Engineering a Permissioned Blockchain Architecture for Cross-Institutional EHR Sharing
Blockchain; Healthcare; Electronic Health Records (EHR); Data Sharing; Data Security; Hyperledger Fabric.
The healthcare industry faces critical challenges in managing Electronic Health
Records (EHRs), particularly regarding data security, interoperability, and patient privacy.
Traditional centralized systems often lead to fragmented data storage, vulnerabilities, and
inefficiencies that compromise care and integrity. This dissertation explores how blockchain
technology—leveraging decentralization, immutability, and transparency—can enhance se-
cure and interoperable EHR management. A systematic mapping study of 35 peer-reviewed
papers from Scopus highlighted blockchain’s potential to improve interoperability, security,
and patient control, while also identifying ongoing concerns with scalability, privacy, and
regulatory compliance. In response, this work proposes a blockchain-based architecture
that defines clear functional and non-functional requirements focused on security, interop-
erability, and consent management. The solution integrates smart contracts, consensus
mechanisms, and a permissioned blockchain network to enable robust, auditable data
exchange across healthcare institutions. A proof-of-concept (PoC) built using Hyperledger
Fabric demonstrates secure EHR transactions, fine-grained access control, and patient-
driven consent management. The PoC was validated against defined Quality of Service
(QoS) metrics, confirming technical feasibility and alignment with system goals. This
research contributes a viable architectural approach for secure and efficient EHR sharing
and lays the foundation for future work on scalability, infrastructure integration, and
regulatory alignment.