SecureEdge-MedChain: A Post-Quantum Blockchain and Federated Learning Framework for Real-Time Predictive Diagnostics in IoMT

The burgeoning Internet of Medical Things (IoMT) offers unprecedented opportunities for real-time patient monitoring and predictive diagnostics, yet the current systems struggle with scalability, data confidentiality against quantum threats, and real-time privacy-preserving intelligence. This paper introduces Med-Q Ledger, a novel, multi-layered framework designed to overcome these critical limitations in the Medical IoT domain. Med-Q Ledger integrates a permissioned Hyperledger Fabric for transactional integrity with a scalable Holochain Distributed Hash Table for high-volume telemetry, achieving horizontal scalability and sub-second commit times. To fortify long-term data security, the framework incorporates post-quantum cryptography (PQC), specifically CRYSTALS-Di lithium signatures and Kyber Key Encapsulation Mechanisms. Real-time, privacy-preserving intelligence is delivered through an edge-based federated learning (FL) model, utilizing lightweight autoencoders for anomaly detection on encrypted gradients. We validate Med-Q Ledger’s efficacy through a critical application: the prediction of intestinal complications like necrotizing enterocolitis (NEC) in preterm infants, a condition frequently necessitating emergency colostomy. By processing physiological data from maternal wearable sensors and infant intestinal images, our integrated Random Forest model demonstrates superior performance in predicting colostomy necessity. Experimental evaluations reveal a throughput of approximately 3400 transactions per second (TPS) with ~180 ms end-to-end latency, a >95% anomaly detection rate with <2% false positives, and an 11% computational overhead for PQC on resource-constrained devices. Furthermore, our results show a 0.90 F1-score for colostomy prediction, a 25% reduction in emergency surgeries, and 31% lower energy consumption compared to MQTT baselines. Med-Q Ledger sets a new benchmark for secure, high-performance, and privacy-preserving IoMT analytics, offering a robust blueprint for next-generation healthcare deployments.