Title:
Two-level Security Approach for Secure EHR Sharing via Blockchain and Cryptography

Authors:
Gayathri Hegde M, P Deepa Shenoy, Venugopal K R, India

Abstract:

Electronic Health Records (EHRs) have transformed healthcare by enabling the easy sharing of information, but large-scale deployment is raising important privacy, security, and effectiveness issues. Existing EHR-sharing infrastructures are biased toward single-layer cryptographic methods, which either limit performance or leave emergency and real-time applications vulnerable to weaknesses. To address these limitations, we present a two-level security solution that combines blockchain and cryptography to provide timely access while preserving privacy. Our research exhaustively compares symmetric (AES, XChaCha20) and asymmetric (RSA, ECC, ECDSA) cryptographic algorithms on medical records of varying sizes, showing that XChaCha20 and ECC dramatically outperform the others in encryption/decryption time. Building on these findings, we develop and deploy a blockchain-supported framework that uses dual-layer encryption to store and transfer EHRs over IPFS securely. The system is tested in a medical context during surgical second opinions, where EHRs are shared. Experimental results demonstrate that two-level security using XChaCha20 and ECC is reliable and effective. Hence, this method enhances EHR confidentiality, integrity and availability without compromising the practical needs of healthcare decision-making.

DOI: http://dx.doi.org/10.51505/ijaemr.2025.1505