Abstract

not-yet-known not-yet-known not-yet-known unknown The digitalization of healthcare is being transformed through the integration of IoT, cloud environments, and blockchain technology, significantly enhancing security and infrastructure robustness. This study conducts a systematic review of over 200 articles on blockchain-enabled healthcare systems, analysing current applications, security threats, cyber-attacks, and system challenges, along with proposed solutions. Despite blockchain’s potential to revolutionize medical data handling, sharing, and processing, our findings reveal persistent issues: 17 security threats compromising privacy and data integrity, 21 cyber-attacks impacting security and quality of service, and 16 system problems such as node compromise, scalability, efficiency, regulatory challenges, computation speed, and power consumption. We propose a layered architecture for future healthcare infrastructure, categorizing issues within this framework and evaluating existing solutions. Our comparative analysis demonstrates the superiority of this architecture in terms of security, trustworthiness, and efficiency over traditional systems. Real-world case studies and a comparative evaluation of blockchain protocols and consensus mechanisms offer deeper insights into their applicability in IoMT and healthcare. This review provides a comprehensive perspective on enhancing e-healthcare services through improved security and privacy, addressing regulatory and ethical challenges. By mapping out limitations, future scopes, and emerging trends, we aim to foster the development of robust, trustworthy, and privacy-preserving healthcare systems.