Blockchain-based access control and privacy preservation in healthcare: a comprehensive survey

Abstract In recent years, blockchain technology has emerged as a promising solution for securing electronic health records (EHRs) while preserving patient privacy. Traditional e-health systems facilitate EHR sharing among healthcare providers but also introduce significant privacy risks, such as unauthorized access and data breaches. Blockchain, when integrated with privacy-preserving techniques, enhances transparency, integrity, and availability in EHR management. Smart contracts further strengthen security by enabling automated authentication and access control. This paper provides a comprehensive survey of blockchain-based access control frameworks in healthcare, categorizing them into permissioned and permissionless approaches. It also explores cryptographic privacy-preserving techniques designed to mitigate privacy risks. Additionally, blockchain platforms and consensus protocols commonly used in these frameworks are analyzed. The methodology follows a structured paper selection process, leading to the final inclusion of 45 research papers focusing on blockchain-based privacy preservation and access control in healthcare. Furthermore, it presents real-world case studies that illustrate the practical implementation of blockchain-based access control in healthcare settings, highlighting their strengths and challenges. Finally, it identifies privacy-related challenges, open research issues, and future directions to guide further research in this evolving domain.