This study presents an advanced version of the Blockchain-based e-health system (BC-EHS) to address the current e-health system shortcomings. BC-EHS represents a system based on Blockchain technology which optimizes the shortcomings within standard e-health solutions. systems. The solution integrates advanced features for managing electronic health records securely, efficiently, and at scale, optimizing transaction processing and query performance. Key improvements include the implementation of consensus protocols like Proof-of-Authority (PoA) and Delegated Proof of Stake (DPoS), which decrease transaction times from approximately 900 ms to 550 ms for 50 transactions. The system also excels at handling concurrent queries, reducing query times from 70 ms to 40 ms for 50 simultaneous queries, a 43% performance boost. Additional optimizations, such as sharding and in-memory caching, enhance query speed, while using off-chain storage for large medical files lowers ledger memory consumption by 20%, from 100 GB to 80 GB for 10,000 transactions. These advancements position the BC-EHS as a scalable, interoperable solution for modern healthcare, ensuring secure and reliable patient data management across healthcare providers.