JMIR Publications

ABSTRACT

Background:

The self-sovereign identity (SSI) provides a decentralized approach to digital identity management, providing users control over their data without rely- ing on third-party providers. Blockchain technology (BC), introduced using Bitcoin, provides a decentralized and immutable ledger with potential applications in health- care. SSI when combined with BC, has gained attention as a possible solution to long-standing challenges in several studies to address diverse problems, including privacy risks, fragmented identity systems, and limited patient autonomy. Although numerous studies have proposed BC-SSI approaches for healthcare, the current land- scape remains scattered, with varying scopes, technological maturity, and limited real-world evaluation.

Objective:

This paper presents a scoping review of the scientific literature to systematically map current research areas in BC-SSI-based applications in the health domain. The goal is to identify health domain problems addressed with BC-SSI technology, BC-SSI application areas, development stages of BC-SSI applications,types of health data considered, aims of different studies, challenges that BC-SSI technology aims to improve, and the different BC-SSI technologies applied to the health domain.

Methods:

This study followed the PRISMA-ScR methodology; a literature search conducted between September 2024 and August 2025 yielded 37 research articles for detailed analysis. Studies were screened using predefined inclusion and exclusion criteria. The extracted data were charted by application area, data types, development stage, technological components, and intended challenges.

Results:

The findings suggested that BC-SSI research in healthcare is still emerging, with most studies at the conceptual, architectural, or prototype stage and limited in real-world implementation or evaluation. The most common application areas include elec- tronic health records (EHR), mHealth, wearables, healthcare services, and access control. Research focuses on privacy-preserving (authentication, access control, con- tact tracing, and verification), secured (authentication, revocation, verification, and validation), patient-centric systems, and decentralized identity management and data management. Hyperledger Indy and Fabric were the most frequently adopted platforms, while decentralized identifiers (DIDs), verifiable credentials (VCs), and cryptographic mechanisms such as zero-knowledge proofs and attribute-based en- cryption were widely used. Despite promising designs, practical challenges persist, including interoperability limitations, governance gaps, usability concerns, and insuf- ficient empirical validation.

Conclusions:

BC-SSI technologies in healthcare hold potential promise for enabling secure, in- teroperable, and patient-controlled healthcare identity ecosystems. However, the current evidence base remains conceptual mainly, with significant gaps in real-world testing, regulatory alignment, system integration, and user adoption. Future work must prioritize cross-institutional pilots, performance benchmarking, governance models, and human-centered evaluations to determine whether BC-SSI solutions can be effectively integrated towards clinical practice.