Blockchain and Internet of Medical Things for Resilient Healthcare

Abstract

The COVID-19 pandemic exposed persistent weaknesses in health-data interoperability, cybersecurity, provenance, cross-organizational governance, and continuity of digital care. This short communication presents an updated focused narrative synthesis and a five-layer governance framework for integrating blockchain and the Internet of Medical Things (IoMT) in patient-centered digital health. The literature was updated through 10 August 2026, with recent peer-reviewed evidence complemented by authoritative standards and European regulatory sources. The synthesis positions blockchain primarily as a distributed governance, provenance, and audit layer rather than a clinical database or stand-alone security solution, while IoMT provides heterogeneous sensing infrastructure for continuous and distributed care. The framework separates: (1) device and data acquisition; (2) network and edge orchestration, including 5G/SDN where clinically justified; (3) blockchain-based governance; (4) privacy-enhancing data, analytics, and AI; and (5) application and service delivery. Homomorphic encryption, zero-knowledge proofs, secure aggregation, differential privacy, and federated learning are treated as complementary controls with distinct threat models and computational trade-offs. The revised framework also incorporates the European Health Data Space, the EU AI Act and its medical-device interplay, and NIS2 as a regulatory overlay. Across six use-case domains, evidence is strongest for technical feasibility, provenance, and programmable access control; evidence for clinical effectiveness, cost-effectiveness, equity, sustainability, and large-scale deployment remains limited. The proposed model therefore emphasizes standards-based interoperability, minimization of on-chain personal data, endpoint trust, auditable human oversight, and prospective real-world validation.