1 Introduction

Among the 21st century’s global challenges, Sustainability is one of the utmost, if not the greatest, concerns [1]. This is one of the reasons that the 17 Sustainable Development Goals (SDGs) by the United Nations (UN), as introduced in 2015, become the common agenda of countries worldwide. These SDGs are integrated and indivisible [2]. Among these goals, the third SDG’s goal, ‘Good Health and well-being,’ become the top priority because of the COVID-19 pandemic across the world [3]. This true global epidemic of the digital era appeared as a great problematic concern among general populations and healthcare professionals [4]. Hence, this situation, in addition to anxiety, also provided chances for countries worldwide to assess and advance their healthcare systems [5].

Digital transformation is gaining traction across all SDG sectors. However, despite significant research and practical application, the healthcare SDG target still appears splintered and early in its implementation process. With the help of modern ICT technologies, the digital transformation of the health sector undergoes a major disruptive process. This change in health sectors is possible due to the disruptive ICT technologies [6, 7]. The term “disruptive technologies” is used in the context of ICT to describe developments that cause a sea shift in how industries function. These innovations typically provide new goods, services, or operations that shake up current marketplaces and value networks. Industries plagued by inefficiency or issues for a long time may find new hope in disruptive technology [8]. Innovative solutions to difficult issues may emerge due to recent developments in computer power, network connectivity, or data processing. Thus, industry dynamics are known to undergo dramatic changes due to the broad adoption of new technologies that provide improved and novel answers to long-standing problems [9].

The ICT is critical for advancing sustainable health and well-being. As a disruptive force, ICT revolutionizes healthcare delivery, benefits individuals with disabilities, and advances the health of society as a whole [10, 11]. Furthermore, disruptive ICT technologies possess the capacity to upheaval entire ecosystems of healthcare systems and transform them into sustainable approaches that offer cutting-edge remote health services and treatment. Significant changes may ensue in healthcare value service chains, distribution channels for pharmaceuticals and remedies, patient confidence, and conduct towards physicians and their services. Therefore, in this context, developing a sustainability-focused ICT infrastructure that can better contribute to the progress of SDGs’ ‘Good Health and Wellbeing’ goal is vital [12, 13].

Several tangible examples of digital transformation in healthcare include telemedicine, IoT and AI-based devices, and blockchain-based health records, drastically altering how patients and doctors communicate and collaborate to improve patient care and health outcomes [14]. Health records built on the blockchain are a game-changer in healthcare information management because they provide a decentralized, transparent, and secure system for keeping and exchanging medical records. The use of AI and robots in healthcare is changing the game by streamlining administrative processes, improving the accuracy and efficiency of surgical procedures, and automating monotonous but necessary activities. Therefore, reliable responses to this sustainability concern facing the world today can be explored in the form of more reliable ICT developments such as Artificial Intelligence (AI), Blockchain Technology, and the Internet of Things (IoT) [15, 16].

The fundamental role of digitalization in achieving all the SDGs is broadly recognized [17]. However, concerning SDG 3, digital advancements and its related technologies and challenges still need to be endured in healthcare, though they certainly attained a level of maturity [5]. It is worth mentioning that the healthcare industry in the United States is of significant magnitude, as seen by the expected national health spending, which is estimated to reach a staggering $5.7 trillion by the year 2026. There is an opportunity for individuals to acquire a comprehensive understanding of digital technology and leverage its capabilities to enhance corporate growth. To effectively transition conventional practices into a successful digital framework in 2023, it is important to understand the contemporary healthcare environment fully. However, while 15% of businesses overall have gone digital, just 7% of those in the healthcare and pharmaceutical industries have done so [18]. The World Health Organization (WHO), for its global strategy on digital healthcare, has recommended appreciating principles of accessibility, privacy, interoperability, confidentiality, transparency, security, scalability, and replicability [19]. Therefore, placing principle-based assessment criteria on several available digital options (e.g., IoT, Blockchain Technology, cloud, big data, AI, etc.) and their different underlying integrating challenges, including design and security to advance the healthcare system across the countries, must be studied. Therefore, to recognize the importance of incorporating digital technologies into healthcare, in this paper, we discuss the digital transformation in healthcare concerning its components, importance, and benefits, further explore its integration and design challenges, and classify the security and privacy challenges. Furthermore, we also addressed the role and application and highlighted several open issues with key challenges concerning different ICT technologies and Blockchain in healthcare systems.

1.1 Problem statement and motivation

Based on our research into one of the most crucial SDGs-healthcare-and its ongoing digital transformation with the help of cutting-edge ICT technologies, we were able to identify several weaknesses in the survey literature on the topic of ICT integration with healthcare systems, especially concerning the three sustainability perspectives (environmental, social, and economic): (i) research surveys (like [20, 21]) which provide an overarching view of sustainability but don’t go into the specifics of ICT integration and the associated challenges (ii) Only environmental sustainability considerations are presented in the survey study [22], which also describes IoT as an integration technology and focuses on its limited applicability, (iii) The research study [23] only covered telemedicine and ICT technologies (e.g., 5th Generation mobile network (5G)) concerning health care, and (iv) the research papers [24,25,26] discuss the limited sustainability viewpoints, highlight the limited ICT integration issues, and make use of AI and big data as integration technologies.

We are motivated to present a state-of-the-art research study by comparing existing studies and highlighting their shortcomings to discuss the digital transformation in healthcare concerning its components, importance, and benefits; explore its integration and design challenges; and classify the security and privacy challenges. As a second source of inspiration for this research, we describe the characteristics of Blockchain Technology, highlight its benefits, and list the different types of applications/use cases that can be implemented using Blockchain Technology in E-Health.

To address the limitations present in current healthcare research studies, particularly about healthcare, there is a noticeable trend towards the implementation of digital transformation in the healthcare sector. This trend encompasses exploring the integration, design, security, and privacy challenges associated with adopting digital transformation. In this regard, the utilization of Blockchain Technology and its various characteristics and applications is being examined. To contribute to the existing body of knowledge and provide a foundation for future research endeavors, we aim to present a multifaceted survey that focuses primarily on the integration of ICT in healthcare, with a specific emphasis on the aforementioned challenges. Furthermore, we discuss ICT integration’s positive and negative impacts and highlight the significance of incorporating Blockchain Technology by identifying key research questions and suggesting potential future directions.

1.2 Contributions

The research effort presented in this study has made several notable contributions, which may be summarised as follows:

  • To examine current studies focusing on integrating ICT technologies into healthcare, an important SDG, regarding sustainability, security, and privacy challenges, design and integration issues, E-Health applications, and future directions.

  • To investigate the need for digital transformation in healthcare, its key components, E-Health’s benefits, integration and design challenges, security and privacy issues, and key evaluation metrics.

  • To explore the Blockchain Technology’s significance to E-Health systems from sustainability perspectives, including its benefits and potential use cases.

  • To compare the positive and negative impact of ICT integration, including Blockchain Technology, into the health systems.

  • To explore the open challenges, implications, and barriers of integrating ICT technology into healthcare systems and emphasize future research areas to assist researchers.

The organization of the research work is as follows: Sect. 2 provides a related work consisting of a detailed comparison of existing studies on integrating ICT technologies to the SDG (healthcare). Sect. 3 presents the methodology of our research study. The findings and discussion of our research findings are presented in Sect. 4. Future research directions and implications of our study are presented in Sect. 5. Finally, we concluded the research work in Sect. 6.

2 Existing work

This section provides an overview of the extant research that specifically examines the impact of digitalization on well-being and healthcare, which is considered a significant SDG. The derived taxonomy of current literature is presented in Fig. 1, which emphasizes our proposed study’s significant aims and objectives. The perspectives mentioned above encompass published timelines focused on problem approaches, an emphasis on sustainability factors, challenges encountered, applications connected to electronic health, and potential future research directions.

Fig. 1
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Taxonomy of digitalisation and sustainability perspectives based on the published timeline, problem focused, sustainability focused, ICT integration technologies, challenges, applications, and future directions

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Initially, the selection process involved carefully examining the published chronology, wherein we specifically identified and included pertinent articles published throughout the timeframe spanning from 2021 to 2024. Furthermore, we have identified many specific issue areas within the current body of research that examine the interplay between digitalization, sustainability, and healthcare. These problem areas are of great importance as they provide light on the implications and outcomes of such relationships on potential solutions. Thirdly, the focus is on environmental, social, and economic sustainability concerns. Subsequently, this study examines several ICT integration technologies, including the IoT, cloud computing, 5 G, big data, AI, and Blockchain Technology. Additionally, the challenges were categorized into design, integration, security, and privacy. The taxonomy we have developed places significant emphasis on E-Health-related applications. Finally, we delineated several prospective avenues for further investigation within our taxonomy. This taxonomy will facilitate the comprehension of literature categorization and attaining study objectives for the research community and enterprise.

By adhering to the proposed literature taxonomy, we present an evaluation and comparison of the selected research papers with our study, as depicted in Table 1. For example, using a case study on empirical estimation, Abbas et al. [20] provided the results of a survey that looked at digitalization in the context of SDG3-healthcare services. The research was conducted to aid in formulating long-term decisions regarding policy and ethical principles in the Asian healthcare industry by shedding light on how cybersecurity measures might improve service quality and increase institutional excellence. However, the proposed research is limited in that it only describes a small subset of the possible cybersecurity solutions that could have a major effect on the digital transformation of healthcare. Furthermore, another study by Ullah et al. [21] integrated the implications of the China-Pakistan Economic Corridor (CPEC). It looked into the use of digitalization and e-governance to deal with the COVID-19 problems. In light of the recent COVID-19 epidemic, this study set out to explore and analyze the UN E-Government Development Index (EGDI) reports and rankings. Despite the importance of discussing the security and privacy concerns, design integration challenges, and the consequences of real-time applications, the proposed work only focused on studying the usage of digital technology in the healthcare sector.

In another study, the hybrid method provided by Espinosa et al. [22] combines a literature study with an analysis of the effects of healthcare’s adoption of digitalization technologies like the IoT. The study set out to answer a wide range of concerns about the influence of the IoT and similar technologies on healthcare and their related issues on the public. The primary limitation of this research was that it focused solely on healthcare IoT implications without addressing security, privacy, and design issues. A recent systematic review by Carbonell et al. [23] examines how the advent of the 5G network will affect how doctors and hospitals use data from various digital apps to enhance the care they deliver to their patients. This research focuses on the following use cases: Telesurgery, mobile ultrasonography, biosensor technology, robotic surgery, and the linked ambulance were recognized as the key medical uses. However, discussion on sustainability, security, and design challenges is limited in the proposed study.

To establish SDG (healthcare) for developing countries, Joshi et al. [24] presented a survey study intending to integrate digitalization technology like AI to comprehend its relevance and uses for healthcare and medicine. This research sheds insight into the social, economic, and institutional obstacles to implementing AI in public healthcare. The study’s limitations include its narrow focus on privacy concerns as a security criterion and other important design considerations like governance and scalability. In addition to the above research, Thayyib et al. [25] investigate how various developing fields-including business, engineering, healthcare, sustainable operations, and hospitality tourism-can benefit from digitalization technologies like AI and big data. The study’s primary objective was to use bibliometric reviews to investigate the effects of AI and big data on these five areas and to inform managers of the most recent practical applications of these digitalization trends. However, this study merely covered the basics of how these digital technologies integrate with those mentioned five growing industries; it did not delve into privacy and security issues, nor did it address the difficulties of integrating these technologies into existing designs or focusing on sustainability. Piorunkiewicz and Morawiec [26] have published a study detailing the significance of AI in long-term E-Health systems from a theoretical perspective in light of the practical Polish healthcare experience. However, this research was limited in that it did not specifically address security and privacy concerns, as well as design and integration challenges; instead, it merely described the conceptual problems of sustainable growth in E-Health and made some suggestions about the role of ICT as a knowledge management factor in the healthcare system.

Table 1 Evaluation and comparison of existing studies on integration of ICT to the SDG (Healthcare and Well-Being) with Our Proposed Study
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In their research study, [27] investigated to assess the impact of digital transformation on the healthcare sector. To do this study, a comprehensive bibliographic review is conducted by collating many papers. Nevertheless, this study has several limitations about the examination of sustainability viewpoints, integration technologies of ICT, and future implications. In another research, Marques and Ozben [28] conducted a comprehensive analysis that explores the available data on the impact of digital technology on healthcare and clinical laboratories. Their study emphasizes the necessity of digital transformation in these domains, highlighting its potential to minimize inefficiencies and costs by improving effectiveness without compromising quality. Moreover, this study examines the significance of environmental sustainability as a crucial component. However, it fails to consider the aspects of security, design, challenges, and future directions. Hadjiat [29] conducted research to evaluate the implications of digital health on disparities and inequities in healthcare. Nevertheless, the scope of this study was restricted as it just focused on the fundamental aspects of the issue, neglecting to go into the intricacies of design, integration, security concerns, as well as the applications and potential future developments. In a subsequent study, Ngongoni et al. [30] conducted a study to elucidate the intricacies surrounding the enhancement of scaling and the augmentation of sustainability of innovations within the African area. The primary purpose of this research is to fortify health systems and foster innovation. This research encompassed several design problems, including minimalistic design, cross-functional innovations, modular designs, off-grid capabilities, and interoperability.

Alajlan and Baslyman [31] conducted a study to assess the long-term sustainability and ecological implications of E-Health solutions that have been proposed or are now being implemented. The study above highlights a lack of empirically grounded and comprehensive sustainability models and evaluation tools that can effectively inform and guide practices in real-world scenarios. Nevertheless, this research solely concentrates on sustainability’s social and environmental aspects, neglecting other crucial elements such as design, integration, security issues, and future views. In an additional study, [32] conducted a scholarly inquiry presenting the utilization of ICT applications in response to the COVID-19 pandemic. Subsequently, the study offers a comprehensive review and subsequent analysis of the current state of ICT applications. This research primarily examined the uses of Big Data, specifically focusing on privacy and data accessibility considerations and potential future ramifications. Berardi et al. [33] undertook a qualitative systematic investigation to identify the elements enabling and impeding the adoption of digital technology in mental healthcare systems to influence policy development. Research has shown that the integration of digital treatments for mental health has been difficult despite the potential benefits it may bring to the overall mental health and well-being of the population. Another conclusion from the systematic review research by Sen et al., [34] highlights the importance of technology use in reducing social isolation in older persons. The recommended research posited that, as technology develops, we may evaluate the efficacy of treatments that leverage it to combat social isolation and boost community health. In addition, the study aimed to determine which older persons would gain the most from easily available and inexpensive technology and how to educate best and administer such interventions to achieve this goal.

In summary, the prevailing focus of the literature has been on integrating ICT technologies in well-being and healthcare. Only a few studies have incorporated sustainability considerations into their research design. Furthermore, our literature evaluation shows that the current body of work primarily emphasizes digital technology while neglecting to adequately address the associated design, integration, security, and privacy challenges. Integrating diverse technologies and elements presents possible issues that must be identified and addressed. Consequently, to rectify the limitations observed in current survey studies and to bridge the gaps about multiple dimensions, such as intricate ICT integration technology and its constituents, security and privacy obstacles, design and integration hurdles, and sustainability considerations, we hereby present a multifaceted and cutting-edge research survey that focuses mainly on sustainability aspects, security and privacy challenges, design and integration challenges, and diverse potential applications. Our research stands out from other studies as it examines the significance and importance of the present-day technology known as “Blockchain Technology” as an integration technology in healthcare. Considering the taxonomy viewpoints, this study guides researchers in utilizing Blockchain Technology to propose effective solutions.

3 Research methodology of our study

The research methodology employed in this paper was conducted following the guidelines of a systematic review. We designed a review plan comprising various stages to effectively implement our research methodology for our survey paper under the review guidelines and protocol. The proposed plan utilized by our research methodology is illustrated in Fig. 2.

3.1 Review plan

To develop and implement our review strategy, we divided it into three primary phases: planning, data collection, and review. Each phase was further subdivided into distinct tasks. This review plan details every pertinent study for which an appropriate search strategy has been devised and every step we take. The plan for review comprises the following three primary steps:

Fig. 2
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Methodology review plan of the proposed research study

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  • Step 1: Planning the review: In this step of our review plan, two further sub-steps are formulated.

    • Research objectives and motivations: A research objective is a brief, well-defined statement describing the investigation’s desired outcomes. Research motivations provide insight into the significance of the research and the possible consequences of its outcomes.

    • Research questions: Any research project/study addresses well-defined, often called research questions. The research questions are formulated as the groundwork for the study’s focus and direction and are essential to quantitative and qualitative research.

    The detailed set of research questions, along with the research objectives and motivations, are described in Table 2.

  • Step 2: Conducting the review: During this phase of our review plans, we will make the following steps: Database sources, studies selection, screening relevant studies, extracting data, and analyzing the results. The specifics of each stage, as well as how they are developed, are outlined as follows:

    • Database sources: Finding and exploiting suitable database sources is essential to the systematic research technique for comprehensively gathering pertinent facts and studies. Table 3 provides a few of the most widely utilized database sources across several disciplines in our research methodology:

    • Studies selection: As part of the review plans, we have compiled a list of strings comprising various search terms that were utilized in the selection of studies. Table 4 contains a list of strings and their corresponding keywords.

    • Screening relevant studies: A set of criteria was devised to determine the inclusion and exclusion of publications in the systematic review. We established specific criteria and parameters to choose the appropriate research for our survey study. These criteria were then categorized into inclusion and exclusion groups. Figure 3 depicts screening several selection characteristics (such as identification, screening, eligibility, and synthesis) to find the relevant articles in our survey investigation.

    • Data extraction: We specify a limited number of parameters that facilitate the extraction of data from the chosen studies/articles by the research questions and objectives established to execute the data extraction portion of our review plan. The parameters and specifications of the data extraction methods utilized in our review strategy to obtain the refined information/results are presented in Table 5. We classify the parameters into two distinct categories: those associated with the publisher and those that pertain to the actual document. We believe that data becomes more refined as parameter definitions increase.

    • Result analysis: For the most stringent process of result analysis, we refine our findings through the utilization of a widely accepted selection scheme, such as quality assessment. The quality appraisal, the most crucial stage in the review process, is the foundation for the article selection process. A quality assessment is conducted to enhance the overall quality of the paper and facilitate a more precise analysis of results. This is due to the main research papers’ varied structures, which employ qualitative and quantitative methodologies. We have included the criteria mentioned in the table to conduct the quality assessment of our research studies using the review plan model.

  • Step 3: Reporting the review: The last stage of the review plan involves the process of creating a report, which includes presenting the findings and then performing a detailed discussion, as outlined below. We have included a separate section (Sect. 4) regarding findings and discussion.

Table 2 Research questions, objectives and motivations
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Table 3 List of database sources and URLs
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Table 4 List of strings and keywords
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Fig. 3
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Screening Process of Relevant Studies

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Table 5 Data extraction parameters
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4 Findings and discussion

After a comprehensive literature analysis on digitalization’s effects on healthcare and well-being and using our systematic review approach, we derived many findings that we discussed in detail. Our research addresses security, privacy, integration, and design issues relevant to healthcare digital transformation, contributing to scholarly conversation. Our research and analysis also evaluate the importance of Blockchain Technology as a growing technology with potential applications and benefits. In conclusion, our research investigates our study’s consequences and future directions, which will help academics design new and effective healthcare system solutions while recognizing the obstacles and constraints.

The high-level taxonomy in Fig. 4 organizes sections for simplicity of understanding and facilitates detailed discussions.

Fig. 4
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A high-level taxonomy of our research findings

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4.1 Digital transformation in healthcare

Organizations often use the phrase “digital transformation” to describe integrating new information and technology to enhance operations and customer experience [35]. Utilizing cutting-edge digital technologies in healthcare systems has transformed how the industry and its sectors (medicine, insurance, supply chain) approach pressing medical care and health issues [36]. Global health issues are becoming a key priority for the UN system’s work on sustainable development, including economic, social, and environmental components, across borders [37].

The WHO defines E-Health as using ICT in medicine to improve diagnosis and treatment [38]. The digital health paradigm involves using ICT for healthcare and health-related purposes in diverse settings, both inside and outside healthcare. Advancements in healthcare technology are creating new market opportunities and business models, addressing medical treatment, economic development, and elderly community challenges [39]. Primary service providers-healthcare professionals, nurses, hospital administration, and support staff-and supporting services like diagnostic labs and health insurance make up healthcare as a system. Examples of digital healthcare models are E-Health, M-Health, and Telemedicine [40].

Due to the growing number of gadgets, ICT can help treat and prevent health issues. New technologies like robots and the IoT have led to the widespread use of digital gadgets among healthcare personnel in hospitals and clinics [41]. Fitness trackers and wearables can greatly contribute to remote patient health monitoring [42]. EHRs have also revolutionized and simplified remote care for various sorts of patients. A growing digital data bank is linked to healthcare treatment and patient records [43].

To conclude, the healthcare system as a whole could stand to gain from the use of ICTs. No matter how close or far a patient may be from a hospital or clinic, they can still contact medical professionals [44]. In the medical field, this means diagnosing patients remotely, accessing expert advice during a crisis, learning about and preparing for disease epidemics, and so on. Big Data analytics can all aid snapshots, trend analyses, and forecasts regarding disease outbreaks, health service utilization, and patient knowledge, attitudes, and practices [45].

4.1.1 ICT-based healthcare system components

This section provides a complete overview of healthcare system components to help you understand ICT requirements in healthcare. A healthcare system may have one or more medical devices with many sensors to collect patient data and make independent treatment decisions. To function properly, a healthcare system needs six basic elements: patients, providers, medical devices, sensors, networks, and data processing facilities [46]. Healthcare design, as shown in Fig. 5, includes the above-mentioned components.

Fig. 5
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E-Health architecture, as an example

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  • Patient: E-Health patients use telehealth, electronic consultations, or E-Health platforms to get healthcare. All individuals requiring medical treatment, including those with chronic conditions, acute illnesses, or those seeking wellness, are called patients [47].

  • Healthcare provider: Hospitals, organizations, doctors, and nurses are included. They communicate with the data processing element via wired and wireless transmission modules. In the cloud, the health server maintains sensitive medical and patient data. Doctors and nurses can use this information to treat patients [48].

  • Medical device: A medical device is any tool, equipment, appliance, or gadget used for diagnosis, monitoring, treatment, or relief. The Food and Drug Administration (FDA) listed medical devices as throat syringe needles and complicated programmable implantable cardioverter-defibrillators (ICDs). Different categorization standards exist for medical devices in the European Union (EU) based on their non-invasive, invasive, or active therapeutic properties [49].

  • Sensor: Sensors monitor patients’ physiological characteristics in medicine. Many healthcare operations, such as diagnosis and monitoring, are automated using physiological sensors like blood sugar and heart rate sensors. Sensors are often classified as physiological, biological, or environmental [50].

  • Network/E-Health architecture: E-Health architecture’s networking components manage how medical devices and sensors communicate with each other and the healthcare system. The main aim of data transmission in an E-Health network is to convey signals from sensors or devices to the central node and then send aggregated measures to a health server or healthcare practitioner [51].

  • Data processing: E-Health systems collect, organize, and analyze patient data to improve care. Electronic health care data processing involves IoT and AI to store and retrieve patient health and treatment data [52].

4.1.2 E-Health importance and benefits

Health practitioners and patients benefit from ICT integration with health systems in the following areas:

  • Enhancing public health and medical facilities: Improvements in hospital operations, electronic health records (EHR), and health information are just a few examples of how this integration might help the public and private sectors of healthcare. In addition, quick information and data sharing among healthcare providers and experts can increase patients’ access to high-quality care [53].

  • Aiding medical professionals: One of the most promising applications of this integration is the enhancement of surgical procedures/operations or guidance, including remote telesurgery. Digital health technology allows various outlying medical facilities to offer telemedicine and remote diagnosis to their patients. Hospitals in China, for instance, have used 5G to conduct remote surgery, such as liver procedures and deep brain stimulation implants for Parkinson’s illness [54].

  • Real-time monitoring and management: Personal health and dedicated devices, such as sensors, monitors, wristwatches, and mobiles, are widely deployed and utilized for monitoring and feedback purposes, providing an additional benefit to integrating ICT with the existing healthcare systems. For example, remote ultrasound imaging for kidney stones and fertilization, as well as swab testing, have all been accomplished with the help of mobile phones. It has been predicted that by 2025, there will be half a million mobile health monitoring and feedback applications available [55].

  • Improved and accurate analysis: Health data may now be analyzed and predicted with more precision because of cutting-edge ICT technologies and ideas, such as AI, big data, and virtual reality (VR) simulations. In addition, imaging, diagnostics, and data analytics are all made possible by computing at the edge, which collects data from devices and sensors [56].

4.1.3 E-Health challenges

ICT in health systems can improve access to health services, communication and coordination among medical providers, patient outcomes, and treatment approaches. To integrate ICT into health systems, various challenges must be solved, including:

We categorize challenges into integration and design and security and privacy.

  • Integration and design challenges: Users (patients and doctors) and stakeholders (government and private enterprises) have identified multiple design problems to explain the slow adoption and integration of ICT in healthcare. Health-related information is also created due to the complexity of system design, data formats, controlling accessing authorities, policies and regulation of healthcare artifacts, and interoperability challenges of various systems and their used health information technologies, which can affect system speed, performance, efficiency, technology adoption, and costs.

    We categorized these concerns as integration and design. The integration concerns involve integrating ICT into current healthcare systems [57]. Design issues enforce health scenario implementation and design using various techniques and technology.

    • Centralised architectures: Current healthcare systems, based on centralized architectures, face fundamental design difficulties, including treatment quality [58]. The centralized design may be less scalable and efficient because healthcare systems encompass numerous organizations worldwide and are expanding. Extended wait times and increased error risk can result in fatalities in severe instances [59]. The single point of failure problem in centralized architecture might significantly impact patient care if the entire healthcare system fails [60].

    • Unsecured networks: Healthcare providers risk exposing patient data to unauthorized third parties by employing unprotected Wi-Fi or public networks [61].

    • Non-trusted storage options: Non-trusted storage solutions in healthcare systems pose significant risks to patient privacy and data security [62]. Doctors can store patient data on their local servers without a security system or on their smartphones, tablets, and desktops. In either case, the devices may not be as secure as the healthcare system’s infrastructure. However, employing untrusted public clouds for storage increases the risk of data breaches, unauthorized access, and loss [63].

    • Data collection: Every healthcare establishment needs data collecting to maintain quality and efficiency or improve outcomes. Data from multiple sources is sometimes disconnected or non-standardized across healthcare entities. Gathering information regarding patients’ race, ethnicity, and language can be challenging for healthcare organizations, requiring careful collection, preparation, and management [64].

    • Non-availability of infrastructure and resources: Health systems may struggle to embrace and use ICT solutions without adequate internet connectivity, hardware, and software. For example, governments may struggle to invest in ICT technology and infrastructure, making integration with health systems difficult [65].

    • Interoperability: Many health systems use ICT solutions and platforms supported by heterogeneous and distant network infrastructures, making data sharing, storage, and exchange difficult. Interoperability protocols and specifications are necessary for effective collaboration and interaction among ICT technologies [66].

    • Data management and integration: As clinics and hospitals digitize their operations, the healthcare industry faces IT challenges combining and managing data from multiple sources. E-Health data includes patient notes or transcripts, insurance, treatment plans, laboratory findings, referrals, medical history, and vital data from remote monitoring devices like wearables. Various E-Health data types include health history and referrals [67]. Patients sometimes consult multiple experts at linked facilities, so each data type in their file may come from a different source. Healthcare practitioners need electronic health records (EHR) software to gather, integrate, and manage patient data properly. This leads to better diagnosis, treatment, and patient outcomes [68].

    • Data access: Data accessibility supports patient healthcare record access and emergency response, essential to good healthcare standards. Doctors may immediately obtain patients’ medical history, test results, and comments from other practitioners, benefiting them [69]. The ability to swiftly retrieve essential information from a patient’s record can improve clinical efficiency by reducing the number of times a doctor has to switch between programs to end a consultation and diagnose a patient. E-Health data is growing exponentially, highlighting the need for better data accessibility and ICT solutions. While this expansion has many benefits, obtaining high-quality care data remains a barrier [70].

    • Cost: Low-income or underfunded locations may be unable to build ICT-based health systems. Implementing and supporting ICT infrastructure for a complete healthcare system can be costly, as well as training staff to use new technologies compared to manual methods [71].

    • Compliance: Billing, equipment maintenance, and software updates are examples of changing regulations. Despite compliance measures protecting patient data, healthcare CIOs must navigate legal complexities [72]. Healthcare companies and practices use remote solutions from Ta and Cervey. Arena offers a medical device manufacturing quality management system. Medical device manufacturers can use this system to ensure compliance with ISO 3485 requirements [73].

    • Reluctant to adoption new technology: Because ICT integration into health systems may upset their practices, many healthcare workers may be reluctant to use new technologies. For instance, health personnel may lack the technical expertise to effectively use and maintain ICT solutions, hindering their adoption and use in health systems [74].

  • Security and privacy challenges: Security and privacy are important priorities for healthcare since sensitive patient health information is accessible and exchanged online. Most E-Health data is transferred and shared over open channels, making it vulnerable to network attacks. So we split the section into security and privacy sub-sections. Figure 6 categorizes security and privacy challenges of integrating ICT technologies into healthcare systems.

    • Security challenges

      E-Health security involves restricting access to sensitive patient data using security rules and policies to prevent misuse. Patients’ health records (PHI) are recorded, exchanged, and stored electronically in many nations.

      • Physical access to resources: Keeping healthcare infrastructure resources safe is a major security issue. This is especially true for patient data storage and access. Healthcare institutions must implement and maintain physical access controls to safeguard patient data from unwanted access [75].

      • Third-party untrusted manufacturers/Devices: The growing usage of IoT devices in healthcare systems promises to improve care but poses security risks. Many businesses in the health sector have adopted IoT due to its potential to improve data operations and treatment processes [76]. Unreliable vendors often design and manufacture IoT devices, leading to a lack of security patches and built-in defenses, posing security risks for healthcare systems [77].

      • Cyber attacks: Cyberattacks, including ransomware, phishing, spoofing, and malware, rapidly affect the healthcare business [78]. In addition to interrupting hospital operations, hacks may steal or leak patient data. The healthcare business is prone to ransomware attacks, where hackers encrypt patient data and demand payment for decryption [79].

      • Insider threats: Many firms overlook internal threats in data security, focusing instead on external attacks [80]. However, insider threats often stem from overlooked design or security vulnerabilities. Insider dangers, which are as serious as outside ones, have increased in healthcare. Insider threats in E-Health often emerge within the organization, including past or current staff, suppliers, associates, healthcare officials, doctors, or inept staff [81].

    • Privacy challenges

      Health information “privacy” refers to protecting an individual’s medical records from unauthorized access and keeping them secret [82]. This can be achieved by strictly implementing appropriate regulations and legislation. Patients have a right to know who has access to their medical records, how they are used, whether they will be shared with a third party, and under what conditions. Health Insurance Portability and Accountability Act (HIPAA) safeguards patient privacy [83].

      Doctors and patients may confront the following privacy challenges when using E-Health scenarios.

      • Device privacy: Device privacy is a major concern in E-Health due to the device anonymity principle, which entitles patients to know who configures and installs their medical devices, as well as who interacts with and manages them [84].

      • Data privacy: Protecting personal and medical data is crucial to data privacy. Data privacy in healthcare systems safeguards patient health information from misuse [85].

Fig. 6
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Security and privacy challenges of integrating ICT technologies to the healthcare systems

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4.1.4 Key evaluation metrics

Several key evaluation metrics and indicators must be considered to assess the efficacy and longevity of healthcare digital transformation initiatives. To evaluate how digital transformation has affected healthcare systems, here are a few very important metrics and indicators to consider.

  • Patient satisfaction: It involves collecting patient feedback in the form of polls and online evaluations to gauge how satisfied patients are with electronic medical services, how easy digital technologies are to use, and how much better healthcare is seen to be overall. It can also center on monitoring how patients’ health literacy levels have changed and how emboldened they feel due to access to self-care resources alongside medical information.

  • Healthcare access and equity: Healthcare access facilitates the quantification of telehealth service utilization, encompassing metrics such as the quantity of downloaded digital health applications, distant monitoring sessions, and telephone consultations. However, equal opportunity access guarantees that all population segments have access to digital health treatments by monitoring indicators of obstacles to access, including assistance with languages, cost, and compatibility with gadgets.

  • Resource utilisation: Healthcare managers may track changes in resource utilization patterns, such as fewer unneeded trips to the hospital department, fewer hospitalizations, and reduced admissions, with the help of resource utilization, the primary evaluation matrix. In addition, using cost-effective solutions may save significant resources while estimating cost savings from digital transformation initiatives, including medical bills, management expenses, and ancillary charges.

  • Health system resilience: To successfully respond to emergencies, adjust to new conditions, and keep vital healthcare services running in the face of adversity, health systems must be resilient. To measure the resilience of a health system, one must look at how well it can foresee, incorporate, adjust to, and recuperate from pressures and disturbances.

  • Security and control of data/Information: To guarantee compliance with data protection rules, information and data security control can track the frequency and impact of security events or breaches affecting patient health information. Patients must also provide permission before their data is shared or used in research to determine how trustworthy digital health systems are and how well they follow ethical guidelines.

4.1.5 Healthcare systems challenges and opportunities: a comparison of developed and developing countries

This part examines the opportunities and challenges healthcare systems face to the diversity and challenges of global healthcare. It also includes a case study that contrasts developed and developing nations.

  • Global healthcare diversity and challenges: A variety of elements, such as cultural competency, ethnic diversity, socioeconomic position, political hurdles, and technical development and advances, contribute to the diversity of healthcare systems and environments worldwide. Due to these variances, healthcare delivery, availability, and innovation face particular challenges and possibilities. In this section, we explore the challenges associated with digital transformation and discuss the distinct ways digital transformation projects vary worldwide.

    • Cultural competence: The ability to collaborate effectively across cultural borders is known as cultural competence and is an asset to both patients and healthcare professionals. Diversity in cultural background, gender, and ethnicity is noticeably lacking in healthcare leadership roles and training programs. The healthcare system must prioritize the improvement of cultural competency to meet the requirements of a varied population.

    • Ethnic diversity: In healthcare, ethnic diversity refers to the variety of people who receive and give treatment, as well as the effect that this variety has on people’s health, their ability to get treatment, and their overall experience. To improve healthcare for all and reach health equity, one must address ethnic diversity. There has been speculation regarding the potential influence of adverse social factors of health on the limited healthcare access experienced by ethnic diversity.

    • Economic status: One of the biggest obstacles to universal high-quality healthcare is that people’s socioeconomic position strongly predicts their health results. A person’s and their family’s financial state may be affected by their health, and vice versa. Consequently, there is a mutually beneficial relationship between economic status and health.

    • Political barriers: Many kinds of political interference in healthcare can lower service quality, make it harder for people to get the care they need, and reduce the efficiency of health systems. Political atmosphere, policies, and actions on a global and national scale can give birth to such obstacles. We must identify and remove these barriers for better health outcomes and universal healthcare access.

    • Technological innovation: A constantly shifting set of possibilities and threats characterizes the terrain of technological advancement in healthcare. Technological breakthroughs might dramatically improve healthcare delivery, patient experiences, and healthcare system effectiveness. However, these innovations also bring new problems that must be solved to take full advantage of them. For example, as electronic health records increase, the likelihood of information theft and privacy infractions increases [86].

  • A case study of developed and developing countries: The phrase “digital health” has recently entered the vernacular, and with the current state of affairs-the COVID-19 pandemic, the need for social isolation, and the worldwide economic meltdown-the necessity for healthcare innovation is greater than ever. Innovation in digital technology presents a game-changing opportunity to enhance healthcare accessibility, quality, and results on a global scale. Developed and developing nations have different problems and possibilities when it comes to embracing the implementation and effect of these technologies. This section delves into case studies for both developed and developing nations, illuminating the unique possibilities and challenges each faces when trying to improve health and wellness via technology.

    • Australia: The Australian government has increased expenditure on healthcare IT and is working to enhance cooperation among the public and private sectors in response to the COVID-19 epidemic to extend its opportunities towards the sustainable healthcare program. The Australian government asserts that by implementing Medicare telehealth for the entire population, ten days’ worth of reform that would have otherwise taken ten years to complete has been completed. MyHealth Record, an electronic health record system that maintains patient medical records and facilitates communication across various clinical information systems, was introduced with public funding. Even in the public sector of Australia, numerous positive technological developments have occurred despite international political pressure. Consider, for instance, the Sydney Local Health District. In just seven months after establishing the first virtual hospital in the state in February 2020, they attended to more than 3500 patients.

    • Pakistan: Pakistan, among the developing nations, has not reaped substantial benefits from telemedicine, notwithstanding the potential to surmount numerous obstacles hindering the provision of reproductive healthcare in emergent markets. The absence of a regulatory framework, political barriers, technological innovations, and the lack of government interest in Pakistan pose significant challenges for emerging enterprises seeking to establish innovative and affordable healthcare initiatives. Additionally, during the COVID-19 epidemic, Pakistan’s dependence on telemedicine increased, and the government felt obligated to institute a statewide lockdown due to the geometrically expanding number of COVID-19 patients.

4.2 The role of blockchain technology in E-Health

The basics and principles of Blockchain Technology are covered in this part, followed by its key features. Next, we discuss Blockchain Technology’s benefits in E-Health. We’ll conclude with Blockchain Technology applications and use cases.

4.2.1 Blockchain technology

Blockchain Technology combines a decentralized network and Distributed Ledger Technology (DLT), which joins network nodes in a peer-to-peer (P2P) manner so users can communicate directly without a trusted third party. Blockchain Technology utilizes a decentralized network to build a setting without a central authority, eliminating the requirement for a trusted third party [87]. The distributed ledger stores transactions in shared, immutable, append-only blocks. Blockchains are created by connecting each block to the one before it using a cryptographic hash in the block header. Each block structure stores a specific event’s timestamp, nonce, and transaction data. The specifics of this information are: (i) a timestamp shows when each block was created; (ii) a nonce is a one-time generated, unique random number for each person; and (iii) a transaction contains data to be sent to other nodes and stored in the ledger after approval. Blockchain Technology uses nonce, hashes, encryption, digital signatures, and more to establish trust between network nodes [88, 89].

Both types of Blockchain Technology nodes create and validate blocks. Basic nodes create wallets and network transactions. The rest are full miners who verify and add Blockchain Technology transactions. Blockchain Technology’s consensus protocol eliminates the requirement for a trusted third party to oversee node interactions. Their behavior is regulated to maintain confidence and ensure transaction integrity [90]. Mining on the Blockchain Technology network involves miner nodes managing the consensus protocol. Verify transactions and add them as Blocks using computational puzzles or challenges. Each consensus mechanism is also tied to miners’ time and effort rewards [91].

Different consensus procedures are presented using the Blockchain Technology [92]. The most commonly used consensus methods in Blockchain Technology applications are PoW (Proof of Work), PoS (Proof of Stake), PBFT (Practical Byzantine Fault Tolerance), and DPoS (Delegated Proof of Stake) [93,94,95,96]. Bitcoin, the most famous Blockchain Technology application, uses PoW consensus. The Ethereum platform used PoS to mine Ether blocks and reward network nodes with Ether for participation [97].

4.2.2 Blockchain technology characteristics

According to [57], Blockchain Technology is characterized by decentralization, immutability, security, privacy, consensus mechanism, anonymity, open source, smart contracts, and transparency. These features assist users in meeting design criteria and security goals for efficient and safe applications.

  • Decentralisation: A decentralized network operates without a central authority, with a set of nodes maintaining the network’s structure through P2P organization [92].

  • Immutability: Immutability (or tamper-proof) in Blockchain Technology, a block, and its data are irrevocably protected after many miner nodes confirm it. As Blockchain Technology data is immutable, it ensures data integrity and authenticity and may be used to trace its past [98].

  • Security and privacy: Blockchain Technology secures and immutably stores transactions in a distributed ledger using cutting-edge cryptography. Blockchain Technology transactions are recorded on the distributed ledger using consensus methods after encryption and digital signature. A verifiable chain is created by encrypting and hashing each block [99].

  • Consensus mechanism: Blockchain Technology’s consensus process needs all network nodes to agree to add only legitimate transactions and blocks to the distributed ledger. The consensus approach is a set of rules that all network members must agree upon to solve a tough problem or puzzle [97].

  • Anonymity: Blockchain Technology anonymity could revolutionize user and data privacy and security. Anonymity in Blockchain Technology is a promising step towards user privacy and trust in data and transactions, particularly in high-stakes circumstances involving financial or personal information [100].

  • Open source: This open-source functionality allows developers to create decentralized and secure applications to establish trust between network nodes and their data using Blockchain Technology’s coding properties. This allows for efficient and automated application development for various social and corporate use cases [101].

  • Smart contracts: Blockchain-based smart contracts are exciting uses for Blockchain Technology since they self-manage and execute code. Smart contracts use predetermined rules to automate sender-recipient agreements on set conditions. To simplify contract negotiations and attain autonomy, smart contracts confirm and apply contract norms. Smart contracts in Blockchain Technology enable accountability for all parties involved, as their terms are public and visible to all nodes [102].

  • Transparency: Blockchain Technology is transparent, allowing anybody with network access to track and validate distributed ledger transactions. Users can record and manage transactions in a public blockchain, visible to all network users [103].

  • Traceability: To maintain auditability, the blockchain’s traceability and security rules prevent transactions from being altered after being added to the ledger. Thus, transaction histories may be traced in detail [104].

4.2.3 Blockchain technology benefits in E-Health

  • Decentralise Architecture: Due to global E-Health systems, a decentralized management system is needed to process, manage, and store health data. Global players, such as doctors, patients, hospitals, healthcare stakeholders, and medication distributors, desire remote access to the system for various jobs [105]. Blockchain Technology can provide a decentralized health data management infrastructure, allowing parties to access similar medical records without a worldwide authority securely [12].

  • Tamper-proof record: The immutability of distributed ledgers significantly enhances the security of health data recorded on them [106] due to the encryption, hashing, time-stamped, and chronological order of data in a chain. Data recorded using Blockchain Technology cannot be altered, recovered, or tampered with. Additionally, patient health records are encrypted and kept on the Blockchain Technology using cryptographic keys, safeguarding patient identities and privacy [107].

  • Data availability: Traditional healthcare providers routinely communicate patient data without security, raising the danger of data loss and unauthorized access. Because Blockchain Technology is distributed and immutable, records are duplicated across multiple nodes, making it resistant to data loss, criminal activity, and security assaults targeting data availability [108].

  • Data control and ownership: Patient data in E-Health systems is sensitive and crucial, thus patients must retain ownership and understand how the healthcare system uses it [109]. It also states that patients have a right to know that third parties would not mishandle their health information. Blockchain Technology addresses these demands with safe cryptography and smart contract functionality [110]. Patients can grant or cancel access to their medical records utilizing Blockchain technologies. Blockchain Technology’s privacy features enable patients to control access to their health information and revoke access at any time [111].

  • Verifiable record: Blockchain Technology allows electronic health care providers to validate patient and provider medical records without accessing them. This feature is used in drug supply chain management and insurance claim processing to verify tamper-proof ledger records in case of discrepancies. This is essential for maintaining data integrity [112].

  • Transparency: Blockchain Technology enables E-Health transparency by recording transactions and patient data through a consensus mechanism [113]. This feature makes it harder for healthcare workers to falsify or manipulate data. Transparency ensures that all parties involved, including patients, medical professionals, healthcare institutions, and insurance companies, can access the same information and verify its credibility [114].

4.2.4 Blockchain technology-based E-health use cases/applications

Blockchain Technology has typically been used in finance and cryptocurrency but is fast spreading to healthcare. Blockchain Technology has potential in E-Health, telehealth, medicine, genomics, neurology, and personalized healthcare applications due to its decentrlised access control, secure and tamper-proof data, autonomous and tracking. This section covered Blockchain Technology-based E-Health use cases whose operations and procedures benefited from Blockchain Technology’s properties.

  • Management of electronic health record (EHR): EHR administration is one of the most essential applications of Blockchain Technology in healthcare. Blockchain Technology creates, stores, and manages patient data using its distributed and immutable storage capability [105]. Data provenance, consensus methods, smart contracts, and improved security and privacy procedures are essential for patient EHR storage and management. In healthcare, HealthChain [115] is a permissioned, private Blockchain Technology network built on IBM Blockchain Technology’s Hyperledger Fabric [116] and deployed on Bluemix. This application uses Blockchain Technology to securely store and manage patient health records, empowering individuals to handle their personal information. Another Blockchain Technology-based medical record management app is Ancile [117]. Smart contracts on the Ethereum Blockchain Technology platform enable access control, data protection, privacy, and interoperability of electronic medical information. Medical data sharing faces challenges throughout EHR rollout, including data access management, monitoring and verifiability, and transparency. MeDShare is a Blockchain Technology-based platform Xia et al. [77] developed to securely share medical records between companies with uncertain reliability. Healthcare systems also need reliable patient records to offer timely and effective care. Dubovitskaya et al. [8] proposed a Blockchain Technology-based framework using permissioned Blockchain Technology to securely track and share cancer patients’ electronic medical records, ensuring access, management, and storage of encoded patient data.

  • Medical bill/Insurance claims: Fraud increases as the insurance industry goes digital due to a lack of ethics and legal knowledge among key players. The International Association of Insurance Supervisors (IAIS) reports that about 25% of insurance claims have been probed for fraud annually since 2010 [118]. In medicine and health insurance, key stakeholders like insurance companies, medical institutions, and patients face design mechanisms, service provision, and security issues when communicating. Blockchain Technology’s decentralization, immutability, transparency, and traceability have led to great gains in ICT, particularly in medical bill digitalization and insurance claims. Data storage systems use immutability to prevent data modification. Advanced security and privacy procedures are used to develop Blockchain Technology-based transaction systems that protect multiple participants’ privacy. Blockchain Technology’s smart contract feature allows for an efficient and automatic medical insurance claim system for signing contracts, managing databases, and handling payments. Policy details and premiums can be pre-programmed in Blockchain Technology to settle claims.

  • Remotely analysing/Monitoring patients: Digitalisation in E-Health allows remote data analysis and patient monitoring. IoT devices (body sensors) or wearables connected to patients are used for “remote patient monitoring” to collect patient data. Patients and healthcare providers benefit from RPM in various ways with Blockchain Technology in E-Health. The decentralized environment allows patients to receive therapy remotely from anywhere in the world, giving them greater freedom. Blockchain Technology’s transparency and auditability can improve disease management and track drugs and history with real-time input. Griggs et al. [119] developed a remote patient monitoring system using Ethereum Blockchain Technology, prioritizing safe data exchange and enabling real-time patient-doctor interaction. Ashraf et al. [120] built a Blockchain Technology-based system with a patient-centric agent to ensure data security and privacy in an irreversible remote patient patient monitoring setup. In contrast, Ji et al. [121] proposed BMPLS (Blockchain Technology-based Multi-level Privacy-preserving Location Sharing) for secure geographic location sharing.

  • Health data analysis: Health data analytics involves collecting, analyzing, and interpreting data from many sources, including EHRs, wearables, and health apps, in the healthcare business. Health data analytics utilizes machine learning and deep learning to evaluate large quantities of healthcare data and identify health patterns [122, 123]. Data analysis can enhance patient outcomes, lower costs, and maximize resource utilization [124]. It can also improve healthcare data prediction analytics and medical research. Healthcare can be upgraded and optimized using health data analytics and Blockchain Technology. Integrating Blockchain Technology with health data analytics can secure sensitive patient data on a distributed, immutable ledger [125]. It can also be safely and efficiently exchanged across healthcare providers and systems, improving interoperability.

  • Clinical trials/Data: Trial donors and clinical research institutions have adopted remote studies and other novel methods due to the global epidemic over the previous two years. Although pharmaceutical companies, academic institutions, government agencies, and others participating in clinical trial research have attempted to solve these issues, none have been successful [126]. However, technology can speed testing, secure data, and ensure organizations comply with all standards. Blockchain Technology is used in clinical studies to secure sensitive data and improve dependability [127]. Blockchain Technology, a novel technology that can transform organizations and change how data is transacted, kept, and shared, may solve the above challenges. Blockchain Technology is primarily used in clinical trials to maintain records and provide a transparent audit trail of data collecting modifications [128].

4.3 Impact of ICT integration into health systems

ICT and its underlying technologies have had a major impact on society, particularly in digitalizing patient records, improving access to healthcare services, modernizing patient treatment, improving patient satisfaction, the pharmaceutical supply chain, and promoting health and well-being. We discuss some of the most promising benefits of integrating ICT technology into healthcare, which will benefit society. We discussed Blockchain Technology’s environmental, social, and economic repercussions and their detrimental effects on society.

4.3.1 Positive impacts

This section discusses the positive impacts of ICT integration into health systems.

  • Digitalisation of patient records: Digitalizing patient health records is a major benefit of ICT in healthcare. Converting paper-based medical records to electronic format simplifies storage, retrieval, and sharing among healthcare professionals [129]. Digitizing patient data reduces administrative costs, including storage, printing, and shipping. This matters for sustainability. The digitization of patient data in E-Health may also help nature. To reduce the healthcare industry’s environmental impact, consider reducing paper and energy use, transportation costs, hazardous chemical use, and promoting sustainable procurement practices [130].

  • Improved and quality access to healthcare services: ICT has enabled telehealth, telemedicine, remote surgery, remote consultations, and more, improving healthcare accessibility and quality. ICT can help provide secure, cost-effective, and safe healthcare services in areas with low healthcare resources and difficult emergency access. By integrating healthcare professionals, patients in urban and rural areas can save time and money while gaining equal access to medical treatment [131].

  • Improved quality of life: Health care is another area where technology has improved civilization. For instance, getting a doctor’s appointment no longer needs hours of waiting or outpatient care. Patients can also check office hours and organize hospital visits on their phones. Medical procedures are faster and more efficient thanks to technology. For instance, many hospitals and clinics use healthcare document scanners to digitize old patient information. Digitizing patient records lets any healthcare team member view them with a computer. Additionally, secure data storage on a website or app reduces the risk of losing or forgetting patient records [16].

  • Patient independence and autonomy: Patients can manage and control their data in ICT-enabled healthcare systems, giving them independence and full access. Data security requires that no unauthorized person accesses patient data. Additionally, socially, it can enhance health outcomes, patient trust, and engagement in modern healthcare systems [132].

  • Real-time diseases monitoring: Integration positively impacts society by enabling the development and consistency of real-time plans for managing diseases or outbreaks in a region through data collection and prompt responses [133]. In particular, ICT-enabled healthcare systems lower the cost of healthcare providers like physicians or analysts traveling to a location to collect data for analysis. E-Health systems aid healthcare providers and policymakers in making informed decisions and responding to public health emergencies, promoting environmentally conscious cultures during epidemics like COVID-19 [134].

  • Mental health treatment: The WHO’s 2020–2025 global plan on digital health is one of many national and international attempts to promote digital technologies in mental healthcare. Digital health technologies can be used to collect and share health data and treat patients, strengthening mental healthcare systems. According to consistent empirical analysis, Telemedicine and virtual therapy have enhanced mental health treatment delivery. Digitalization, a key health factor, is becoming recognized for its potential to enhance health outcomes and modify mental healthcare access [33].

  • Equity healthcare services culture: Health equity assures that individuals, groups, and communities can reach their full health potential by eliminating social, economic, and environmental inequities. This includes equitable medical care, nutritious food, and safe housing. ICT can reduce health inequities by making healthcare more affordable and accessible. Telehealth and remote consultations reduce travel costs and connect underserved and rural areas to healthcare services [135].

  • Social well-being and spatial barriers: By delivering user-friendly, inexpensive, and easily available communication technologies, technology can improve geriatric social engagement and well-being. Instant messaging, email, and multimedia communication are possible on these devices anytime. Social success requires external and internal factors, such as being in a relationship and being happy. Technology-based communication can improve social well-being for elders by providing free access to information, secure health services, and user-friendly gadgets with identity verification and connectivity features [136].

4.3.2 Blockchain Technology impacts on sustainability

Blockchain Technology has the potential to help achieve sustainability goals, especially in healthcare, and stimulate society. This work will also discuss the positive social benefits of adopting ICT into healthcare systems. Blockchain Technology could improve healthcare’s sustainability in the following ways.

  • Environmental impact: Many corporations, including hospitals, plan to integrate ICT technologies into their programs and operations to lessen their environmental impact. Some ICT integrations harm businesses and society. Blockchain Technology has been questioned for its environmental impact when employed in ICT-based corporate processes for consensus mechanisms like Bitcoin’s proof-of-work (PoW). To decrease this impact, Ethereum switched to the proof-of-stake (PoS) consensus process, which is more energy-efficient than PoW. This change will reduce the network’s negative social and environmental effects [137, 138].

  • Social impact: The introduction of Blockchain Technology has greatly impacted societal progress and development by increasing access to data and information and transforming traditional networks into collaborative value networks [139]. With Blockchain Technology and socially beneficial applications like cryptocurrencies, the goal is to develop sustainable behavior-based apps to use smart contracts and promote long-term sustainability. Cryptocurrencies like Bitcoin assist society by eliminating the need for trusted third parties in financial transactions and providing a safe way to move and store wealth. Additionally, these coins invest in social and environmental good. In healthcare, insurance firms use Blockchain Technology and smart contracts to audit and monitor funds without an intermediary, ensuring trustworthy parties make changes [140].

  • Economical impact: The benefits of Blockchain Technology for businesses and consumers are boosted by global environmental and social issues, including financial inclusion. According to [141], Blockchain Technology is a crucial tool for achieving the G20 agenda’s goal of promoting economic involvement in businesses and benefiting society. Financial inclusion criteria must be defined to help more people and companies use Blockchain Technology to exploit economic opportunities. These criteria cover using financial services, investing in businesses, saving for retirement, protecting oneself from financial loss, and paying for education. Healthcare spending may increase opportunities, human capital, efficiency, and economic growth by applying the same principle [142].

4.3.3 Negative impacts

We highlight both the pros and cons of this integration into society. Here are the drawbacks of digital transformation, including ICT and Blockchain Technology in healthcare:

  • Cost: Digitalizing healthcare systems has benefits for service development, but it comes with substantial costs for design, implementation, and deployment [143]. However, new ICT technologies and systems are making medical treatment expensive, and patients must pay high fees for even minor procedures, which may be passed on to them in the form of higher healthcare costs. Ultimately, digitalization increases financial burdens for patients, particularly those without insurance or subsidies [9].

  • Technical knowledge: Stakeholder and end-user technical skills are among the biggest barriers to integrating ICT technologies into healthcare. The installation, configuration, and implementation of the latest ICT systems and their underlying technologies with existing health systems can be burdensome for system developers and administrators, and users may need specialized knowledge and training. Patients may experience delays in treatment requests, data loss during system upgrades, and technological issues that impact medical treatment delivery [144].

  • Doctor–patient interaction: Digitising healthcare systems can lead to less face-to-face interaction between doctors and patients, hindering honest conversations and trust-building [145]. Digital health technologies like telehealth have led to patients receiving appointments and medication suggestions over the phone, potentially reducing the personal connection and compassion between patients and medical professionals [146].

  • Patient’s information privacy: EHRs and other patient data are vulnerable to hacking and other unauthorized access due to the growing use of ICT and other digital technologies in healthcare systems. Inappropriate access to patient data can result in identity theft, discrimination, and other negative consequences [82].

  • Over-relience of ICT technology: Healthcare systems are becoming more complex and computerized. Therefore, patients and physicians are using them for diagnosis and treatment. The reliance on digital systems can pose risks for doctors and patients if the technology fails or is compromised, potentially resulting in patient deaths [147].

  • Increased social imbalance: Unfortunately, not everyone has simple access to the technologies they need to engage in this digital world. Not all E-Health patients can access digital health technologies, which may lead to healthcare benefits and service disparities. Thus, this challenge may worsen social and economic inequality and lower health outcomes for vulnerable people [148].

5 Future research directions and implications of our study

This section discusses future research directions that will increase researchers’ ability to solve challenges in future solutions, as well as the implications of our findings across multiple disciplines.

5.1 Future research directions

  • Interoperability: Another significant challenge to Blockchain Technology adoption in many industries is interoperability, which is necessary for information exchange and speedy decision-making. Interoperability in E-healthcare systems requires common technological standards for constructing and designing systems to share information and work together. There is no single protocol for Blockchain Technology interoperability; therefore, different Blockchain Technology networks may have trouble exchanging data [149]. In Blockchain Technology-based healthcare models, interoperability involves combining smart contracts, record keeping, and consensus mechanisms, which can be difficult to integrate and maintain [150].

  • Security and privacy: EHR security involves confidentiality (hiding sensitive information from unauthorized users) and integrity (keeping accurate data). In unprotected EHR environments, adversaries can change stored data, resulting in false data. Thus, protecting saved data against threats and attempts to alter it is difficult [151]. Additionally, authorization is crucial for E-Health security, ensuring only authorized users access sensitive patient data in EHR systems. Offenders may use stolen credentials to access critical patient data [152]. Additionally, data ownership is crucial in healthcare, including “who owns the data” and “who has access to it”; attackers can alter ownership data to invalidate it. Blocking unlawful access to ownership data is crucial to system security [153].

  • Use of trusted storage options: Healthcare providers and organizations must emphasize patient data security and privacy in the face of non-trusted storage by using trusted systems and strong security measures. Establishing distributed secure networks, using advanced encryption to transfer data, implementing adequate authorization and access control, and regularly monitoring and recording suspicious activity can achieve this [154, 155].

  • Increased volume of health data: The use of Blockchain Technology in healthcare has many benefits, including data security, but the influx of patient data from smart sensing IoT devices and E-Health has created challenges for data collection and management [156]. Healthcare has been a leading Blockchain Technology user for collecting and analyzing huge amounts of data. Blockchain Technology is designed to address centralization issues by storing transaction data on a distributed, tamper-proof ledger with limited data and minimal storage needs [157]. In this context, decentralized parties must provide massive amounts of patient data to all Blockchain Technology nodes, including medical history, test samples, diagnosis images, Computed Tomography (CT) scans, etc. The increased volume of patient transactions slows record searching and access, making it unsuitable for many transactions. Therefore, a Blockchain Technology solution must be robust and scalable. Blockchain Technology’s transactional nature leads to rapid database growth [158].

  • Social and cultural adoption barrier: Blockchain Technology is still in its infancy and faces social and cultural shifts in addition to technical challenges, making it unsuitable for designing efficient and reliable healthcare solutions, which requires a new way of thinking about how to do things. Although the healthcare sector is gradually adopting Blockchain Technology, academia and industry must work together to solve challenges and fully transition to this new system [159]. For instance, it’s crucial to debate how to convince the healthcare business and patients to switch to cutting-edge technology that encourages autonomy, transparency, and security. Due to its low adoption and failure in the health field, Blockchain Technology and its benefits are also questioned. Due to challenges and risks, it cannot be considered a complete solution for healthcare industry issues [10].

  • Medical industry settings/Standards: The medical industry comprises many entities and parties, each with its norms and regulations. With the expansion of ICT technologies like Blockchain Technology and the current needs of health organizations, various authenticated and accepted standards from global standardization authorities are needed. Blockchain Technology will encounter standardization challenges in its early stages before being widely used in healthcare and medical [160]. Therefore, medical researchers must identify the necessity for predefined criteria to specify the volume, kind, and structure of Blockchain Technology-based data sharing. These standards will also verify and secure shared data.

5.2 Implications of our study

Valuing ICT innovations, particularly Blockchain Technology, is necessary to address healthcare sustainability issues. Due to their promising performance in other industries like banking, supply chain management, healthcare, and well-being, decision-makers should introduce and support Blockchain Technology-based apps to boost E-Health. Due to a few negative effects of digital technology, the government and related organizations should adopt policies to address E-Health issues. Further ramifications of our findings include:

  • Security and privacy implications: Our study affects secure and private third-party storage, analysis, and sale of sensitive medical data. Health information is given to associated businesses. Businesses must assess the feasibility of using Blockchain technologies to improve control, privacy, and authenticity. Decision-makers must support patients in owning and maintaining their patient data instead of sharing it with healthcare providers. These steps can help healthcare providers resolve legal and ethical difficulties.

  • Stakeholder implications: Considering ICT and Blockchain Technology problems, our study’s conclusions should wake up the healthcare industry, which needs strategic collaborations to ensure resource availability. Healthcare corporations must build stronger partnerships with funders, training institutions, and medical research and development agencies.

  • Research and development implications: For future sustainability research in E-Healthcare, our findings suggest that academia and researchers should investigate the sustainability-related challenges of ICT integration in the healthcare sector instead of just providing an overview.

6 Conclusion

Healthcare reform that improves access, quality, and productivity relies more on disruptive ICT technology. Integrating ICT technology into healthcare systems is challenging due to integration, application design, and security issues. Despite numerous studies on ICT in healthcare systems, a comprehensive study is needed on integration and design, security and privacy, application domains, and potential benefits and drawbacks. After finishing this investigation, we made the following contributions that may benefit the research community. The study begins with a taxonomy of literature on healthcare ICT integration. We compare our proposed study to previous studies, focusing on sustainability, security and privacy, design and integration, E-Health applications, and future healthcare ICT integration directions. Second, we analyze the need for digital transformation in healthcare, its key components, E-Health’s benefits and importance, its integration and design obstacles, and its security and privacy issues. Third, we address Blockchain Technology’s role in E-Health, its characteristics, benefits, and various use cases. From a sustainability perspective, we analyze the pros and cons of ICT integration, particularly Blockchain Technology, on health systems. Finally, we argued that Blockchain Technology makes E-Health more sustainable. We also identified six challenges that render Blockchain Technology-based health systems unjust to stakeholders. Our study helps future research studies choose the best option by addressing these challenges and giving solutions.

In addition to concluding the accomplishment of our objectives, we have also identified several limitations that may have implications for the technological advancement of ICT in the direction of sustainability and best practices.

  • The study underscores the significance of establishing resilient cybersecurity protocols. It is critical to fortify data privacy and security measures to protect confidential information, technological solutions for encryption, and data protection frameworks to alleviate privacy risks and retain individual rights.

  • For sustainable growth and fairness in society to truly develop, it is crucial that we come together to eradicate the technological gap and ensure that every single person has equal access to the incredible world of technology-related resources.

  • Making significant headway towards long-term, sustainable information, and communication technology solutions requires close cooperation and teamwork.

  • This research study is seriously shedding light on something super important—we need to prioritize sustainability when developing and using ICT technologies.