Patient-Centric Secure Medical Record Sharing on Ethereum: Topic Analysis and Proof-of-Concept

Abstract

This paper investigates Ethereum-based smart contracts as a decentralized cybersecurity governance layer for Electronic Medical Records (EMRs). It addresses challenge of fragmented healthcare data silos and strict compliance requirements for electronic protected health information (ePHI), such as HIPAA and GDPR by analyzing how blockchain technology enables explicit, patient-centric access control. Current legacy systems often centralize authorization, creating vulnerablilities. Through topic analysis and a Solidity-based Proof of Concept (PoC), the study demonstrates a hybrid architecture that uses on-chain execution for permission management while storing sensitive clinical data off-chain. The PoC shows how immutable ledger entries enforce least-privilege principles, block unauthorized queries, and provide tamper-evident auditability. The architecture’s trade-offs between enhanced accountability, patient sovereignty, and practical limitations in scalability, governance, and costs are assessed. It concludes that while blockchain offers a robust trust layer, integration with off-chain interoperability standards remains essential for clinical adoption.