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Bluesky Ahead – Healthcare Blog


I’ve been thinking about writing about Bluesky ever since I heard about the Jack Dorsey-backed Twitter alternative and decided it was finally time, for two reasons. The first is that I’ve seen a lot other people write about it so i get FOMO. The second is that I checked out Nostr, another Twitter alternative backed by Jack Dorsey, and I’m in no way trying to write about it. that (eg Jack’s Nostr username is npub1sg6plzptd64u62a878hep2kev88swjh3tw00gjsfl8f237lmu63q0uf63m. Seriously).

It’s not that I’ve come to hate Twitter, although Elon Musk makes it hard to like it, because our shared distaste for existing social media platforms makes it a good time to look for alternatives. I’ve written about Mastodon and BeReal for example, but Bluesky has some features that might make sense in the Web3 world we may be moving into.

And, of course, I’m looking for any classes for healthcare.

Bluesky describes itself as “the social internet”. It started as a Twitter project in December 2019 to “develop an open and decentralized standard for social media”. The apparent goal at the time was for Twitter to be a client of the standard, but things happened, Jack Dorsey left Twitter, Elon Musk bought it, and Bluesky became an independent LLC. In March 2023, it launched an invite-only, “private beta” for iOS (Apple) users, followed by an Android version (again, invite-only) in mid-April. People can sign up to be on the waiting list. There are reportedly over 40,000 current users, with several million people on a waiting list.

By all accounts, it’s similar to Twitter in many ways. You can search and follow other users, you can create posts (please don’t call them “skates”) of 256 characters, you can attach (some type of) media, and you get a stream of posts recommended by other users. You can like, reply or share posts. It still doesn’t have all the features of Twitter like DMs or hashtags. It works on “composite moderation”.

The issue isn’t how much it looks and acts like Twitter, but how different the underlying platform is. It is built on what is called AT Protocol – Authenticated Transfer Protocol. A blog post last fall explained what makes it unique.

Account portability. A person’s online identity should not be owned by corporations that are not accountable to their users. With the AT protocol, you can move your account from one provider to another without losing your data or social graph.

Algorithmic selection. Algorithms dictate what we see and who we can reach. We must control our algorithms if we want to trust our online spaces. The AT protocol includes an open algorithms mode to give users more control over their experience.

Interaction. The world needs a diverse market for connected services to ensure healthy competition. Interaction should feel like second nature on the web. The AT protocol includes a schema-based interoperability framework called Lexicon to help solve coordination challenges.

Execution. Many new protocols throw performance out the window, resulting in long load times before you can see your schedule. We don’t see performance as optional, so we’ve made building for fast loading at scale a priority.

There is a lot to collect. more than I’m qualified to do, but here are a few basics. Currently, you don’t have much control over your Twitter (or your other social media feeds). The platform’s algorithms dictate. Bluesky promises that the AT Protocol will allow users to both know what algorithm is being used and choose from a library of algorithms. How users will understand the consequences of different choices is not clear.

CEO Jay Graber says:

Our goal is not to build every algorithm in-house, but to enable the developer community to bring new algorithms to users quickly and effortlessly… We want a future where you control what you see on social media. We aim to replace the conventional “master algorithm” controlled by one company with an open and diverse “algorithm market”.

Just as importantly, Bluesky’s goal is for you to be able to share your Bluesky experience—your follower list, your history feed, and more. – to other platforms (presumably also built on the AT protocol). It will break down the “walled gardens” that have been recreated on existing social media platforms.

Cade Garrett writes Decode“In essence, the AT protocol will allow you to create not one social network, but a federation of social networks that can interact with each other… On a technical level, it will allow you to host servers on your own. of your own company, profile or social media platform”.

Like Bluesky on Twitter“We can change mobile operators without losing our phone numbers. If we could switch between social apps without losing our identity or social graph, then social media would become a competitive open market again.” It sees switching platforms as more akin to switching cell phone providers, keeping the same number, than switching email providers, which requires a new email address. address:

It’s all based on what Bluesky calls a “self-authentication protocol,” which shifts the power of authentication from the host to the user. But I’m going to explain how it works as an exercise for the interested reader. Mr. Garrett explains the importance of this. “The goal of such a design is to ensure that user data and the user platform experience are resistant to influence by corporations, governments, and other centralized entities.”

Who wouldn’t prefer that?


Social media is messy. Most platforms have been built on an approach that has done untold damage to our privacy and our level of discourse. The kind of platform Bluesky is aiming to be is very attractive, though whether it can work, let alone create a viable business, remains to be seen.

Healthcare has been a mess even longer than social media. Sure, it pays for our privacy, but has failed to protect it (e.g. hospitals) and is only belatedly recognizing the kinds of gaps it has (e.g. health trackers). We are all subject to more algorithms than we realize (like pre-authorizations) and AI is going to increase this exponentially. It talks about interoperability and now has FHIR and TEFCA, but if you think you’re in control of your data now, you’re wrong.

I don’t know how or even if the AT protocol can be used in healthcare, but healthcare definitely needs something like it.

Kim is a former Head of Marketing at Blues Masterplan, Editor of the late and lamented, and now a regular contributor to THCB.

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