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Cyber attacks mitigation strategies for healthcare 4.0 using blockchain
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DOI：10.1007/s12083-026-02260-4.png)
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Abstract
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The integration of Internet of Medical Devices (IoMD) in healthcare 4.0 enables real-time patient monitoring but introduces severe cybersecurity risks across sensor, network, and application layers. Traditional security models fail to address multi-layer threats such as device tampering, Man-in-the-Middle (MITM), Denial-of-Service (DoS), Eavesdropping, and insider attacks in a unified manner. This work proposes a blockchain (BC)-based IoMD security framework leveraging AES-256 encryption for confidentiality, SHA-256 hashing for integrity, and Practical Byzantine Fault Tolerance (PBFT) consensus for decentralized trust. The framework incorporates cryptographic firmware verification, BC-based device fingerprinting, payload hashing, and smart contract-based access control. The experiments demonstrate that the proposed system improves security effectiveness by up to 96% at the sensor layer, reduces unauthorized access by 93%, and mitigates MITM, DoS, and Eavesdropping attacks by 88-94%. Latency remains within real-time bounds (115-190 ms), while throughput scales up to 155 TPS. Encryption performance analysis confirms AES-256 as the most reliable option with a 99% success rate, despite moderate latency overhead. Comparative benchmarking reveals that the proposed system outperforms PoW and PoS-based models by achieving 60.3% lower gas costs, 35-42% lower latency, and broader attack coverage (covering five threat categories). These results validate the proposed framework’s effectiveness, scalability, and resilience for secure, decentralized, and performance-efficient IoMD deployments.
Keywords:
Internet of Medical Devices (IoMD)
Blockchain
Man-in-the-Middle (MITM)
Denial-of-Service (DoS)
Eavesdropping
Insider threats
PBFT consensus
Access control
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