{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T14:35:56Z","timestamp":1781188556792,"version":"3.54.1"},"reference-count":70,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Systems"],"abstract":"<jats:p>This research examines the emerging ecosystem of models that are developed and run across a distributed network of computers called decentralized artificial intelligence. The focus is to understand these models in the healthcare context and with a focus on their core components: technologies, governance frameworks, and real-world applications. A systematic literature review was conducted, analyzing peer-reviewed studies from PubMed, Scopus, and Web of Science to map the current landscape of the field. The primary objective was to synthesize the current research on decentralized approaches in healthcare, including core approaches like federated learning and blockchain-based AI models, as well as emerging concepts such as agentic AI blockchain-based AI models and DAOs, to comprehend their application in clinical and operational settings. The research assesses the maturity of these implementations, ranging from pilot programs to large-scale organizational settings. It also identified the key computational and technical methods and platforms used and the key benefits and challenges influencing their adoption. The findings underscore the pivotal role of the decentralized paradigm in addressing the fundamental limitations of traditional AI, including data privacy, trust, institutional silos, and regulatory complexity. Insights are also offered for healthcare providers, technology developers, researchers, and policymakers aiming to navigate and leverage decentralized AI to build more equitable, efficient, and collaborative healthcare systems.<\/jats:p>","DOI":"10.3390\/systems14040414","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T07:48:07Z","timestamp":1775720887000},"page":"414","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Decentralized AI Ecosystem in Healthcare: A Systematic Review of Technologies, Governance, and Implementation"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1530-6451","authenticated-orcid":false,"given":"Antonio","family":"Pesqueira","sequence":"first","affiliation":[{"name":"Department of Technology, ISCTE-IUL University of Lisbon, 1649-026 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Cucul","sequence":"additional","affiliation":[{"name":"Etheros HealthData Foundation (EHF), 5200 Brugg, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5839-8934","authenticated-orcid":false,"given":"Thomas","family":"Egelhof","sequence":"additional","affiliation":[{"name":"Merian Iselin Clinic, 4054 Basel, Switzerland"},{"name":"Crypto Valley Association (CVA), 6300 Zug, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Fuchs","sequence":"additional","affiliation":[{"name":"Crypto Valley Association (CVA), 6300 Zug, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3697-8062","authenticated-orcid":false,"given":"Leilei","family":"Tang","sequence":"additional","affiliation":[{"name":"Etheros HealthData Foundation (EHF), 5200 Brugg, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Sofia","sequence":"additional","affiliation":[{"name":"Etheros HealthData Foundation (EHF), 5200 Brugg, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4404-0341","authenticated-orcid":false,"given":"Andreia","family":"de Bem Machado","sequence":"additional","affiliation":[{"name":"Engineering and Knowledge Management Department, Federal University of Santa Catarina, Florian\u00f3polis 88040-970, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"key":"ref_1","unstructured":"ElBaih, M. (2026, January 30). The Role of Privacy Regulations in AI Development (A Discussion of the Ways in Which Privacy Regulations Can Shape the Development of AI). Available at SSRN 4589207. Available online: https:\/\/ssrn.com\/abstract=4589207."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Jalil, S., Rafi, S., LaToza, T.D., Moran, K., and Lam, W. (2023). ChatGPT and software testing education: Promises & perils. Proceedings of the 2023 IEEE International Conference on Software Testing, Verification and Validation Workshops (ICSTW), Dublin, Ireland, 16\u201320 April 2023, IEEE.","DOI":"10.1109\/ICSTW58534.2023.00078"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1080\/12460125.2023.2214304","article-title":"Blockchain technology as a driver of economic development in small economies: A dynamic capabilities framework","volume":"33","author":"Kwok","year":"2024","journal-title":"J. Decis. Syst."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"414","DOI":"10.48175\/IJARSCT-3140","article-title":"Utilization of Artificial Intelligence in Healthcare System, Pharmaceutical Industry & Education","volume":"2","author":"Patil","year":"2022","journal-title":"Int. J. Adv. Res. Sci. Commun. Technol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1080\/08982112.2023.2206479","article-title":"How generative AI models, such as ChatGPT, can be (mis) used in spc practice, education, and research? An exploratory study","volume":"36","author":"Megahed","year":"2024","journal-title":"Qual. Eng."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Tanniru, M.R., Woo, C., and Dutta, K. (2023). A Conceptual Model to Share Resources and Align Goals: Building a Blockchain Application to Support Care Continuity Outside a Hospital. J. Risk Financ. Manag., 16.","DOI":"10.3390\/jrfm16040247"},{"key":"ref_7","unstructured":"Zekiye, A., and \u00d6zkasap, \u00d6. (2023). Decentralized Healthcare Systems with Federated Learning and Blockchain. arXiv."},{"key":"ref_8","unstructured":"Vlasta, M. (2023). Methodological Framework for European Regulation of (Artificial) Intelligence and Its Limits. [Master\u2019s Thesis, Charles University]."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2550","DOI":"10.1038\/s41591-025-03726-3","article-title":"Comparative benchmarking of the DeepSeek large language model on medical tasks and clinical reasoning","volume":"31","author":"Tordjman","year":"2025","journal-title":"Nat. Med."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Agrawal, K., and Aggarwal, M. (2023). Blockchain Applications in Healthcare: Recent Advancements. Proceedings of the 2023 International Conference on Computer Communication and Informatics (ICCCI), Coimbatore, India, 23\u201325 January 2023, IEEE.","DOI":"10.1109\/ICCCI56745.2023.10223473"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1002\/ase.2270","article-title":"The rise of ChatGPT: Exploring its potential in medical education","volume":"17","author":"Lee","year":"2024","journal-title":"Anat. Sci. Educ."},{"key":"ref_12","first-page":"61","article-title":"Blockchain Technology\u2014An Algorithm for Drug Serialization","volume":"1","author":"Kumar","year":"2022","journal-title":"Univ. J. Pharm. Pharmacol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Banu, A., Annette, R., and Chandran, S. (2023). A Framework for Securing Health Information Using Blockchain in Cloud-Hosted Cyber-Physical Systems. arXiv.","DOI":"10.5120\/ijca2023922914"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e41588","DOI":"10.2196\/41588","article-title":"Federated machine learning, privacy-enhancing technologies, and data protection laws in medical research: Scoping review","volume":"25","author":"Brauneck","year":"2023","journal-title":"J. Med. Internet Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"110424","DOI":"10.1016\/j.patcog.2024.110424","article-title":"Federated learning for medical image analysis: A survey","volume":"151","author":"Guan","year":"2024","journal-title":"Pattern Recognit."},{"key":"ref_16","unstructured":"Beauchemin, D., Tremblay, Y., Youssef, M.A., and Khoury, R. (2025). A Set of Quebec-French Corpus of Regional Expressions and Terms. arXiv."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"103834","DOI":"10.1016\/j.jnca.2024.103834","article-title":"An optimized blockchain-based healthcare framework empowered by mixed multi-agent reinforcement learning","volume":"224","author":"Mohamed","year":"2024","journal-title":"J. Netw. Comput. Appl."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Ali, S., Armand, T.P.T., Athar, A., Hussain, A., Ali, M., Yaseen, M., Joo, M.-I., and Kim, H.-C. (2023). Metaverse in healthcare integrated with explainable AI and blockchain: Enabling immersiveness, ensuring trust, and providing patient data security. Sensors, 23.","DOI":"10.3390\/s23020565"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"43421","DOI":"10.1109\/ACCESS.2022.3169285","article-title":"Prediction of User\u2019s Intention to Use Metaverse System in Medical Education: A Hybrid SEM-ML Learning Approach","volume":"10","author":"Almarzouqi","year":"2022","journal-title":"IEEE Access"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"4178","DOI":"10.1109\/ACCESS.2023.3349187","article-title":"Blockchain-IoT healthcare applications and trends: A review","volume":"12","author":"Zahary","year":"2024","journal-title":"IEEE Access"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Barr, N., Cucul, C., and Moutinho, J. (2025). How Can Decentralized Technologies, Digital Twins, and Ethical AI Empower Rare Disease Patients?. Navigating Privacy, Innovation, and Patient Empowerment Through Ethical Healthcare Technology, IGI Global Scientific Publishing.","DOI":"10.4018\/979-8-3693-7630-0.ch004"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Bazel, M.A., Ahmad, M., Mohammed, F., Al-Kumaim, N.H., Mater, W., and Yasin, A. (2023). The Factors Influencing Blockchain Adoption in Hospitals: A Pilot Study. International Conference on Computing and Informatics, Springer Nature.","DOI":"10.1007\/978-981-99-9592-9_2"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1108\/LHT-10-2022-0467","article-title":"An analysis of the current status of metaverse research based on bibliometrics","volume":"42","author":"Feng","year":"2024","journal-title":"Libr. Hi Tech"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Bhattacharya, P., Obaidat, M., Savaliya, D., Sanghavi, S., Tanwar, S., and Sadoun, B. (2022, January 3\u201315). Metaverse-assisted telesurgery in healthcare 5.0: An interplay of blockchain and explainable AI. Proceedings of the 2022 International Conference on Computer, Information and Telecommunication Systems (CITS), Piraeus, Greece.","DOI":"10.1109\/CITS55221.2022.9832978"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1109\/TSUSC.2024.3409329","article-title":"Safeguarding patient data-sharing: Blockchain-enabled federated learning in medical diagnostics","volume":"10","author":"Myrzashova","year":"2024","journal-title":"IEEE Trans. Sustain. Comput."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Farry, G. (2026, January 30). DAO Governance Models for Social Impact and the Potential for a Human Rights Token for the Global Amnesty International Movement on the Cardano Blockchain. Available at SSRN 5332134. Available online: https:\/\/ssrn.com\/abstract=5332134.","DOI":"10.2139\/ssrn.5332134"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Gazendam, A.M., Slawaska-Eng, D., Nucci, N.W., Bhatt, O., and Ghert, M. (2022). The Impact of Industry Funding on Randomized Controlled Trials of Biologic Therapies. Medicines, 9.","DOI":"10.3390\/medicines9030018"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Bhattamisra, S.K., Banerjee, P., Gupta, P., Mayuren, J., Patra, S., and Candasamy, M. (2023). Artificial intelligence in pharmaceutical and healthcare research. Big Data Cogn. Comput., 7.","DOI":"10.3390\/bdcc7010010"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1002\/tie.22367","article-title":"Blockchain technology applications in retail branding: Insights from retailers in the developing world","volume":"66","author":"Hoang","year":"2024","journal-title":"Thunderbird Int. Bus. Rev."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Hue, J., Rychkova, I., and Herbaut, N. (2024). On the Alignment of DAO with Socio-political Principles of Decentralised Governance Using TOGAF and ArchiMate. International Conference on Enterprise Design, Operations, and Computing, Springer Nature.","DOI":"10.1007\/978-3-031-79059-1_8"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"108321","DOI":"10.1016\/j.cmpb.2024.108321","article-title":"Blockchain in clinical trials: Bibliometric and network studies of applications, challenges, and prospects based on data analytics","volume":"255","author":"Castro","year":"2024","journal-title":"Comput. Methods Programs Biomed."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"102480","DOI":"10.1016\/j.technovation.2022.102480","article-title":"Blockchain\u2019s coming to hospitals to digitalize healthcare services: Designing a distributed electronic health record ecosystem","volume":"120","author":"Cerchione","year":"2023","journal-title":"Technovation"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Kshetri, N. (2023). Facilitation of Entrepreneurial Activities. Blockchain in the Global South: Opportunities and Challenges for Businesses and Societies, Springer Nature.","DOI":"10.1007\/978-3-031-33944-8"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"101111","DOI":"10.1016\/j.iot.2024.101111","article-title":"A systematic state-of-the-art review on digital identity challenges with solutions using the conjunction of IOT and blockchain in healthcare","volume":"25","author":"Jena","year":"2024","journal-title":"Internet Things"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"141371","DOI":"10.1016\/j.jclepro.2024.141371","article-title":"A systematic study on integrating blockchain in healthcare for electronic health record management and tracking medical supplies","volume":"447","author":"Liu","year":"2024","journal-title":"J. Clean. Prod."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1287\/mnsc.2023.4671","article-title":"The economic value of blockchain applications: Early evidence from asset-backed securities","volume":"70","author":"Chen","year":"2024","journal-title":"Manag. Sci."},{"key":"ref_37","first-page":"1","article-title":"On identity, transaction, and smart contract privacy on permissioned and permissionless blockchain: A comprehensive survey","volume":"56","author":"Liang","year":"2024","journal-title":"ACM Comput. Surv."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Jaime, F.J., Mu\u00f1oz, A., Rodr\u00edguez-G\u00f3mez, F., and Jerez-Calero, A. (2023). Strengthening privacy and data security in biomedical microelectromechanical systems by IoT communication security and protection in smart healthcare. Sensors, 23.","DOI":"10.3390\/s23218944"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Jung, D.H. (2022). Enhancing Competitive Capabilities of Healthcare SCM through the Blockchain: Big Data Business Model\u2019s Viewpoint. Sustainability, 14.","DOI":"10.20944\/preprints202201.0172.v1"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"342","DOI":"10.32628\/IJSRSET24105474","article-title":"Decentralized Security Mechanisms for AI-Driven Wireless Networks: Integrating Blockchain and Federated Learning","volume":"11","author":"Kataria","year":"2024","journal-title":"Int. J. Sci. Res. Sci. Eng. Technol."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Lin, H., Wan, S., Gan, W., Chen, J., and Chao, H. (2022, January 17\u201320). Metaverse in education: Vision, opportunities, and challenges. Proceedings of the 2022 IEEE International Conference on Big Data (Big Data), Osaka, Japan.","DOI":"10.1109\/BigData55660.2022.10021004"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Mhlanga, D. (2023). Blockchain for Digital Financial Inclusion Towards Reduced Inequalities. FinTech and Artificial Intelligence for Sustainable Development: The Role of Smart Technologies in Achieving Development Goals, Springer Nature.","DOI":"10.1007\/978-3-031-37776-1_12"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Odeh, A., Keshta, I., and Al-Haija, Q.A. (2022). Analysis of blockchain in the healthcare sector: Application and issues. Symmetry, 14.","DOI":"10.20944\/preprints202206.0285.v1"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Mahammad, A.B., and Kumar, R. (2023). Scalable and Secure Framework to Secure and Maintain Healthcare Data using Blockchain Technology. Proceedings of the 2023 International Conference on Computational Intelligence and Sustainable Engineering Solutions (CISES), Greater Noida, India, 28\u201330 April 2023, IEEE.","DOI":"10.1109\/CISES58720.2023.10183494"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Meisami, S., Meisami, S., Yousefi, M., and Aref, M.R. (2023). Combining Blockchain and IOT for Decentralized Healthcare Data Management. arXiv.","DOI":"10.5121\/ijcis.2023.13102"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Mirdad, A., and Hussain, F.K. (2022). Blockchain-based pharmaceutical supply chain: A literature review. Advances on P2P, Parallel, Grid, Cloud and Internet Computing: Proceedings of the 16th International Conference on P2P, Parallel, Grid, Cloud and Internet Computing (3PGCIC-2021), Springer International Publishing.","DOI":"10.1007\/978-3-030-89899-1_11"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1177\/20438869231181151","article-title":"Decentralized autonomous organization (DAO): The case of MakerDAO","volume":"14","author":"Ellinger","year":"2024","journal-title":"J. Inf. Technol. Teach. Cases"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"102487","DOI":"10.1016\/j.artmed.2023.102487","article-title":"Automatic documentation of professional health interactions: A systematic review","volume":"137","author":"Falcetta","year":"2023","journal-title":"Artif. Intell. Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/10494820.2023.2180191","article-title":"Artificial intelligence in teaching and learning: What questions should we ask of ChatGPT?","volume":"31","author":"Rospigliosi","year":"2023","journal-title":"Interact. Learn. Environ."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e4245","DOI":"10.1002\/ett.4245","article-title":"Artificial intelligence-powered decentralized framework for Internet of Things in Healthcare 4.0","volume":"35","author":"Puri","year":"2024","journal-title":"Trans. Emerg. Telecommun. Technol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Mozumder, M.A.I., Sheeraz, M.M., Athar, A., Aich, S., and Kim, H.-C. (2022, January 13\u201316). Overview: Technology roadmap of the future trend of the metaverse based on IoT, blockchain, AI techniques, and medical domain metaverse activity. Proceedings of the 2022 24th International Conference on Advanced Communication Technology (ICACT), Pyeongchang, Republic of Korea.","DOI":"10.23919\/ICACT53585.2022.9728808"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1007\/s10257-025-00699-1","article-title":"Decentralized autonomous organization in built environments: Applications, potential and limitations: R. Ly and A. Shojaei","volume":"23","author":"Ly","year":"2025","journal-title":"Inf. Syst. e-Bus. Manag."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s43926-025-00095-8","article-title":"Generative AI, IoT, and blockchain in healthcare: Application, issues, and solutions","volume":"5","author":"Mazhar","year":"2025","journal-title":"Discov. Internet Things"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"4209","DOI":"10.1109\/ACCESS.2021.3140175","article-title":"A Metaverse: Taxonomy, Components, Applications, and Open Challenges","volume":"10","author":"Park","year":"2022","journal-title":"IEEE Access"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"4821","DOI":"10.1002\/bse.3395","article-title":"Building blockchain-driven dynamic capabilities for developing circular supply chain: Rethinking the role of sensing, seizing, and reconfiguring","volume":"32","author":"Quayson","year":"2023","journal-title":"Bus. Strategy Environ."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.ijresmar.2023.03.001","article-title":"On ChatGPT and beyond: How generative artificial intelligence may affect research, teaching, and practice","volume":"40","author":"Peres","year":"2023","journal-title":"Int. J. Res. Mark."},{"key":"ref_58","unstructured":"Qu, Y., Ma, L., Ye, W., Zhai, X., Yu, S., Li, Y., and Smith, D. (2023). Towards Blockchain-Assisted Privacy-Aware Data Sharing For Edge Intelligence: A Smart Healthcare Perspective. arXiv."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"101006","DOI":"10.1016\/j.patter.2024.101006","article-title":"BloodCounts! Consortium Recent methodological advances in federated learning for healthcare","volume":"5","author":"Zhang","year":"2024","journal-title":"Patterns"},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Tahir, N.U.A., Rashid, U., Hadi, H.J., Ahmad, N., Cao, Y., Alshara, M.A., and Javed, Y. (2024). Blockchain-based healthcare records management framework: Enhancing security, privacy, and interoperability. Technologies, 12.","DOI":"10.3390\/technologies12090168"},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Savioz, G., Honer, K., and Pesqueira, A. (2025). The Impact and Potential of AI and DAO in Life Sciences R&D Financing. Navigating Privacy, Innovation, and Patient Empowerment Through Ethical Healthcare Technology, IGI Global Scientific Publishing.","DOI":"10.4018\/979-8-3693-7630-0.ch009"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"100193","DOI":"10.1016\/j.bcra.2024.100193","article-title":"Blockchain for secure and decentralized artificial intelligence in cybersecurity: A comprehensive review","volume":"5","author":"Saleh","year":"2024","journal-title":"Blockchain Res. Appl."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Shah, V., Thakkar, V., and Khang, A. (2023). Electronic health records security and privacy enhancement using blockchain technology. Data-Centric AI Solutions and Emerging Technologies in the Healthcare Ecosystem, CRC Press.","DOI":"10.1201\/9781003356189-1"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"109015","DOI":"10.1016\/j.ijpe.2023.109015","article-title":"Are both generative AI and ChatGPT game changers for 21st-century operations and supply chain excellence?","volume":"265","author":"Wamba","year":"2023","journal-title":"Int. J. Prod. Econ."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.iotcps.2023.05.006","article-title":"Blockchain-inspired secure and reliable data exchange architecture for cyber-physical healthcare system 4.0","volume":"3","author":"Kumar","year":"2023","journal-title":"Internet Things Cyber-Phys. Syst."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"101419","DOI":"10.1016\/j.xcrm.2024.101419","article-title":"Federated machine learning in healthcare: A systematic review on clinical applications and technical architecture","volume":"5","author":"Teo","year":"2024","journal-title":"Cell Rep. Med."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"103497","DOI":"10.1016\/j.media.2025.103497","article-title":"From challenges and pitfalls to recommendations and opportunities: Implementing federated learning in healthcare","volume":"101","author":"Li","year":"2025","journal-title":"Med. Image Anal."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1007\/s10796-023-10455-w","article-title":"Towards blockchain decentralized autonomous organizations (DAO) design","volume":"27","author":"Saurabh","year":"2025","journal-title":"Inf. Syst. Front."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Wahdain, E.A., and Abdullah, N.L. (2024). Data Integration in Big Data Environment: A Review. Proceedings of the 2024 4th International Conference on Emerging Smart Technologies and Applications (eSmarTA), Sana\u2019a, Yemen, 6\u20137 August 2024, IEEE.","DOI":"10.1109\/eSmarTA62850.2024.10638957"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1049\/blc2.12062","article-title":"The application of distributed autonomous organization governance mechanisms to civic medical data management","volume":"4","author":"Cunningham","year":"2024","journal-title":"Iet Blockchain"}],"container-title":["Systems"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-8954\/14\/4\/414\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T08:39:19Z","timestamp":1775723959000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-8954\/14\/4\/414"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,9]]},"references-count":70,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["systems14040414"],"URL":"https:\/\/doi.org\/10.3390\/systems14040414","relation":{},"ISSN":["2079-8954"],"issn-type":[{"value":"2079-8954","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,9]]}}}