 4 X
[90] X 4 X X 4 X X
[87] X 4 X X X X 4
[88] X 4 X X 4 4 X
[80] X X 4 X 4 X X
[81] X 4 X X 4 4 X
[82] X 4 X 4 4 X X
[83] X X 4 X 4 X X
[85] 4 4 4 X X X X
[86] 4 4 4 X 4 4 X
[89] 4 X 4 4 X X X

almost 185 GB, making storing the entire blockchain on lightweight nodes, storing only a portion of the blockchain
each IoT device impractical. data (such as the hash value), carrying out less computa-
tionally demanding tasks (e.g., initiating transactions), and
7.1.1 Suggested solution utilizing Mobile Edge Computing and cloud for more
computationally heavy tasks [91]. Fog/Edge-based design
Utilizing mobile edge computing (MEC) and cloud com- reduces latency while allowing for more computational
puting technologies can help IoT devices overcome their complexity with limited resources [91]. This way, appli-
resource limitations. IoT devices can function as cations that require high processing power and quick

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Table 10 Different healthcare applications that used IoT

References Contribution

[79] Proposed a novel protocol known as ‘‘Blockchain-enabled IoMT Authenticated Key Exchange’’ (B-IAKE), designed to establish a
distributed environment using Hyperledger Fabric within the Internet of Medical Things (IoMT). This protocol effectively
removes the requirement for a central trusted entity and guarantees secure access to data produced by IoMT devices
[3] A healthcare solution that combines cognitive computing and IoT with Blockchain has been proposed. The proposal is effective in
managing the effects of the COVID-19 outbreak in the examples given
[84] For safe data storage, the suggested concept employs blockchain technology. The proposed solution for secure data storage utilizes
blockchain technology. Medical sensor data is stored in a blockchain format on a medical server, making it tamper-proof and
preserving patient privacy. This enhances the confidentiality of the eHealth services
[90] The proposed framework outlines the use of blockchain in eHealth to improve and strengthen the security, transparency, and
accessibility of electronic records and to track the movement of medical documents and pharmaceuticals from provider to patient
using IoT devices. It emphasizes the need for blockchain to collect and record data on intermediary activity, patient records, and
the shipping process between providers and patients
[87] In the context of this research, a blockchain system was developed to manage the supply chain of pharmaceuticals. The system’s
efficiency was evaluated by analyzing various parameters, such as the time it takes for a response to be received (latency), the
amount of energy used by the system (energy consumption), and the additional data added to a packet for control functions
(packet overhead). The study’s findings indicated that the proposed blockchain system demonstrated a significant decrease in
transaction latency, indicating a viable and efficient solution. Furthermore, the use of a simpler consensus mechanism allowed for
the validation of blocks to be performed efficiently on devices with limited computational capabilities and low power
consumption. Specifically, the validation process took 30 ms and consumed 45 mJ of energy
[88] The primary contribution of this research. is the introduction of a new multiagent system architecture that utilizes a private,
distributed blockchain. This design offers a lightweight solution and security for Internet of Things (IoTs) systems
[80] The design of IoT and Blockchain is described in this proposal, as well as its problems and possible uses. The two case studies are
thoroughly reviewed, and solutions are offered and worked on to implement them. The solutions to the challenges have been
proven to be safe in a variety of scenarios
[81] The study presented a blockchain-enabled Internet of Medical Things (IoMTs) system to address confidentiality problems. The
research also examined the potential benefits that the blockchain-enabled IoMT could bring to address challenges related to
COVID-19 from five different perspectives
[82] A telemedical laboratory service is being introduced in which clinical tests are conducted on patients by technicians directly at the
hospital using Internet of Things (IoTs) medical equipment, and the results are instantly communicated to doctors from
distributed hospitals for validation and/or review through the hospital Cloud
[83] The study proposed a zero-knowledge blockchain architecture for Bahrain’s IoT smart cities, which can be used to support a secure
method for sharing health information in smart cities
[85] The study explains how the application and assessment of a mobile crowdsourcing system for diabetes research and care uses a
Continuous Glucose Monitoring (CGM) device connected to the Internet of Things (IoTs). The system is designed to gather blood
glucose data quickly, easily, and affordably from a large population, providing a transparent and reliable source of data for
diabetes research and care
[86] A secure and private smart healthcare architecture that utilizes Federated Learning and blockchain technology to protect patient
data on IoT cloud platforms. This system allows for scalable machine learning applications in healthcare using Federated
Learning

response times can be handled. In contrast, most IoT 7.2 Security

devices use minimal bandwidth. As the number of con-
nected devices grows and blockchain technology demands, The IoT system is made up of billions of diverse IoT
significant bandwidth usage may be required. Various devices that are often manufactured with minimal focus on
suggestions have been put forth to tackle these obstacles, security measures. IoT devices with weak security mea-
such as utilizing permissioned blockchains for IoT devices sures are vulnerable to various security risks. Combining
[92, 93]. Another option is to employ Blockchain networks IoT with blockchain technology can enhance Confiden-
that are based on a low-energy consensus method like tiality, Integrity, and Privacy by utilizing blockchain’s
PoET PBET. Another alternative algorithm is outlined in encryption, immutability, tamper-proofing, and digital
[94]. IOTA is a solution that is designed for use in IoT signature capabilities. However, security is still a signifi-
systems. It is built on the directed acyclic graph (DAG) cant concern in deploying a high-performing IoT system
called ‘‘tangle’’ [95]. that incorporates blockchain. Furthermore, the IoT system
cannot use advanced, complicated encryption techniques

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Fig. 12 Research issues in blockchain of things

Table 11 Research issues and

Research issues Suggested algorithm
suggested algorithm
Limited resources • Fog/edge computing [91]
• IOTA [95]
Security • SABRE [98]
• Corda and Stellar [99]
Privacy • Private Blockchain [75, 102, 103]
• Homomorphic encryption and proxy re-encryption [106–108]
Scalability • Scalable consensus algorithms [58]
• Off-chain, on-chain [109, 110]
Interoperability • GS1-based data standards [111–113]
Data Management • Off-chain solutions [116]
Consensus Algorithm • Proof of elapsed time and Stellar consensus [59]
• Tangle [94]

due to resource limitations. Meanwhile Reference [96], cooperative jamming strategy [97] several methods were
Blockchain technology has some vulnerabilities in security studied to enhance security issues with the Internet of
measures, such as attacks on smart contract software and Things without requiring additional hardware for current
attacks on decentralized autonomous organizations Internet of Things nodes. In particular, Reference [98]
(DAOs). SABRE (Secure and Authenticated Blockchain Routing
Engine) has recently been proposed as a protected relaying
7.2.1 Suggested solutions system for blockchains that can safeguard blockchains
from BGP routing vulnerabilities. To protect against DAO
Addressed by either improving the security of IoT systems vulnerabilities, platforms such as Corda and Stellar have
or closing loopholes in the blockchain. For instance, a traded the flexibility of smart contracts for their

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verifiability [99]. An issue of security in the healthcare 7.4.1 Suggested Solution

sector is implementing blockchain technology in tracking
patients, specifically with permission and consortium References [109, 110] a review proposed categorizing
blockchain systems [100]. In [101] a solution based on a available scaling solutions into three tiers: Layer-0 for
public blockchain that addresses issues of SPOF (single solutions that improve data transmission standards, Layer-1
point of failure), MitM attacks, DoS, and data sniffing for on-chain solutions such as connections, consensus, and
vulnerabilities for Remote Hardware Management. data structure, and Layer-2 for off-chain solutions such as
off-chain channels, cross-chain protocols, and side-chain
7.3 Privacy approaches. Additionally, the survey also suggested the use
of private or consortium blockchains for IoT and the cre-
Because the healthcare industry requires a high level of ation of more scalable consensus algorithms [58].
privacy, using public Blockchains to store and distribute
sensitive data is inappropriate. Every transaction on a 7.5 Interoperability
public Blockchain is visible to everybody. Having an
anonymous identity does not guarantee the safety of sen- Refers to the capability of various Blockchains to interact
sitive information. seamlessly with one another. This is a main challenge in
the field of healthcare, as many Blockchain-based systems
7.3.1 Suggested solution in eHealth use a wide range of Blockchain networks and
platforms.
Private and permissioned Blockchains, in general, are not
affected by the privacy issue. As a result, the private 7.5.1 Suggested solutions
Blockchain is the best option for a healthcare application
[75, 102, 103]. Gathering personal data, including health The growing adoption of Blockchain technology across
details, location, and images, can compromise an individ- multiple industries has highlighted the need for a solution
ual’s privacy. To safeguard against privacy breaches, pri- allowing different Blockchains to interact and communi-
vacy-preserving scientific computations (PPSC) can be cate. Blockchain interoperability is a key solution to this
used [104] should be used. Another strategy for developing problem, and various methods, such as cross-blockchain
IoT application trust has been developed [105]. To protect frameworks, smart contract interaction, and token transfers,
user privacy on a blockchain network, research in both have been proposed to achieve this. Additionally, existing
blockchain and IoT has looked into Methods like homo- standards, such as the GS1-based data standards, are also
morphic encryption and proxy re-encryption. These meth- being used by companies like IBM and Microsoft to
ods depend on the Chinese remainder theorem (CRT) and facilitate interoperability between different blockchain
have been studied by researchers like [106–108]. Federated networks [111–113].
learning-based Blockchain provides private data process-
ing. Federated learning enables participants of the Block- 7.6 Data management
chain to learn an ML algorithm without exchanging their
information. The Blockchain can then secure the trained One primary difficulty when utilizing blockchain technol-
algorithm via a smart contract, ensuring its integrity and ogy is its limited storage capacity. Unlike the Internet of
confidentiality. Things, known for producing large amounts of data,
blockchain was not designed to handle and store significant
7.4 Scalability volumes of information. This limitation in storage capacity
can pose significant challenges to developing blockchain in
Scalability is a complex issue encompassing various fac- IoT applications. The whole Bitcoin blockchain is roughly
tors, such as max delivery ratio, delay, start-up time, and 150 terabytes in size, as is the complete Ethereum block-
cost per verified transaction. It also refers to a consensus chain. The blockchain is around 400 terabytes in size. It’s
mechanism’s ability to be more scalable by supporting necessary to save all the blockchain blocks. In the absence
many nodes. The primary focus is often on throughput and of IoT, devices, like all prior blocks, cannot authenticate
latency. Throughput measures the number of successful transactions generated by other devices. Besides, to create
TPS, while latency refers to the period needed to validate new transactions, past data is necessary [114]. Due to its
and execute a transaction. These properties are decided by restricted storage space, the large amount of information
the consensus algorithm employed in the Blockchain produced by IoT sensors, measured in zettabytes, makes it
network. impossible to store on the blockchain. In blockchain net-
works, it is required that multiple, or even all, nodes have a

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copy of the data, which put a strain on the constrained in implementing and evaluating blockchain integrated with
resources of IoT devices. This presents a significant IoT based on healthcare.
obstacle for the combined blockchain and the Internet of
Things, as the devices cannot handle and store such mas-
sive volumes of information. 8 Discussion

7.6.1 Suggested Solutions In this survey, the discussion explores and categorizes key
challenges encountered in integrating blockchain technol-
Reference [115, 116] to handle the issue of limited storage ogy with Internet of Things (IoTs) applications in health-
capacity in blockchain, many researchers have proposed care. The first challenge, limited resources on IoT devices,
the use of off-chain solutions to handle the vast amount of necessitates innovative solutions such as leveraging Mobile
information sent by IoT. One approach is to combine Edge Computing (MEC) and cloud computing technologies
blockchain storage with traditional cloud storage. Another to overcome computational and storage limitations.
option is to send IoT data among different sources, such as Addressing security concerns is paramount, given the
cloud services, which can provide various storage options, diverse and often insecure nature of IoT devices, and
including repositories, local computers, and utilizing a proposed strategies include cooperative jamming and sys-
blockchain that is on-chain based on the characteristics of tems like SABRE to fortify blockchain against vulnera-
the data and the specific scenario. This method enables the bilities. Privacy concerns, particularly pertinent in the
efficient and effective storage of large amounts of infor- healthcare sector, are addressed by recommending private
mation generated by IoT sensors while minimizing the and permissioned blockchains, complemented by privacy-
usage of the constrained resources of IoT sensors. preserving scientific computations and federated learning.
Scalability, a complex issue affecting throughput and
7.7 Consensus algorithm latency, can be mitigated using tiered scaling solutions and
private or consortium blockchains. Interoperability chal-
Consensus is used in blockchain to develop a way for all lenges in healthcare arising from diverse blockchain net-
blockchain nodes to agree. Because of the resource con- works find potential resolutions in cross-blockchain
straints in IoT, selecting a consensus algorithm is critical to frameworks and standardization efforts. The limited stor-
resolving resource constraints and security issues in IoT age capacity of blockchain versus the massive data gen-
and blockchain. erated by IoT devices underscores the need for off-chain
solutions involving the combination of blockchain with
7.7.1 Suggested solution traditional cloud storage or distributed data management.
Selecting appropriate consensus algorithms, like Proof of
Reference [59] suggested Proof of elapsed time and Stellar Elapsed Time and Stellar Consensus Protocols, is crucial
consensus protocols (SCP) as a good solution for IoT based for overcoming resource constraints and ensuring scala-
on healthcare applications with high scalability and low bility in healthcare focused IoT applications. Lastly, the
computation overhead, and [94] Tangle is a lightweight, gap between theoretical frameworks and practical imple-
endlessly scalable framework that’s ideal for IoT networks. mentation is highlighted, urging the research community to
develop and evaluate tangible solutions for the seamless
7.8 Practical solutions integration of blockchain and IoT in healthcare systems.
Overall, addressing these challenges is imperative for
When preparing this survey, we found that most works unlocking the full potential of blockchain technology in
suggested frameworks without showing practical solutions, revolutionizing healthcare through the Internet of Things.
such as [3, 84, 88, 117–120].

7.8.1 Suggested solutions 9 Conclusion

Using blockchain to integrate with existing healthcare This study examines the challenges and opportunities of
systems and IoT that require extensive adjustments to combining IoT and blockchain technology in the rapidly
current systems (such as a significant duration, meticulous expanding eHealth industry. The adoption of eHealth,
planning, financial support, and specialized human exper- which enables remote care using various technologies has
tise) and additional expenses. In explaining research gaps, improved the management of chronic illnesses and posi-
we introduce suggested solutions that guide the researchers tively impacted various healthcare domains including
EHRs, Remote patient monitoring, forecasting illnesses,

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112. Schulte, S., Sigwart, M., Frauenthaler, P., Borkowski, M.: Ibrahim Gomaa received the
Towards blockchain interoperability. Lect. Notes Bus. Inf. B.Sc. degree in Electrical Engi-
Process. 361, 3–10 (2019). https://doi.org/10.1007/978-3-030- neering (Communication sec-
30429-4_1 tion), from Cairo University,
113. Yaqoob, I., Salah, K., Jayaraman, R., Al-Hammadi, Y.: Block- Egypt, in 2002, the M.Sc.
chain for healthcare data management: opportunities, chal- degree In Electronics Engineer-
lenges, and future recommendations. Neural Comput. Appl. ing (Computers and Systems
34(14), 11475–11490 (2022). https://doi.org/10.1007/S00521- Department), from Helwan
020-05519-W/METRICS University and National
114. Alenezi, A., Zulkipli, N.H.N., Atlam, H.F., Walters, R.J., Wills, Telecommunication Institute,
G.B.: The impact of cloud forensic readiness on security. In: Egypt, in 2011. In 2014, he
CLOSER 2017—Proceedings of the 7th International Confer- joined Helwan University to
ence on Cloud Computing and Services Science, 2017, complete Ph.D. degree in Com-
pp. 511–517 (2017). https://doi.org/10.5220/0006332705390545 puter Science. He spent 13 years
115. Uddin, M.A., Stranieri, A., Gondal, I., Balasubramanian, V.: as a network security expert at
Rapid health data repository allocation using predictive machine National Telecommunication Institute, Cairo, Egypt (2005–2018).
learning. Health Inform. J. 26(4), 3009–3036 (2020). https://doi. His current research interests include Information Security, network
org/10.1177/1460458220957486 security, Virtualization, Cloud Computing, Big-data science, and
116. Ashraf Uddin, M., Stranieri, A., Gondal, I., Balasubramanian, Internet of Things. He is currently an Assistant Professor at National
V.: Dynamically recommending repositories for health data: a Telecommunication Institute (NTI), Cairo, Egypt.
machine learning model. In: ACM International Conference
Proceeding Series, February 2020 (2020). https://doi.org/10. Hala H. Zayed received her
1145/3373017.3373041 B.Sc. in electrical engineering
117. Banotra, A., Sharma, J.S., Gupta, S., Gupta, S.K., Rashid, M.: (with honor degree) in 1985, the
Use of Blockchain and Internet of Things for Securing Data in M.Sc. in 1989 and Ph.D. in
Healthcare Systems, pp. 255–267 (2021). https://doi.org/10. 1995 from Benha university in
1007/978-981-15-8711-5_13 electronics engineering. She is
118. Kazmi, H.S.Z., Nazeer, F., Mubarak, S., Hameed, S., Basharat, the ex-dean of faculty of Com-
A., Javaid, N.: Trusted remote patient monitoring using block- puters and Artificial Intelli-
chain-based smart contracts. Lect. Notes Netw. Syst. 97, gence, at Benha university. She
765–776 (2019). https://doi.org/10.1007/978-3-030-33506-9_70 is now a professor at faculty of
119. Ahmadi, V., Benjelloun, S., El Kik, M., Sharma, T., Chi, H., engineering, Egypt University
Zhou, W.: Drug governance: IoT-based blockchain implemen- of Informatics, Egypt. She is a
tation in the pharmaceutical supply chain. In: 2020 6th Inter- member of the committee of
national Conference on Mobile and Secure Services, experts in the national commit-
MOBISECSERV 2020, February 2020 (2020). https://doi.org/ tee of UNESCO (committee of
10.1109/MOBISECSERV48690.2020.9042950 communications and informatics). Her areas of research are computer
120. Lemieux, V.L., et al.: Having our ‘Omic’ cake and eating it too? vision, biometrics, image forensics, image processing and machine
Evaluating user response to using blockchain technology for learning.
private and secure health data management and sharing. Front.
Blockchain 3, 59 (2021). https://doi.org/10.3389/FBLOC.2020. Mohamed Taha is an Associate
558705 Professor at Benha University,
Faculty of Computers and Arti-
Publisher’s Note Springer Nature remains neutral with regard to ficial intelligence, Computer
jurisdictional claims in published maps and institutional affiliations. Science Department, Egypt. He
received his M.Sc. degree and
his Ph.D. degree in computer
science at Ain Shams Univer-
Aya H. Allam Received B.Sc. in
sity, Egypt, in February 2009
computer science from Faculty
and July 2015. He is the founder
of Computers and Artificial
and coordinator of ‘‘Networking
intelligence, Benha University,
and Mobile Technologies’’ pro-
Egypt in 2013 and received the
gram, Faculty of Computers and
M.Sc. degree in 2020. She is
Artificial Intelligence, Benha
currently working as teaching
University. His research inter-
assistant at computer science
est’s concern: Computer Vision (Object Tracking-Video Surveillance
department, Faculty of Com-
Systems), Digital Forensics (Image Forgery Detection – Document
puters and Artificial intelli-
Forgery Detection - Fake Currency Detection), Image Processing
gence, Benha University, Egypt.
(OCR), Computer Network (Routing Protocols - Security), Aug-
Currently, she is working on his
mented Reality, Cloud Computing, and Data Mining (Association
Ph.D. degree. Her research
Rules Mining-Knowledge Discovery). Taha has contributed more
interests are: Blockchain, secu-
than 20? technical papers in international journals and conferences.
rity, IoT and healthcare.

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