The widespread adoption of Electronic Health Records (EHRs) has remarkably transformed healthcare delivery through rapid retrieval of patient information and enhancement of internal clinical decision-making. The rapid adoption of digital health infrastructures and remote patient monitoring systems has further highlighted the need for data-driven care. Although digital health infrastructures and remote patient monitoring systems support real-time care and care planning, the majority of EHR systems remain susceptible to data breaches and privacy violations. Major EHR systems also continue to lack cross-institutional interoperability and sufficient protection against data breaches and cyber-attacks. While the majority of EHR systems remain vulnerable, the centralized architectures and cloud-based systems commonly employed to support them also fail to provide the necessary protections and assurances. 
This work proposes a tailored management framework for EHR systems based on blockchain technology, incorporating automation through smart contracts. The framework employs a dual storage system in which sensitive clinical information is stored off-chain, while on-chain data pertains to access control logs, integrity proofs, and system control metadata. 
The proposed system utilizes blockchain consensus mechanisms to confirm data immutability, smart contracts for role-based and policy-secured access control, and encryption algorithms for secure data storage. Data integrity is maintained through hashing, and the distributed ledgers allow interoperable healthcare network policies to be traced and kept unmodifiable. 
Testing indicates that the proposed blockchain-based EHR system demonstrates enhanced data security, reduced access latency due to authorization, and improved resistance to cyber-attacks compared to traditional cloud-based EHR systems. The hybrid storage method effectively minimizes storage overhead while maintaining system efficiency. The system demonstrates a viable approach to integrating smart contract systems and blockchain technologies within EHR management systems.