applied
sciences
Review
Blockchain-Based Internet of Medical Things
Hamed Taherdoost
Citation: Taherdoost, H.
Blockchain-Based Internet of Medical
Things. Appl. Sci. 2023, 13, 1287.
https://doi.org/10.3390/app13031287
Academic Editors: Kim Phuc Tran,
Yi Man and Zhenglei He
Received: 9 December 2022
Revised: 13 January 2023
Accepted: 16 January 2023
Published: 18 January 2023
Copyright: © 2023 by the author.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
Appl. Sci. 2023, 13, 1287. https://doi.org/10.3390/app13031287
Department of Arts, Communications and Social Sciences, University Canada West,
Vancouver, BC V6B 1V9, Canada; hamed.taherdoost@gmail.com; Tel.: +1-236-889-5359
Abstract: IoMT sensor nodes, Internet of Things (IoT) wearable medical equipment, healthcare
facilities, patients, and insurance firms are all increasingly being included in IoMT systems. Therefore,
it is difficult to create a blockchain design for such systems, since scalability is among the most
important aspects of blockchain technology. This realization prompted us to comprehensively
analyze blockchain-based IoMT solutions developed in English between 2017 and 2022. This review
incorporates the theoretical underpinnings of a large body of work published in highly regarded
academic journals over the past decade, to standardize evaluation methods and fully capture the
rapidly developing blockchain space. This study categorizes blockchain-enabled applications across
various industries such as information management, privacy, healthcare, business, and supply chains
according to a structured, systematic evaluation, and thematic content analysis of the literature
that is already identified. The gaps in the literature on the topic have also been highlighted, with
a special focus on the restrictions posed by blockchain technology and the knock-on effects that such
restrictions have in other fields. Based on these results, several open research questions and potential
avenues for further investigation that are likely to be useful to academics and professionals alike
are pinpointed.
Keywords: Internet of Medical Things; IoMT; blockchain; healthcare; Internet of things; IoT
1. Introduction
Securely recovering and correctly managing the amount of individual health data
created by delivering service operations and normal business is a major challenge for the
healthcare industry. Most of the health data is not easy to access or standardized across
systems, and is difficult to interchange, utilize, and understand. They are compiled from
several locations and stored in centralized information technology systems, making them
challenging to share and administer. Time and energy are required to synthesize, receive,
send, and request medical information [1]. Safe data retrieval and management enable
healthcare systems to improve health outcomes, communication, treatment quality, and
patient views in their entirety [2].
Legacy systems are notorious for being incompatible with newer technologies and for
only being able to communicate with other healthcare and medical systems on a limited scale.
Data shows various advantages of integrating these networks for better and linked health-
care; however, researchers in health informatics should consider interconnection across
different companies [3]. One of the biggest challenges in this area is multi-organizational
data sharing, which requires healthcare providers to make their patients’ medical records
freely accessible to other organizations, including research or physician institutions [4].
Given the present state of affairs, comprehensive reform of the universal healthcare
system is necessary. Historically, medical professionals have handled their evaluations, doc-
umentation, and reports on patients and any necessary adjustments to their treatments [5].
With longer life expectancies and a growing world population, a more powerful tool is
required for population control. The Internet of Things (IoT) or other decentralized plat-
forms may be employed in this context for achieving dispersed coverage [6]. In light of
this, healthcare systems are a crucial IoT application [7,8].
https://www.mdpi.com/journal/applsci
Appl. Sci. 2023, 13, 1287 2 of 19

Internet of Medical Things (IoMT) is the kind of IoT that is used in the healthcare
industry [9]. IoMTs are the wave of the future in healthcare since they will enable the con-
nectivity and remote monitoring of all medical equipment [10]. Due to these developments,
healthcare may now be provided more rapidly and at a lower cost [11]. Medical workers
(nurses, physicians, etc.), medical data servers, and medical sensor equipment make up the
bulk of an IoMT system that provides remote healthcare [12,13].
There is a long way to go before IoMT can be utilized widely. Most implanted and
wearable medical sensor devices lack the computational power and battery life to make
complex encryption schemes practical. This means that wireless data transport in the IoMT
is open to external attacks [14]. Due to the sensitive nature of patient information included
in medical records, it is important to realize that only authorized parties have access to
these records [15]. Poor IoMT interoperability [16] is also a problem because of the wide
range of medical sensor devices that are available [17] and the diversity of IoMT networks.
The integration of blockchain with IoMT may address the above issues [16,18]. Blockchain
is defined by its specific openness, traceability, dependability, and decentralization features.
Thus, blockchain technology may be able to address concerns with compatibility, confiden-
tiality, and safety [19]. Blockchain makes it possible for parties who do not trust each other
to nevertheless complete a variety of network transactions. Data from a distributed network
of devices may be stored and tracked in a blockchain [20]. To the best of our knowledge,
this systematic review offers a general overview of the present state, significance, and
future of blockchain-based IoMTs, which has not been executed previously.
The structure of the current investigation is as follows: The research methodology
that was used to search, filter, and choose the literature is described in detail in Section 2.
The third section includes an important review of works that have been undertaken in
the area of IoMT using blockchain and summarizes all the papers that have been chosen,
concentrating on their primary results and indicating research needs for future studies. The
last section of the paper concludes the results.

2. Research Methodology
2.1. Prior Reviews
While blockchain is still a new field of research, several literature evaluations have
already been conducted on the topic and its potential uses. In addition, some studies zero
in on certain problems in one particular field of application. A review entails the following
phases: preparation, execution, identification of core research questions, formulation
of search criteria, identification of data sources, and presentation of findings. Detailed
examples of each of these stages may be found in the following subsections.

2.2. Planning the Review

This systematic review aims to establish the present standing of blockchain in the
IoMT. This investigation was conducted with due diligence by thoroughly reviewing
the relevant literature published in the present situation. Structured research questions,
databases, and methods for locating and analyzing evidence are all part of the review
process. Characteristics of the recommended items in reporting for conducting systematic
reviews have been selected to provide a clear, quantitative, and thorough assessment of
existing applications in healthcare based on blockchain technology and IoMT. The following
points are the main phases in the overall plan:
n Recognizing the necessity for conducting an analysis, generating a review proposition,
and creating a review.
n Finding the appropriate research and studies.
n Results overview of the investigation.

2.3. Research Questions

This study aims to organize and describe the present body of research on blockchain
and IoMT development, as well as the existing uses of these technologies. Since this study
 Appl. Sci. 2023, 13, x FOR PEER REVIEW 3 of 20

Appl. Sci. 2023, 13, 1287 2.3. Research Questions 3 of 19

This study aims to organize and describe the present body of research on blockchain
and IoMT development, as well as the existing uses of these technologies. Since this study
needed to
needed to be
be structured,
structured, aa set
set of
of research
research questions
questions was
was developed.
developed.Listed
Listedbelow
beloware
arethe
the
specific study topics and their associated sub-questions:
specific study topics and their associated sub-questions:
RQ1 (Research
RQ1 (Research Question
Question 1):1): Where
Where dodo blockchain-based
blockchain-based IoMT
IoMTsystems
systemsnow
nowstand?
stand?
RQ2 (Research Question 2): How important are blockchain applications inthe
RQ2 (Research Question 2): How important are blockchain applications in theIoMT?
IoMT?
RQ3 (Research
RQ3 (Research Question
Question 3):3): What
What is
is the
the future
future of
of blockchain-based
blockchain-basedIoMT?
IoMT?
2.4. Research
2.4. Research Strategy
Strategy
AA full
full examination
examination of ofthe
theliterature
literaturecalls forfor
calls anan
all-encompassing
all-encompassingperspective. To in-
perspective. To
increase the possibility of finding highly relevant publications, an appropriate selectionofof
crease the possibility of finding highly relevant publications, an appropriate selection
databaseswas
databases waschosen
chosenbefore
beforethe
theresearch
researchwas
waseven
evenbegun.
begun.During
Duringthe
thereview,
review,the
thefollowing
follow-
ing Scopus sources were
Scopus sources were explored. explored.

2.5. Search
2.5. Search Criteria
Criteria
To ensure that the
To ensure that the research
research presented herehere is
is comprehensive,
comprehensive,aathorough
thoroughsearch searchofof
relevantdatabases
relevant databaseswas
wasconducted.
conducted.However,
However,for foraavariety
varietyofofreasons,
reasons,not
notall
allofofthe
thecanonical
canon-
ical literary
literary worksworks
have have
been been included
included in theinspecified
the specified
searchsearch criteria.
criteria. AboutAbout 144 Scopus
144 Scopus results
results
have have
been been analyzed
analyzed until 30until 30 October
October 2022. Among
2022. Among them,them,
aboutabout 73 were
73 were determined
determined to be
to be relevant
relevant (Figure
(Figure 1). 1).

0%
1% Computer Science
0%
1% Engineering
1% 1%
1%
Mathematics

2% Biochemistry, Genetics and Molecular

5% Biology
Materials Science

6% Physics and Astronomy

39% Chemistry

7% Medicine

Business, Management and Accounting

Chemical Engineering
7%
Agricultural and Biological Sciences

Health Professions
7%
Immunology and Microbiology

Neuroscience

22% Psychology

Figure 1. The number of publications produced by the subject area between 2017 and 2022.
Figure 1. The number of publications produced by the subject area between 2017 and 2022.

The research domain and research questions informed the construction of the search
string. By searching for the terms “Blockchain”, “Block chain”, “IoMT” or “Internet of
Medical Things,” the essential literature was identified and retrieved.
n Inclusion criteria (IC).
Appl. Sci. 2023, 13, 1287 4 of 19

1. Research may have been published at any point from 2017 to 2022.
2. Research is confined to the journal.
n Exclusion criteria (EC).
1. Papers that are not in English.
2. Reviews, conferences, book chapters, periodicals, theses, monographs, and
interview-based pieces are eliminated.

3. Analysis
Results from answering the research questions presented in the previous systematic
review are listed in this section. This study seems to make a substantial contribution to the
use of blockchain in the medical field. This part introduces blockchain-based IoMT and
covers its fundamentals, different varieties, development teams, platforms, and consen-
sus processes. The importance of using blockchain and IoMT in healthcare is discussed
further on.

3.1. Selection Results

This search returned 144 results, of which 71 were deemed suitable for screening. This
systematic review consists of 73 research papers. Some articles in press met the inclusion
criteria but they were not considered in the range of 2017–2022. Following is a list of chosen
publications with explanations of the overall classification findings.
RQ1: Where do blockchain-based IoMT systems now stand?
This systematic study examines the attained descriptive data on the several articles
published every year, the publishing source, and the annual average number of citations
received by research papers. To conclude this systematic review, blockchain-related IoMT
research articles published in the area of blockchain between 2017 and 2022 are inves-
tigated. Table 1 displays the amount of cited research publications according to their
respective periodicals.

Table 1. Count of publications in various journals.

Journal Number of Publications

IEEE Internet of Things Journal 10
IEEE Access 8
Sensors 8
Electronics Switzerland 5
SN Computer Science 3
Computers Materials and Continua 2
IEEE Transactions on Industrial Informatics 2
Intelligent Automation and Soft Computing 2
International Journal of Advanced Computer Science and Applications 2
Security and Communication Networks 2
ACM Transactions on Multimedia Computing Communications
1
and Applications
Applied System Innovation 1
Array 1
Biomedical Engineering Applications Basis and Communications 1
Computational and Mathematical Methods in Medicine 1
Computational Intelligence and Neuroscience 1
Computer Communications 1
Computer Networks 1
Computer Systems Science and Engineering 1
Computers and Electrical Engineering 1
Computers in Biology and Medicine 1
Frontiers in Public Health 1
ICT Express 1
 Appl. Sci. 2023, 13, 1287 5 of 19

Table 1. Cont.

Journal Number of Publications

IEEE Journal of Biomedical and Health Informatics 1
IEEE Sensors Journal 1
IEEE Transactions on Consumer Electronics 1
IEEE Transactions on Engineering Management 1
Information Switzerland 1
Journal of Information Security and Applications 1
Journal of Network and Computer Applications 1
Journal of Sensor and Actuator Networks 1
Journal of Supercomputing 1
Mathematical Biosciences and Engineering 1
Microprocessors And Microsystems 1
Multimedia Tools and Applications 1
Pervasive and Mobile Computing 1
Soft Computing 1
Technological Forecasting and Social Change 1
Technology and Health Care 1

From 2017 to 2022, Figure 1 depicts the number of publications produced by topic
area. The main subject areas are computer science (65 articles) and engineering (36 articles),
mathematics (12 articles), biochemistry, genetics and molecular biology (11 articles), materi-
als science (11 articles), physics and astronomy (10 articles), chemistry (8 articles), medicine
(4 articles), etc., respectively. About 39% of research is dedicated to computer science,
a unique feature of blockchain and IoMT fundamentals. The next category is engineering
(about 22%), which can usefully cover all these subjects.
Figure 2 shows the number of publications published between 2017 and 2022. There is
Appl. Sci. 2023, 13, x FOR PEER REVIEW 6 of 20
no content from 2017 to 2019. In 2019, two papers were published, while in 2020, six articles
were published. The evident anomaly exists between 2020 and 2021. In 2021, 29 articles
were published, whereas, in 2022, 36 papers were published. The number of papers
published has increased throughout the years. This indicates the concept of integrating
IoMT with blockchain has taken shape and expanded over the past four years.
40 36
35
29
30

25
Quantity

20

15

10 6
5 2
0 0
0
2017 2018 2019 2020 2021 2022

Year

Figure 2. The number of publications published annually between 2017 and 2022.
Figure 2. The number of publications published annually between 2017 and 2022.
In addition, the examination of author-indexed terms using a word cloud revealed
that the focus of the articles was on “blockchain,” “IoMT,” “health care,” “security,” “digital
storage,” and “privacy,” as shown graphically in Figure 3. This shows that blockchain and
IoMT can be integrated for benefits such as privacy, healthcare, security, and digital storage.
 0 0
0
2017 2018 2019 2020 2021 2022

Year
Appl. Sci. 2023, 13, 1287 6 of 19

Figure 2. The number of publications published annually between 2017 and 2022.

3.Main
Figure 3.
Figure Mainkeywords
keywordsof articles.
of articles.
RQ2: How important are blockchain applications in the IoMT?
RQ2: How important are blockchain applications in the IoMT?
IoMT has significant benefits for human health, including improved quality of life
IoMT has
and reduced significant
healthcare costsbenefits
[13]. Thefor human health,
healthcare industryincluding improved
stands to save as much quality
as of l
and reduced healthcare costs [13]. The healthcare industry stands to
USD 300 billion annually if it adopts IoMT devices, notably for telemedicine and chronicsave as much as US
x FOR PEER REVIEW 300 billion
diseases. annually
Investing if IoMT
in the it adopts IoMT since
is lucrative devices, notably
it brought for 28
in USD telemedicine ofand
billion in72017 andchronic
20 is d
projected
eases. to bring in
Investing in USD 135 billion
the IoMT by 2025 [21].
is lucrative sinceKey elements, in
it brought as shown
USD 28 in billion
Figure 4,inare
2017 and
wireless sensors
projected thatin
to bring mayUSD be 135
usedbillion
to perform remote
by 2025 monitoring
[21]. of patient’s
Key elements, health in
as shown states
Figure 4, a
and communication technologies to relay that data to healthcare providers.
wireless sensors that may be used to perform remote monitoring of patient’s health stat
and communication technologies to relay that data to healthcare providers.

Figure 4. Conceptual design for the IoMT.

Figure 4. Conceptual design for the IoMT.

Because of its sensitivity, volume, and importance, medical data requires rigorous
guarding [22]. Furthermore, blockchain technology is paving the way for innovative ap-
proaches to healthcare data management, access control, sharing, retrieval, storage, and
more [23]. Now that blockchain technology is introduced, researchers are more focused
Appl. Sci. 2023, 13, 1287 7 of 19

Because of its sensitivity, volume, and importance, medical data requires rigorous
guarding [22]. Furthermore, blockchain technology is paving the way for innovative
approaches to healthcare data management, access control, sharing, retrieval, storage, and
more [23]. Now that blockchain technology is introduced, researchers are more focused on
employing blockchain strategies to ensure the security of applications in healthcare [24].
IoMT problems emerged as soon as IoT systems started incorporating medical devices. The
lack of consistency is a major barrier. The extensive application of blockchain technology in
healthcare is expected to bring along a rise to new “smart” healthcare provider applications
that sidestep the latest medical research and create individualized pathways to address
the situations [25]. The same level of access to information will be provided for both the
patient and the healthcare professionals allowing them to engage in a productive dialogue
based on hard facts about the best course of therapy for the patient’s illness [26,27].
Several recent studies have focused on the potential of blockchain technology in the
healthcare sector [28–32]. Blockchain technology has made a significant impact on the
healthcare sector in terms of transforming digitally in recent years. Blockchain applica-
tions for healthcare data management facilitate the regulation of patient record access, the
handling of payments and claims, the protection of IoMT [33], and the verification and
exchange of research results for financial audits [34] and transparency. To handle, analyze,
and make sense of patient health data, the main features of blockchain, including encrypted
and distributed ledgers that are updated in real time, are employed [35]. Conceptually, there
are layers to access technologies that are new in the blockchain-based healthcare area in-
cluding healthcare applications, stakeholders, data sources, and blockchain technology [36].
Daisuke et al. [37] employed Hyperledger fabric blockchain technology to transport medi-
cal data to the Hyperledger blockchain network, with a particular emphasis on medical
records. Telephones were used to collect medical records. The goal of their work was to
use the blockchain to record medical records.
There are a number of different approaches in which blockchain technology might
improve healthcare for patients, doctors, and scientists [38]. The benefits of customized
and research treatment will be maximized by establishing granular data access rights,
monitoring individualized data in real-time, and building a central repository for all health
data [39]. To better manage healthcare data, Anuraag et al. [40] looked at blockchain tech-
nology. They considered a wide range of articles for their research; much of it speculated
about the advantages and disadvantages of using blockchain technology in the healthcare
industry without providing proof or a system evaluation. The group has finished debating
whether or not blockchain technology is more suitable than existing solutions for managing
patients’ health information in the cloud without compromising patient confidentiality.
When it comes to healthcare management, Khezr et al. [41] found several problems that
may be solved with the use of blockchain technology. They highlighted the current re-
search on the application of distributed ledger technology in healthcare and numerous
prospective medical applications where blockchain technology may play a critical role
in improving efficiency. They also proposed a way for delivering IoMT over existing
network infrastructure.
Researchers in the healthcare field are reliant on large sets of data to construct tailored
therapies that are based on lifetime, the environment, and genetics, promptly monitoring
the development of novel pharmaceuticals, accelerating biomedical discovery, and expand-
ing understanding of the condition [42]. The shared data system in the blockchain would
provide a diversified collection of data [43,44] if it included patients from a wide range of
ethnic, socioeconomic, and geographical backgrounds. As blockchain records medical in-
formation over a person’s whole life, it is well suited for longitudinal studies [45]. Through
the use of a healthcare blockchain, those who are underserved by the medical community
or who are not generally engaged in research may be included in studies [46]. Because
of blockchain’s shared data environment, it is much easier to include formerly difficult-
to-reach communities and boost public confidence in the reliability of results [47]. Smart
Appl. Sci. 2023, 13, 1287 8 of 19

healthcare systems, as can be guessed, need copious amounts of data sharing between
medical professionals and their respective tools [48].
A “blockchain” was developed to link all the databases on the network to address this
issue. As time goes on, blocks of data are added to a distributed ledger and secured using
cryptographic hashing in what is known as a blockchain. Each record includes a crypto-
graphic hash of the previous record to prevent constant unnecessary modifications [49].
A blockchain is recognized by its immutable “ledger,” which implies that once a record is
recorded, it cannot be changed in any manner and is available to individuals and under
their control. This is the basic aspect of the smart contract system with which the blockchain
conforms to the maintenance of one’s identity. Therefore, only licensed medical profession-
als are allowed to access patient electronic medical records (EMRs) [50]. The “MedBlock” is
a blockchain-based information management system that provides immediate EMR access
and retrieval [51] thanks to its secure access control and encryption. Vangipuram et al. [52]
developed a blockchain implementation and edge architecture called the “Healthcare Data
Gateway” (HDG) to ensure the privacy of medical records for COVID-19 patients being
transferred to hospitals. To combat the spread of the COVID-19 virus, Alsamhi et al. [53]
developed a blockchain setup for a distributed network of robots.
Hassanien et al. [54] used the term “medical of things” to describe the challenges of
processing massive volumes of data in the healthcare industry. A related problem is the
extraction of intelligent patterns in healthcare data [55]. Medical big data is generated in
large quantities by smart IoT devices, making this a potentially life-changing area of study.
According to Dey et al. [56], there are many tiers inside the IoT system where sensors are
enabled to collect data. This study analyzed the issues occurring at various tiers of the
IoT ecosystem. In a similar vein, Kamal et al. [57] investigated the use of a map-reduce
architecture to classify medical data in light of preexisting impediments. Another study
looked at the need to optimize healthcare data for cloud computing [58].

3.2. Advantages of Using Blockchain-Based Technologies in IoMT Systems

The benefits of employing blockchain technology are outlined below. These include
open architecture, trustless consensus, transparency, tamper-proofing, smart contracts, and
a distributed ledger [59].
• The term “open architecture” refers to a kind of technological infrastructure whose
developers provide detailed plans for the system. It encompasses both government-
sanctioned norms and custom-built structures.
• Trustless consensus: since distributed consensus is at the heart of blockchain-based
IoMT applications, relying on third-party trusted intermediaries such as banks and
governments is unnecessary.
• Transparency: all peers in the network may see all data that is recorded in a block, and
the data cannot be modified once it is recorded. To combat problems like counterfeit
pharmaceuticals, for instance, it is possible to verify and secure critical drug informa-
tion by tracking every transaction between drug makers, pharmacists, and patients.
The capacity to track where drugs came from will result.
• Recordings cannot be tampered with, so any attempts to steal or modify patients’
health records are easily uncovered. The dishonest practice of manipulating or altering
data from clinical studies, for instance, might be eliminated.
• In situations where rule-based approaches to patient data access are developed, smart
contracts are likely to be utilized to ensure that only authorized parties have access
to that data. In this section, authorization for certain medical institutions might
be made. Smart contracts may be employed to define the behavior of IoMT appli-
cations, automate routine tasks, and provide secure two-way communication and
financial transactions between IoMT devices and third parties including patients,
and physicians.
• Because of its decentralized design, the blockchain cannot be hacked or brought down
by any one central authority.
Appl. Sci. 2023, 13, 1287 9 of 19

3.3. Privacy and Security

Some of the privacy and security benefits that may be realized when a blockchain is
integrated with IoMT systems are provided in the following:
• To ensure that only those who need access to a patient’s medical records do so by
the rules put out by the lawful administrator, smart contracts may give access to
control property.
• Each participant in an IoMT system values their privacy and does not want it invaded
in any way by the exchange of information. The digital identity of the transactions is
used by blockchain to make transactional data unreadable to other parties.
• CIA (confidentiality, integrity, availability): because the blocks containing data are
signed, blockchain provides high levels of integrity protection. In addition, the linking
through hashes and the unanimity requirement make it very difficult, if not impossible,
to alter the contents inside a block. In addition, a complete version of the data is copied
and stored in all nodes, which means a high degree of availability is supplied by con-
struction. However, privacy is compromised due to blockchain’s inbuilt transparency
and verifiability checks for every data transaction. Since blockchain implementation
focuses more on ensuring the data’s integrity and availability than its secrecy, the latter
is less strictly enforced. Since application-level encryption and other techniques where
(sensitive) data is not immediately accessible by unauthorized nodes are beyond the
purview of this study, the system must offer extra security if a high degree of secrecy
is needed [60].
While integrating blockchain and IoMT systems offers security and privacy advan-
tages, serious privacy concerns may occur.

3.4. Blockchain Scalability

Blockchain is an immutable and append-only database that allows for auditable and
transparent data management [61]. A hash of the prior block is stored in each block, and
the whole structure is implemented as a linked list [62]. The scalability problem is a major
issue with blockchain and has been examined at length in [63,64]. The difficulty of scaling
blockchain-based Internet of Things applications is addressed in detail in several recent
publications [65,66]. Blockchains have scalability issues due to inefficient architecture and
consensus procedures [67].
With bitcoin, for instance, the transaction confirmation time is around 10 min, and
7 transactions per second may happen. Companies such as Visa, which handle large
volumes of transactions, have a throughput of roughly 24,000 per second. When discussing
blockchain scalability, the following metrics are of primary interest [68]:
• Transaction latency is the time it takes for a payment to be approved. There are other
measures, such as bootstrap time and cost per confirmed transaction (CPCT) for the
approval process.
• If you want to know how many transactions per second a blockchain can confirm, you
need to know the maximum block size and the average block duration.
This part will explore how blockchain technology is being used for data manage-
ment in the contexts of the Internet of Things (IoT) and healthcare. It also evaluates the
methods that have been taken to combine blockchain technology with the Internet of
Things. To illustrate the methods utilized to combine blockchain with IoMT, published
papers are also examined. Case studies of blockchain implementations in IoMT are
included in Table 2.
Appl. Sci. 2023, 13, 1287 10 of 19

Table 2. Studies on blockchain’s potential use in IoMT systems (2017–2022).

Objective Year Journal Cited by Reference

“Blockchain For Secure EHR Cloud-Based Mobile E-Health
2019 IEEE Access 280 [69]
System Sharing”
International Journal of
“Protecting The Internet of Medical Devices
2019 Advanced Computer Science 51 [20]
with Blockchain”
and Applications
“Blockchain-Based IoMT for Uninterrupted, Ubiquitous,
User-Friendly, Unfaltering, Flawless, Unrestricted Health 2020 IEEE Access 29 [70]
Care Services (BC IoMT U6HCS)”
“An In-Depth Analysis of the COVID-19 Pandemic and the
Role of IoT, Drones, AI, Blockchain, and 5G in Managing 2020 IEEE Access 818 [71]
its Effects”
“Design of Blockchain-Enabled Authenticated Key
Management Protocol for Deployment of Internet of 2020 IEEE Access 77 [72]
Medical Devices”
“The Prospective Use of EHR, IoMT, and Blockchain in
2020 Electronics (Switzerland) 30 [73]
Improving Healthcare Effectiveness”
“E-healthcare Blockchain-Based Smart Contracts for The
2020 Electronics (Switzerland) 75 [74]
Internet of Medical Devices”
“Enhancing Medical Smartphone Networks Against
IEEE Transactions on
Insider Attacks Using Blockchain-Based 2020 65 [75]
Engineering Management
Trust Management”
“Integrated Blockchain and IPFS Framework in Bilevel Computational and
Fog-Cloud Network for IoMT Device Security 2021 Mathematical Methods 5 [76]
and Privacy” in Medicine
“Scalability of Blockchain-Based IoMT Systems” 2021 IEEE Access 6 [77]
“Blockchain-enabled serverless network with cost-effective Mathematical Biosciences
2021 18 [78]
service selection and execution for the IoMT” and Engineering
“A Systematic Analysis of Current and Future Trends in International Journal of
IoMT-Enabled Smart Healthcare Systems’ Security, Privacy, 2021 Advanced Computer Science 18 [79]
and Trust” and Applications
ACM Transactions on
“A Cross-blockchain Approach to Fog-based Secure Multimedia Computing,
2021 6 [80]
Service Discovery for Internet of Multimedia Things” Communications,
and Applications
“Blockchain for Public Healthcare in The Microprocessors
2021 24 [81]
Intelligent Society” and Microsystems
“SaYoPillow: A Blockchain-Integrated, Privacy-Assured
IEEE Transactions on
IoMT Framework for Stress Management Taking Sleeping 2021 26 [82]
Consumer Electronics
Habits into Consideration”
“Convergence of security and Blockchain with the Internet
Journal of Network and
of Multimedia Things: Current trends, research problems, 2021 40 [83]
Computer Applications
and future directions”
“Intelligent Framework Using Disruptive Technologies for Technological Forecasting and
2021 167 [84]
Analysis of COVID-19” Social Change
“A Case Study Using Blockchain and IoMT against Journal of Sensor and
2021 5 [85]
Physical Abuse: School Bullying” Actuator Networks
Biomedical
“Blockchain-Based Cybersecurity Architecture for the
2021 Engineering—Applications, 4 [86]
IoMT and Linked Devices”
Basis, and Communications
“Intelligent Medical System Agent Architecture Based on Journal of Information Security
2021 47 [87]
Federated Learning and Blockchain Technologies” and Applications
“Smart-Contract-Aware Ethereum and Client-Cloud
2021 Sensors 51 [88]
Fog-Computing Healthcare System”
“BEdgeHealth: A Blockchain-based decentralized
2021 IEEE Internet of Things Journal 40 [89]
architecture for edge-based IoMT networks”
“Fortified-Chain: A Blockchain-Based Framework with
Effective Access Control for Securing and Protecting 2021 IEEE Internet of Things Journal 68 [90]
the IoMT”
Appl. Sci. 2023, 13, 1287 11 of 19

Table 2. Cont.

Objective Year Journal Cited by Reference

“Blockchain Technology for the IoMT, A Remedy Pervasive and
2021 20 [91]
for COVID-19” Mobile Computing
“Utilizing Blockchain and IPFS Technologies to Build and
2021 Journal of Supercomputing 36 [92]
Deploy a Security and Privacy Framework for IoMT”
“The Mechanism for Establishing Trust in the Internet of Multimedia Tools
2021 11 [93]
Multimedia Things Based on Blockchain Technology” and Applications
“Automatic Creation of Smart Contracts for the Internet of
2021 ICT Express 4 [94]
Media Things”
“A Blockchain-Based Framework for Non-repudiable
Contact Tracing in Healthcare Cyber-physical Systems 2021 SN Computer Science 17 [52]
During Pandemic Outbreaks”
“In the Age of COVID-19, Applications of Machine
2021 Applied System Innovation 6 [95]
Learning and High-Performance Computing”
“Deep Learning-Based Blockchain-Secured
2021 Frontiers in Public Health 4 [96]
Recommendation System for Patients with Special Needs”
“Blockchain-Based Miyauchi–preneel ruzickaindexed
2021 Sensors 3 [97]
Deep Perceptive Learning for Malware Detection in IoMT”
“Federated Learning Across Clusters and Blockchain for
2021 IEEE Internet of Things Journal 13 [98]
the IoMT”
“Secure IoMT Data Analysis Powered by Blockchain and
2021 IEEE Internet of Things Journal 15 [99]
SGX-Enabled Edge Computing”
“MEdge-Chain: Using Edge Computing and Blockchain to
2021 IEEE Internet of Things Journal 53 [100]
Exchange Medical Data Efficiently”
“Applying Collective Reinforcement Learning to Task
Offloading for VR-Enabled Wireless Medical Treatment 2021 IEEE Internet of Things Journal 27 [101]
with Blockchain Security”
“HealthBlock is a Secure Blockchain-Based Solution for
2021 Computer Networks 31 [102]
Managing Healthcare Data”
“A Framework for Sharing Collateral Sensor Data in
2021 IEEE Sensors Journal 2 [103]
Decentralized Healthcare Systems”
“DSMAC: Privacy-Aware Blockchain-Based Decentralized
2022 IEEE Access 0 [104]
Self-Management of Health Data Access Control”
“Trusted and Confidentiality-Preserving Distributed Security and
2022 0 [105]
Computing for the Internet of Mobile Things” Communication Networks
“BIoMT: A State-of-the-Art Serverless Network
2022 IEEE Access 2 [106]
Architecture for a Blockchain-Based Healthcare System”
“Trends and Progress of Smart Healthcare System Based Computational Intelligence
2022 1 [107]
on the IoMT” and Neuroscience
Computer Systems Science
“Protocol for Proof of Activity for IoMT Data Security” 2022 0 [108]
and Engineering
“IoMT Framework Crypto Hash-Based Intelligent Automation and
2022 2 [109]
Malware Detection” Soft Computing
“Without IPv6, Healthcare Digital Transformation
2022 Technology and Health Care 0 [110]
is Impossible”
“Blockchain-Enabled Secure and Privacy-Preserving Security and
2022 2 [111]
Sharing of Health Data at the Edge of IoMT” Communication Networks
“Blockchain Connects Critical National Infrastructures:
2022 IEEE Access 2 [112]
A Perspective on E-Healthcare Data Migration”
“IoT Malware Detection Employing a Decision Tree-Based Computers, Materials
2022 0 [113]
SVM Classifier” and Continua
“Cost-Effective Scheduling Using Ethereum Smart Intelligent Automation and
2022 0 [114]
Contracts for IoMT” Soft Computing
“Neural Network-Based Industrial IoT-Based
Blockchain-Enabled Secure Searchable Encryption for 2022 Sensors 18 [115]
Healthcare Systems”
“Integration of Blockchain Technology with Fog Computers, Materials
2022 3 [116]
Computing for the Administration of Medical Records” and Continua
Appl. Sci. 2023, 13, 1287 12 of 19

Table 2. Cont.

Objective Year Journal Cited by Reference

“An Artificial IntelligenceEnabled Hybrid Lightweight
Authentication Model for Digital Healthcare Utilizing 2022 Sensors 0 [117]
Industrial IoT CyberPhysical Systems”
“Blockchain-Based IoMT Edge Network Security
Mechanisms in IoMT-Based Healthcare 2022 Sensors 7 [118]
Monitoring Systems”
“BACTmobile: An Intelligent Blood Alcohol Concentration
Monitoring System for Smart Vehicles in the Healthcare 2022 SN Computer Science 1 [119]
CPS Framework”
Regarding the Design of “Blockchain-Based ECDSA With a
IEEE Journal of Biomedical and
Fault-Tolerant Batch Verification Protocol for 2022 52 [120]
Health Informatics
Blockchain-Enabled IoMT”
“Blockchain-Enabled Access Control that Preserves
2022 IEEE Internet of Things Journal 6 [121]
Privacy for Data Publication and Sharing in the IoMT”
“Lightweight Authentication Protocol for Wireless Medical
2022 IEEE Internet of Things Journal 65 [122]
Sensor Networks Based on Blockchain and PUF”
“IoMT-Based Osteosarcoma Cancer Detection in
Histopathology Images using Transfer Learning, 2022 Sensors 1 [123]
Blockchain, Fog Computing, and Edge Computing”
“Smart Healthcare System Management Model for
2022 Sensors 1 [124]
Self-Sovereignty Identities”
“K-Nearest Neighbor-Based Smart Contract for the
Computers and
Security of the Internet of Medical Devices 2022 0 [125]
Electrical Engineering
Utilizing Blockchain”
“Blockchain Multi-objective Optimization Enables
Cost-effective and Secure Scheduling for the IoMT in a 2022 Soft Computing 8 [126]
Fog-cloud Environment”
“Context-aware blockchain-based CP-ABE schema for
2022 Array 1 [127]
IoMT security”
“Sharing of Secure and Confidential Personal Health
2022 IEEE Internet of Things Journal 2 [128]
Records Using Consortium Blockchain”
“Trusted and Secure Blockchain-Based IoMT Architecture” 2022 Electronics 1 [129]
“Blockchain-Based IoMT-Based Platform for
2022 Electronics 4 [130]
E-Health Monitoring”
“Privacy-Aware IoMT Data Certification Framework on
2022 Computer Communications 0 [131]
the Healthcare Blockchain”
“RAMi: A New Real-Time IoMT Architecture for
2022 Information 0 [132]
Monitoring of Elderly Patients”
“Access Control Based on Blockchain Technology in
2022 Electronics 0 [133]
a Globalized Healthcare Provisioning Ecosystem”
“PUFchain 2.0: Hardware-Assisted Robust Blockchain for
Sustainably Concurrent Device and Data Security in 2022 SN Computer Science 0 [134]
Smart Healthcare”
“Prediction of Kidney Cancer Facilitated by Blockchain
2022 Sensors 0 [135]
Security and Transfer Learning”
“A Secure Authentication Protocol for Wireless Medical
Sensor Networks Based on Blockchain and Physically 2022 IEEE Internet of Things Journal 9 [136]
Unclonable Functions”
“A Secure Healthcare 5.0 System Using Blockchain Computers in Biology
2022 0 [137]
Technology and Federated Learning” and Medicine
“ANAF-IoMT: An Innovative Architectural Framework for
IEEE Transactions on
IoMT-Enabled Smart Healthcare Systems by Strengthening 2022 3 [138]
Industrial Informatics
Security Using RECC-VC”
“FAITH: A Rapid Edge Computing Platform with IEEE Transactions on
2022 1 [139]
Blockchain Support for Healthcare Applications” Industrial Informatics
Appl. Sci. 2023, 13, 1287 13 of 19

RQ3: What is the future of blockchain-based IoMT?

Several substantial research gaps are revealed by the examination of relevant literature.
The following problems must be addressed for the future:
I. The solutions offered are proprietary. They do not create protocols to adapt diverse
technology and foster interoperability, preventing their adoption. It is essential to
create platform-agnostic, universal solutions that control the interaction between
cloud computing, blockchain, IoMT devices, and end users.
II. Scalability is one of the significant problems that current blockchain-based IoMT ap-
plications face, causing slow transaction validation, high transaction fees, high storage
memory requirements, and long synchronization times [67,140]. Hence, scalability is
an essential factor that needs more research and direction.
III. The incorporation of blockchain into the IoMT opens the door to several health-related
applications. However, the implementation of such technology (blockchain-IoMT) is
complex and necessitates in-depth interdisciplinary knowledge, ranging from low-
level, such as managing IoMT devices and configuring blockchain to meet IoMT
criteria, to high-level knowledge, such as treating, storing, and sharing IoMT data.
IV. An advancement in personalized medicine, utilizing the most cutting-edge machine
learning methods that computer science has to offer, would be made possible by the
opportunity of freely sharing sensitive data between experts and health institutions.
IoMT gathers huge amounts of information. Finding usable information from the
acquired data is a challenge. The IoMT device may provide practical information
when using data analytics to examine the data and find flaws, vulnerabilities, and
bottlenecks in the system. IoMT data heterogeneity, however, presents difficulties
for data analytics [16]. Deep learning advances in machine learning may assist in
resolving these issues [141].
V. The bulk of present works is solely concerned with healthcare applications such as
IoMT data management and remote patient monitoring, such as data exchange and
storage. Tracking apps that prevent counterfeit medications and medical mishaps are
critical. In this context, the adoption of blockchain technology in conjunction with
IoMT may be an effective solution for controlling doctor behavior as well as managing
the medication supply chain.
Data can be stored in the blockchain’s blocks (which is challenging because of the
scalability issues), data provenance can be exploited by storing the locations of data in the
blockchains rather than the data itself, and distributed storage can be used in tandem with
the blockchain to serve as off-chain storage. The data that could be easily accessed and
utilized would never have to be sent over the network in any of the systems.
It is obvious that user-centric solutions are becoming more popular, even if it is
not the primary focus of the study. Despite efforts to give consumers more control over
their data, developing a truly decentralized system that is user-centric for health data
remains a challenge. Authorized systems that are controlled by healthcare institutions
are not always clear, since they may provide consumers more control over their data
but ultimately need them to comply with consortium norms around data management.
Decentralized storages run the danger of being squandered because of this security issue in
permissioned systems, which reduces their value. Even in the case that user data is stored in
a decentralized manner on the blockchain, this does not ensure a user-centric system if the
blockchain might be tampered with by participants. Several actual uses demonstrate this.
If these networks can incentivize users to share personal healthcare data with the
community in exchange for benefits, it would be even more astounding if a solution could
be found, maybe via hybrid implementations between permissioned and permissionless
implementations. No one ever receives credit for the value added by their usage of
an IoMT system or an IoT device. In most cases, when people pay for expert assistance,
their investment exceeds the results they see. As a matter of fact, in theory, they help
advance scientific understanding. Certainly, data sharing and crowdsourcing might be
made possible by the Internet of blockchains in a blockchain-enabled society.
Appl. Sci. 2023, 13, 1287 14 of 19

To do this, however; it must be shifted from a viewpoint that is rather system-centric,

in which a user is just the end consumer of the application, to a user-centric stance, in
which a user is an integral part of the design process. A method where each user stores
their data locally, as on a smartphone or other portable device, may be quite appealing. If
these gadgets serve as secure, distributed storage, then any unknown entity might have
easy access to the information kept there, subject to the restrictions set by the users who are
the rightful proprietors of the material being shared.

4. Conclusions
A growing number of people are paying attention to the blockchain-based Internet
of Medical Things (IoMT) since not only it is likely to reduce healthcare costs but also it
can enhance the quality of treatment by relying on continuous and real-time continuous
monitoring. IoMT sensor nodes, Internet of Things (IoT) wearable medical devices, patients,
healthcare facilities, and insurance companies are just some of the numerous entities
that are increasingly being included in IoMT systems. As scalability is one of the key
features of blockchain technology, it is challenging to develop a blockchain framework for
such systems. This review of blockchain-based IoMT solutions created between 2017 and
2022 was inspired by this insight. The aim is to explore the current state of blockchain
technology, the applications it has found, and how its unique features could alter current
practices. This study integrates the theoretical foundations of a significant body of work
that has been published in prestigious academic publications over the last ten years to
standardize assessment techniques and completely capture the blockchain realm, which
is quickly evolving. There were 73 papers in the relevant field that are evaluated. Based
on a structured, systematic examination and thematic content analysis of the available
literature, this research classifies blockchain-enabled applications across a range of sectors,
including supply chain, business, healthcare, IoT, privacy, and data management. With
a particular emphasis on the limitations presented by blockchain technology and the ripple
effects such limitations have in other sectors, the gaps in the literature on the subject have
also been emphasized.

Funding: This research received no external funding.

Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Data Availability Statement: Not applicable.
Conflicts of Interest: The author declares no conflict of interest.

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