Collective Proxy Delegation forBlockchain-Based Electronic Health Record: Delegasi Proxy Kolektif Sebagai Pendekatan Akses Darurat Pada Rekam Medis Elektronik Berbasis Blockchain

Glen Mark Bonde; Alwin Melkie Sambul; Steven Ray Sentinuwo

doi:10.35793/qvtkw723

Authors

Glen Mark Bonde Universitas Sam Ratulangi Author
Alwin Melkie Sambul Universitas Sam Ratulangi Author
Steven Ray Sentinuwo Universitas Sam Ratulangi Author

DOI:

https://doi.org/10.35793/qvtkw723

Keywords:

blockchain, electronic health records, emergency access, smart contract, collective proxy delegation, Ethereum, Solidity, access control

Abstract

Abstract — Blockchain-based electronic health records (EHR) offer strong data integrity and patient-centric access control through smart contracts. However, the strict permission model creates a critical gap: when a patient is unconscious or otherwise unable to grant access, medical staff cannot retrieve health history in time-critical emergencies. Existing approaches—break-glass encryption and proxy delegation—each address part of the problem but introduce their own vulnerabilities. This paper proposes Collective Proxy Delegation, a mechanism that requires the independent approval of at least three authorized physicians before emergency access is granted. The mechanism is implemented as the MedicalRecordLock smart contract deployed on the Ethereum Sepolia testnet, within a layered hybrid architecture combining PostgreSQL off-chain storage with on-chain cryptographic commitments. Functional testing across 35 scenarios achieved a 100% pass rate, and security analysis shows five out of six identified threat vectors are mitigated with high effectiveness. The only residual risk which is authorized physician collusion is deterred by an immutable on-chain audit trail.

Key words— blockchain, electronic health records, emergency access, smart contract, collective proxy delegation, Ethereum, Solidity, access control.

Abstrak — Rekam medis elektronik (RME) berbasis blockchain menawarkan integritas data yang kuat dan kontrol akses berpusat pada pasien melalui smart contract. Namun, model yanf pasiensentris menimbulkan celah masalah ketika pasien tidak sadar atau tidak mampu memberikan akses, staf medis tidak dapat mengakses riwayat kesehatan dalam keadaan darurat. Pendekatan yang ada baik enkripsi break-glass dan delegasi proksi masing-masing mengatasi sebagian masalah tetapi menimbulkan masalah baru. Penelitian ini mengusulkan Delegasi Proksi Kolektif, sebuah mekanisme yang memerlukan persetujuan independen dari setidaknya tiga dokter yang berwenang sebelum akses darurat diberikan. Mekanisme ini diimplementasikan sebagai smart contract MedicalRecordLock yang digunakan pada testnet Ethereum Sepolia, dalam arsitektur berlapis yang menggabungkan penyimpanan off-chain PostgreSQL dengan commit kriptografis on-chain. Pengujian fungsional pada 35 skenario mencapai tingkat kelulusan 100%, dan analisis keamanan menunjukkan lima dari enam vektor ancaman yang teridentifikasi dapat dimitigasi dengan efektivitas tinggi. Resiko kolusi dokter yang berwenang yang merupakan resiko residual juga dicegah oleh jejak audit on-chain yang immutable.

Kata kunci — blockchain, rekam medis elektronik, akses darurat, smart contract, delegasi proksi kolektif, Ethereum, Solidity, kontrol akses.

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