Zero-Knowledge-Based Policy Enforcement for Privacy-Preserving Cross-Institutional Health Data Sharing on Blockchain

This study presents ZK-EHR, a decentralized access control framework designed to enable secure and privacy-preserving sharing of encrypted electronic health records across institutional boundaries. Unlike existing blockchain-based EHR access control systems that expose user identities on-chain or lack cryptographic privacy guarantees, ZK-EHR decouples authorization from identity disclosure by integrating zk-SNARK-based proofs with blockchain smart contracts to verify policy compliance without revealing user roles, affiliations, or credentials. The framework employs three differentiated actor roles—Patient (Data Owner), Doctor (Care Provider), and Researcher (Authorized Analyst)—with distinct policy-driven access workflows, a custom Groth16 zero-knowledge circuit for role-based constraint enforcement, and a modular architecture combining on-chain verification with off-chain encrypted storage via IPFS. Concrete design proposals for access revocation and replay attack prevention are introduced to address operational security requirements. The system was evaluated under multiple operational and adversarial scenarios. Experimental results indicate consistent on-chain verification latency (approximately 390 ms), reliable rejection of tampered submissions, and per-verification gas consumption of 216,631 gas. A comparative analysis against representative baseline systems demonstrates that ZK-EHR uniquely combines identity anonymity, on-chain cryptographic policy enforcement, and auditable encrypted record retrieval. These findings establish the feasibility of zk-SNARK-based access control for decentralized, verifiable, and privacy-aware EHR management.