<p>Cross-chain technology is the key to solving the “data silo” problem in medical blockchain systems. However, it is difficult for existing cross-chain consensus mechanisms to meet the high standards of data security and consensus efficiency in medical scenarios. Therefore, this paper proposes a medical cross-chain Delegated proof of stake consensus(DPoS) scheme that integrates reputation and contribution evaluation. First, a dynamic reputation evaluation model was constructed, and the historical behaviour and communication quality of nodes were incorporated into the evaluation system, thereby mitigating the risk of centralization caused by the excessive reliance on the number of coins held in the DPoS consensus. Second, a hybrid random block generation mechanism combining the multiparty coin-tossing protocol and the secure shuffling algorithm was proposed. By collaboratively generating a verifiable global random seed and uniformly and randomly shuffling the candidate node sequence, the predictability of the block generation order was eliminated. Finally, a two-layer incentive architecture based on the Shapley value was proposed. Fine-grained contribution assessment mechanisms were established at both the candidate node layer and the voting node layer, making the reward distribution more equitable, enhancing the enthusiasm of nodes for voting and improving the consensus efficiency. Theoretical analysis and experimental results show that compared with the DPoS scheme, the proposed scheme improves the throughput by approximately 30% and reduces the average latency by approximately 50%. Compared with existing similar schemes, this scheme also has significant advantages in terms of reputation calculation overhead and malicious node elimination and can provide efficient and reliable consensus support for cross-chain scenarios in the medical field.</p>