Electronic health records (EHRs) are important assets of the healthcare system and should be shared among medical practitioners to improve the accuracy and efficiency of diagnosis. Blockchain technology has been investigated and adopted in healthcare as a solution for EHR sharing while preserving privacy and security. Blockchain can revolutionize the healthcare system by providing a decentralized, distributed, immutable, and secure architecture. However, scalability has always been a bottleneck in blockchain networks due to the consensus mechanism and ledger replication to all network participants. Sharding helps address this issue by artificially partitioning the network into small groups termed shards and processing transactions parallelly while running consensus within each shard with a subset of blockchain nodes. Although this technique helps resolve issues related to scalability, cross-shard communication overhead can degrade network performance. This study proposes a transaction-based sharding technique wherein shards are formed on the basis of a patient’s previously visited health entities. Simulation results show that the proposed technique outperforms standard-based healthcare blockchain techniques in terms of the number of appointments processed, consensus latency, and throughput. The proposed technique eliminates cross-shard communication by forming complete shards based on “the need to participate” nodes per patient.

With the growing utility of blockchain technology, the desire for reciprocal interactions among different blockchains is growing. However, most operational blockchain networks currently operate in a standalone setting. This fragmentation in the form of isolated blockchains creates interoperability difficulties, inhibiting the adoption of blockchains in various ecosystems. Interoperability is a key factor in the healthcare domain for sharing EHRs of patients registered in independent blockchain networks. Each blockchain network could have its own rules and regulations, obstructing the exchange of EHRs for improving diagnosis and treatments. Examples include patients being treated by healthcare providers in different countries or regions, or within one country but with a different set of rules per state or emirate. By contrast, a federation of blockchain networks can provide better communication and service to stakeholders in healthcare. Thus, solutions for facilitating inter-blockchain communication in such a blockchain federation are needed. However, this possibility has not been fully explored, and further investigations are still being conducted. Hence, the present study proposes a transaction-based smart contract triggering system for inter-blockchain communication, enabling EHR sharing among independent blockchains. We use local and global smart contracts that will be executed once a transaction is created in the blockchain. Local smart contracts are used for EHR sharing within the blockchain, whereas global smart contracts are used for EHR sharing among independent blockchains. The experimental setup is conducted using the Hyperledger Fabric blockchain platform. Inter-blockchain communication between two independent fabric networks is conducted through a global smart contract using Hyperledger Cactus for EHR sharing in a health federation setup. To the best of our knowledge, our study is the first to implement an inter-blockchain communication model in the healthcare domain.