A secure, transparent, and decentralised framework for cross-domain healthcare data sharing using blockchain-based EHRs

Abstract

Secure, interconnected, and compatible data sharing of Electronic Health Records (EHRs) across healthcare domains is essential for timely patient care and improved adaptability in healthcare infrastructures. Current challenges must be addressed, including centralization threats, fragmented standards, and threats from quantum computing. This paper proposes a blockchain-based EHR framework using post-quantum cryptography and HL7 FHIR standards for secure, interoperable data sharing. It employs smart contracts for patient-centric access control and HotStuff BFT consensus, achieving 928 TPS with 2.1-second finalization. Zero-knowledge proofs enable privacy-preserving authentication, and dynamic accumulators improve revocation storage efficiency by 89%. On a 20-node testbed, the system sustains 620 TPS at 500 ms latency, with under three-second access grants and 95% storage efficiency via cryptographic pointers. Compared to current systems, it offers 20× higher throughput and resists quantum threats. Multi-hop exchange across three hospitals reduced normalization efforts by 40%. Comprehensive assessment on the system outcomes reveals that our framework significantly enhances security, scalability, and interoperability for decentralized healthcare networks.