Computational Framework for Privacy-Regulated Healthcare Data Sharing: Iterative ZKP-Blockchain-Cloud Architecture

Computational Framework for Privacy-Regulated Healthcare Data Sharing: Iterative ZKP-Blockchain-Cloud Architecture | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Computational Framework for Privacy-Regulated Healthcare Data Sharing: Iterative ZKP-Blockchain-Cloud Architecture Abirami S.K, Karpagam G.R This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8561779/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Electronic health records (EHRs) capture the entire patient data history that enables early diagnosis, predictive analytics,improved co-ordination between health care providers,etc. However, centralized storage of EHR exposes the sensitive patient data to breaches while regulations such as GDPR Article 17 “right to be forgotten” and HIPAA 6-year retention limits sharing of data across different institutions. This systematic review consolidates 81 peer- reviewed studies (2015–2024) across different domains namely zero-knowledge proofs (ZKPs), blockchain consensus, trusted cloud execution, and regulatory compliance to propose a three-tier integrated framework that helps in regulatory compliant health care data sharing, yet preserving the privacy.The first tier is to generate ZKPs on the client side and redact personal information with chameleon hashes. The second tier anchors metadata hashes on PBFT blockchain with $f=\lfloor(n-1)/3\rfloor$ fault tolerance. The third tier stores data with an attribute-based encryption (ABE) off-chain on the cloud, integrated with FHIR/HL7 standards. It allows selective sharing, balances blockchain immutability with deletion via ZKP invalidation. The proposed architecture maps tools like zk-SNARKs/Circom for proofs, Hyperledger Fabric for blockchain, AWS KMS for keys. Challenges include lack of real-world testing, achieving proof generation latency (2-15 seconds), and scaling needs via Layer-2 hybrid consensus prototypes. \textbf{Keywords:} Zero-knowledge proofs, blockchain PBFT consensus, GDPR-HIPAA compliance, FHIR interoperability, attribute-based encryption. Zero-knowledge proofs blockchain PBFT consensus GDPR-HIPAA compliance FHIR interoperability attribute-based encryption Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8561779","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":587735587,"identity":"0de8a0f7-f376-4590-b192-ad01f563621b","order_by":0,"name":"Abirami S.K","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYDACHgglB+UeQCIJaDEGYsYGkrQkNiBrwQvkew4/YPjxxyZ9O//x6w8+1Nxh4G8/wHi4AI8Wg7NtBoy9bWm5O2fkFDbOOPaMQeJMAsPhGfi08DMYMDM2HM7dcIMnsZm34TADww0GhsM8+BzWz/6BmeHP/3SD82cSm/8CtcgT0sJwtseAmYHtQILBgfSDzUDrGAwIaTE4c6bgYG9bsiHQL4wze44d5jE8k9iA32E96Rsf/PhjJ2/Of/zBhx81h+Xkjh8+/BmvwxigcWHAwGMAonkg8UMMMGBgf0CcylEwCkbBKBhxAAD+zlUe84plugAAAABJRU5ErkJggg==","orcid":"","institution":"PSG college of technology","correspondingAuthor":true,"prefix":"","firstName":"Abirami","middleName":"","lastName":"S.K","suffix":""},{"id":587735588,"identity":"5e56bc10-f642-44dd-a3bf-cafd22b7c880","order_by":1,"name":"Karpagam G.R","email":"","orcid":"","institution":"PSG college of technology","correspondingAuthor":false,"prefix":"","firstName":"Karpagam","middleName":"","lastName":"G.R","suffix":""}],"badges":[],"createdAt":"2026-01-09 14:08:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8561779/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8561779/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102293948,"identity":"6ee12d7e-ff06-4c31-95e3-0b5bad5fe3b5","added_by":"auto","created_at":"2026-02-10 09:42:47","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":752731,"visible":true,"origin":"","legend":"","description":"","filename":"mtpbzngbdcqhsdgcyhmsppfqgtqvhxzq.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8561779/v1_covered_b1655dae-a032-4662-990c-596ce450429d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Computational Framework for Privacy-Regulated Healthcare Data Sharing: Iterative ZKP-Blockchain-Cloud Architecture","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Zero-knowledge proofs, blockchain PBFT consensus, GDPR-HIPAA compliance, FHIR interoperability, attribute-based encryption","lastPublishedDoi":"10.21203/rs.3.rs-8561779/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8561779/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Electronic health records (EHRs) capture the entire patient data history that enables early diagnosis, predictive analytics,improved co-ordination between health care providers,etc. However, centralized storage of EHR exposes the sensitive patient data to breaches while regulations such as GDPR Article 17 “right to be forgotten” and HIPAA 6-year retention limits sharing of data across different institutions. 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