<p>Electronic medical records (EMRs) represent critical infrastructure in modern healthcare, yet face significant challenges in balancing accessibility with security and privacy that conventional systems struggle to address. This study introduces a transformative blockchain-based framework that integrates Ethereum, Hierarchical Attribute-Based Encryption (HABE), and InterPlanetary File System (IPFS) to revolutionize medical data management. Blockchain technology provides unique advantages through its immutable ledger, transparent audit trails, and decentralized architecture—directly addressing healthcare’s most pressing data management challenges. While blockchain technology offers transformative potential for electronic medical records, our research explicitly addresses critical implementation challenges like regulatory compliance, interoperability constraints, scalability concerns etc. By leveraging blockchain’s cryptographic capabilities alongside attribute-based access control and distributed storage, the system ensures data integrity while maintaining patient privacy and regulatory compliance. Our comprehensive methodology encompasses rigorous performance analysis, statistical validation, formal security proofs, and machine learning-driven verification. Results demonstrate the framework’s capacity to enhance data sovereignty by giving patients control over their records, enable secure cross-institutional data sharing, and dramatically reduce vulnerability to data breaches. Performance evaluations confirm the solution’s scalability and computational efficiency even under high transaction volumes. Through the synthesis of advanced cryptographic techniques with distributed ledger technology, this research presents a viable approach to next-generation EMR systems that balances security with usability, interoperability with privacy protection, and clinical utility with patient autonomy—establishing new standards for intelligent healthcare information management.</p> Graphical abstract <p></p>