Skip to content
New issue

Have a question about this project? Sign up for a free GitHub account to open an issue and contact its maintainers and the community.

By clicking “Sign up for GitHub”, you agree to our terms of service and privacy statement. We’ll occasionally send you account related emails.

Already on GitHub? Sign in to your account

Copyedited docs & updated with information on new features added #62

Merged
merged 5 commits into from
Feb 3, 2024
Merged
Show file tree
Hide file tree
Changes from all commits
Commits
File filter

Filter by extension

Filter by extension

Conversations
Failed to load comments.
Loading
Jump to
Jump to file
Failed to load files.
Loading
Diff view
Diff view
15 changes: 7 additions & 8 deletions faqs.md
Original file line number Diff line number Diff line change
Expand Up @@ -20,11 +20,9 @@ Most of us are aware that HIPAA ensures that our medical data stays private and

> See [lega/HIPAA.md](./legal/hipaa.html) for more information.

## Can I manually add my Medical data?
## Can I manually add my medical data?

Fasten will support manual data entry, but I don't think it'll be a day-1 feature. It's a lot more complicated and the UI/UX will be pretty complicated.

At that point I'll probably need to hire a UX designer tbh.
Yes, Fasten presently supports adding medical data manually. To add medical data, you need to either create an encounter or append it to an existing encounter. This limitation may be removed in the future.

## Where is my Medical data stored?

Expand All @@ -38,6 +36,7 @@ Fasten supports [full database encryption](https://en.wikipedia.org/wiki/Databas
As an additional layer of protection, we're considering record-level encryption, however that has some ramifications for search-ability.

## Is my Medical data available offline if I'm unable to communicate with the Provider?

100%, the (raw) data is stored in a local SQLite DB, and the app will be designed so it can work offline (with certain functionality disabled -- like automatic updates).

## Will there be a cloud-based offering of Fasten?
Expand All @@ -54,16 +53,16 @@ I've been working on complaint software/infrastructure (PCI, HIPAA, SOC, FedRAMP

HIE's are ubiquitous and ONC's information blocking rules require providers to contribute PHI data for all patients to HIE's. However, HIE's have no way to determine which providers should have access to an individual's medical records, so they have no authorization layer preventing unauthorized access. Any healthcare employee authorized to access patient records through an HIE essentially has access to the medical records of everyone in the US.

**Fasten doesn't integrate with HIE/HIX's** and you will still be able to access your records, even if you decide to opt-out of HIE sharing. Fasten integrates directly with your healthcare institutions to retrieve your health records -- its more tedious, but there's no middleman.
**Fasten doesn't integrate with HIE/HIXs** and you will still be able to access your records, even if you decide to opt-out of HIE sharing. Fasten integrates directly with your healthcare institutions to retrieve your health records -- it's more tedious, but there's no middleman.

## What is the Fasten Lighthouse? I thought Fasten was Self-Hosted?
<a id="lighthouse"></a>

1. The Lighthouse allows users to search for any supported healthcare institution by name, tag, address (and eventually country). It returns logos and additional metadata about the endpoint so that the Fasten application knows how to correctly communicate with the healthcare institution. As you can imagine, this dataset will be large ([NPPES](https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand/DataDissemination) is 8gb by itself -- and that only contains US institutions).
1. The Lighthouse allows users to search for any supported healthcare institution by name, tag, address (and eventually country). It returns logos and additional metadata about the endpoint so that the Fasten application knows how to correctly communicate with the healthcare institution. As you can imagine, this dataset will be large ([NPPES](https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand/DataDissemination) is 8GB by itself -- and that only contains US institutions).
2. Conforming US Healthcare institutions must allow patient access using the SMART-on-FHIR authentication protocol (its basically OpenID Connect). This means that app developers need to register an app with each EMR system (and sometimes each institution) and then securely store the returned client_id and client_secret.
- Registering applications is supposed to be simple, however in practice it can be a huge pain in the ass (legal contracts, privacy policies, technical documentation, audits, registered corporation, etc) -- its part of the reason why progress in [PLATFORM_LIST.md](https://github.com/fastenhealth/fasten-sources/blob/main/PLATFORM_LIST.md) is taking so long. I think that more PHR applications in the healthcare space will force EMR systems to streamline their developer onboarding flow, but until then a service like Fasten Lighthouse is required to have even a minimally functional user-experience.
3. Fasten Lighthouse is designed such that it is only involved in the authentication flow. Where possible we leverage [PKCE](https://auth0.com/docs/get-started/authentication-and-authorization-flow/authorization-code-flow-with-proof-key-for-code-exchange-pkce) & Public Clients to ensure it does not have access to the Access Token & Refresh Token.
- In some cases, Healthcare Providers will require a [Confidential client](https://oauth.net/2/client-types/), which means that the client application cannot directly exchange the authorization code for an access token, a Client Secret is necessary. For security purposes the Client Secret is not stored in the client application, but is stored on the Lighthouse server.
- In some cases, Healthcare providers will require a [Confidential client](https://oauth.net/2/client-types/), which means that the client application cannot directly exchange the authorization code for an access token, a Client Secret is necessary. For security purposes the Client Secret is not stored in the client application, but is stored on the Lighthouse server.
- Confidential client token exchange requests must be proxied through the Lighthouse server (which is different from the Public Client flow), and will have temporary access to the Access Token.
4. Patient data never transits the Fasten Lighthouse (the requests are made directly by the Fasten application, running on your own hardware).
- See [FastenHealth/docs AUTHENTICATION.md](https://github.com/fastenhealth/docs/blob/main/technical/authentication.html) for more information and a data transfer diagram.
Expand All @@ -81,7 +80,7 @@ Ideally Fasten will become a zero-knowledge application, where monetizing user-d

- (**SAAS/APP STORE**) free open-source self-hosted version but charge for cloud-hosted and app store versions - this broadens our market to include non-technical users and allows for the possibility of sharing data with healthcare institutions (with the patients consent)
- (**DATA-PLATFORM**) become a data-platform/gateway, similar to plaid, and charge institutions to integrate with Fasten. This means when a patient changes healthcare providers/insurance companies, they may see an "import" button in their patient portals to pull their full history from Fasten into their provider. This is only viable if Fasten has significant market share.
- (**NICHE-GROWTH/REFERRALS**) become a data-gateway, for a specific niche. Partner with researchers/providers that work with high-risk groups (diabetics, liver disease, etc) and build dashboard widgets focused on providing relevant information for those patient types, so that the researchers and providers in that niche direct all new users towards Fasten. rinse-and-repeat for other diseases, then tackle Enterprise agreements. This strategy can also be used to offer condition/disease-specific referrals & services (Continuous-Glucose-Monitoring/home-care-monitoring)
- (**NICHE-GROWTH/REFERRALS**) become a data-gateway, for a specific niche. Partner with researchers/providers that work with high-risk groups (diabetics, liver disease, etc) and build dashboard widgets focused on providing relevant information for those patient types, so that the researchers and providers in that niche direct all new users towards Fasten. Rinse-and-repeat for other diseases, then tackle enterprise agreements. This strategy can also be used to offer condition/disease-specific referrals & services (Continuous-Glucose-Monitoring/home-care-monitoring)


Ideally Fasten is free for self-hosted users, and free/minimal cost for cloud-users. Eventually I'd like to partner with (and charge) medical institutions, as B2B/B2E is the most lucrative, but it'll probably be a long time before that's viable. Personally I'm not depending on Fasten making money anytime soon, I just want to build something that will help people track their medical information, and build a community around it. If our community becomes big enough, monetization will be easy. The community will support the sharing features since they are in control, and our goals align.
6 changes: 2 additions & 4 deletions features.md
Original file line number Diff line number Diff line change
@@ -1,6 +1,6 @@
---
layout: default
title: Features
title: Future features
redirect_from:
- /FEATURES.html
---
Expand All @@ -13,20 +13,18 @@ redirect_from:
- CT/MRI/Xray Scans
- PDF's of patient charts
- Multiple users
- Encryption at rest
- Integration with external apis
- (Apple Health?)
- [https://www.researchandcare.org/carekit/](https://www.researchandcare.org/carekit/)
- smart scales
- Integration with DNA suites
- Historical data from lab results (bloodwork over time)
- Import via forwarded emails
- Features: [https://github.com/carekit-apple/CareKit/tree/master/OCKSample](https://github.com/carekit-apple/CareKit/tree/master/OCKSample)
- [https://awesomeopensource.com/project/carekit-apple/CareKit](https://awesomeopensource.com/project/carekit-apple/CareKit)
- [https://docs.smarthealthit.org/](https://docs.smarthealthit.org/)
- Vaccine records
- User entered family history
- billing comparisons with external data:
- Billing comparisons with external data:

| Data Sources | Data Elements | Insurance Types |
|:--------------------------------|:-----------------------------------|:----------------|
Expand Down
16 changes: 6 additions & 10 deletions funding.md
Original file line number Diff line number Diff line change
Expand Up @@ -16,11 +16,7 @@ Here's my current plan:

# What do you get? 

**A lifetime license to the Fasten Health software.** However, at this point, you'll receive essentially nothing tangible since the app is entirely open source. In the future, we plan to monetize Fasten by offering a SAAS version with a subscription fee and desktop versions which you'll be able to purchase in the Windows/Mac App Stores. Your lifetime license will apply to both.

{: .important }
To make sure you still get *something* for your money, users who purchase the lifetime license will get exclusive access to the **Fasten Health Desktop App private beta**. It's a desktop version of the Fasten Health app that is available for Windows, Mac & (eventually) Linux.
It's a standalone (non-docker) app that will allow you to access your health record offline, and will open Fasten up to a new set of users who may not have their own home server or understand how Docker works.
**A lifetime license to the Fasten Health software.** Presently, we offer a desktop version available for sale in the Windows/Mac App Stores. We also plan to potentially offer a cloud-based, self-hosted version of Fasten. Your lifetime license would apply to both.

# $75,000 is a lot of money! What are you going to do with it? 

Expand All @@ -29,11 +25,11 @@ Agreed, it sounds like a lot, however after taxes, legal fees & infrastructure c

Specifically, there are a number of features I’ll be prioritizing with this funding: 

- **Enhanced User Experience**
- **Enhanced user experience**
- **Smart device/wearable integration**
- **ChatGPT-Like Offline Interface** for Querying Your Health Record
- **Predefined Dashboards for Chronic Conditions** - work with a number of chronic condition communities to see how we can display the data they actually care about
- **Integration of a WHO Recommendation Engine** to highlight discrepancies from the guidelines for condition-based care, vaccines, boosters, checkups, etc. 
- **ChatGPT-Like offline interface** for Querying Your Health Record
- **Predefined dashboards for chronic conditions** - work with a number of chronic condition communities to see how we can display the data they actually care about
- **Integration of a WHO recommendation engine** to highlight discrepancies from the guidelines for condition-based care, vaccines, boosters, checkups, etc. 
- **Integration of Health Plan Price Transparency Information** - allowing users to see how the cost of their tests, procedures & medications compare between other providers in their region. 

# $75,000 isn’t much money! Why don’t you raise prices/total lifetime license count/capital from VCs?
Expand All @@ -42,7 +38,7 @@ Let's be crystal clear, anyone who purchases a “lifetime” license at this po

Increasing the count of total lifetime licenses could have long-term consequences. If Fasten becomes successful, "power-users" who upgrade and use our services regularly will be grandfathered into heavily discounted plans, potentially paying much less than the actual service costs to run. **It's a balancing act.**

As for Venture Capitalists (VCs), while they’ll give money to [almost anyone](https://techcrunch.com/2014/07/18/yo-raises-1-5m-in-funding-at-a-10m-valuation-investors-include-betaworks-and-pete-cashmore), their money comes with serious strings attached. Founders are typically required to rapidly expand their user base and profit, which may not might not align with our mission of patient empowerment.
As for venture capitalists, while they’ll give money to [almost anyone](https://techcrunch.com/2014/07/18/yo-raises-1-5m-in-funding-at-a-10m-valuation-investors-include-betaworks-and-pete-cashmore), their money comes with serious strings attached. Founders are typically required to rapidly expand their user base and profit, which may not might not align with our mission of patient empowerment.
Frankly it just makes me uncomfortable, and I believe that selling directly to our users keeps our incentives in alignment.

# This sounds great, sign me up!
Expand Down
20 changes: 11 additions & 9 deletions index.md
Original file line number Diff line number Diff line change
Expand Up @@ -17,13 +17,14 @@ Fasten is an open-source and self-hosted electronic medical record aggregator fo

{: .warning }

> Fasten is a Work-in-Progress and can only communicate with a limited number of Healthcare Instutions (approx 25,000 at last count).
> Fasten is a Work-in-Progress and can only communicate with a limited number of healthcare instutions (approx 25,000 at last count).
> Please fill out this [Google Form](https://forms.gle/SNsYX9BNMXB6TuTw6) if you'd like to be kept up-to-date on Fasten
>
> To ensure Fasten's long-term sustainability, we're exploring some funding options. While we're still deciding a long-term monetization strategy, I'm kicking off with a crowdfunding/fundraising experiment for the first 500 users (including a surprise desktop app):
> To ensure Fasten's long-term sustainability, we're exploring some funding options. The first 500 users have access to a lifetime license, including support for the self-hosted version, as well as all current & future apps.
>
> - [Fasten Self-Hosted Lifetime License - **$200**](https://buy.stripe.com/fZe00deiUexS58Y4gg)
>
> The Windows & Mac apps are also available as standalone downloads at the [Microsoft Store](https://apps.microsoft.com/detail/Fasten%20Health/9PL8CZV1NRFP?launch=true&mode=full) and [App Store](https://apps.apple.com/us/app/fasten-health/id6471036301) for a one-time purchase of $50.
> Got questions or want to learn more about our fundraising experiment? [Click here to dive into the details & FAQs](https://docs.fastenhealth.com/FUNDRAISING.html)

# Introduction
Expand All @@ -37,12 +38,12 @@ I wanted a single (private) location to store our medical records, and I just co

- **Self-hosted** - this is my medical history, I'm not willing to give it to some random multi-national corporation to data-mine and sell
- **All inclusive** - It should aggregate my data from multiple healthcare providers (insurance companies, hospital networks, clinics, labs) across multiple industries (vision, dental, medical) -- all in one dashboard
- **Automatic** - It should pull my EMR (electronic medical record) directly from my insurance provider/clinic/hospital network - I dont want to scan/OCR physical documents (unless I have to)
- **Open Source** - The code should be available for contributions & auditing
- **Automatic** - It should pull my EMR (electronic medical record) directly from my insurance provider/clinic/hospital network - I don't want to scan/OCR physical documents unless I have to
- **Open-source** - The code should be available for contributions & auditing

So, I built it.

**Fasten is an open-source, self-hosted, personal/family electronic medical record aggregator, designed to integrate with 100,000's of insurances/hospitals/clinics**
**Fasten is an open-source, self-hosted, personal/family electronic medical record aggregator, able to integrate with the electronc medical records your healthcare providers & insurers are already using.**

<p align="center">
<a href="https://imgur.com/a/vfgojBD">
Expand All @@ -57,12 +58,13 @@ So, I built it.
Fasten is designed with a solid foundation that is easily extensible:

- Self-hosted
- Designed for families, not Clinics (unlike OpenEMR and other popular EMR systems)
- Supports the Medical industry's (semi-standard) FHIR protocol
- Uses OAuth2 (Smart-on-FHIR) authentication (no passwords necessary)
- Designed for families, not clinics (unlike the EMR your doctors use)
- Supports the FHIR protocol required by U.S. law
- Uses OAuth2 (Smart-on-FHIR) authentication, so you don't need to trust Fasten with your password
- Uses OAuth's `offline_access` scope (where possible) to automatically pull changes/updates
- Multi-user support for household/family use
- (Future) Dashboards & tracking for diagnostic tests
- Dashboards & tracking for lab work, panels, & vitals
- Ability to manually add data from paper charts or self-ordered lab work
- (Future) Integration with smart-devices & wearables

---
Expand Down