Differentiated Communication Strategies for Remote Electrocardiogram Monitoring With a Multilevel Blockchain System

To enhance the security of Internet of Medical Things (IoMT) systems against cyber threats, we introduce a Multilevel Blockchain Infrastructure combined with a Differentiated Communication Strategy for real-time medical data transmission, utilizing an embedded hardware setup to provide cost-effective solution for resource-limited environments. The workflow of Multilevel Blockchain Architecture is proposed, incorporating an embedded hardware-driven K-nearest neighbors (KNN) algorithm for diagnosing real-time Electrocardiogram (ECG) signals, with Rivest-Shamir–Adleman (RSA) encryption protocol to secure medical records. The simulations are performed using MIT-BIH arrhythmia and normal sinus rhythm datasets. The feature extraction algorithm, incorporated with optimized KNN model, demonstrated promising results for each emergency classification class. The evaluation metrics for Healthy, E1, and E2 classes showed an accuracy of 91.1%, 88.9%, 84.4%; precision of 78.9%, 100%, 75%; and specificity of 86.7%, 100%, 86.7%, respectively. The feasibility of executing optimized algorithms on Arduino platform is confirmed through computational complexity, execution time, and memory requirement. The proposed system architecture provides a robust solution for enhancing IoMT security, strengthening the confidentiality, integrity, and authenticity of medical data, safeguarding against cyber threats. Additionally, the simple embedded hardware setup offers a user-friendly solution, making it well-suited for resource-constrained surroundings.