Sharing Electronic Health Record (EHR) data is critical for improving medical decision-making and emergency care. However, EHRs contain sensitive patient information, making data breaches and misuse a significant concern during sharing. To tackle this challenge, we propose the Blockchain-Based Secure Access and Sharing (BCAS) scheme, a patient-centered, secure, and efficient solution for large-scale EHR access and sharing that intelligently combines blockchain with proxy re-encryption. Four smart contracts are designed for the BCAS to achieve effective user identity registration, precise virtual identity verification, strict access control, and secure data management. The adoption of hybrid on-chain and off-chain storage structures, coupled with the four smart contracts, effectively optimizes the efficiency of the blockchain in BCAS. Proxy re-encryption further enhances data confidentiality and streamlines EHR sharing among authorized users. The security analysis indicates that BCAS can resist DDoS, spoofing, and man-in-the-middle attacks, ensuring the privacy and security of patient EHR data. The performance evaluation demonstrates that the CPU usage of smart contracts does not exceed 15%. The on-chain and off-chain storage structures require less than 30s for uploading and downloading an 800MB file. Additionally, the proxy re-encryption scheme can process a 10MB file in less than 43ms. These results indicate that BCAS offers efficient performance without compromising data security and privacy. Compared with existing blockchain-based EHR sharing systems, BCAS offers superior performance, a more comprehensive solution, and increased resistance to attacks.
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