Internet of Things (IoT) devices have revolutionized real-time monitoring and distant patient care in smart cities’ healthcare systems. However, this advancement has come with several issues, such as data security, scalability, operational efficiency, and fault tolerance. Previous approaches are not well suited to the real-time processing of IoT data in healthcare, given the low latency, high throughput, and effective anomaly detection needed for such a task. Given these challenges, this paper proposes a hybrid Artificial Intelligence (AI)- and blockchain-based IoT governance framework for Internet hospitals using Proof-of-Authority (PoA) in smart cities. It encompasses application of the enhanced RSA for secure data transmission, real-time anomaly detection through the Isolation Forest algorithm, and a private blockchain architecture designed for high scalability. It effectively detects tampering and replay attacks to minimize illegitimate and unauthorized access or manipulation of patients’ data. The proposed framework achieves relatively significant improvements over a state-of-the-art baseline model. It has cut the transaction response time by 50%, doubled the Throughput Per Second (TPS), and attained a 100% detection performance in anomalies. Comparative analysis reveals its linear scalability with increasing workload, ensuring consistent performance under varying transaction volumes. This study’s findings highlight the proposed framework’s potential to mitigate key issues in IoT-enabled Internet hospitals in smart cities.
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