A systematic literature review on distributed ledger technologies in healthcare: Applications, challenges, and future directions

Context: Distributed Ledger Technologies (DLTs), including blockchain, are increasingly used as tools enabling the transformation and improvement of healthcare management. There is a strong need to study how these technologies have been impacting healthcare recently through a review of the scientific literature on the subject. Objective: This study explores how, as reported in the literature, DLTs can enhance healthcare data and process management with or without complementary technologies like AI, IoT, and cloud computing. Method: Through a systematic literature review, the paper analyzes the contributions of DLTs to healthcare and proposes a reference conceptual model for their adoption, with a focus on affordability and systemic enhancements. Results: The study highlights challenges such as scalability, privacy, and regulatory compliance; it also shows innovative opportunities such as real-time monitoring and secure data exchange. Literature identifies that the integration of DLTs with other emerging technologies is transforming healthcare practices. More work should be done at the level of Layer 2 solutions to improve scalability while preserving security and decentralization. Conclusion: To fully unlock DLT’s potential and overcome current challenges, collaboration among healthcare stakeholders and policymakers will be essential. The reference model offers a strategic framework for healthcare providers, outlining key directions for future research and development to enhance healthcare services and operational effectiveness.