{
  "name": "Vimty: nine pieces of healthcare, rebuilt from first principles",
  "url": "https://vimty.com/first-principles",
  "updated": "2026-10-13",
  "read_this_first": "This is a design. Each piece states what runs today and what comes next. Nothing here is for sale, nothing unsigned is called approved, and Boulder (co-op.care) is the first node, still being built.",
  "rules": [
    { "id": "record", "rule": "The person keeps the record.", "why": "The person is the only one present at every visit, so the record starts with them and institutions see what they choose to share." },
    { "id": "signature", "rule": "A machine may draft. A named, licensed person signs or declines.", "why": "Drafting has become cheap and accountability has not. Unsigned work is never called approved." },
    { "id": "ownership", "rule": "The people who do the work own it.", "why": "Whoever owns a care system decides whom it serves; when caregivers and families own it, the value stays with them." }
  ],
  "pieces": [
    {
      "n": 1, "piece": "Paying for care", "job": "Get the right care paid for, without the family fighting the paperwork.",
      "grew_into": "A third party decides after the fact, and a stack of forms, codes and denials sits between the family and their own money.",
      "first_principle": "Much of the care an aging person needs is paid by the family, often from accounts set aside for health costs. What opens that money for a specific need is a physician's judgment on that one case.",
      "rebuilt": "A physician reviews the family's case and signs a letter of medical necessity or declines it. The family keeps the letter and the receipts together.",
      "rules": ["signature", "record"],
      "doors": [{ "name": "ComfortCard", "url": "https://comfortcard.org" }, { "name": "ClinicalSwipe", "url": "https://clinicalswipe.com" }],
      "status": "designed", "today": "The review flow is built and runs on test cases only. Letters are not open yet."
    },
    {
      "n": 2, "piece": "The physician's signature", "job": "A licensed person stands behind a clinical decision.",
      "grew_into": "Physician time drains into documentation. AI now drafts more of it, and it is getting harder to tell who actually decided.",
      "first_principle": "Drafting has become cheap. Accountability has not. The scarce thing is a named person who reviewed this case and put their name on it.",
      "rebuilt": "A machine drafts. A named, licensed physician signs or declines, and the signature becomes a record anyone can check.",
      "rules": ["signature"],
      "doors": [{ "name": "HarnessHealth", "url": "https://harnesshealth.ai" }],
      "status": "designed", "today": "Runs in a sandbox on synthetic cases."
    },
    {
      "n": 3, "piece": "Hands-on care at home", "job": "Someone skilled and steady helps at home.",
      "grew_into": "Agencies place caregivers they pay little and keep briefly, so the relationship, which is the real product, starts over each time someone leaves.",
      "first_principle": "Care is a relationship. Whatever makes caregivers stay is the product.",
      "rebuilt": "A cooperative in which caregivers are worker-owners and families are members, so the value stays with the people who create it.",
      "rules": ["ownership"],
      "doors": [{ "name": "co-op.care", "url": "https://co-op.care" }],
      "status": "building", "today": "Boulder is Node One. Sign-ups, a family assessment and a time bank run today; paid care begins once it is licensed and staffed."
    },
    {
      "n": 4, "piece": "The health record", "job": "Remember the person across every visit.",
      "grew_into": "Each clinic, hospital and agency keeps its own slice. The family carries the rest in their heads and a kitchen drawer.",
      "first_principle": "The person is the only one present at every visit. The record should start with them.",
      "rebuilt": "The record lives on the person's own device, and institutions see what the person chooses to share.",
      "rules": ["record"],
      "doors": [{ "name": "ComfortCard", "url": "https://comfortcard.org" }, { "name": "chanio", "url": "https://chanio.com" }],
      "status": "device", "today": "ComfortCard's family file keeps papers on the family's own device. chanio runs on the founder's own Mac, not yet for members."
    },
    {
      "n": 5, "piece": "Getting paid for surgery", "job": "A surgeon is paid correctly for work that was done.",
      "grew_into": "Coders, clearinghouses and vendors sit between the operative note and the claim. Each takes a share, and each is a place for errors.",
      "first_principle": "The operative note already says what was done. The work is translation, and the surgeon is the one accountable for it.",
      "rebuilt": "Software reads the surgeon's own note, a rules engine checks it, and the surgeon signs or strikes each line under their own number.",
      "rules": ["signature"],
      "doors": [{ "name": "SurgeonValue", "url": "https://surgeonvalue.com" }],
      "status": "designed", "today": "The receipt runs on sample notes. Nothing is for sale."
    },
    {
      "n": 6, "piece": "Getting ready", "job": "A person understands what is about to happen to them.",
      "grew_into": "Handouts, a portal and a rushed visit.",
      "first_principle": "Understanding shows when someone can explain it back, not when they have been handed a pamphlet.",
      "rebuilt": "Short classes with sources cited on the page, and a check of what you know that stays on your device.",
      "rules": ["record"],
      "doors": [{ "name": "JointClass", "url": "https://jointclass.com" }, { "name": "SurgeryProcess", "url": "https://surgeryprocess.com" }],
      "status": "live", "today": "Live. No account and nothing to buy."
    },
    {
      "n": 7, "piece": "Between visits", "job": "Know whether recovery is on track before the next appointment.",
      "grew_into": "Patients wait weeks for a visit to find out something went wrong.",
      "first_principle": "Recovery happens at home, so that is where to measure it, with a licensed clinician reading what comes in.",
      "rebuilt": "A phone camera tracks movement at home. A licensed physical therapist reviews it and sends the summary on to the surgeon.",
      "rules": ["signature", "record"],
      "doors": [{ "name": "JointCoach", "url": "https://jointcoach.com" }],
      "status": "building", "today": "Built, and the recovery summary already passes to the surgeon's side. The first patients come next, with a licensed physical therapist."
    },
    {
      "n": 8, "piece": "The end of life", "job": "A person's wishes are known and honored.",
      "grew_into": "Forms signed once, filed, and not found when they matter.",
      "first_principle": "Wishes come out of a conversation, and the family is who carries them.",
      "rebuilt": "The conversation happens in tap cards and is written down in the family's own words, kept by them.",
      "rules": ["record"],
      "doors": [{ "name": "CareGoals", "url": "https://caregoals.com" }, { "name": "Quality Death", "url": "https://qualitydeath.com" }],
      "status": "live", "today": "Live. The answers stay on the device."
    },
    {
      "n": 9, "piece": "Owning it", "job": "Pay for the system and decide whom it serves.",
      "grew_into": "Outside owners hold the system, so the returns, and the decisions, leave the community.",
      "first_principle": "Whoever owns it decides whom it serves. Rural America got electric power when communities owned the lines.",
      "rebuilt": "Member-owned cooperatives, federated so each community runs its own node on a shared, open protocol.",
      "rules": ["ownership"],
      "doors": [{ "name": "co-op.care", "url": "https://co-op.care" }, { "name": "Vimty", "url": "https://vimty.com/#federation" }],
      "status": "building", "today": "co-op.care is a filed Colorado cooperative. Boulder is Node One; this is not yet a national grid."
    }
  ],
  "left_alone": "Hospitals, drug makers and device makers are not rebuilt here. The aim is that a person needs the hospital less often, and arrives with their own record when they do.",
  "next_step": { "family": "https://co-op.care", "community": "https://vimty.com/start" }
}