At Hashed Health some of our favorite blockchain use cases sit at an intersection with the Internet of Things (IoT). For years IoT has been a valuable tool for reducing costs, improving quality and empowering consumers in their health and wellness. When combined with the blockchain, the value of IoT leaps forward, enabling a range of new, proactive healthcare services and economies.
Today’s Healthcare IoT Use Cases
A common legacy IoT use case is in securing high value assets in the supply chain. In many cases, healthcare providers, manufacturers and suppliers still suffer from a wasteful, inefficient supply chain in which excess inventory, product loss and expiration, charge leakage and unnecessary shipping costs are common. Most activities are responsive and retrospective, instead of planned and proactive. Demand signals and utilization signals for implants and other expensive products are not in real time. Inventory counts in parts of the supply chain are still manual. Hospital supply rooms are often still stocked with too much inventory, suffering from expired inventory or inventory that does not cycle. Suppliers and distributors generally do not have inventory awareness or sharing abilities on costly implants and medical devices.
According to GHX, “manual processes and lack of visibility to product demand and consumption contribute more than $5 billion in waste each year in the U.S. alone, shared equally by hospitals and healthcare systems and their suppliers.” 
It’s not just a cost issue. These inefficiencies impact patient safety and clinician time that could be spent on direct care. Value-based care efforts are driving investment in IoT, radio frequency identification (RFID) and other initiatives aimed at resolving these issues, but much work remains. For example, smart supply cabinets enabled by RFID can interface with a hospital’s inventory master database, automating counts and providing stock-out and expiration alerts.
IoT-based services also include mobile wayfinding, patient engagement, remote monitoring and hospital infection control. Another hot area of IoT includes the aggregation of wearables data to report on patient health and home care. It is estimated that by 2019 as many as 5.5 billion consumers will be wearing a biometric device. 
Centralization and Security Challenges
Current supply chain IoT solutions primarily leverage centralized cloud platforms for the sharing, analysis and visualization of device data. A primary challenge with current solutions lies in this centralized approach which creates a bottleneck when it comes to the security and scalability of large-scale deployment. Centralization makes deployment costly and results in a single point of failure for critical tasks and sensitive data.
Security of the current IoT system is of primary concern. As an example of how important security is, just look at the massive October 2016 Mirai botnet attack on Dyn, a major DNS services company. Well-known malicious code was deployed to attack IoT servers and disabled website access to sites such as Paypal, Amazon, Netflix and Twitter for millions. The attack hacked IoT devices such as video cameras and digital video recorders, most of which were registered on the internet with default usernames and passwords.  This kind of attack makes healthcare security experts very nervous. Centralized maintenance activities are inherently more expensive, more time-consuming and place responsibility for the registration and identity of the device in the service provider’s system resulting in risk of loss or breach.
Oct 21 Internet outage. Source: Downdetector.com. 2
Blockchain and The Future of IoT
At a fundamental level, the blockchain solves these issues by decentralizing the control of the registration, verification and ownership. The distributed ledger is used to chronologically track activities from devices. Filtered device data can be translated to blockchain application program interfaces (APIs) and business rules established by participating peers that can then trigger real-time workflows, alerts, invoicing or payment. Device wallets enable machine-to-machine transactions that are not possible in today’s centralized systems. The result is improved trust, accountability, transparency and automation between devices.
By leveraging the decentralized model, IoT systems become unbound. Connected devices of the future can enforce contracts, enable new collateralized finance models and execute payments. Digital certificates can prove authority, origin and compliance. The basic operating principles of device identity registration and verification can be made to scale. Transfers of ownership of pharma, biologics, implants, medical equipment and all sorts of other assets become properly structured and auditable. IoT data can be monetized in new ways that empower patients. Connected devices will also help shift more services out of expensive hospitals to the home or an alternative site where patients can access services at a lower cost and a lower risk.
This is why we are so excited at Hashed Health. The distributed IoT model not only secures and scales existing solutions, but it gives rise to a variety of new ways to manage or pay for products and services. Using the blockchain, we can enable new business models for expensive assets such as scanners and robots, create new inventory control and inventory sharing systems, empower patients with new care coordination platforms and guarantee compliance to pharma and device provenance requirements. We encourage entrepreneurs, corporations and IoT thought leaders interested in these or related use cases to get involved now as a way of becoming familiar with this exciting technology.