Enterprise
What can a healthcare organisation put on a shared ledger, and what can it never put there?
The governing constraint rules out most of the category before the design starts.
The answer
Patient data does not go on a shared ledger — that constraint is not negotiable and it rules out a large share of what this sector gets pitched. What can go there is consent state, provenance for a sample or a batch, and decision evidence for a clinical AI system, provided every one of those records is designed to carry no personal data itself, only a reference a permissioned system can resolve.
Where this practice has recommended against the ledger
An architecture review that cannot keep personal data off the shared record gets a recommendation against the ledger, in writing, before a build starts — that has been the outcome of more than one engagement scoped in this sector, and it is the reason the recommendation is trusted on the ones where the answer is yes.
What a compliant design looks like instead
A consent record that stores a decision and a revocation path, not the underlying health data. A batch or sample provenance chain that references a physical item by identifier, with the identity data held entirely off the shared record. Decision evidence for a clinical AI system that reconstructs which inputs and policy applied — without those inputs themselves needing to live on a shared ledger.
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Tell us what you are trying to build and what has to be true for it to work.
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