In Healthcare 4.0, we are witnessing a fundamental shift from provider-centric systems to patient-centric models, where individuals, empowered by technologies such as blockchain, the Internet of Medical Things, and artificial intelligence (AI), assume the role of the Self-Sovereign Patient, exercising control over their health data and care journey. These technologies enable new forms of data ownership, interoperability, and personalized care, building on the structured reliability of legacy systems. However, significant challenges remain. Tensions between blockchain immutability and regulatory rights such as data erasure, the unresolved question of digital inheritance, and ethical concerns surrounding consent, monetization, and health equity must all be addressed. In addition, institutional barriers such as clinical integration, data governance, and uneven access to digital infrastructure pose risks of deepening existing disparities. AI agents, when responsibly deployed, offer promising pathways to augment care delivery and alleviate workforce burdens. Realizing this vision requires coordinated action across clinical, technical, legal, and ethical domains to design trustworthy, privacy-preserving systems that enhance transparency and accountability.

The Executive Session, Trust by Design: Enabling Responsible Precision Health through Blockchain-Powered Digital Twins and Trusted AI, explores how the convergence of blockchain, artificial intelligence, genomics, 6G wireless technology, and other advanced technologies can be leveraged to power precision health digital twins. The dialogue focused on governance, interoperability, cybersecurity, and the impact of blockchain and trusted AI-powered digital twins on advancing precision healthcare and personalized medicine. Use cases-for genomics, radiology, theranostics, and end-of-life care-illustrated both opportunities and barriers. Throughout the discussion, speakers emphasized the centrality of trust, patient sovereignty, and resilient infrastructures for the next generation of healthcare.

Genomic data sharing remains a core problem in precision medicine because genomic data are highly sensitive and unchangeable. In this article, we propose a blockchain-based framework that utilizes zero-knowledge proofs (ZKPs), smart contracts, and off-chain storage to facilitate secure, privacy-preserving data sharing within health record systems. We implemented and evaluated a proof-of-concept prototype in Python on a simulated genomic dataset. The prototype uses a hybrid storage system where metadata is retained on a blockchain and encrypted data are placed in an emulated InterPlanetary File System (IPFS). Rule-based access is controlled using smart contracts, while privacy and security are achieved using ZKPs with interactive Schnorr protocol and elliptic curve cryptography (ECC). Empirical analysis using real-time testing over 100 iterations reported an average zero-knowledge proof with blockchain (ZKPB) query latency of 5.83 ms with a 90.00% accuracy, smart contract latency of under 0.01 ms with 90.00% accuracy, blockchain query time of 0.01 ms with 90.00% accuracy, and ECC latency of 8.72 ms with 90.00% accuracy. These empirical findings validate the effectiveness and privacy guarantees of the framework, which can be utilized in healthcare research, clinical genomics, and personalized medicine workflows.

This systematic review examines critical usability factors that influence the adoption of mobile health (applications among older adults) and identifies gaps in current usability models, including ISO 9241-11, Nielsen's heuristics, and Panicoideae, Aristidoideae, Chloridoideae, Micrairoideae, Arundinoideae, Danthonioideae. This review also explores the potential role of blockchain technology in enhancing multimodal medical data systems within mHealth applications. A comprehensive search across six databases yielded 1,073 studies, with 60 meeting the inclusion criteria. Studies were analyzed through thematic synthesis to identify key success factors (RQ1) and comparative analysis to assess limitations in existing frameworks (RQ2). Key factors promoting mHealth adoption included ease of use, efficiency, error prevention, learnability, memorability, and user satisfaction. Blockchain integration emerged as a promising approach to improve data security, interoperability, and user trust, particularly for older adults who engage with complex, multimodal health data. Findings from RQ2 highlighted gaps in usability models, such as the lack of age-specific guidance for multimodal interaction, error recovery, and data privacy. These results underscore the need to define a new usability framework and incorporate blockchain to meet the unique needs of older adults in mHealth applications, supporting both secure and accessible healthcare management.

The presentation discusses the potential of blockchain and AI to revolutionize the pharmaceutical supply chain. The author, with a rich history in healthcare technology, highlights the inefficiencies and challenges faced by the industry, particularly in areas like drug discovery, manufacturing, and distribution. Blockchain technology, with its ability to create immutable records, can enhance transparency, traceability, and security across the supply chain. This can help in tracking the journey of drugs from raw materials to the final product, reducing the risk of counterfeiting and ensuring quality. AI, on the other hand, can optimize various processes, such as drug discovery, clinical trials, and supply chain logistics. By analyzing vast amounts of data, AI can identify patterns, predict trends, and make informed decisions. This can accelerate drug development, improve manufacturing efficiency, and optimize inventory management. The integration of blockchain and AI can create a powerful synergy, leading to significant improvements in the pharmaceutical supply chain. This includes enhanced patient safety, reduced costs, and faster time-to-market for new drugs. The presentation provides a concise view of the health care supply chain processes and discusses AI patterns such as RAG, GAM and Fine-Tuning methods such as LoRA and QLoRa that can help in building trust in the supply chain.

The application of blockchain technology to healthcare offers promise in providing solutions to some key challenges related to data sharing, privacy, security, and access control. However, several barriers prevent the widespread adoption of blockchain and prompted research efforts. This study aims to conduct a bibliometric analysis of 196 documents indexed in the Scopus database to examine their structure, impact, contributors, and journals. The bibliometric analysis provides information on the publication and citation structure, as well as the most productive authors, universities, countries, journals, and most cited studies. In addition, it identifies the most prevalent keywords and their co-occurrence patterns on blockchain challenges in healthcare. A topic modeling approach, using Latent Dirichlet Allocation (LDA), is also employed to reveal the latent topical structure of this literature. As a result of these findings, the research landscape in this area has been quantitatively analyzed, identifying six critical challenges regarding the use of blockchain in healthcare: data privacy/security, integration with smart devices, interoperability, scalability, governance, and cost.

Fog computing (FC) is an emerging technology that extends the capability and efficiency of cloud computing networks by acting as a bridge among the cloud and the device. Fog devices can process an enormous volume of information locally, are transportable, and can be deployed on a variety of systems. Because of its real-time processing and event reactions, it is ideal for healthcare. With such a wide range of characteristics, new security and privacy concerns arise. Due to the safe transmission, arrival, and access, as well as the availability of medical devices, security creates new issues in the area of healthcare. As an outcome, FC necessitates a unique approach to security and privacy metrics, as opposed to standard cloud computing methods. Hence, this article suggests an effective blockchain depending on secure healthcare services in FC. Here, the fog nodes gather the information from the medical sensor device and the data are validated using smart contracts in the blockchain network. We propose a functional biased elliptic curve cryptography algorithm to encrypt the data. The optimization is performed using the galactic bee colony optimization algorithm to enhance the procedure of encryption. The performance of the suggested methodology is assessed and contrasted with the traditional techniques. It is proved that the combination of FC with blockchain has increased the security of data transmission in healthcare services.

The rapid evolution of blockchain technology in healthcare presents unparalleled opportunities for advancements, including enhanced patient data security, decentralized systems for trustless operations, and transparent supply chain management. However, as blockchain reshapes the healthcare landscape, it demands a robust ethical framework that guides its design and implementation. "Ethics of Blockchain by Design" emphasizes embedding ethical principles at the heart of blockchain innovation, fostering public trust, equity, and long-term societal benefits. In this article, the author proposes a set of best practices guidelines on the ethics of blockchain by design.

We are witnessing an unprecedented convergence of scientific discoveries, technology innovations, exponential adoption of technology, and remarkable population demographic shifts towards a digitally native society. The Nobel Prizes in medicine, chemistry, and physics awarded this year further validate the profound impact of technology on healthcare and life sciences. For 2025, designated by the United Nations as The Year of Quantum Technology, we envision further technology-driven innovations in all domains, triggering the transition to a novel health ecosystem. The role of artificial technology in modern drug development, the demand for quantum-proof encryption, and the opportunities of blockchain in health data monetization are all trends that can be disruptive for pharma, healthcare, and healthcare finance.

The integration of blockchain technology and smart contracts presents a transformative opportunity in healthcare financing by enabling the creation and trading of futures contracts based on the value of medical innovations. Traditional financial mechanisms struggle to capture the downstream savings generated by new therapies, particularly as insurers and health systems face the challenge of managing short-term costs while realizing long-term health benefits. Blockchain’s decentralized, transparent, and tamper-proof infrastructure offers a solution by providing reliable data that tracks health outcomes, cost savings, and patient behavior in real-time. This paper explores how a blockchain-governed healthcare marketplace can facilitate the trading of Health Impact Futures (HIF) contracts that allow stakeholders—such as self-insured health plans, insurers, biotech firms, and speculators—to hedge risks, capture savings, and invest in medical innovations. By leveraging smart contracts, which automate transactions and ensure trust through pre-defined algorithms, the platform offers a seamless and secure environment for managing complex healthcare data and financial instruments. The introduction of health cost indices, anchored in reliable blockchain-verified data, allows for accurate pricing and risk management, promoting liquidity and market efficiency. Additionally, tokenization of health savings enables insurers to capture the economic value of improved health outcomes, even when patients switch health plans. This approach not only ensures the continuity of value but also introduces a new financial layer that reflects the real-world impact of medical innovations. By using structured notes and algorithm-driven health indices, market participants can dynamically hedge against fluctuations in healthcare costs while aligning incentives across the healthcare value chain. The paper concludes by addressing the technological, regulatory, and data integrity challenges associated with developing a blockchain-based futures market for healthcare and proposes a roadmap for overcoming these barriers to unlock the full potential of this innovation.