‘The Medical‘™
A Medical Supply Network Application
Offering Wide Area, BlockChain-Backed
Database Networking
To anyone involved in the Health Sector, it comes as no surprise that there is a broad network of Supply-Lines involved in the delivery of safe clinical care. From parts & supplies for air conditioning equipment cleaning and maintenance, to supplies for operating theatres, dispensaries, ward and general cleaning, catering and far beyond, the requirements for the continuous and reliable supply of high quality inputs (including secure document, audio and video transfers) are always demanding. Automated and secure Supply Chain networking is desirable. ITOTCCA can make the Information and Operational Technology domains of those supply lines as affordable as they are secure and convenient.

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Executive Summary
Summarising, what you get is a system that enables automated trading using Smart Contracts that are enacted on a private network, and where, due to the ability to share information with supply/health partners, using asymmetric cryptography, and also due to all database clusters acting as Masters in replication procedures, a partner organisation can access the shared data on their own local server. Sharing may also be completely revoked.
You also get a comprehensive Enterprise Application that works on Mobile devices and provides all accounting as part of the package, where the database we use (PostgreSQL) has zero licence fees. The accounts system can be interfaced in a READ-ONLY fashion to your broader system. We have the detailed understanding of Accounting Systems necessary to have built a fully integrated system from the ground up – we do not need to “partner” with insecure vendors, relying as they do on inferior software.
In addition you receive an economical and very security-conscious system, incorporating our ChubbyChecker Ultimate Cross-Checking package, which fills the security gap inherent in stand-alone distributed systems that employ either Crash- or Byzantine Fault Tolerance, as well as the normal security measures — in-transit encryption is TLS 1.3 and measured, while client-side at-rest encryption is BUILT but switched on nowhere today — together with the absence of risk of Man-In-The-Middle and Denial-Of-Service attacks (with the optional employment of libp2p/Kademlia, bypassing, as it does, the normal Domain Name System – DNS). The distributed nature of the system is what allows the operation of private-networked Smart Contracts, incorporating unlimited volumes of data per contract (and overall), and also it is what allows the secure sharing of information, as necessary, to enable business/health operations to function efficiently.
But what is the magnitude of the risk against which we are protecting? According to an independent analyst organisation (Analysis) there were 25,949,000 personal records compromised in the healthcare sector in 2023 alone.
“These are often called ’supply chain attacks.’ In fact, it is not just one
customer that can be attacked, but essentially every customer that uses
an (inferior) vendor’s services. Thus, a single vulnerability can threaten
many thousands of organizations, such as in the 2023 MOVEit attack where
already over 2,600 companies in more than 30 countries admitted to
being attacked, with more than 80 million individuals’ data being
compromised. In fact, 98% of organizations have a relationship with an
(inferior) vendor that experienced a data breach within the last two years.
In some studies, the number of data compromises due to supply chain
attacks in 2023 jumped 78% over 2022.”
Stuart Madnick – Harvard Business Review
The problem is no longer a case of “if” but now a case of “when” will your systems be attacked.
There are many vectors by which attacks may be mounted. Our use of kademlia avoids some, however, still, the most common and “fruitful” means of attack involve targeting individuals using Social Engineering. As an example of Social Engineering, the attackers may use knowledge gained in any fashion about an employee’s vulnerabilities, contacting that employee and using this knowledge to obtain the employee’s cooperation in an attack or in the exfiltration of information from your database. It is very important to have multiple offline data backups in place in the case of an attack, which may also arrive in the form of Ransomware. The basic process involves the attackers accessing your data and re-encrypting the data to prevent your access, then demanding a Ransom for decrypting the data. If you have a good back-up system, and your data is strongly encrypted, this is simply not a problem. Note that the backups need to be kept offline and thus inaccessible to an infiltrator online.
In the case of a Ransomware Hack,
where (typically Russian) attackers gain access to a company’s
online data, the simple strategy necessary to survive the
attack is to ensure the maintenance of regular
(eg. half-hourly) backup procedures which MUST store the
backed-up (and, naturally encrypted) data OFFLINE so that no
network connection is presented for Hackers to access backups.
Thus, armed with encrypted backups, (all data both in-transit
and at-rest must be encrypted, not just backups) a company
can ignore Ransom Demands in the event of a successful attack,
and simply restore business data from offline backups, then
carry on with business (losing not more than a day’s work).
Better than paying 100’s of 1,000’s or millions in Ransom
to regain decrypted data, originally stolen by Hackers.
Security 101 in Business
– – It should be obvious that Business Data is very valuable, and – the above simple strategy of
a. encrypting all data and –
b. regularly backing up data to offline locations, should be: –
Security 101 in Business.
– – Of course, after such an attack, the company needs to harden the security of their systems to prevent further successful attacks. –
Talk to us. ‘The Minders’.
– – While the additional problems relating to “insider jobs” are – partially preventable by our higher-level systems, by – combining our security with the use of AI-led supervision of users, excursions of behaviour to criminal activities, – from within, can be prevented (see the Elastic Company) by systems using AI. These systems get smarter as they work. –
Also consider the number of people who send passwords via email to themselves as a record, or to others to access their account in an “emergency”. If these emails are compromised in external third-party attacks outside your system, your system may become compromised by a malicious agent. This touches on the concept of an Attack Surface, meaning the myriad vulnerabilities any system may have.
Thus, there is a multitude of possible attack vectors threatening your system. Sealing it with the use of kademlia goes a long way towards total security. But there are many other practices that should be used to defend against Hacking, Hijacking and System Penetration. We can only offer advice to be vigilant and aware of the size of the threat, and to take appropriate counter measures (and there are many measures to take). As noted elsewhere our use of client side encryption will assist, as will the frequent, programmed running of Backup operations (stored offline) and our ChubbyChecker. Insider jobs via Social Engineering techniques and third-party breaches are still high on the list of threats. Education of all staff can help here, as can monitoring of database access patterns, and vigilance (automated with AI) against abnormal patterns of use. Also, the use of Artificial Intelligence in this monitoring can make a difference when it comes to detection of “insider jobs”. An AI system can be trained to recognise excursions from normal usage patterns, and its performance is actually enhanced over time as it gains “experience”.
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‘The Medical‘™
Tx-Rails never reads patient records. Clinical notes, diagnoses, prescriptions, test results, and personally identifying information stay encrypted on the hospital’s side under the hospital’s own keys.
The integrity layer we provide — anchored to the public Hedera ledger, cross-checked by our 98-check ChubbyChecker — verifies that what was recorded is what was committed, without us ever needing to see the patient. This is the privacy posture required for NSQHS clinical-evidence audit, GDPR-equivalent patient-data sovereignty, and the trust the public requires of any health-system audit infrastructure.
There are four modes of connecting your existing systems to our Underlay:
The four modes
| Mode | What customer does | Metadata fidelity | Use case |
|---|---|---|---|
| A. Hash-only | One value, a hash. Your commit path computes a digest of the committed transaction and publishes it through a signed call | 11 of the 36 record fields carry a value. No content crosses — a digest only — and no semantic intent | Low-stakes flows where the audit just needs “this row existed at time T” |
| B. CDC observation | You run an observer against your database’s logical-replication stream — pglogrepl decoding pgoutput directly, with no Debezium or Kafka dependency |
Content crosses: the changed row, as JSON. CRUD intent comes from the WAL operation itself. Coarse service-account attribution, not per-user | Mid-stakes flows; most existing apps that already write created_by / modified_by to their rows |
| C. Gateway-mediated | You run a gateway inline, in front of your own backend; the application is unchanged | Content crosses: the request body. Semantic intent comes from the matched route. The only preventative mode — it can refuse before your backend sees the request | High-value flows; new app deployments where touching the network edge is cheap |
| D. SDK / atomic dual-write | Your application writes to an outbox in the same transaction as its business write, and a relay forwards it | Content crosses: the outbox payload. The only mode carrying explicit REVERSAL / CORRECTION / RESTATEMENT | The very-high-value flows where the customer wants explicit REVERSAL / CORRECTION / RESTATEMENT tagging |
Mode A is what you would be buying today, and it remains the only mode we offer for onboarding. Modes B, C and D are now deployed in our own development estate, and each has carried a real change through to a committed attestation on a live validator mesh. They remain reference implementations your own team adapts, not packaged products you can install. No customer has been onboarded through any mode.
[How this works in detail →](/how-it-works/privacy)
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The six levels, and where a district sits in them
The same six levels carry banking and social housing. The architecture does not change between sectors. What changes is exactly one thing — what counts as a set of LIKE members — and which levels carry the weight follows from it.
Health uses TWO axes, and it is the first sector to use both deliberately. Level 1, the registry, is keyed by the DISTRICT: who is a member, and who vouches for them. Level 2 is keyed by the SECTOR: what may cross, under which regime, and the record that it did. This is not a new capability — an identity claim already records a sector and a country.
A district holds both extremes at once. A tertiary hospital has the capability of a bank. A single-handed rural practice has the capability of a one-person joinery. Both are members of the same district, and any structure that works for one fails the other. That is the case this level model was designed for.
| Level | What it is | What it means in a district |
|---|---|---|
| 5 — the edge | Stateless. Authorises locally against a signed envelope and reconciles afterwards. | A ward scanner, a theatre, a loading dock, an ambulance. Disconnected operation is normal in regional health, not exceptional. A terminal forges a CLAIM, never a FACT. |
| 4 — the Executive mesh | MEMBER-OWNED. A consensus tier in its own right: own validators, own quorum, own paired auditor. | A district plausibly runs one, with facility, service line and campus as tenancy SCOPES CARRIED BY that mesh. A single rural pharmacy never will. |
| 3 — the member’s own node | MEMBER-OWNED. The member’s own validators, run by the member. | Where health differs from every other sector. A district runs a real cluster. A community pharmacy or single-handed practice runs nothing and reaches the network through a shared gateway. Both are members of the same district. |
| 2 — gov-reg and gov-comm | SHARED, keyed by SECTOR. What may cross, under which regime, and the record that it did. Belongs to NEITHER side of a trade. | Not usable yet — deployed and committing, but its gates are unarmed and no regime rules are defined. Biomedical, cold-chain, sterile-processing. Regime evaluation by SECTOR lives here — a consignment arriving into health from a manufacturer, a logistics operator or a supplier. Inter-district movement and statewide recall do NOT: the re-keying of 30 September 2026 made the district a tenancy inside NATIONAL HEALTH, so those are ordinary level 3/4 transactions. |
| 1 — the registry | SHARED, keyed by DISTRICT. Who is a member, in which district, with what standing. | The least foreign part of the model. Credentialling, scope of practice and facility accreditation already exist as registers with an owner. |
| 0 — cross-border | SHARED. A protocol plane, not a deployment. No nodes run here. | Imported devices and consumables — a real and regulated path, and the least pressing of the four. Designed rather than built. |
The numbering says where a level SITS, not what depends on what. Levels 3, 4 and 5 do not rest on 0, 1 and 2. Levels 0, 1 and 2 are shared and operated by no single member, but they do NOT share one state: Level 1, the registry, is BUILT — deployed at n=4 and committing; Level 0 is not deployed at all; and Level 2 is deployed and committing but has its gates UNARMED, with no regime rules defined, so nothing is evaluated yet. A statement about delivery, never about importance.
Most health evidence is of one shape, and it is the shape Mode A already produces. A sterilisation cycle against an instrument tray. A cold-chain excursion against a consignment. An implant serial for recall. A calibration record against a device. Each is “this record existed, unaltered, at this time, under this verified party”. Within a district, Mode A is sufficient.
Where it stops. The moment a consignment crosses into health from ANOTHER SECTOR — a manufacturer, a logistics operator, a supplier — or a regime must evaluate what a transaction IS rather than that it happened, Level 2 is required, and Level 2 needs Mode B or deeper. Inter-district transfer and statewide recall are NO LONGER in that class: a district is a tenancy inside national health, so they are ordinary level 3/4 transactions and Mode A covers them. It is a split, not a verdict.
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Who operates what
Decided, and it is the same arrangement we offer banks — with one condition added. Stated here rather than left for a reader to assume a difference.
| Operates | Holds | |
|---|---|---|
| The district | Its own levels 3, 4 and 5 — its own validators, its own Executive mesh, its own edge. Its own data machinery. | Its own data. |
| ITOTCCA | The metadata workload for the auditors — the trace, aggregation and anchoring pipeline. | Nothing it can read. Transmitted metadata only: an entnum and a hash. |
| A national neutral body | The audit tier’s custody and control plane. | The keys ITOTCCA never sees. No body has yet been named, the arrangement is unsigned, and until one exists ITOTCCA CAN read these keys — measured 30 September 2026, not assumed. An auditor must hold its key to sign with it, so custody separation means the custodian OPERATES the auditor units; no key-storage change achieves it. |
This is the same arrangement we offer banks. Banks are offered the sites that run the receivers of the bank’s transmitted metadata — the entnum and the hash of the metadata trace record — and those receivers are the metadata workload. In both domains ITOTCCA operates nothing inside the member boundary, reads no transaction content, and does not hold the audit keys or control the audit control plane. The one health-specific condition is the custodian’s scope: in banking the third party already exists and is already national, while in health districts are State entities and the regulated objects are Commonwealth, so the custodian must be explicitly national — and, unlike banking’s, it has not been named. That is the difference: a gap, not a different design. The trade is defensible in both — most districts will not want to run an audit pipeline, and a regional district plainly cannot — but it costs something specific, and the cost is published here rather than discovered. The audit tier is independent of the consensus and not of the operator; operating the metadata receivers makes that sharper, not softer, and it does so for the bank offering exactly as much as for this one.
So the neutral body is the only thing that makes the arrangement honest, and it has three concrete jobs rather than a name to lend. It must hold keys ITOTCCA never sees. It must be able to verify our operation without trusting it — the checkers’ outputs recomputable from anchored evidence, so that the body can contradict us. A witness that can only agree is not a witness. And it must control the audit control plane.
Why national rather than state. Districts are state entities, so a state body auditing its own State’s health services is not neutral. Device recall, therapeutic goods and practitioner registration are already Commonwealth matters, and a state-scoped custodian cannot follow an implant across a border. INTERSTATE and cross-sector movement is the case Level 2 exists for — inter-district movement is not, since the re-keying; a custodian whose writ stops at a State line cannot witness the crossings that do matter. And an interstate rollout would need the arrangement renegotiated from zero in each State.
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What health depends on that is not usable yet
Stated here rather than found in month three. Health’s position is genuinely stronger than social housing’s — within a district — which makes it more important, not less, to be exact about where that stops.
| What | What it blocks in health | State |
|---|---|---|
| Level 2 — gov-reg and gov-comm | Regime evaluation by SECTOR, and cross-sector arrivals into health. No longer inter-district movement or statewide recall — the re-keying took those off Level 2. | Not usable yet — deployed and committing, but its gates are unarmed and no regime rules are defined. Within national health, INCLUDING between districts, Mode A is sufficient and this does not bite. It bites at the SECTOR boundary. |
| A mode Level 2 can use | Level 2 needs Mode B or deeper, because a digest cannot be regime-checked. | Mode A is the only mode we offer for onboarding. B, C and D are deployed in our own development estate and each has committed a real attestation, and they remain reference implementations your own team adapts. No customer has been onboarded through any mode. |
| Committee rotation | How a district federation is operated when its members cannot all operate. | Designed, not operating. consensus.validator_set and consensus.rotation_approver exist in code; neither has yet run. |
| The custody arrangement | The independence claim entirely — and the operating split above depends on it. | Unsigned, and no national neutral body named. This gates a claim, not a component. It is the largest open item here. |
| Level 0 — cross-border | Imported devices and consumables whose chain leaves the country. | Designed rather than built. The least pressing of the five. |
None of that gates a purchase, and the distinction matters. What is sold is levels 3, 4 and 5 — a district’s own nodes, its own Executive mesh, its own edge — and one member buys and runs those alone, waiting on no federation forming and on no agreement between States and Territories. Level 1 and Level 2 are not priced and are not a precondition on your purchase. Nor does Level 1 ask anyone for a NEW agreement: it keys on registers that already exist and already have a single national owner — AHPRA for practitioner registration, the TGA for therapeutic goods and recall, the ACSQHC for facility standards. We do not operate a new register that a State must admit members into. And the regime rules Level 2 is waiting on are an agreement between the two SECTORS that trade and their regulators, not between jurisdictions — movement inside health is an ordinary level 3/4 transaction and never reaches Level 2 at all.
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The health position, stated in full
Migrated here on 3 October 2026 from the second health page, which is now retired. These paragraphs are the author’s own words, unaltered.
Health is not a third point on a line between banking and social housing. It is both of them at once.
This is the first domain where the answer to “is what is built enough?” is partly yes. Both halves are stated with equal force.
Health holds both extremes at once — but so does social housing, and an earlier draft of this page made that health’s strongest argument when it is not. A tertiary hospital has the capability of a bank; a single-handed rural practice has the capability of a one-person joinery. True — and a large housing provider is a substantial organisation while a one-person joinery is not, so housing has the same spread. Levels 3, 4 and 5 being deep for some members and nothing for others within one federation is a property of the level model, not a finding about health.
What actually distinguishes health is how OFTEN members must work across an administrative line. A referral, a transfer, a consignment, a recall — all routine, all constant, and all lawful. That is what decided where the federation boundary belongs, and it is why this page was re-keyed on 30 September 2026.
District size varies on two scales and only one of them matters. A regional district may cover a large share of a State’s area; an inner-metropolitan district is geographically tiny and may serve a comparable population. Area is irrelevant. Member count and operator capability are what decide whether a district can staff a committee.
The scope is equipment and supply chain. No EMR contact, no clinical-information system, no patient record. Several conclusions below depend on that holding, and they are marked where they do.
Your own nodes, your own edge, one hash, one anchor. Levels 3 and 4 are your nodes, level 5 is your edge, one cryptographic digest per transaction, and an anchor in a public ledger. Nothing else, and nobody else’s agreement. This is Mode A, the only mode we offer for onboarding. The public ledger is the neutral third party — what levels 1 and 2 would otherwise have to be, and it already exists, so the proof does not wait on an institution being founded.
What crosses at levels 3 and 4
Stated here because a reader who is not told will assume the opposite, and that misreading surfaces late, in security review, after the architecture has been agreed.
Both levels are the member’s own machines running the member’s own code. ITOTCCA operates nothing inside them and reads no transaction content. The scope is equipment and supply chain: no EMR contact, no clinical-information system, no patient record. What leaves is TRANSMITTED METADATA, emitted by member-owned code — an entnum, and a hash of the metadata transaction-trace record. No balances, no counterparties, no payloads, and a hash is not reversible into the transaction it came from.
The metadata is the member’s data; its design and specification are ITOTCCA’s. Which fields exist, how the trace record is formed, and how it is hashed. Ownership of the data and authorship of the schema are different questions, and answering only the first reads as though the schema came with it.
Which shared levels your mode can use
Which of the three shared levels a transaction can actually use is decided by the MODE, because they do not all need the same thing from you.
| Shared level | What it needs from the record | Usable at |
|---|---|---|
| 1 — the registry | An identity, established at REGISTRATION rather than per transaction. | Every mode, Mode A included. The verified tenant identity Mode A already carries is exactly what the registry exists to establish. It is a prerequisite, not something a transaction consumes. |
| 2 — by sector | The parties, and the nature of the transaction. | Mode B or deeper. A digest cannot be regime-checked; at Mode A there is nothing for Level 2 to evaluate, by construction and not by omission. |
| 0 — cross-border | As Level 2. | Mode B or deeper, and designed rather than built. |
Mode A needs none of them, and Mode A remains the only mode we offer for onboarding. Within national health — including between districts — for existence-and-integrity evidence, that is sufficient. It is not sufficient for crossing into another sector, or for any regime that must read what a transaction IS. That sentence is the whole commercial shape of health, and the re-keying moved a great deal of routine work from the second half of it into the first.
The data-visibility ladder is less fraught here — and why
Less fraught because of the scope commitment, not because of a property of the ladder. The condition is the thing that could change.
YOURS. At rungs 1 and 2 — plaintext, or the platform’s own key — we can read, so Level 2 evaluates FULLY. At rungs 3 and 4 — your key, or a named partner’s — we cannot, so Level 2 records THAT something crossed but never WHAT. That is a real trade, and it is yours to make.
NOT YOURS, and the trade-off framing hides it. On ANY rung Level 2 ALSO needs its gates ARMED and regime rules DEFINED. Neither exists, both are OURS, and no rung you pick supplies either. At rung 1 — where everything actually runs today — Level 2 would read fully and still does nothing. The ladder is not why Level 2 is unavailable; we are.
AT MODE A THE LADDER DOES NOT ARISE: we receive no content, only an entnum and a hash, so the rungs matter only for the content-receiving modes — and no customer is on one. With no EMR contact there is no clinical content to protect either way. What crosses is equipment, consumable and consignment metadata. That is why this section is shorter here than on the banking or social-housing pages.
Two caveats, which belong here rather than in a footnote. Supplier pricing and contract terms in procurement records ARE commercially sensitive even when nothing clinical is present. And the moment anyone proposes extending the scope to clinical records, the ladder conversation restarts from the beginning — and the answer today is that rungs 2, 3 and 4 are BUILT TO DIFFERENT DEPTHS and switched on nowhere — rung 3 end to end, rung 2 in one action that has never run, rung 4 not deployed: no commitments have been written in any running deployment.
What counts as “like”
A federation is a set of LIKE members. That is the whole definition, and everything domain-specific is the choice of what counts as alike.
| Health | Banking and social housing, for contrast | |
|---|---|---|
| What a federation is | ONE national health sector; a district is a TENANCY inside it | Banking: one jurisdiction. Social housing: one trade or profession. |
| Its members | Hospitals · community health · pharmacy · pathology · device and consumable suppliers | Banking: the banks of that country. Social housing: carpenters, plumbers, electricians, architects, providers. |
| Who operates it | The district runs its own machinery; a national neutral body holds the audit keys | Banking: the member banks, all of them could. Social housing: the trade or professional body, which already keeps the register. |
| Cross-federation work | A MINORITY — crossings are between SECTORS, not between districts. | Banking: a minority of traffic. Social housing: almost all of it. |
| Member capability | Both extremes in one federation — a tertiary hospital and a single-handed practice. | Banking: uniformly capable. Social housing: uniformly not. |
A federation must be big enough to staff a committee, and n is the size of a rotating COMMITTEE drawn from the membership, not the member count. Membership grows freely; the committee does not. Because the federation is national rather than district-scoped, the committee is drawn from the whole membership — which removes the too-few-operators problem a single district would have had, and creates the governance one below — which is one of the reasons the custodian question below is not cosmetic.
Tx-Rails for Health & Medical IIoT (Industrial Internet of Things)
Continuous cryptographic audit for medical devices, sterile processing, cold chain, and biomedical equipment — without touching a single patient record.
Hospitals run two parallel audit obligations. One is patient-facing — EMR, medication administration, surgical safety checklists — and that one stays exactly where it is, owned by the clinical systems your staff already use. The other is *equipment-facing* — biomedical asset registers, cold-chain monitoring, sterile-processing cycle records, infusion-pump and ventilator service histories, MRI / CT / ultrasound calibration evidence, medical-gas alarm logs. This second world is currently spreadsheet-and-PDF, and it’s the one that fails an accreditation surveyor at exactly the wrong moment.
Tx-Rails is the substrate that makes the equipment-facing audit cryptographic. We do not touch the EMR. We do not store patient identifiable information. We capture the audit-significant events about the devices, refrigerators, autoclaves, monitors, dispensers, and instruments that surround the patient — and make that evidence tamper-evident, jurisdiction-independent, and verifiable by a surveyor, regulator, or coronial inquiry without trusting the operator at all.
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What we audit — and what we don’t
We audit the device, not the patient. The IIoT events captured on the Tx-Rails ledger concern the equipment: when an infusion pump was last calibrated, when a freezer alarm fired, when a ventilator’s firmware was updated, when an autoclave’s cycle parameters were validated. We do not store, replicate, or have access to PHI. The patient data stays in the EMR and the systems your privacy officer has already certified for PHI custody. The audit trail we produce is about the device’s behaviour, not the patient who happened to be connected to it.
This separation matters. It means Tx-Rails deployment does not trigger a new privacy-impact assessment for PHI custody; it does not affect HIPAA or Australian Privacy Act compliance posture; and it does not require renegotiation of any existing data-sharing agreement with a regional health authority. The compliance boundary is exactly where the privacy officer needs it to be.
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What we capture
Medical-device provenance and lifecycle
- Device registration with GS1 / UDI device identifier, TGA registration reference, manufacturer / model / serial number, firmware version, ATA-equivalent device taxonomy, regulatory cert reference
- Status lifecycle — Commissioned / Operational / In Maintenance / Faulted / Decommissioned / Retired — with full audit trail of every transition
- Master-data amendments with previous and new payload captured verbatim
- Firmware updates with binary hash and signature verification — the cybersecurity evidence the FDA pre-market guidance and EU MDR now require
Sterile processing, calibration, and validation
- Calibration events for every biomedical instrument with traceability to NIST / NMI / NATA standards, pre- and post-deviation, next-due date
- Setpoint changes — every threshold on a vital-signs monitor, every alarm trip-point on an infusion pump, every safety interlock on a sterile-processing washer
- PLC / control-system program changes for autoclaves, washer-disinfectors, sterile-barrier systems, with verified checksum — AS/NZS 4187 evidence in cryptographic form
- Compliance attestations** — ISO 13485 medical-device quality, IEC 62304 medical-device software, IEC 80001 medical-IT-network risk, AS/NZS 4187 sterile-processing, FDA 21 CFR Part 11 electronic records, GMP for hospital pharmacy compounding
Cold chain and pharmaceutical storage
- Telemetry aggregates — hourly / shift / daily summary statistics for every refrigerator, freezer, blood-bank fridge, and pharmaceutical cool-room (min, max, average, p95, p99, sample count, anomaly count)
- Anomaly events — temperature excursions detected by threshold or by pattern deviation (compressor short-cycling indicating impending failure; door-open anomalies indicating procedure breakdown)
- Alarm events with severity, trigger condition, threshold value, automatic-recovery status — the timeline that determines whether a $400,000 batch of immunoglobulin was compromised
- Operator acknowledgements of alarms with action taken — investigation started, contents transferred, batch quarantined, supplier notified
Operational state and predictive maintenance
- Health indicators per device — 0-100 score, trend direction, remaining useful life — for high-value equipment (MRI / CT / linear accelerator / surgical robot) where unplanned downtime is patient-impacting
- Maintenance triggers derived from telemetry that link directly into your existing biomedical engineering work-order workflow
- Commands issued to devices — every override, every interlock bypass, every recipe load, with operator identity, authentication method, and execution outcome
- Data integrity checks — gaps and timing anomalies in the telemetry stream itself, because missing data during an investigated event is a finding in its own right
Cybersecurity and forensic
- Cybersecurity events — authentication failures on connected medical devices, firmware verification failures, unauthorised command attempts, anomalous network traffic. The forensic timeline that survives the local-log destruction phase of a ransomware attack on the hospital, because it lives on a Byzantine-fault-tolerant mesh and is periodically anchored to a public DLT.
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What we don’t replace
We do not replace your EMR (Cerner / Epic / Allscripts / iPM+ / eMR), your PACS, your RIS, your LIS, your CIS, your pharmacy management system, your medical-device integration platform, your patient-monitoring central station, your biomedical asset register, your CMMS, or any clinical workflow. Every one of those is a deep investment your clinicians and biomedical engineers know intimately. Tx-Rails binds underneath via one of three integration modes — hash-only attestation, atomic dual-write, or change-data-capture observation — and produces cryptographic evidence about the equipment beneath those systems.</span
This is the underlay positioning. It is the only positioning that survives a CIO’s first question: *”how much does this change the workflow for clinicians?”* Answer: nothing.
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Why this matters now
Joint Commission and ACHS accreditation surveyors increasingly ask for continuous evidence, not periodic snapshots.** The current state of equipment-audit evidence — sterile-processing cycle printouts, fridge-temperature logbooks, calibration spreadsheets — is not designed for surveyor scrutiny under a focused investigation. A cryptographically verifiable audit trail of every cycle, every calibration, every alarm, every override is. It also halves the preparation time for the audit itself, because the evidence is queryable on demand rather than reconstructed each visit.
TGA UDI and GS1 traceability is becoming load-bearing for therapeutic-goods compliance.** From 2024-25 onward, TGA expects unique-device-identifier-based traceability for implants and high-risk devices. Tx-Rails records the UDI on every device registration, every firmware update, every maintenance event, and every recall-execution — and links the chain backward to the supplier and forward to the patient encounter (the encounter ref alone; the patient stays in the EMR). When a recall arrives, you answer the *”which patients received affected lots”* question in minutes rather than weeks.
Medical-device cybersecurity has moved from theoretical to mandatory.** FDA’s 2023 pre-market cybersecurity guidance and the EU MDR’s evolving cyber requirements both require evidence of firmware provenance and incident response on connected medical devices. Local logs destroyed by the attack are not evidence. A BFT mesh with mirrored independent auditors anchored to a public DLT is. Tx-Rails records firmware updates with SHA-256 binary hash and signature verification at the moment of deployment — the evidence the regulator expects, captured automatically as part of normal device maintenance.
Cold-chain failures hit the financial statement.** Every immunoglobulin batch, every vaccine batch, every blood product, every transplant tissue, every chemotherapy stock loss has a dollar figure attached. The current process — log the excursion, attempt to recover, write off if not — is at least partly avoidable. Continuous monitoring with tamper-evident timestamps converts ambiguous excursions (“we think the freezer was within spec, the printout is missing for two hours”) into verifiable timelines that drive insurance recovery and supplier accountability.
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What we’d ask of you to start
A single ward, or a single sterile-processing department, or the pharmacy cold-chain. Read the audit-significant events out of your existing biomedical engineering systems via change-data-capture; flow them through Tx-Rails for one operating month. At the end of the month you have a tamper-evident audit trail of every calibration, every alarm, every firmware update, every temperature excursion, every maintenance event — verifiable cryptographically against a public anchor. We then have a real conversation about what that’s worth on your next accreditation survey, your next TGA inquiry, or your next ransomware tabletop exercise.
[Contact ITOTCCA →] john@itotchaincloud.com.au
Tx-Rails Smart Contracts for Health & Medical
Multi-party clinical, supply-chain, and outcomes agreements that execute themselves — with full audit of every automated step.
Health and medical organisations live in a permanent multi-party state: a hospital admits a patient under a payer’s funding rules, prescribes a drug whose supply chain crossed three countries and four cold-chain handovers, implants a device whose manufacturer must be notified of every adverse event, and bills against an outcomes-based contract co-signed by the payer, the provider, and the regulator. The agreements between those parties are real, but the execution of those agreements is manual — phone calls, spreadsheets, email confirmations, and the perpetual hope that nothing fell through a crack.
Tx-Rails now turns those agreements into **on-chain smart contracts that execute themselves** when their conditions are met. Multi-party signatures, conditional escrow, IIoT-triggered condition resolution, automated payment release on outcome verification — all running on the same audit-bearing ledger that already underpins the operational record. The contract executes; the audit trail records exactly *why* every automated step fired; the regulator can verify every transition cryptographically.
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What you could automate
Read the four that follow as CAPABILITIES, not as products. Each is a worked example of what the platform’s primitives — escrow, conditions, workflow rules, dimensional accounting and the audit trail — compose into for a health supply chain. None of the four is a packaged product you can buy today, none has been built as a named process, and none has run for a customer. They describe what the mechanisms make possible and what a first deployment would be scoped to build.
Cold-chain pharmaceutical delivery
A vaccine shipment leaves the manufacturer, traverses three carriers, and arrives at a hospital pharmacy 96 hours later. Today: the receiving pharmacist scans the package, reviews a temperature log on a USB-stick data-logger, and decides whether to accept the consignment. Tomorrow with tx-rails:
- The shipment’s release of payment is held in **escrow** at dispatch — co-signed by manufacturer, carrier, pharmacy, and (where required) Medicare or a state payer.
- A **release condition** is attached: “cold-chain integrity intact throughout transit” — predicate evaluates against IIoT telemetry rolled up into hourly aggregates.
- If the temperature breaches 8°C for more than 15 minutes during any leg, a **workflow rule** auto-resolves the condition as FAILED, freezes the escrow, and auto-opens a dispute for the arbiter named in the original contract.
- If the cold chain holds, the condition resolves MET on delivery scan, escrow releases automatically, payment posts to the manufacturer’s account, the GST is recognised, and the dimensional accounting (cost-centre, project, fund) is preserved across every step.
No human had to make a decision at midnight on a Saturday. The audit trail records: which rule fired, which event triggered it, which block of the ledger the auto-fire landed in.
Outcomes-based pricing
A novel oncology drug is contracted at $400,000 per patient — but only if the patient achieves a defined clinical response at six months. Manufacturer, hospital, and payer all signed the contract; today, payment reconciliation happens in spreadsheets twelve months after the fact.
With tx-rails: the $400,000 sits in **escrow** from day one. A **condition** is attached requiring a witnessed clinical-attestation event (“six-month-response-assessment attested by treating oncologist + radiology”) with the actual attestation being a multi-party action that the oncologist, radiologist, and pathologist co-sign. When that attestation lands, a **workflow rule** matches it, auto-resolves the condition MET, and releases payment. If the attestation lands as a negative outcome, the rule auto-resolves FAILED and returns funds to the payer — same audit trail, same regulator-verifiable provenance.
Medical-device explant + recall co-execution
A hip implant manufacturer issues a Class II recall. Today: thousands of phone calls, a national registry that gets updated quarterly if you’re lucky, and uncertainty over which patients still carry the affected lot.
With tx-rails: the recall is a **multi-party transaction** between manufacturer, TGA (or your jurisdiction’s equivalent), implant centres, and the insurer who funds explant procedures. The **batch tracking** already attached to every implant locates affected patients across every centre that received from those batches. A **workflow rule** triggered by the recall execution auto-creates a maintenance-trigger record at every implanting centre, attaches a release condition to the insurer’s payment commitment (“explant confirmed and disposed per regulatory protocol”), and as each explant lands, the corresponding payment auto-releases.
Multi-site clinical trial milestones
A Phase III trial across 47 sites, three CROs, an academic sponsor, and an ethics oversight committee. Today: every milestone payment is a manual reconciliation between the sponsor, CRO, and site finance offices, three months in arrears.
With tx-rails: each milestone (FPI, FPC, LPI, LPC, database lock, CSR) is a **commitment group** with the required M-of-N signatures from sponsor monitor, CRO PI, ethics chair, and site PI. The payment to the site sits in escrow against that milestone. The signatures land, the threshold flips MET, the workflow rule fires, the escrow releases — all atomically recorded in the same block.
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Why this matters
Patient safety has a price for delay.** A cold-chain breach that takes 48 hours to surface in the spreadsheet reconciliation is a vaccine that was administered before anyone knew it was compromised. The smart-contract version raises the dispute the same block as the breach — the receiving pharmacy sees the failed condition before the box is opened.
Outcomes-based contracts only work if execution is automatic.** Manual outcomes-pricing reconciliation costs more than the rebate it captures. Automated outcome-triggered payment release makes outcomes-based contracts economically rational at scale — and gives both manufacturer and payer cryptographic evidence of the basis on which every payment moved.
Recalls are M-of-N by their nature.** The manufacturer can’t force an explant; the centre can’t decide alone whether to charge the insurer; the TGA needs evidence the recall actually executed. The audit trail today is months-delayed phone-tag. The smart-contract version puts every party’s signature on the same record at the same time.
The audit is built in, not bolted on.** Every auto-fired action records *which rule fired, which event triggered it, which block it landed in*. A clinical-trial monitor, a TGA auditor, an insurance fraud investigator, or a coroner can query the same ledger and reconstruct exactly what happened, in what order, under whose authority — without trusting the institution being audited.
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What this doesn’t replace
We don’t replace your hospital information system, your pharmacy management system, your clinical-trial management system, your medical-device registry, your TGA-reporting platform, your payer-claims-and-adjudication stack, or your laboratory-information-system. Tx-Rails sits **underneath** all of them as the multi-party-aware audit substrate. The smart contracts run as on-chain logic; the operational systems remain the systems of record. When a contract fires a payment, the action posts to your existing accounting stack via the dimensional-accounting layer — your CFO sees a normal journal entry with full provenance back to the underlying clinical or supply-chain event.
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Architecture, briefly
Off-chain: Raw continuous telemetry from monitors, refrigerators, autoclaves, MRI systems — stays in your existing biomedical-engineering historian or device-integration platform. We do not duplicate.
On-chain: The audit-bearing events derived from that stream — commissioning, calibrations, setpoint changes, firmware updates, PLC program changes, alarms, acknowledgements, commands, anomalies, health indicators, maintenance triggers, compliance attestations, data integrity checks, cybersecurity events.
Anchored: Every block of audit events is committed to a Byzantine-fault-tolerant validator mesh, periodically aggregated into Merkle roots, and anchored to a public DLT (Hedera) for cross-jurisdictional verifiability. An accreditation surveyor, a TGA investigator, a coronial inquiry, or a regional health authority’s internal audit team can verify the audit trail without trusting your IT department at all.
The audit volume is bounded by event rate, not by sensor rate. A hospital with 12,000 monitored devices producing meaningful audit events at a few thousand per day is well within sustainable on-chain volume.
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The Medical uses …

Tx-Rails is based on a combination of
the Byzantine Fault Tolerant
CometBFT engine, formerly Tendermint (no mining)
supervised by ITOTCCA’s own ChubbyChecker

As a Software Engineering System, Tx-Rails is based on Juju Charms, both Standard and Custom. It resides within a Charmed Kubernetes System, with several “Models”, acting as Namespaces to contain separable parts. The development is approaching a successful conclusion with the Business Process Design Studio (a Front End with GUI) now ready. The BPD Interface (BackEnd) has a number of Business Process “Atoms” (actions) to be coded, towards a final Proof of Concept. All other sections are approaching completion with the final deployment path entirely mapped out.
The overall concept is to use the core Tx-Rails code as a configurable basis which will not need to be altered for different applications. The package is designed for infinitely flexible reconfiguration. It is not even a prerequisite that an application involve a supply network, since even standalone applications (such as Real Estate Agencies (Chubba Morris) and Land Title Conveyancing (convey_IT)) are catered for. Networked applications, however are where Tx-Rails shines.
A customer of Organisation C enters an order for Z units of Product C. This causes Org C’s Database System to order X of Product B (order sent directly to Org B internal to the database supply network) to help produce the fulfilled order. The order from Org C hits Org B’s database. This causes the order to generate a call to Organisation B’s Factory Y for X units of Product B (the amount required to replenish Org C’s inventory of Product B, by the number of Units used to produce Z units of Product C). The NodeRed server at Org B’s Factory Y automatically generates an order for Y Units of Product A from Org A, which Org B requires to replenish its inventory of Product A after producing X units of its Product B for Org C. (This stage could also be accomplished within the database system, but we use NodeRed to show the capabilities of the system). NodeRed’s order hits the Load Balancer, then one of the 13 nodes and finally is received as an order at Org A’s database. Luckily for us, Org A has plenty of Stock to produce Y units of Product A. The units are delivered in short time. Meanwhile Org B has produced and delivered the X product B units to Org C (having sufficient Inventory) and Org C has also shipped the Z units of Product C (also with sufficient Inventory). All inventories are already topped up.
In a Supply Network situation such as this, most operations involving data processing can be handled internal to the databases, with the generation of production activities, including data recording, involving systems such as NodeRed, and connected Mechatronic Equipment (such as Bosch/Rexroth’s Ctrl-X 6-axis movement automation platform), in communication with the databases.




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Please refer to the “Our Agreements” page for details of ITOTCCA’s “G.O.O.D” policy and our attitude to your data. In summary, we are “Hands Off” your data.

The Operational Technology Domain of Supply Chains encompasses many problems of Automatic Control and Monitoring as well as straightforward recording of sensor data output, possibly in co-ordination with other actuation devices or recorders. In some cases actuation of mechanical, chemical, pharmaceutical, electrical or electronic actions and flows is called for, with varying control/response times demanded. Some control problems need to be solved at “the Edge” – ie in the clinic/factory, or field (eg; when mobile, on road, rail and in the air) or theatre, or on the hospital/surgery floor, due to possibly very tight response periods required by some machinery (for example involving the use of Raspberry Pi, Industrial Pi, Arduino and equivalent computers). Others can be solved in the cloud, leaving IoT devices to control themselves with the localised assistance of Pi’s, PLC’s and other control devices. There is also a realm called “the Fog” level, lying between Cloud and Edge. Hybrid methods of solving Automatic Control problems are also possible.
ITOTCCA is ready to participate in the design of Supply-Chain-Technology. It is expected that Client Organisations will wish to be responsible for the control of their own IoT network devices. ITOTCCA undertakes to assist in the design of control networks and systems, and in the selection of fundamental control devices, but the responsibility for Full Design is a Cooperative undertaking, with mutual obligation, including the need to employ specialised contractors, in order to successfully achieve a properly controlled system. The pricing in this section (ie of Operational Domain Design) of overall work is determined by current rates for professionals in the fields of work at the time of design and implementation. ITOTCCA plays the role of Coordinator and Project Manager in this operational domain. All charges during development and implementation in the Operational Technology Domain (the “OT” in our “IT/OT”) are on an “at cost” basis, as with development and implementation in the IT domain. Remember, here we are talking about a continuous Metadata Audited and Controlled System.
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We pay blockchain fees, for trusted Authentication,
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ITOTCCA is currently in a phase of completing development of our Chubby Register/Chubby Checker “Zero Trust Enforcer”.


Our imaginations are the only limiting factors in determining the possibilities for the use of secure Blockchain-backed Database/Datachain Networks, and automated IoT technology, in internetworked Supply Line Applications.
However, we can only say this ethically, if the Military, and the Accountants, MBAs and other “monetisers” are kept out of the scene. You require Ethics to call yourself a Professional. These groups, too often, display a total absence of social ethics. Their Members seem to be taught to behave this way, and mutually reinforce their confidence in doing so. They can be rip-off merchants, and peddlers of the idea that these excesses of “Commercial Reality” should be accepted. Greed is NOT good.

We have a new dApp called The Medical, and it’s taking shape on Bitbucket. Here are 14 screenshots of the front end, as it exists so far. This Front End is intended to connect to a Backend, following the Bucordo design principles, which is also developing on Bitbucket, & is called “the-medical-backend”.













At this point it is worth noting that due to the nature of our Datachain/Blockbase System, which is intended to mimic a real Blockchain, no database records are ever completely deleted. All details are retained in some form, indefinitely. Obviously this gives rise to a need to protect information in strict adherence to the Commonwealth Government’s 13 Principles of Information Privacy.
As mentioned elsewhere, all but the minimum necessary data to provide our security services and to manage the system remains secret from us and others. You value your Information. We respect that – and we provide our services with Privacy and Security as our highest priorities. The Metadata you “channel” to us, via your devices, automatically using our Public Key for encryption, and sent to our Metadata Stores, thence Anchored as a Trace of Traces to Hiero, amounts to a list of 36 Metadata fields encrypted with our Public Key, and sent to our Metadata Stores.
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In addition to these fields, any client data which is indicated by any of the following conditions will likewise be encoded with ITOTCCA’s Public Key, processed then encrypted with the Customer’s Public Key before storage.
- Spatial queries and transformations (e.g., ST_Within, ST_Buffer).
- Joins, aggregations, and proximity calculations.
- Validation, filtering, and indexing operations.
- Processing and formatting results for client delivery.
ALL DATA IS ENCRYPTED BOTH IN TRANSIT AND AT REST
GENERALLY USING YOUR OWN PRIVATE KEYS, BUT USING OUR PUBLIC KEY,
OR PARTNERS’ PUBLIC KEYS, TO SEND US CHANNELED, PRIVATE COMMUNICATIONS
Your set of cryptographic keys remains yours to manage with utter secrecy for different roles and users. We are not privy to customer crypto keys, with the exception of the common, business sub-network-wide, shared list of member public keys, intended to enable channeled secure and private communication.
We employ Electronic and Mechatronic Engineers to undertake the high level design of IoT control systems, which are interfaced with your software and hardware components. The safe and secure operation of your Operational Technology Domain in concert with your Information Technology Domain is our driving goal, here. The low level purchasing and tuning of hardware components in order to carry this through, however, is your responsibility as our customer, with the full cooperation of ITOTCCA participating in Project Management.
Some Topical Nostalgia .. the Flying Dogtor & the Monster
And, the Real Thing .. sometimes even with “monsters”:
“I love a sunburnt country
A land of sweeping planes“
“Of ragged mountain ranges,
Of droughts and flooding rains.
I love her far horizons,
I love her jewel-sea,
Her beauty and her terror –
The wide brown land for me!”
with apologies, and acknowledging the original copyright (1907) by
Dorothea MacKellar, of ‘My Country’.
The original wording was “plains”, Bruce.








URL for IBM article
Please note there are 2 possible senses of the words Order and Orderer. One is intended to refer to the ordering of Health supplies. This is not the sense intended in the following paragraphs. The sense intended is the Ordering of Transactions – ie putting submitted transactions into an order determined by a consensus process on a virtual machine, and then committing or aborting them in that order. The order will appertain to each Virtual Machine independently.



A possible Fully Developed National Database Network
The tableau shows an array of 22 Hardware On-Prem Canonical OpenStack Cloud Servers, positioned around the nation at State and Territory locations (minimum 8 in a fully developed network) and at Royal Flying Doctor Entity locations (minimum 7), of which 7 Hardware Servers represent the 7 Supplier Classes.
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These cloud servers are interconnected and designed to replicate all transactions faithfully across all
7×7 + 8×8 + 7×7 nodes (162 nodes).
The extended diagram below gives an indication of the nature of replicating from each client’s requests, across all networked nodes, using a single client as an example. Each client submits transactions to their own V.M./load balancer which is multicasting each transaction to all other V.M’s in the entire national network (ie to the other 22 – 1 = 21 load balancers). Each load balancer is programmed to be aware of its own expected local client id’s from the range of clients “belonging to” that load balancer. Transactions from these clients are multicast across the network, as well as participating in their local round robin process. When a load balancer receives a transaction request from an “external” client, (ie not on the list of local clients “belonging to” that load balancer/V.M.), it distributes this request to an inernal node, (determined by the current position in the round robin process for that load balancer), on its V.M., without further multicasting the request.
Whilst the various load balancers are engaged in a round robin process of distributing transactions upon receipt to one single node in its own V.M., and, for “local” requests only, multicasting to the remaining V.M.’s across the national network, it is the CometBFT ordering and replicating packages (ie ‘the orderer nodes’) which multiply (replicate) the transactions received on each node, across all nodes in a V.M., each holding the status of a Master Copy, and order the full set, defined in terms of Blocks, before executing then committing/rolling-back the transactions in the Block. The size of the Blocks (currently 1000 transactions) is determined by software written by ITOTCCA, as is the number of Block Commitments (currently 24) in an Ultimate Checking phase involving ChubbyChecker.

Our Virtual Machines











A different perspective is provided by the Social Housing, Real Estate and Construction Industries


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Tx-Rails — Built by IT/OT Chain & Cloud Australia (ITOTCCA). Sydney · London.









