# A hybrid blockchain migration framework for converting traditional databases into blockchain-based EMR systems

## TL;DR

This paper introduces a framework to convert traditional EMR systems into blockchain-based systems, ensuring data integrity and compliance while maintaining performance.

## Contribution

A hybrid framework that combines MySQL and Hyperledger Fabric for EMR systems, enabling tamper-proof logging with minimal performance loss.

## Key findings

- The hybrid system sustains near-native responsiveness with a median latency of 2.1 ms.
- It achieves 480 TPS with modest CPU and RAM overhead.
- The framework enhances data integrity and compliance with regulations like Oman’s PDPL.

## Abstract

Electronic Medical Records (EMRs) are crucial to modern healthcare. However, traditional relational databases fail to fulfill increased expectations for integrity, auditability, and compliance in regulated environments. This paper proposes a Hybrid Blockchain Migration Framework that integrates a conventional MySQL-based EMR system (OpenMRS) with a permissioned blockchain network (Hyperledger Fabric). Sensitive data fields are selectively mirrored to the blockchain, ensuring tamper-evident logging while retaining the high performance of SQL for routine operations. A middleware layer, implemented using Java Spring Boot, monitors changes in the EMR and commits cryptographic hashes and metadata to the blockchain in near real-time. We evaluate the hybrid system against both standalone MySQL and full-blockchain implementations using controlled benchmarks, analyzing latency, throughput, resource utilization, and auditability. Results show that the hybrid architecture sustains near-native responsiveness (median 2.1 ms versus 1.6 ms for pure MySQL and 60.5 ms for Fabric) and delivers 480 Transaction Per Second (TPS), while incurring only modest overhead (47% of i7-9750H CPU, 1.15 GB RAM) and enhancing data integrity and compliance with regulations such as Oman’s Personal Data Protection Law (PDPL). The framework is extensible to multi-institutional deployments and supports regulatory alignment, making it a viable pathway for blockchain adoption in clinical settings.