Recent years have seen a paradigm shift in the data sharing and interoperability of Electronic Health Records (EHRs), especially in cloud environments. EHR systems traditionally used to exchange health information amongst healthcare stakeholders have been criticized for centralizing power, failures, and attack points with the exchange data custodians. However, this paradigm also raises many concerns about data privacy and security for ehealth systems. Blockchain promises to address the many EHR challenges, primarily trust-less and secure health information exchange among stakeholders.

This study considered 15 healthcare models and frameworks based on Blockchain that discussed theoretical, technical, and architectural viewpoints that addressed interoperability, privacy, security, cost, and performance dimensions. Based on that, it presents a novel EHRs interoperability framework that combines Blockchain, cloud, and decentralized data sources among multiple healthcare ecosystems based on the strict-layered topology. The empirical results show that our framework provides an effective solution for interoperability and reliable data exchanges while preserving sensitive health information against potential threats.
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