Blockchain-Based Electronic Health Record Management Using Hyperledger Fabric and IPFS: Architecture, Security Analysis, and Performance Benchmarking

Electronic Health Records (EHRs) represent a critical information infrastructure in modern healthcare, yet centralised EHR systems remain vulnerable to single-point-of-failure attacks, unauthorised access, data tampering, and lack of patient-controlled consent mechanisms. India's National Digital Health Mission (NDHM), launched in 2021 under the Ayushman Bharat Digital Mission (ABDM) framework, mandates interoperability across 600,000+ health facilities through a federated health ID and linked health record architecture, creating an urgent need for tamper-evident, auditable, and privacy-preserving EHR management infrastructure. This paper proposes and evaluates a permissioned blockchain-based EHR management system built on Hyperledger Fabric 2.4 with InterPlanetary File System (IPFS) hybrid storage, implementing attribute-based access control (ABAC) smart contracts for fine-grained patient consent management. The proposed architecture stores cryptographic hashes and access control metadata on-chain while delegating encrypted EHR document storage to IPFS, achieving a 7.3× reduction in on-chain storage cost versus full on-chain storage. Performance benchmarking using Hyperledger Caliper demonstrates a sustained transaction throughput of 450 TPS with average confirmation latency of 28 ms at block size 50 — outperforming Ethereum PoW (14 TPS, 8,500 ms) and matching Hyperledger Fabric with Kafka consensus (520 TPS) at significantly lower infrastructure complexity. Security analysis across six attributes — data integrity, access control, auditability, privacy, availability, and non-repudiation — demonstrates superiority over centralised EHR alternatives on five of six dimensions. A six-month operational audit across three simulated hospital nodes records 99.2% authorised access compliance with 0.3% anomalous access attempts successfully detected and blocked by smart contract policy enforcement.