Blockchain-integrated IoT framework for tamper-proof healthcare data management in smart hospitals

The rapid expansion of IoT in smart hospitals enables continuous patient monitoring, automated diagnosis and real-time clinical decision support. However, centralized healthcare data systems remain vulnerable to unauthorized data modification, single points of failure and poor audit transparency threatening patient safety and regulatory compliance. This paper proposes a Block-chain-IoT (BC-IoT) framework built on a three-tier hierarchical architecture. The first tier connects heterogeneous medical devices (ECG monitors, glucose sensors, infusion pumps, pulse oximeters) through a lightweight IoT sensor layer. The second tier applies AI-based anomaly detection at edge computing nodes. The third tier employs a dual-block-chain approach, combining the IOTA Tangle protocol for feeless micro-transactions with a permissioned Hyperledger Fabric network for enterprise-grade data governance. Medical data is encrypted using AES-256 and TLS 1.3, screened for anomalies at edge nodes and stored on an immutable distributed ledger. Smart contracts enforce role-based access control, ensuring only authorized personnel can access or modify patient records. The Inter Planetary File System (IPFS) handles decentralized storage of large medical files, with cryptographic content identifiers stored on-chain for full traceability. Evaluation on a simulated smart hospital testbed with 350 IoT nodes across five department’s demonstrated strong results: 42ms transaction latency, 1,250 transactions per second, a 99.7% tamper detection rate and a 99.98% data integrity score outperforming existing block-chain-IoT healthcare systems across all key metrics. The BC-IoT framework offers a scalable, energy-efficient and standards-compliant solution for securing digital health infrastructure.