Smart Healthcare Governance: The Role of Blockchain and Internet of Things in Real-Time Patient Monitoring

The concept of smart healthcare governance is transforming the process of collecting, sharing, and storing patient information in real-time. Using the Internet of Things (IoT) and tracking vital signs every second and combining it with blockchain technology that ensures the formation of secure and unchangeable records, doctors can now provide quicker and more personal services. This potent combination gives the tangible optimism in the improved management of chronic diseases and faster emergency assistance. Meanwhile, it raises some critical legal issues regarding patient privacy, meaningful consent, international data sharing, and accountability in the event of error. This article examines these legal issues and opportunities of governance at an international legal perspective. It contrasts the best examples of the well-known blockchain e-health system in Estonia, Singapore and the Smart Nation programme, the United States under its HIPAA regulations and India with Ayushman Bharat Digital Mission and the Digital Personal Data Protection Act 2023 and the newly notified DPDP Rules 2025. Although most research is done on the technical facet of joining the IoT and blockchain, limited research has thoroughly analyzed the legal and policy constraints that delay real-life application. This gap is filled in this paper with proper doctrinal and comparative legal research. It researches the most recent laws, regulations, and practice cases until March 2026. Based on the analysis, blockchain can significantly enhance consent management, clean audit trails, and flow of data across systems. Nonetheless, it continues to struggle with such issues as the size of the system, ambiguous regulations, and liability matters. The paper concludes with specific and sound recommendations towards a balanced global governance system. Such a moderate solution will keep patients safe and promote safe innovation in intelligent healthcare across the globe.