BTMH: A blockchain-powered trust management system for IoMT in healthcare

The Internet of Things (IoT) has transformed daily life, particularly in healthcare, through the Internet of Medical Things (IoMT), which revolutionizes medical services and enables telemedicine. However, this increased reliance on IoMT devices raises concerns about their reliability, trust, and security, emphasizing the need for secure, decentralized solutions. While Trust Management Systems (TMS) have been developed to address these issues, centralized TMS are vulnerable to single points of failure if compromised. Although decentralized TMS have been explored for IoMT, a scalable solution that balances security, scalability, and performance has yet to be realized. Existing systems often fall short in addressing security threats such as bad-mouthing, ballot stuffing, and whitewashing, leaving trust management exposed. Blockchain-based decentralized approaches offer dynamic management but are still susceptible to vulnerabilities, including attacks on honest nodes and manipulation of trust levels for malicious ones. To overcome these limitations, we propose a Blockchain-powered Trust Management system for IoMT in Healthcare (BTMH), which utilizes a two-chain architecture to separate authentication and trust data management. This design enhances both security and scalability, with one chain dedicated to authentication and the other to trust data management. Our implementation, using Hyperledger Fabric and benchmarking via Hyperledger Caliper, shows that BTMH outperforms existing solutions in trust convergence, throughput, and latency, providing robust protection against security threats while delivering superior performance.