MeDiStore trust protocol integrating reputation based proof of stake consensus for enhanced security of blockchain networks in electronic health record management

• Published in: Discover Computing Vol. 28; no. 1; pp. 167 - 24
• Main Authors: Sanober, Adla, Anwar, Shamama
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.12.2025; Springer Nature B.V; Springer
• Subjects: Blockchain; Computer Science; Cryptography; Curves; Data Mining and Knowledge Discovery; Data Structures and Information Theory; Electronic health records; Electronic health records (EHRs); Energy consumption; Ethereum blockchain; Health care; Information Storage and Retrieval; Interoperability; MeDiStore trust protocol; Natural Language Processing (NLP); Pattern Recognition; Performance evaluation; Privacy; Proof of stake (PoS); Security; Smart contract; Smart contracts; Sybil attacks; MeDiStore trust protocol; Ethereum blockchain; InterPlanetary file system (IPFS); Proof of stake (PoS); Smart contract; Electronic health records (EHRs); Sybil attacks
• ISSN: 2948-2992; 1386-4564; 2948-2992; 1573-7659
• DOI: 10.1007/s10791-025-09540-2

The rapid digitization of the healthcare sector has led to the generation of massive volumes of Electronic Health Records (EHRs), necessitating a robust, secure, and scalable system capable of efficiently managing and accessing this ever-growing data. Ensuring privacy, security, and scalability in managing voluminous and sensitive healthcare data, particularly when stored across various geographical locations, poses critical challenges that require innovative solutions. To address these issues, MeDiStore, a decentralized framework built on the Ethereum blockchain, is proposed. By integrating the InterPlanetary File System (IPFS), MeDiStore ensures scalable and secure storage while mitigating centralization risks and providing improved accessibility for EHRs. The framework leverages Elliptic Curve Cryptography (ECC) to encrypt and secure patient records, ensuring data ownership remains with the patient. To further enhance scalability, security, and reliability, of the blockchain network, the MeDiStore Trust Protocol, introduced a modified Proof of Stake (PoS) consensus mechanism that evaluates validators based on their network stake and reputation score, derived from their historical performance. Additionally, a Data Translation Layer is incorporated to ensure interoperability by converting EHRs into Fast Healthcare Interoperability Resources (FHIR) or Health Level 7 (HL7) systems without compromising security. Performance evaluation across 200 consensus rounds highlights metrics such as smart contract execution time, average IPFS file upload time, and reputation score behavior of validators. A comprehensive security analysis simulates Sybil attack scenarios, demonstrating the system's resilience through reputation-based validator selection. By integrating these factors, MeDiStore offers a scalable, secure, privacy-preserving, and interoperable solution tailored for efficient EHR management in the healthcare domain.