A Blockchain-Enabled Secure Framework for Electronic Health Records Sharing: Architecture, Implementation, and Performance Evaluation

Abstract

The widespread digitization of contemporary healthcare infrastructure has catalyzed an unprecedented transition toward electronically managed patient data, fundamentally reshaping the operational landscape of medical institutions. While Electronic Health Record (EHR) systems have substantially improved clinical efficiency, care coordination, and administrative responsiveness, the prevailing reliance on centralized data management architectures introduces critical vulnerabilities, including unauthorized intrusion, systemic data corruption, catastrophic single-point failures, and persistent privacy breaches that compromise confidential patient information. Equally pressing is the challenge of enabling reliable, auditable, and consent-governed information exchange across disparate healthcare organizations engaged in collaborative diagnosis, translational research, and longitudinal patient care. In response to these deeply entrenched challenges, the present study introduces a comprehensive, permissioned blockchain-based framework specifically engineered for the secure and interoperable sharing of EHR data. The proposed system integrates off-chain encrypted record storage with on-chain metadata management, deploys smart contract-driven access control mechanisms, and enforces accountability through immutable audit logging. Patient-centric data governance is realized through a dynamic permission model that allows granular control over granting, monitoring, and revocating access to personal health records. Data authenticity and non-repudiation are maintained through cryptographic digital signatures and deterministic hash verification, while smart contracts automate compliance enforcement aligned with established data protection standards such as HIPAA and GDPR. The architecture employs lightweight consensus protocols and indexed retrieval strategies that significantly reduce latency without compromising security guarantees. Empirical evaluation against three benchmark systems reveals that the proposed framework achieves superior performance across twelve quantitative dimensions, including authentication accuracy (97.8%), transaction throughput (104 TPS), hash verification success (99.5%), and attack detection efficacy (96.7%). The study confirms that blockchain-enabled decentralization, when combined with hybrid storage and cryptographic controls, offers a transformative and scalable approach to the pressing interoperability and security deficits of modern healthcare data ecosystems.