A Quantitative Landscape Analysis of Blockchain for EHR Security and Interoperability

Blockchain technology presents a transformative potential for enhancing the security and interoperability of Electronic Health Records (EHRs) by enabling decentralized, auditable, and tamper-evident management of health data without centralizing sensitive information. This computational meta-research conducts a quantitative landscape analysis of blockchain-based EHR systems, evaluating their architectural patterns, standards alignment, security mechanisms, and implementation maturity. Through systematic screening of PubMed and Scopus, 15 studies met the inclusion criteria, focusing on provider-operated EHR exchange with off-chain protected health information (PHI) and on-chain policies or audit trails. Results indicate that while systems like FHIRChain and ACTION-EHR demonstrate strong integration with HL7 FHIR standards and patient-centric access controls, full interoperability via SMART on FHIR or IHE profiles remains unrealized. Security features commonly include on-chain integrity verification and varied access models, though privacy-enhancing cryptography such as proxy re-encryption is inconsistently applied. Implementation maturity ranges from conceptual designs to pilot testing, with performance feasibility shown in permissioned setups that minimize on-chain computation. The findings underscore a persistent gap between architectural promise and production-ready, standards-complete solutions, highlighting the need for tighter bindings to end-to-end clinical workflows and rigorous cryptographic lifecycle management.