Healthcare Micro-apps on Nostr

At NosFabrica, we envision a future of healthcare where the individual is in charge of their health data and empowered to take responsibility for their own health. We are building health applications on Nostr and bitcoin to enable individuals own their health data. Nostr’s architecture will allow different healthcare providers to write data onto the individual’s relay. We see many potential use cases to solve specific problems in healthcare when the individual in a world where everyone has a comprehensive, portable and interoperable health record over time. We are looking to show what is possible with the “other stuff” on Nostr, starting by developing micro-apps so you can start compiling your health data, which you control.

If you’re like most people on earth, your eyes aren’t perfect. About half of us - 4 billion humans - have eye glasses, yet nearly a billion people can’t get glasses due to inaccessibility of eye care or affordability.

With our microapp, Lazer Eyes, eye care providers can now write an eyeglasses or contacts prescription directly onto your own health relay. The optometrist simply needs to enter in your Nostr public key profile (nprofile), which relay to write the data to, and your prescription data; the encrypted prescription will be sent in an encrypted note directly to your relay. You can now send this signed note to your eye glasses provider to fulfill your glasses or contacts order.

If you’re using Amethyst today, you will be able to see this prescription rendered into your DMs. In our NosFabrica future vision, different clients would be able to show you this piece of your health record alongside other health information with different user interfaces and experiences. You will then have the power to selectively disclose this information, as needed.

There are many benefits to using Nostr for health as an individual:

1. Patient Ownership and Control

   • Patients have full control of their prescription, and they can share it securely with confidence and even privately if required with eyewear providers or optometrists whenever needed.

   • Patients no longer rely on email or paper copies that can be easily lost or tampered with. Emailing a PDF to a patient brings the issue of requiring an optometrist signature leading to excess time taken to generate, print, sign, scan and email the copy. Public / private key cryptography provides a verifiable, time saving option in this case.

   • Continuity of care and ability to track changes in prescription over time - there are numerous forum posts where patients have found it difficult to get their prescription data from their optometrist practice when requesting it months or years later.

   • Removes the need for the patient to contact their old opticians and go through a process of trying to request their details, which can be time consuming.

2. Identity Verification

   • Optometrists sign prescriptions with a cryptographic key that patients could verify using their private Nostr identity (also known as a public/private key pair). This ensures that the prescription is authentic, accurate, and hasn’t been altered after issuance. This would remove the need for issuing a “signed prescription” that currently has to be done in the physical sense, as a print out and issued to the patient. Have the option to have an indisputable and verifiable ‘Optometrist Identity Key’ would enable this legal requirement (in the UK) to go completely digital over Nostr.

   • The decentralized nature of Nostr ensures that prescriptions can be easily verified and traced back to the original issuer, avoiding forgery or fraud.

3. Privacy:

   • Unlike traditional methods where patient information is stored on centralized databases of the electronic medical record company (eg, Epic), or large health systems (eg, Ascension), Nostr keeps patient data decentralized and private, accessible only through permissioned sharing. This ensures no third party can access, manipulate, or misuse this sensitive information.

4. Immutable Records

   • Once a prescription is issued and signed on Nostr, it is stored immutably on the decentralized network. This ensures a permanent and trustworthy ledger of the patient’s eye health history. This feature adds to accountability and should bring a higher standard to complete and accurate prescribing across all practices.

   • These records can persist over time and are portable to travel with you, wherever you seek care or glasses.

5. Global Access

   • Patients can use their Nostr-stored prescription with any provider across the globe, without needing to worry about differing national data standards or carrying physical documents when they travel or move.

   • This opens up a wider use case when considering the 2 Billion + individuals who currently cannot get access to sight care services.

Benefits for Optometrist Practices and Operators:

1. Improved Patient Retention and Care through Trust and Transparency

   • By empowering patients with ownership of their data, practices foster trust and loyalty, reducing churn over time. If patients know they can rely on your practice for transparency, secure record-keeping, and access to the latest technology, they are more likely to return for future eye exams and other services.

   • A decentralized, tamper-proof record of prescriptions can improve administrative efficiency. No more handling lost prescriptions, disputes about validity, or delays in getting updated information to patients or other providers.

   • The decentralized storage of prescriptions allows optometrists to securely share and access patient data, making cross-practice collaboration easier for referrals, second opinions, or specialized care.

2. Cost Savings on Paperwork and Administration

   • Digitizing and decentralizing prescription records could lead to long-term savings on administrative costs, such as paperwork management, prescription re-issues, and managing patient data in outdated systems.

   • Optometrists can ensure their records are always accessible, accurate, and trusted by all parties (patients, insurers, other clinics).

   • By reducing the burden of handling prescription storage and verification manually, the practice can focus more on patient care.

3. Adaptation to Future Consumer Behavior and building a Tech-Savvy Reputation

   • As patients increasingly take control of their health data and seek decentralized solutions, practices that adapt to this trend are future-proofing their business model. Over time, patients will expect more control over their medical data, and being ahead of this shift will ensure long-term relevance.

   • Practices that embrace new technologies like Nostr can market themselves as tech-forward and adaptable to future trends, gaining an edge over more traditional competitors. This reputation is especially important as younger generations increasingly value privacy and digital autonomy. A Nostr-based service helps position the practice as aligned with these values.

4. Integration with Bitcoin

   • By integrating a service built on Nostr, naturally linked with the bitcoin ecosystem, the practice can also introduce bitcoin payments as a novel way to reduce transaction fees and differentiate their practice from the competition.

   • Attract bitcoiners: The optics practice can appeal to the Bitcoin community, who value decentralization and would appreciate paying with bitcoin or using a decentralized protocol for prescription management. This opens up a new market of patients interested in technology and financial independence.

5. Upsell Opportunities and Revenue Diversification

   • The practice can still maintain a competitive eyewear sales strategy by offering upsell opportunities. When patients receive their prescription digitally, they can be automatically sent tailored offers for high-quality lenses, frames, or even add-ons like blue light coatings or progressive lenses, keeping them within the practice’s ecosystem. Practices can offer value-added eyewear options, such as free adjustments, repairs, or personalized lens consultations, which online retailers can’t easily match.

   • The Nostr system can open doors to additional services beyond eyewear sales, including personalized consulting services, specialized testing (e.g., for contact lenses, binocular vision, myopia control), and more frequent checkups due to the ease of updating and verifying records.

Of course, utilizing this tool means providers need to help onboard individuals onto Nostr. In many ways, we see providers as playing into the Nostr network and flywheel effect. This is better technology with global access - and we invite you to consider other micro-apps that can continue to build out the decentralized healthcare ecosystem built on Nostr and bitcoin.

We have partnered with the Bitcoin Optometrist, Dr Alan Bryden, to continue to refine the micro-application and start testing its use. We’d like to thank Dr Alan for his insights that contributed to this micro-app and write-up. Check out his site and nonprofit, Sats for Sight, to learn more about utilizing bitcoin to provide eyeglasses to those in need, along with his HODL eyewear line.

We’re excited about the future of building healthcare applications on nostr and bitcoin. If you have ideas or are facing any health challenges, we’re conducting product discovery interviews to understand your biggest pain points when it comes to managing and optimizing your health and healthcare data. Please reach out to jon@nosfabrica.com or schedule time here to learn more about how to get involved!

Note: Lazer Eyes is currently only available for testing purposes as we evaluate regulatory considerations across jurisdictions.