Blockchain-Enabled Distributed Data Management for Smart Health: Enhancing Integrity and Auditability in Edge-Fog-Cloud Ecosystems

Technological advancements are transforming the healthcare sector, bringing solutions such as IoT and artificial intelligence, which enable faster diagnostics, near-real-time monitoring, and personalized care. However, challenges such as scalability, security, privacy, and interoperability still persist. This work proposes a distributed data management architecture for a Smart Healthcare environment, which integrates edge-fog-cloud computing, IoT, containers, and blockchain, and Apache Kafka for near real-time data streaming. The adoption of edge computing enables decentralized processing closer to data sources, reducing latency and improving responsiveness, while fog computing facilitates intermediate data aggregation and pre-processing, enhancing scalability and efficiency before reaching the cloud. The solution uses the Hyperledger Fabric blockchain network from the Amazon AWS cloud provider and the InterPlanetary File System (IPFS) content-addressable distributed storage system. The architecture is evaluated against a baseline solution, ensuring the integrity and auditability of information, and demonstrating the feasibility of its application in medical systems. The results demonstrate that the proposed approach significantly improves data access time, enhances system reliability, and security. The findings suggest that combining edge-fog-cloud layers is essential for scalable and secure healthcare data management, optimizing computational resources while ensuring data integrity and auditability. Furthermore, this research highlights future directions for Smart Healthcare, emphasizing emerging trends and opportunities to enhance interoperability and distributed technologies in digital health systems.