A federated trust enforcement architecture for secure cross-organizational EHR access over 5G-enabled medical IoT networks
S. R. Ramya, V. Praveena, S. Karthik · Scientific Reports · 2026
The advent of the Internet of Things (IoT) technologies in healthcare has significantly changed the ways in which patient health information is collected, communicated, and managed within a wide array of geographically distributed healthcare ecosystem. The technological convergence not only increases clinical responsiveness but also creates significant issues related to trusted, interoperable cross-domain sharing of electronic health records (EHRs). Existing federated learning systems do not have tools to handle bad actors, implement zero-trust policies for access across organizational boundaries, or offer formally provable security guarantees. To address these challenges, this research work introduces Fed-ZTMA, a Federated Zero-Trust Medical Access Framework that combines the Byzantine-resilient weighted federated trust aggregation with adaptive zero-trust policy enforcement via Blockchain deployed smart contracts. The proposed framework splits the Synthea Synthetic EHR dataset across four independent logical healthcare organizations and assesses performance using a multi-node Ganache Ethereum testnet with seven different adversarial attack scenarios. Compared to existing approach such as FedHealthDP, BCMedShare, ZeroTrust-IoT, BlockEHR, and ABAC-Chain, Proposed Fed-ZTMA performs better, including a cross-organization access success rate of 98.7%, attack suppression rate of 97.9%, inter-domain access latency of 18.4 ms at 1000 devices, and security stability index of 96.4%. This research work demonstrates practical feasibility for multi-institutional 5G healthcare deployments where both privacy-preservation and Byzantine fault tolerance are mandatory requirements.