Trustworthy Intelligence: Split Learning–Embedded Large Language Models for Smart IoT Healthcare Systems

Abstract

The Internet of Things (IoT) plays an increasingly central role in healthcare by enabling continuous patient monitoring, remote diagnosis, and data-driven clinical decision-making through interconnected medical devices and sensing infrastructures. Despite these advances, IoT healthcare systems remain constrained by persistent challenges related to data privacy, computational efficiency, scalability, and regulatory compliance. Federated learning (FL) reduces reliance on centralised data aggregation but remains vulnerable to inference-based privacy risks, while edge-oriented approaches are limited by device heterogeneity and restricted computational and energy resources; the deployment of large language models (LLMs) further exacerbates concerns surrounding privacy exposure, communication overhead, and practical feasibility. This study introduces Trustworthy Intelligence (TI) as a guiding framework for privacy-preserving distributed intelligence in IoT healthcare, explicitly integrating predictive performance, privacy protection, and deployment-oriented system design. Within this framework, split learning (SL) is examined as a core architectural mechanism and extended to support split-aware LLM integration across heterogeneous devices, supported by a structured taxonomy spanning architectural configurations, system adaptation strategies, and evaluation considerations. The study establishes a systematic mapping between SL design choices and representative healthcare scenarios, including wearable monitoring, multi-modal data fusion, clinical text analytics, and cross-institutional collaboration, and analyses key technical challenges such as activation-level privacy leakage, early-round vulnerability, reconstruction risks, and communication–computation trade-offs. An energy- and resource-aware adaptive cut layer selection strategy is outlined to support efficient deployment across devices with varying capabilities. A proof-of-concept experimental evaluation compares the proposed SL–LLM framework with centralised learning (CL), federated learning (FL), and conventional SL in terms of training latency, communication overhead, model accuracy, and privacy exposure under realistic IoT constraints, providing system-level evidence for the applicability of the TI framework in distributed healthcare environments and outlining directions for clinically viable and regulation-aligned IoT healthcare intelligence.

Ähnliche Arbeiten