A hybrid blockchain migration framework for converting traditional databases into blockchain-based EMR systems

Area of Science:

• Health Informatics
• Computer Science
• Cybersecurity

Background:

• Traditional relational databases in Electronic Medical Records (EMRs) struggle with integrity, auditability, and compliance demands.
• Existing systems lack robust mechanisms for tamper-evident logging and regulatory adherence in healthcare.

Purpose of the Study:

• To propose and evaluate a Hybrid Blockchain Migration Framework for EMR systems.
• To integrate conventional MySQL EMRs with a permissioned blockchain (Hyperledger Fabric) for improved security and compliance.
• To assess the performance and overhead of the hybrid architecture.

Main Methods:

• Developed a middleware layer (Java Spring Boot) to monitor EMR changes and commit data hashes to a permissioned blockchain.
• Integrated OpenMRS (MySQL-based EMR) with Hyperledger Fabric.
• Conducted benchmark analyses comparing the hybrid system against standalone MySQL and full-blockchain implementations.

Main Results:

• The hybrid architecture achieved near-native responsiveness (2.1 ms latency) and high throughput (480 TPS).
• It demonstrated enhanced data integrity and auditability, supporting regulatory compliance (e.g., Oman's PDPL).
• The system incurred modest resource overhead (47% CPU, 1.15 GB RAM).

Conclusions:

• The proposed hybrid framework offers a viable solution for enhancing EMR security, integrity, and compliance.
• It balances the performance of SQL databases with the auditability of blockchain technology.
• The framework is scalable for multi-institutional use and facilitates blockchain adoption in clinical settings.