The healthcare sector faces new challenges with digital transformation, particularly in securing Electronic Health Records (EHRs) throughout their lifecycle. Blockchain technology has emerged as a solution, promising security for transactions, including those involving Internet of Things (IoT) data. In this paper the detailed multitier blockchain framework tailored for healthcare systems, ensuring trust and privacy within internal transactions is introduced. The previously proposed algorithm, Pseudonym Based Encryption with Different Authorities (PBE-DA), is used to establish virtual patient identities within the proposed multi-tier IoT-EHRs systems for privacy preservation. Unlike traditional methods using public/private key pairs, PBE-DA and Healthcare Trust Control (HTC) are utilized, integrating ripple blockchain for privacy, mutual authentication, trustworthiness, data integrity, and availability. The proposed framework minimizes computational demands by eliminating minor competition, with HTC overseeing miner activities and selecting optimal solutions. Moreover, security evaluation and threat analysis are provided to contribute toward a robust, secure, and smart healthcare system, utilizing the most common attack analysis.