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International Journal of Advanced Engineering Application

ISSN: 3048-6807

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Blockchain-Based Decentralised Electronic Health Record Management

Author(s):Rahul Tiwari, Ananya Mishra. Vikram Singh Rajput

Affiliation: Department of Computer Science and Engineering, Harcourt Butler Technical University, Kanpur, Uttar Pradesh

Page No: 64-68

Volume issue & Publishing Year: Volume 3, Issue 5, 2026/05/08

Journal: International Journal of Advanced Engineering Application (IJAEA)

ISSN NO: 3048-6807

DOI: https://doi.org/10.5281/zenodo.17624314

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Abstract:
Electronic Health Records (EHR) fragmentation across multiple healthcare providers represents a critical systemic failure in India's health information infrastructure, resulting in unnecessary repeat diagnostic testing, medication errors from incomplete clinical histories, delayed emergency treatment due to inaccessible records, and significant patient burden from manual medical record transportation. The Ayushman Bharat Digital Mission (ABDM), launched in 2021, provides a regulatory and infrastructure framework for unified health ID-based EHR sharing, but the centralised Health Data Fiduciary architecture raises data sovereignty and single-point-of-failure concerns. This study presents the design, implementation, and performance evaluation of a permissioned blockchain-based EHR management system using Hyperledger Fabric 2.4 that enables patient-controlled, cryptographically auditable medical data sharing across a multi-provider consortium without relying on a central data authority. The architecture implements a three-channel design — patient demographics, clinical records, and consent management — with ABAC (Attribute-Based Access Control) enforcing granular patient consent at the data element level. Off-chain IPFS storage of large DICOM imaging files with on-chain content-addressed hash anchoring addresses the blockchain storage scalability limitation. Chaincode smart contracts implement ABDM FHIR R4 data exchange standards, enabling interoperability with existing hospital HMIS systems via REST API adapters. Performance benchmarking on a four-organisation Hyperledger Fabric network deployed on AWS EC2 instances demonstrates transaction throughput of 842 TPS (ENDORSEMENT + ORDERING + COMMIT) with 2.1-second end-to-end latency at 64 concurrent peer nodes, exceeding the 600 TPS minimum requirement for a district-level (500,000 patient) deployment scenario. Security analysis confirms resistance to Sybil attacks, 51% attacks (permissioned consensus), and DICOM file tampering via SHA-256 content addressing.

Keywords: blockchain, electronic health records, Hyperledger Fabric, FHIR, interoperability, patient data sovereignty, ABDM, smart contracts, IPFS, healthcare informatics

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