The main frustration was fundamental when we were initially sitting down to design this system; a patient who comes to visit a new specialist still has to bring a folder of printed reports, a CD with their MRI still would like to be functional, and thus figure out their history anew. That fact inspired us to create something of quality. The given paper provides an overview of the working prototype of a medical record management system combining MERN web stack (MongoDB, Express.js, React.js, Node.js) and Ethereum smart contracts and IPFS-supported decentralised file storage. Patient, doctor and administrator are three user roles that engage using purpose-specific dashboards. Documents are uploaded by patients, hashed, pushed into IPFS and registered on-chain, after no metadata in the database even interacts with the data; when physicians access the file, the patient can only acquire files after the wallet signs an on-chain grant. Test on Polygon Amoy testnet produced 500 or more transactions, with an average gas price of about 0.0001 MATIC per transaction – would be insignificant in the real world. A small user study (n=20) gave an average score of 4.4 of out of 5 in regard to satisfaction. But the more significant discovery is architectural: a separation of responsibilities between a typical web layer and a blockchain audit layer is sufficient to enable the system to be sufficiently fast to use in everyday clinical practice, and yet be able to produce cryptographically verifiable evidence of who accessed a record and when.

Our goal was to create a medical record system which a patient could really trust that is, where only my doctor can have access to this is not a privacy policy, but actually implemented by mathematics. The system as outlined in this paper is much closer to that objective than a traditional EHR. Locating consent events and file hashes on the Ethereum blockchain and storing large files on IPFS and frequent queries in MongoDB provides the architecture with performance which can be trusted by clinical workflows and security which pure web systems cannot match.security guarantees that pure web systems cannot match. The assessment findings are positive: all the designed func- tionalities are functional, reaction time is good, expenditure on the gas is insignificant, and most of the users who took part in the test gave the experience a good rating. The flaws are not imaginary either: there is no third-party security review, no HIPAA compliance test, a limited user study, or even the testnet that does not necessarily replicate the real production environment. We have attempted to be frank about our gaps instead of making the best of it. The most generalisable thing in this work, in my opinion, is the architecture principle: blockchain is not a database or file system; it is a tool of a particular issue, namely demonstrating that something occurred at a particular time and that one cannot change the record of it. When used this linearly, with selective use, together with proven web technologies, it brings a level of value to the management of healthcare data. Hopefully, the design decisions and code and evaluation data explained in this paper will be useful to researchers and engineers on the path towards the same end.

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