Project Title
Nectar Protocol
Description
Nectar is the fast, private, and HIPAA compliant infrastructure for healthcare’s web3 future. Nectar brings together zk-rollups and HIPAA compliant nodes to create a data rich environment for healthcare, globally.
Manifesto/Vision
The future of healthcare is not bound by geographical boundaries; it blurs the line between reality and digital; it is more effective and less expensive; it is data rich.
The future of healthcare runs on Nectar.
In 2014, the Living Heart Project kicked off, debuting the first simulated real-life heart. The research, led by Dassault Systèmes, has brought together leading physicians, researchers, educators, medical device developers, regulatory agencies, and practicing cardiologists from across the world to develop personalized digital heart models. The project just received additional federal funding, expanding the scope to virtual patients and computational modeling.
In 2017, an article in The Journal of Arthroplasty found that personalized knee replacement devices had far better outcomes at no additional cost than “out of the box” knee replacement devices.
In 2018, a study was published in Acta Orthopaedica about a December 2017 shoulder replacement surgery on an 80-year old woman with advanced arthritis. This surgery was guided by Microsoft’s HoloLens, which personalized guided steps for the surgery based on the patient’s medical history and operating technique which were accessible and visible in real time via the HoloLens: “the surgeon was able to compare, stage by stage, what he was doing with what had to be done” for the surgery.
In 2019, a surgeon in China successfully completed a liver removal of a lab animal over a 5G internet connection. The surgeon was at a different location 30 miles away.
In 2020, because of the COVID-19 Pandemic, clinicians in the United States were allowed to practice telemedicine across state borders without concern for their State Licensure. In 2021, the Center for Care Innovations presented a host of evidence that, for many clinical applications, telemedicine was just as if not more effective than in-person care.
In 2021, the opportunity of in silico trials promises better, faster, and cheaper clinical trials by assessing potential drug and therapy impact via computer simulation and large datasets.
“The living heart (brain and lung) projects could go a lot farther with more data. It’s been really hard for us to access the data we need for the project,” S.Kreuzer, consultant on The Living Heart, Brain and Lung projects for Dassault Systèmes in discussion with Kat.
The innovations we’ve seen in healthcare are exciting, but deprived and restricted due to limitations in data access. To bring these innovations to scale, data access is crucial, but so is protecting the individual’s rights to their data.
The future of healthcare becomes a global reality through access to robust data that is owned and governed by the individuals and institutions that created it.
Once a secure, global data web exists, innovation is limitless.
Problem
There are more than 82 million daily transactions in healthcare:
- Needs to be Fast: Web3 cannot be slower than current healthcare infrastructure
Healthcare data is sensitive and personal:
- Needs to be Private: The majority of healthcare related smart contracts and transactions cannot be public (nor do patients, specifically, want their data to be public)
Healthcare providers are required to follow strict rules for the transport and storage of patient data:
- Needs to be HIPAA Compliant: Healthcare providers cannot be excluded from web3’s healthcare future
Solution
Nectar is a publicly accessible, highly scalable, privacy preserving, compliant network that creates a data rich environment for healthcare’s web3.
Product Features
We are building on existing zk-rollup infrastructure (zkSync), because recreating the wheel is a waste of time. You can read about zkSync here, so we will not be re-covering that material.
Specific to Nectar: Despite the healthcare industry’s history of experimenting on private blockchains to date, Nectar is intentionally secured by Ethereum. Public blockchains, such as Ethereum, provide stronger security, immutability, transparency, lower costs, and the ability to interoperate with other applications compared to private blockchains. Rollups can offer the privacy and security required for the entire healthcare industry from patients to the enterprise, while offering the additional benefit of public blockchains.
In order for healthcare to reap the benefits of a public blockchain, the technology must be safe to use and regulatory compliant, which means adhering to existing data privacy and security regulations. In addition to keeping transactions off L1, Nectar accomplishes compliance in two additional ways:
- Privacy Preserving Contracts
- Authorized Nodes
The private nature of Nectar comes from the zk-rollup infrastructure and permissions for smart contracts. To regulate access to data contained in smart contracts we are adding permissions such that contracts can be made private, with access only permitted for pre-specified accounts. Before a user can access a smart contract they will have to prove they are authorized to do so. This change means that composability between contracts can be restricted as needed. It also means that the global state of Nectar’s smart contracts are private, and discreetly revealed as needed, for those authorized to see it.
The focus on privacy preservation is what makes Nectar accessible to the enterprises that are leading web3 innovation as well as individuals whose data is seeding the future of web3.
Authorized Nodes, called Data Service Providers (DSPs), are required to be HIPAA compliant, maintaining certain policies for safe storage and transfer of highly sensitive, healthcare data. HIPAA was chosen as the first regulatory requirement in Nectar because it is the most well known, widely used healthcare data security regulation globally.
DSPs are authorized to join the network after an authorization and audit, carried out by DSP Authorizers and DSP Auditors. To maintain compliance, DSPs participate in regular audits of HIPAA compliance: passed audits enable DSPs to remain in the network; failed audits kick DSPs out of the network. To discourage fraudulent approvals: DSPs, DSP Authorizers, and DSP Auditors are in a risk-based model with shared revenue and shared data security breach penalties.
HIPAA compliant DSPs create the distributed data storage infrastructure of Nectar. Private data analytics is a promising, efficient web3 technology and can have a significant impact on cost savings for healthcare. While individuals and small businesses are likely to adopt distributed data storage before enterprise, the potential for better security, lower cost, and new revenue streams for enterprises will be quite enticing rather than simply shifting an on-prem server to a cloud-based or hybrid cloud system.
Nectar’s unique combination of roll up technology, focus on privacy preservation, and HIPAA compliance creates the needed foundation for the Web3 future of healthcare.
Validation
Nectar is being built by Tamarin, which was founded in 2017. Tamarin has received more than $1.2M over 2 phases of highly competitive, federal grant funding from the National Science Foundation (NSF) for their blockchain in healthcare work.
We publicly debuted Nectar with Gitcoin’s Grants 11 Round (September). Nearly 300 individuals have donated to our Gitcoin Grant; we continue to receive (small) contributions almost daily.
And, as we are growing our social interaction, we’re receiving great feedback.
“Glad I ran across your account! - I’ve been looking in the space” twitter DM
"Looking forward to learning more about how web3 can benefit the healthcare industry” twitter DM
“Excellent article. Sounds like you are solving some incredibly complex but very important problems ”
In response to Nectar having a team that comes from healthcare: “My sister is a nurse (actually, a nurse unit manager of a large midwifery department) who is trying to break into health tech. She is finding it very difficult in Australia - the industry does not seem to think they need clinical experience to design solutions. So in short, I completely appreciate why what you are doing is going to be more impactful.” SGW, WITCHES DAO
Progress
We officially transitioned our development from a HIPAA-compliant L1 to HIPAA-compliant L2 development in October (because of astronomical gas fees and congestion; plus, rollups remain highly effective in Eth2). Since then we have completed thorough code reviews on existing rollup technologies to confirm our differentiation, and to identify which open source codebase fits our privacy-preserving and HIPAA compliant goals. We reviewed Optimism, Arbitrum, Starkware, Polygon SDK and Hermez, Tornado Cash, Loopring, Aztech, and zkSync and zkPorter (minimal code released so far). From this thorough code review, we landed on zkSync for the zk-Rollup base.
zkSync is a good starting point, but likely will not be complete for our baseline needs. It seems that zkPorter brings us a little closer, but it is not clear yet when zkPorter will be released. So, we’ve designed our development plan for 2 scenarios: zkPorter is not released anytime soon; zkPorter is released earlier than expected. If zkP is not released anytime soon: we will start with engineering the HIPAA compliant decentralized storage (most likely path); if zkP is released earlier than we anticipate, we will move forward with assessing zkP privacy weaknesses and design solutions as required for healthcare, specifically permissioning smart contracts. We will eventually include both HIPAA compliant decentralized storage and permissioned smart contracts, but the order in which we develop them is flexible.
Differentiation (from other projects)
- Privacy Preservation + Permissioned Smart Contracts
- HIPAA Compliant Decentralized storage that is connected to private smart contract infrastructure
- Extensible beyond HIPAA and healthcare:
- GDPR
- California, Virginia, Colorado state-based consumer data privacy laws
- Patient Data Protection Act (Germany)
- Etc.
By 2023, 65% of the world’s population will fall under consumer data privacy protection regulations. Because of the unique infrastructure and requirements, DSPs can implement any additional data security and consumer data privacy policies they want, such as offering geographically compliant databases re GDPR. This increases their service offerings and thus, revenue. DSP Authorizers and DSP Auditors would verify compliance, and would still participate in a risk-based revenue-penalty share model.
Team
Tamarin is led by Kat Kuzmeskas, MPH who is a former hospital administrator at Yale New Haven Health and holds a masters in public health. One of the main roles of Kat’s position at Yale was to analyze data to grow the market share of the health system. Specifically: analyzing data that the health system spent north of $1M for annually. This data was purchased from LexisNexis, which purchases de-identified electronic health record data from health insurance companies, aggregates it, and sells it back to healthcare entities such as hospitals. The lasting impression of working at one of the world’s top healthcare institutions is that incentives in healthcare are completely misaligned. Globally we focus on sick-care, not well-care, and data does not move because it is an asset with high value. Since 2017, when she founded the company, she and her team have been working to flip the incentives in healthcare and make data more accessible.
David Akers is our lead blockchain engineer, joining Tamarin fall 2017, and has worked in emerging tech for over 20 years. Prior to joining the company, he was researching and developing smart contract primitives, composability, and amorphism. He is a strong advocate for web3 and holds us accountable to creating infrastructure that enables a more patient-led, patient-focused, patient-owned health network.
Jayshaline Shethna, MHA is our director of operations and is a dentist by training. She holds a masters in healthcare administration and has volunteered her time and expertise for a variety of public health efforts including more than 30 dental camps to spread awareness for tobacco’s cancerous consequences in the industrial workforce in India. Jayshaline started as an intern for Tamarin in fall 2017 and because of her drive and unparalleled effectiveness, she has moved swiftly up.
Saad Shaikh, MHIT is our newest team member, joining in spring 2021, and is also a blockchain engineer. Saad holds a masters in healthcare information technology and is also a dentist by training. He switched to engineering because of the larger impact he could have on healthcare through software development.
Grant Request $
$367,500
What the Funds Are For
100% of our current NSF funds cover our 2 blockchain engineers, and we have ~10% salary coverage for an additional engineer remaining in our budget. The $367,500 would allow us to expand our team, adding at least 1 Full-stack developer and 1 smart contract developer, with one of the two highly skilled in leadership and project management.
And: Your grant funding could be multiplied for us through the National Science Foundation matching funds program.
The new team members’ high-level focus would be the following:
- Implement Nectar in Rust, using the ZKSync codebase
- Update and develop the roll-up and related smart contracts to support decentralized file sharing
- As an expert on ZKP, create modifications to verify circuits to include file sharing smart contract
- Transition project-lead from David; creating and updating plans and progress reports; serving as the lead on hiring and interviewing additional team members
Help Requested
We would appreciate introductions to high-quality devs that you believe would be a great fit for our team.
We are also running an NFT art auction + competition for our first app on Nectar (https://shyro.health) and would appreciate introductions to NFT artists.
Additional Resources, Links, Portfolio
https://twitter.com/NectarProtocol
LinkedIns:
Kat: https://linkedin.com/in/katherinekuzmeskas
David: https://www.linkedin.com/in/davidmichaelakers/
Jayshaline: https://www.linkedin.com/in/jayshaline/
Saad: https://www.linkedin.com/in/saadshaikh18/