EMR-Chain: Decentralized Electronic Medical Record Exchange System
Ching-Hsi Tseng, Yu-Heng Hsieh, Heng-Yi Lin, Shyan‐Ming Yuan · Technologies · 2025
Current systems for exchanging medical records struggle with efficiency and privacy issues. While establishing the Electronic Medical Record Exchange Center (EEC) in 2012 was intended to alleviate these issues, its centralized structure has brought about new attack vectors, such as performance bottlenecks, single points of failure, and an absence of patient consent over their data. Methods: This paper describes a novel EMR Gateway system that uses blockchain technology to exchange electronic medical records electronically, overcome the limitations of current centralized systems for sharing EMR, and leverage decentralization to enhance resilience, data privacy, and patient autonomy. Our proposed system is built on two interconnected blockchains: a Decentralized Identity Blockchain (DID-Chain) based on Ethereum for managing user identities via smart contracts, and an Electronic Medical Record Blockchain (EMR-Chain) implemented on Hyperledger Fabric to handle medical record indexes and fine-grained access control. To address the dual requirements of cross-platform data exchange and patient privacy, the system was developed based on the Fast Healthcare Interoperability Resources (FHIR) standard, incorporating stringent de-identification protocols. Our system is built using the FHIR standard. Think of it as a common language that lets different healthcare systems talk to each other without confusion. Plus, we are very serious about patient privacy and remove all personal details from the data to keep it confidential. When we tested its performance, the system handled things well. It can take in about 40 transactions every second and pull out data faster, at around 49 per second. To give you some perspective, this is far more than what the average hospital in Taiwan dealt with back in 2018. This shows our system is very solid and more than ready to handle even bigger workloads in the future.