Formal Security Guarantees for Blockchain-Based Patient Digital Twins in Remote Health Monitoring Systems

Abstract

Remote health monitoring systems can be imple mented effectively using Patient Digital Twins (PDTs) to support continuous patient monitoring, predictive analytics, personalized treatment planning, and clinical decision support. However, the large-scale aggregation, storage, and exchange of sensitive health data expose PDT systems to significant security and privacy risks, including unauthorized access, data tampering, identity forgery, and unauthorised disclosure of patient information. Although blockchain technology has been proposed as a mechanism for enhancing trust and auditability in healthcare data-sharing envi ronments, existing blockchain-based PDT frameworks primarily focus on system architecture and functionality, with limited formal security guarantees. The objective of this paper is to determine whether blockchain-based PDTs can provide formally provable guarantees of confidentiality, integrity, access control correctness, revocation security, auditability, and non-repudiation in remote health monitoring environments. To achieve this objective, we develop a blockchain-enabled PDT architecture that combines cryptographic access control, digital signatures, smart contracts, and decentralized off-chain storage within a unified security framework. The security analysis demonstrates that the proposed framework achieves the defined security prop erties against probabilistic polynomial-time adversaries under the stated cryptographic assumptions. Furthermore, an experimental implementation using Hyperledger Fabric and the InterPlanetary File System (IPFS) evaluates the computational overhead, trans action latency, storage efficiency, and scalability of the architec ture with experimental results indicating that the framework introduces modest cryptographic overhead while maintaining practical transaction latency and near-linear throughput scal ability under increasing workloads.