Open Access

REVIEW

MediGuard: A Survey on Security Attacks in Blockchain-IoT Ecosystems for e-Healthcare Applications

Shrabani Sutradhar^1,2, Rajesh Bose³, Sudipta Majumder¹, Arfat Ahmad Khan^4,*, Sandip Roy³, Fasee Ullah⁵, Deepak Prashar^6,7

1 Institute of Engineering and Technology, Dibrugarh University, Dibrugarh, 786004, Assam, India
2 Departments of Computational Sciences, Brainware University, Kolkata, 700125, West Bengal, India
3 Department of Computer Science & Engineering, JIS University, Kolkata, 700109, West Bengal, India
4 Department of Computer Science, College of Computing, Khon Kaen University, Khon Kaen, 40002, Thailand
5 Department of Computer and Information Sciences, Universiti Teknologi PETRONAS, Seri Iskandar, 32610, Perak Darul Ridzuan, Malaysia
6 Department of Computer Science and Engineering (CSE), Lovely Professional University, Phagwara, 144411, Punjab, India
7 Jadara University Research Center, Jadara University, Irbid, 21110, Jordan

* Corresponding Author: Arfat Ahmad Khan. Email:

Computers, Materials & Continua 2025, 83(3), 3975-4029. https://doi.org/10.32604/cmc.2025.061965

Received 06 December 2024; Accepted 07 April 2025; Issue published 19 May 2025

Abstract

Cloud-based setups are intertwined with the Internet of Things and advanced, and technologies such as blockchain revolutionize conventional healthcare infrastructure. This digitization has major advantages, mainly enhancing the security barriers of the green tree infrastructure. In this study, we conducted a systematic review of over 150 articles that focused exclusively on blockchain-based healthcare systems, security vulnerabilities, cyberattacks, and system limitations. In addition, we considered several solutions proposed by thousands of researchers worldwide. Our results mostly delineate sustained threats and security concerns in blockchain-based medical health infrastructures for data management, transmission, and processing. Here, we describe 17 security threats that violate the privacy and data integrity of a system, over 21 cyber-attacks on security and QoS, and some system implementation problems such as node compromise, scalability, efficiency, regulatory issues, computation speed, and power consumption. We propose a multi-layered architecture for the future healthcare infrastructure. Second, we classify all threats and security concerns based on these layers and assess suggested solutions in terms of these contingencies. Our thorough theoretical examination of several performance criteria—including confidentiality, access control, interoperability problems, and energy efficiency—as well as mathematical verifications establishes the superiority of security, privacy maintenance, reliability, and efficiency over conventional systems. We conducted in-depth comparative studies on different interoperability parameters in the blockchain models. Our research justifies the use of various positive protocols and optimization methods to improve the quality of services in e-healthcare and overcome problems arising from laws and ethics. Determining the theoretical aspects, their scope, and future expectations encourages us to design reliable, secure, and privacy-preserving systems.

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