Laercio Alencar

The digitization of healthcare has generated massive volumes of Electronic Health Records (EHRs), offering unprecedented opportunities for training Artificial Intelligence (AI) models. However, stringent privacy regulations such as GDPR and HIPAA have created data silos that prevent centralized training. Federated Learning (FL) has emerged as a promising solution that enables collaborative model training without sharing raw patient data. Despite its potential, FL remains vulnerable to poisoning and Sybil attacks, in which malicious participants corrupt the global model or infiltrate the network using fake identities. While recent approaches integrate Blockchain technology for auditability, they predominantly rely on probabilistic reputation systems rather than robust cryptographic identity verification. This paper proposes a Trustworthy Blockchain-based Federated Learning (TBFL) framework integrating Self-Sovereign Identity (SSI) standards. By leveraging Decentralized Identifiers (DIDs) and Verifiable Credentials (VCs), our architecture ensures only authenticated healthcare entities contribute to the global model. Through comprehensive evaluation using the MIMIC-IV dataset, we demonstrate that anchoring trust in cryptographic identity verification rather than behavioral patterns significantly mitigates security risks while maintaining clinical utility. Our results show the framework successfully neutralizes 100% of Sybil attacks, achieves robust predictive performance (AUC = 0.954, Recall = 0.890), and introduces negligible computational overhead (<0.12%). The approach provides a secure, scalable, and economically viable ecosystem for inter-institutional health data collaboration, with total operational costs of approximately $18 for 100 training rounds across multiple institutions.