🎙️ Decentralizing Healthcare: A Conversation About Bitcoin, Nostr and SALUD with Fabian of Illuminodes
Join Adam as he explores the groundbreaking SALUD protocol—a revolutionary decentralized healthcare data system being piloted in El Salvador. Fabian from Illuminodes discusses how this open-source protocol built on Nostr is reshaping healthcare data management and patient sovereignty.
Key Topics:
The SALUD protocol and its implementation in El Salvador
How Bitcoin and Nostr are revolutionizing healthcare data
Patient control over medical records using public/private keys
Challenges and opportunities in decentralized healthcare
Future developments and global expansion possibilities
🔗 Important Links:
Learn more about the initiative: https://illuminodes.com
Join the builder challenge: https://www.nosfabrica.com/challenge
Learn about Nostr: https://nostr.com
Transcript
Adam
Welcome to this week’s episode of the HIPAA Insider show. I’m your host, Adam, and today we’re discussing a groundbreaking topic, the Salud Protocol, which is a revolutionary decentralized healthcare data system currently being piloted in El Salvador. Joining us to shed light on this incredible project is Fabian, one of the visionaries behind Salute Protocol and a key figure at Illuminotes, the Salvadoran tech initiative leading this charge. Fabian, welcome to the show.
Fabian
Hello. How are you going?
Adam
I’m doing well, thanks. Yeah, we’ve talked quite a bit before this, so, yeah, it’s great to have you on. Could you tell the audience a little bit about yourself?
Fabian
I’m Fabian. I am now in El Salvador, originally from the Netherlands, spent a lot of time in Australia, but now here in El Salvador, I guess riding the wave of opportunity and change that’s happening in the world. I think that’s probably the best way to put it. I mean, I think we all realize that there’s a lot of change going on in the world. I mean, we’re seeing that obviously in all the political realms with, you know, people like Trump and what’s happening over here with people like Bukele and Argentina and obviously stuff that’s happening in Suriname. So, yeah, there’s a lot of change happening and I think the world is sort of moving into more of a decentralized mindset and I think this is one of the places where it sort of started. So again, my history is in it.
Fabian
Originally mechanical engineer, funny enough, but ended up, yeah, I did that for three years and then fell back to the fact that I was always futzing around with computers and software and ever since I was a kid, I guess. And yeah, so that’s sort of what brought me back to it and have been doing that for a long time. I’ve been, I guess, in the IT industry over 25 years now. But I guess my reason for being here, going down this path that we’re actually discussing today is very much about, I guess, me being someone that believes in sovereignty, self reliance and all that kind of stuff. And that’s, I think, what fuels this project that fuels what I do every day and fuels the fact that I’m actually now in El Salvador doing this project as well.
Adam
Yeah, that’s, that’s fascinating. And for the audience, I, I first heard about Fabian on. I can’t remember the exact podcast, but it was a bitcoin related podcast. And obviously, you know, bitcoin’s very much related with the concept of financial freedom. Fabian, you come from an I. T. Background or you worked in IT for healthcare, is that right? Could you tell us about some of the problems that were encountered there and what problems you’re aiming to solve with the salute protocol? And one extra question, how noster can help the. You got the noster sign behind you?
Fabian
Yeah, yeah, I like this. It’s a bit of my pride and joy. This, this sign came out of a booth that we had at adopting bitcoin that was I think in November. Here, look. Like you said bitcoin, right? Bitcoin is a new way for money and state to be separated from each other. And I think we’ve seen over the last century, if not longer, that money is becoming more and more centralized, more and more controlled, more and more centrally controlled. And obviously in 2008, this whole Bitcoin thing came along, which is really about separating those two things. Really in the past we had the church and the state, they were one and that was separated. And now money and the state are also, you know, tied to each other with the way that the world works.
Fabian
And now we’re trying to see, we’re seeing that it’s no longer working and that’s now being separated through open source protocols and technologies like bitcoin. So as the world is centralizing, you can obviously say, okay, it’s getting too centralized and we’re what I’m about. As I said, I like self-sovereignty, I like understanding freedom. I believe in the individual. You know, bitcoin’s great, it’s wonderful. But what about the other stuff? What about things like my personal information, my personal data, the stuff that I owned, stuff that I create, the, my physical being, you know, that too is being centralized and has been centralized over the decades and decades. And we’ve seen that over the last few years.
Fabian
I don’t know if you’ve been around in the last few years, but we’ve definitely experienced what it’s like to have more centralized health systems, more centralized thinking, more centralized ways of running a society. And as a result, you know, we’ve been restricted a lot. And that’s not going to be flying with someone like myself who believes in self-sovereignty and stuff like that. So that sort of inspired me to actually go down this path. And I have a history in health administration systems. So I know what these systems are like and I understand how they’re actually operating and I understand that’s. Yeah, you have zero as a patient or a doctor. Even you have zero control over that data and you have zero control over what’s done with that data.
Fabian
And that obviously brings along a lot of problems with, you know, what is real, what is not real, what are they doing to my information? What is being shown about me? What as a doctor even, you know, what am I, I might be putting something out, but who knows what’s happening to that information? Is someone playing around with it? I don’t know. Right. And that sort of inspired me because I said I’ve been in this, in these systems for a long time to say, okay, well with this world that’s changing and with this opportunity that I guess El Salvador is opening up of separating, of bringing back self-sovereignty, let’s do something about that and let’s go over here and see what we can do. And that’s where this whole thing came from.
Adam
It’s really refreshing to hear, you know, this is the HIPAA insider show. So we focus, the majority of our episodes are talking about regulations and restrictions and it’s really refreshing to talk to someone a little bit more about freedom and the possibility of lifting, you know, restrictions and regulations because I think, you know, our audience, it’s a mix of developers that are in the healthcare industry, some doctors and patients. And I don’t think it’s, you know, at the personal level, at the individual level, I don’t think there’s any, you know, grand scheme from a doctor’s office to try and you know, control patients data. But I think it’s just the nature of technology and the way it’s evolved. Like it’s all, you know, we go back to the, you know, the paper age.
Adam
It’s a lot more efficient to have a filing cabinet with the patient records so that when the patient comes in it’s very easy to access. Oh, if the patient forgot their documents, whatever it was, it’s not a big deal. You know, we’ve got all the documents here but as things evolve that then as you said, gets more centralized. It’s no longer, you know, each doctor’s office has the documents now it’s all with third party data centers. So that creates an issue there. So I think it does that maybe lead us into the technology, maybe talk a little bit about the technology and how that’s evolved in and a bit above the salute protocol.
Fabian
I think. Yeah, I think you’re right. I mean one of the ways that I often explain it, you might have heard of this before, but is our lives are we obviously have our physical beings and we live in our houses and do our things and go surfing and do whatever. But a lot of our lives is actually in the digital realm nowadays. And that wasn’t the case 50 years ago and certainly wasn’t the case 100 years ago, but it’s been evolving into the digital realm. And what’s happened is the way that technology’s evolved, and probably not initially with. With any bad, for bad reasons, but evolved in such a way where we’ve been sort of removed, sort of, We’ve lost control of our own digital information. We do not own our own digital information. And that’s not just in the health sector.
Fabian
That’s everywhere, really. That’s everywhere. So the world has evolved and the digital world has evolved in the way that we don’t really control our identities. And if you can’t control our identities, then we can’t control the data that’s associated with our identities either that we actually put out that is about us, that’s, etc. And that’s in a world where literally, I would say, I mean, sure, I go do all the soccer things and drive my car, but literally all the stuff that is about information is in the digital realm. And that means that more than 50% of our existence is in that digital space. So we now don’t have a way to actually control that.
Fabian
And I think what we’re doing and specifically what things, technologies like Noster and Bitcoin are doing is actually allowing us to take back control of ourselves, our digital selves, like we have in the physical world, in the digital realm. So in other words, we can take back ownership, we could take back control, etc. And it is just. Just isn’t like that right now. So we need to, I believe as a society, we really need to shift about, you know, we need to have that same control over us and our things in the digital spaces, in the physical space. And that’s what this Noster. Nostr thing is creating, this Noster protocol is giving us. And I think, to be perfectly honest, that’s where the future is going.
Fabian
As I said, we’re seeing all this crazy stuff happening over the last few years and people are starting to wake up. I often refer to the fact that if this thing, if this, the crazy health stuff hadn’t happened in the last five years, people wouldn’t have been aware of what’s going on. And people wouldn’t have been woken up enough to say, okay, this is important, this needs to be addressed. And that’s where this comes from. So that obviously is the spawning of the whole Solute protocol project as well.
Adam
Yeah. And I think next we’ll want to get a little bit technical and talk a bit about the Salute protocol. But could you get. Could you give the listeners who haven’t heard of Noster before an easy way for them to check it out? Because it’s a protocol. Right. But how would they be able to interact with it just at a user level?
Fabian
Yeah. So Noster is a protocol. It uses the same sort of idea as Bitcoin, where you have public and private keys. So you own your private key. The public key is out there in the world and people can interact with that public key. That public key is associated with Messages and information, etc.
Adam
And so instead of things like, let’s say, you know, a social media app like Twitter or something where you have your username and password. That’s. That’s not necessarily the case here. There’s a public key and a private key, is that right?
Fabian
Yeah. So basically with that public key, which is a portable now, because it’s mine. Right. I control that private key. So therefore I can tell the public side of it as well. I have the ability to log into digital applications, but I control the data in those different digital applications associated with my. With my keys. What that means then is that I can use that in, say, social media space. So in other words, for people that don’t know Noster, the best way I would say to start is in the social media realm.
Adam
Yeah.
Fabian
Where there’s a whole bunch of applications out there that allow you to take that key, plug that keys those keys in, and then instantly be in this social media realm. So there’s different bit like email, right? A little bit. I can, I can take my email address, I can put it in there, but I can use different applications to interact with the email.
Adam
It’s really cool. As an example of the way that we first started to interact, I was using something called Primal. I’m not sure what you. I’m not sure what you were using. I don’t really care. I was able to direct message you and you’re able to reply back to me. And yeah, it was a secure way of doing that.
Fabian
Yeah. So for the social media realm, there’s applications called Primal. I use Amethyst on my mobile phone. I. I actually use multiple different applications to access the same information with my keys. It’s no longer a Twitter or a Facebook or whatever. They have to be on that specific platform and only on that platform, with my keys, I can plug my identity in and that identity starts interacting with whatever based on my identity, not based on the application itself, like the others.
Adam
Yeah, it’s weird. It’s almost like you’ve got a key and you’re a traveler and every time you go into an Airbnb and you unlock the Airbnb and go in your suitcase is there, and it’s ready to. You’re ready to, you know, vacation. Right?
Fabian
Sure, sure. That’s, that’s the way. And the funny thing is that with that key, like you said, is I, I can unlock it. No one else can unlock it. And that’s the more important part. So the. But the big part there is that it’s portable. Right. So in other words, if tomorrow there’s another application using Noster that everyone else likes more for social media, then what I can do is I can say, okay, I’m going to take that key and I’m going to plug that key into that and then start using that application. So again, I’m not restricted to a Facebook or an Instagram or Twitter or anything like that. I’m actually connected through an open source protocol that no one controls and no one has control over. Okay, that’s big. That’s very.
Adam
Start from there. So we’ve got a good handle on what Bitcoin is, what Noster is. Could you talk a little bit about the Salute protocol and how that fits into Noster?
Fabian
Yeah, so what we’ve decided that, okay, if I can control my. If I have ownership over my own digital identity and I can control my own digital data, that also means that I can control any health data as well. Right. Because right now in the world, the way that it’s managed is that everything is centralized through a few software businesses out there. Massive software businesses. I mean, I’m guessing you’ve heard of the players, like the Cerners out there, right?
Adam
Yeah, yeah.
Fabian
And they are the ones that actually control the health data through their centralized databases, centralized applications. Just like Twitter controls everything in their Twitter world and Facebook controls everything in the Facebook world. So in other words, you as an individual, you don’t own anything, you don’t control anything, you don’t own, and certainly not your health information. And that then means that other people do, and if other people do, they can do whatever they want with that information. And what we’ve said, okay, well, let’s use this Noster protocol, which no one controls and no one actually owns or anything like that. To actually build what we call the solute protocol. So we are in the. In the process of building this protocol. What does that mean? It means that I, as an individual, as a patient, right, I have control over my own health data.
Fabian
So if I have a pathology test that is done, right, I actually get control over that pathology data. And it is up to me what I do with it. If I go to another doctor and said, and they say, I need to have this information, fine, what do you need? And I can say, okay, well, I need this, and this and this. So in other words, I can say, you need those 10 bits of information about me, not 100 bits of information about me. 10 bits of information about me. Okay. And I can release that to this individual. Okay. Or someone says, has an insurance situation, I need to have an insurance claim or something like that. Again, this insurance company does not need 100 points of information about me. There are specific things that are important, an insurance claim.
Fabian
And then I, as an individual can say, okay, these are the bits of information that can be released to that company, whatever it may be. So the. What we’re doing, though, is we’re actually building what we. What is called the. Have you heard of fire? F H I, R. Yeah. All right. I would say you. I would hope you actually would.
Adam
Yeah, we’ve come across there a couple of times.
Fabian
Yes, yes. But so what we’ve done and what we’re doing is so we’re actually building the FHIR standard, which is now an ISO standard, right. In integrating that into the NOSTR messages that we’re creating with the Salute protocol. So in other words, when using the Salute protocol, you’re actually using a standard that’s been around for almost 30 years and is globally adopted at the same time. So we’re using NOSTER to control the information, manage the information, own the information, but still applying a global standard to that information. So in other words, we can still communicate with systems that are out there and existing out there as well as the fact that here in. In the countries like El Salvador where we’re deploying this, Right. We’re actually getting them to a level where they haven’t been yet with that global standard.
Fabian
So we’re actually lifting them over here as well. So I hope that sort of makes sense. So the idea behind Salute protocol is that all of a sudden we own our own identity, digital identity. Therefore, we can control our own digital information, including our health information, but specifically around the health space, and salute is actually the Spanish word for health. So that’s why we called it the Salute Protocol.
Adam
But it stands for something as well, right?
Fabian
Yeah. Salute stands for Sistema de administration. Libertad is in like free unico for the unique individual ide centralizada. So it’s a, an individual, unique decentralized health administration system. That’s basically what it comes down to. Yeah. And the idea is that what we do is we’re building this and we’re building this in the real world. So in other words, we’ve actually teamed up with an organization called Paravida Hospital Group. So Paravita Hospital is a hospital in El Salvador, a private hospital in El Salvador. That was crazy enough to say, yes, we love this idea. We want to go down this path with you. And we’re actually building this Salute Protocol. So it’s a pilot, Right. We’re building that with them in the real world.
Fabian
Because as much as, you know, you’ve got all your Twitters and your online, you know, social media stuff that we discussed earlier with Noster, the real world is very different to just online type applications. You’re dealing with real doctors, you’re dealing with real patients, you’re dealing with real hospitals that are actually interacting with this. So the big thing is how are patients going to interact with this? How are doctors going to interact with this? And that’s why we’ve actually teamed up with the hospital to actually build these real world applications to make sure that it actually gets adopted by the real world properly and that the real world could easily interact with this technology. And I can tell you so far in what we’ve rolled out, the beauty is that the administration and the doctors have no idea that they’re using Noster.
Fabian
They’re just using a system that works better for them.
Adam
Yeah.
Fabian
And is lifting them just from a technological perspective. But they don’t know that they’re actually using nostril. We actually ask them, do you know what master is? They would say, no.
Adam
Yeah. And I mean, they don’t need to know. I mean, it’s the equivalent of asking a doctor, do you know what FHIR is? And say, well, no, but somehow the data gets communicated from one facility to another.
Fabian
Yeah, yeah. It’s important. In the real world, people do not care if, like you said, if we’re using TCP IP protocol to communicate on the Internet, all they want is someone to be able to push a button and they on the other end push another button and they can talk to each other like we’re doing right now. Who cares how it works. Yeah, so no, absolutely. It’s important that the user at the end of day just experiences, has a good experience and that’s why we’re building it in the real world. With the real world.
Adam
Yeah. And I can’t stress this enough, this is very early stages. I mean if people talk about bitcoin and they say it’s just the start, but Bitcoins, you know, been around for over, well over a decade now. Was it 15 years, 16 years now. Noster I think 2020 was when it was first starts to get coded.
Fabian
I think it’s about four years.
Adam
Yeah, yeah. And Salud is fresh off the press. I mean Noster I think I was looking the other day has about 20,000 active and endpubs or, you know, users. So it’s, the user base is very small and so very early stages. So it makes sense that you’re doing this pilot and testing it in a real world environment. But the advantage with it being open source is that they things go very fast and they can get to a very professional level and the software and UI can get to a great place very quickly rather than it being in house. So, yeah, really exciting here. Do you think, you know, from that experience, do you think other countries could learn from the, the experience that you’re having in El Salvador and adopt similar protocols?
Fabian
Yeah, as I said, it’s obviously open source. The way that we are building this is in three phases. In other words, we’ve finished phase one, we’re now into phase two, and then in phase three, I’m expecting that in the next, say 612 months, whatever it is, we’ll have the whole thing defined properly. We’ll put our white paper out there saying, okay, well this is the Solute protocol, this is how it works. These are the parts of it. One of the parts of it is the, what they call the NIP 82 Noster Implementation possibility. So these are like specific little rules that in that realm and The Noster implementation possibility 82 was actually put together by people that are already in the Noster space. So we’ve been going back and forth with them about, okay, we need to somehow integrate that fhir aspect into nostr.
Fabian
And that’s what Nip82 is about. So I don’t know if you’ve heard of Amethyst, the application. Amethyst. Yeah, yeah. So Vitor Pamplona is the guy behind that and we’re actually working with him and his team in Las Fabrica to actually do that as well.
Adam
Sorry, is that an event or is it.
Fabian
No, no. If you go to, if you go to NAS Fabrica as an organization that is also working in that health space. And I would actually, you know, look them up because right now we’re actually, there’s like a open source development initiative. Like, you know, come and join us, start developing on Nip 82, which is the solute protocol. Nip parts, the FHIR parts. And I said, this is an open source world. So we’re already, there’s already stuff out there where people are saying, hey, you can build on Nip82. You can start building and adding to the Solute Protocol with this initiative. And, you know, there’s even, you know, funds out there so you can win money, I guess, for good applications that you might building. So we’re already in that open source realm out there.
Adam
If you’re a developer, programmer watching this, check that out. We’ll make sure. We’ll put the link in the description below. Yeah, Chris, regular listener, viewer. I’m thinking of you. Check it out. All right. Sorry, I. We got sidetracked slightly there, so.
Fabian
No, that’s right. So, yeah, for people like your Chris, you know, there’s already stuff out there. You know, people can always approach us directly if they want to as well. But yeah, we’re already out there. It’s already parts of the Salute protocol are already out there and being developed on. And what you were saying is, you know, it takes time, but the idea is basically to make this all open where everyone can build whatever they want on this thing and make it happen. I mean, there’s so, I don’t know, I’m hoping there’s going to be applications out there that I haven’t even thought about that people are going to be putting together and building in this realm. I mean, the health industry is big and very big.
Fabian
So there’s a lot of opportunity and a lot of things that you can do in this space. I mean, I remember someone talking about a smart watch. We all have smart watches, right? So if I. Yeah, exactly, we all have. Well, I don’t have one. But yes, we all. A lot of people have smartwatches and. Yeah, well, there you go. There’s a lot of health information out there and that’s basically sucked into this central vortex, centralized vortex, and you never ever see it again. You don’t even know what happens to that information. Right. But I can tell you, though, that in the health industry, the value of data, the health Data, is about $2 trillion a year from what I understand. So that’s a lot, a lot of value. That’s, that’s there right now. Again, that’s being sucked from every single device.
Fabian
It’s being manipulated, being controlled. I don’t know what they do with it. Good, bad, it doesn’t really matter. But it is not ours. But it did actually come out of your body, that information, so it should be yours, right? So you should be the one that actually controls that. You should be the one that actually says yes or no, you can use that. But that’s not how the digital world works right now. And that’s, again, not just for health, that’s how digital work. So what we’re doing is we’re saying, okay, well, if I control that health identity and I control that health information, even if it is on my watch, maybe I should get something for it if someone is going to use it.
Fabian
So in other words, trying to then say, okay, let’s turn it back on to the owner and say, give the owner back control back. Instead of, yeah, I think, as I said, I mean, think about, people need to think about what does it mean to own your own digital identity and to control your own digital information? And what we’re doing that is that put it into the health world, which is massive. There’s a lot of money there’s a lot of information there’s a lot of misinformation there and playing around with information there. And if we had a way where the individual can control the information and the data, we know that the data is not manipulated, we know that the data is genuine. It’s not played around with, then what does that mean? If we basically give control back to the individual?
Fabian
And I always think that what we’re really about is we’re about democratizing data. Meaning right now there’s so much information out there and we don’t even know where it came from and who owns it. But if we can actually have individuals verifiably say this is true honest information because it came from them, because they own the keys, then you can really go and say we’re democratizing information, we’re democratizing data in this very centralized world where that’s the word, democracy has actually lost a lot of clout.
Adam
Yeah, definitely. Well, I think those are very poignant points and I wish you the best of luck when it comes to this project and in the future. And you know, we would love to have you back on. Give us an update maybe later down the line and see how things are progressing. If you’d like to come on. Any, any closing thoughts, Fabian, for your audience and, and where can they learn more? We’ve already, you know, talked about Nos Fabrica, but any other. Yeah, the links to Shill.
Fabian
Yeah. So just look up illuminones on Google. It’ll pop up with us with interviews, with podcasts and all that other stuff. Obviously, we’re always, you know, open to feedback, resources. I mean, any initiative, and certainly open source initiative is always looking for people to join and to come on board and work with us or support us or fund us or whatever it is. So definitely open to people that are interested in what we’re doing. And I think the other thing is start looking at nostr. Start looking at what NOSTR is about, what NOSTR can do and start thinking about it as well. I mean, we obviously have busy lives, but there’s some new technologies like Bitcoin and now NOSTR out there that’s are, I think world changing. So.
Fabian
Yeah, so start looking at that, start investigating because I think it’s definitely where the future is going.
Adam
Awesome. Well, thank you very much, Fabian, for joining us. And to our listeners, if you’re inspired as I am by what Fabian and the Illuminates team are doing, keep an eye on El Salvador. It’s becoming a global leader in tech and healthcare innovation. Don’t forget to subscribe to the HIPAA Insider show and leave us a review. Until next time. I’m Adam reminding you, stay compliant, stay informed and take control of your data. Cheers.