We’re excited to launch our new company, NosFabrica! Our mission is to empower sovereign healthcare by building tools for peer-to-peer healthcare interactions, giving individuals and providers the keys to their own health data. We are building a healthcare application factory, shipping health clients built on Nostr and Bitcoin and bootstrapping a decentralized ecosystem of health tools. We want to onboard thousands of people to Nostr and Bitcoin and enable people to live healthy lives. By utilizing Nostr for identity resolution and bitcoin for payments, we’re paving the way for interoperable healthcare applications to exchange health information, and individuals to track and own data that matters to them, connecting to healthcare providers on their health journey.
The Problem:
The fiat healthcare system has led to a dangerous centralization of healthcare records in the US and globally, where companies ultimately own health data, not individuals. Current protocols of oAuths and APIs have led to bloated and expensive walled gardens (eg, Epic, Cerner) and a honeypot for healthcare hackers, most notably the recent Change Healthcare hack, owned by United Healthcare - affecting Avi’s work. In 2023, more than 115 million health records were compromised across 655 data breaches.
High cost and poor outcomes are the current product of fiat healthcare. Of the $4.5 trillion annual US healthcare spend, 25% is administrative cost, and half of that is waste. 6-10% of every healthcare transaction goes to a medical billing middleman. Meanwhile, 6 in 10 Americans has a chronic health condition.
A decentralized healthcare application ecosystem would give the healthy sovereign individual the opportunity to take back ownership of their healthcare data, and their health, too.
The Solution:
NosFabrica means “our factory” in Latin, with of course the nod to Nostr. We aim to build a new, parallel health system on top of open source protocols Nostr and bitcoin. This decentralized healthcare ecosystem will be driven by peer-to-peer interactions between patients and providers. We will move healthcare onto a bitcoin and Nostr standard, giving independent healthcare providers the tools to integrate bitcoin deeper into their practice while maintaining practice sovereignty.
By establishing an open-source protocol for the private exchange of health data on Nostr, NosFabrica will set a foundation for a decentralized healthcare system and enable bitcoin-native electronic medical record (EMR) software clients to be built on top of Nostr.
We will cut out middlemen in healthcare and build tools that put the individual at the center of the solution. The benefits to patients include owning their own medical data, care discovery at competitive prices, portability of health data, and ultimately improve health outcomes. Doctors will also have the ability to reach a much broader population, reduce their administrative cost, and own their key demographic data such as licenses, credentials, and board certifications. Ultimately, we envision a more robust ecosystem of independent providers, combatting the trend of M&A and centralization we see under the current fiat healthcare regime.
There are several impacts for the broader free and open-source community, as it gives tools for individuals with different healthcare use cases to bring solutions to sorely needed applications such as medical consent, data sharing, clinical trials, and public health.
Nostr enables the NosFabrica future in three primary ways.
Identity and Access:
- User identity exists at the protocol layer via your npub/nsec, instead of the application layer.
- Users can sign into any application connected to the protocol
- Users can sign and certify events with their key pair, verifiably demonstrating ownership
Data Standardization
- We can develop specific Nostr event “kinds” created for medical data. Vitor has already started by building NIP-82 for medical data.
- Existing international data standards and formats such as FHIR/HL7 can be “wrapped” within Nostr events”
- This structure provides seamless data portability and interoperability across applications.
Persistence and Availability:
- HIPAA compliant, encrypted healthcare data is stored on relays
- Only the owner of the data and those authorized by the owner can decrypt or view the data - in other words, selective disclosure, which is a cornerstone of privacy.
Boosting the Nostr network effect and flywheel will continue, as there are already 40,000 weekly active users. By building healthcare applications on Nostr, we can onboard more people to the ecosystem, who may not be interested in social media.
Call to Action:
Of course, Nostr and Bitcoin are global protocols and networks that anyone can opt into. While the US gets a lot of the focus due to its expensive and complex healthcare system, there are many challenges globally including healthcare access, affordability, and timely care that we can address with open source tools and permissionless, sound money. We’d love to hear from you if you’re interested in joining our mission.
About the team:
Avi Burra is an experienced healthcare veteran, working as senior director of product management at Optum. He is also the host of PlebChain Radio, a leading bitcoin and nostr podcast. With masters in electrical engineering and financial engineering, Avi brings a wealth of healthcare software product experience to NosFabrica.
Jon Gordon has worked across the healthcare industry, including in provider strategy, payers and suppliers. Jon has been helping healthcare providers integrate a bitcoin strategy with his consulting business, Satoshi Health Advisors. He also has a double masters in health economics and policy.
Vitor Pamplona is the creator of Amethyst, the top Android client for Nostr. Vitor previously led a company spun out of the MIT lab utilizing VR for eye exams at EyeNetra. Vitor has a PhD in computer science from MIT.
Go to nosfabrica.com to learn more and follow us along on Nostr!