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<p>The secure, interoperable, and regulation-compliant management of electronic health records (EHRs) continues to be a critical challenge in modern healthcare due to fragmented data governance, privacy breaches, and limited scalability of centralized digital infrastructures. Existing blockchain-based healthcare systems, although promising, often suffer from performance bottlenecks, weak access control enforcement, and a lack of integration with healthcare interoperability standards such as FHIR/HL7. These limitations hinder the practical deployment of blockchain systems in real-world clinical environments. To address these challenges, this study proposes FabricMedChain, a decentralized healthcare framework built on Hyperledger Fabric for privacy-preserving, auditable, and scalable medical data management. The proposed model integrates a Delegated Proof of Stake (DPoS) consensus mechanism to enhance throughput and reduce latency, a chaincode-level Role-Based Access Control (RBAC) system to enforce patient consent and policy-driven data governance, and FHIR-compatible transaction mapping for standardized interoperability. Experimental evaluation using Hyperledger Caliper shows that FabricMedChain achieves up to 3.5× lower latency (0.07&#xa0;s vs. 0.24&#xa0;s), 50% higher throughput (1600 TPS vs. 1054 TPS), and 35–50% reduced resource consumption compared to RAFT and Kafka-based systems. Security and compliance analysis further confirm alignment with HIPAA and GDPR regulations. Overall, FabricMedChain introduces a novel integration of DPoS consensus and RBAC governance within Hyperledger Fabric, bridging blockchain performance with standardized healthcare informatics requirements. The framework establishes a robust foundation for secure, interoperable, and regulation-compliant EHR management across distributed healthcare ecosystems.</p>

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A Decentralized Solution for Smarter and Safer Healthcare Systems with FabricMedChain

  • 期刊论文

  • 发表日期：

    2026年1月5日

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  • Namdev M. Sawant,
  • Joanne Gomes

摘要

The secure, interoperable, and regulation-compliant management of electronic health records (EHRs) continues to be a critical challenge in modern healthcare due to fragmented data governance, privacy breaches, and limited scalability of centralized digital infrastructures. Existing blockchain-based healthcare systems, although promising, often suffer from performance bottlenecks, weak access control enforcement, and a lack of integration with healthcare interoperability standards such as FHIR/HL7. These limitations hinder the practical deployment of blockchain systems in real-world clinical environments. To address these challenges, this study proposes FabricMedChain, a decentralized healthcare framework built on Hyperledger Fabric for privacy-preserving, auditable, and scalable medical data management. The proposed model integrates a Delegated Proof of Stake (DPoS) consensus mechanism to enhance throughput and reduce latency, a chaincode-level Role-Based Access Control (RBAC) system to enforce patient consent and policy-driven data governance, and FHIR-compatible transaction mapping for standardized interoperability. Experimental evaluation using Hyperledger Caliper shows that FabricMedChain achieves up to 3.5× lower latency (0.07 s vs. 0.24 s), 50% higher throughput (1600 TPS vs. 1054 TPS), and 35–50% reduced resource consumption compared to RAFT and Kafka-based systems. Security and compliance analysis further confirm alignment with HIPAA and GDPR regulations. Overall, FabricMedChain introduces a novel integration of DPoS consensus and RBAC governance within Hyperledger Fabric, bridging blockchain performance with standardized healthcare informatics requirements. The framework establishes a robust foundation for secure, interoperable, and regulation-compliant EHR management across distributed healthcare ecosystems.