Conceptualising a blockchain-based framework for interoperable health data sharing between state-level public health systems

Health data sharing remains a critical yet underdeveloped component of many state-level public health systems, often hindered by fragmented infrastructures, poor interoperability, and limited trust among stakeholders. This study develop a conceptual framework to support secure, interoperable state-boundary health data exchange based on blockchain. Based on a desk-based, thematic synthesis approach informed by the Socio-Technical Systems (STS) Theory, the paper incorporates technology, organisation, and governance aspects in one standard model. It comprises the following major elements: data layers, a permissioned blockchain structure, interoperability (e.g., HL7, FHIR) rules, role-based access control measures and participation of state-level players, e.g., Ministries of Health and state-run hospitals. The model focuses on applying smart contracts to control the process of managing consent, validating transactions with data integrity, and compliance with privacy regulations. The suggested system has several advantages: allowing access to the data in real-time across health institutions, ensuring the higher accuracy of the data, better fraud detection in health financing, and a stronger epidemic tracking and surveillance capacity. Along with its promise, the study also singles out significant implementation barriers such as legal uncertainty, deficiencies in the levels of trust, technology illiteracy, infrastructure investment, and legacy system integration challenges. It has been recommended that enabling regulatory frameworks be developed, capacity building, adoption of international data standards, and pilot in controlled environments. This conceptual approach adds to the discussion of the digital health revolution, introducing a large and safe framework suitable for decentralised health governance. It underlines the possibility of blockchain technology to eliminate ineffectiveness in protecting patient data and enhance inter-state cooperation. The research results provide strategic advice to policy-makers, health administrators, and technology developers who want to modernise the public health information system with innovative/sustainable digital infrastructure.