Building Trust in Smart Hospitals in Developing Countries: A PRISMA Review of Blockchain-Based Health Data Security

Abstract

The exponential growth of digital health data in hospitals has intensified concerns about data breaches, privacy violations, and interoperability failures within healthcare information systems. Traditional centralized data architectures remain highly vulnerable to cyberattacks, unauthorized access, and single points of failure, threatening the integrity of sensitive patient records. As healthcare systems transition toward smart and interconnected digital ecosystems, there is a pressing need for robust, transparent, and tamper-resistant data management frameworks. This study systematically reviews existing literature on the application of blockchain technology as a secure solution for health data management in smart hospitals. Adopting the PRISMA 2020 protocol, publications from 2016 to 2025 were retrieved from major databases, including Scopus, Web of Science, and PubMed. Out of 436 relevant studies, 42 peer-reviewed studies met the inclusion criteria. Data extraction captured study characteristics, blockchain types, implementation contexts, and findings. Evidence synthesis followed Braun and Clarke’s (2006) six-step thematic analysis framework. Findings reveal that blockchain enhances data security and integrity through cryptographic immutability and distributed consensus mechanisms, mitigates privacy risks via smart contracts and zero-knowledge proofs, and improves interoperability across healthcare stakeholders. However, challenges persist in scalability, regulatory alignment, and implementation costs, particularly in low-resource settings. This study concludes that hybrid and permissioned blockchain models offer the most viable pathway for achieving secure, compliant, and efficient healthcare data ecosystems. Therefore, this study recommends further integration with artificial intelligence and cloud technologies to optimize performance, while aligning deployment with ethical, legal, and institutional frameworks governing digital health.