Beyond Theory: Real-World Peer Production
Innovating Cystic Fibrosis Treatment
Introduction
In Sacha Pignot’s previous “What’s hAppening?” article, he explored how Holochain, hREA, Ethereum and Mattereum could revolutionize Open Value Networks (OVNs). In this article, he and Tiberius Brastaviceanu share some of the work they are doing with Sensorica and their PEP (Positive Expiratory Pressure) Master Project.
They are developing the tech stack which includes the Cardano blockchain in conjunction with Holochain using the ADAM interoperability layer. This expanded architecture enables the project’s peer production pilot program to extend into practical applications that address real-world healthcare accessibility challenges.This article benefits from both Sacha and Tiberius’ insight, for a full deep-dive check out the updated full PEP Master documentation!
This article describes an entirely distributed system for medical devices used to treat cystic fibrosis. It discusses the tangible build and its digital counterpart, a cryptographically verified passport. It summarises a very detailed body of work produced by the project team. It’s a remarkable project (I’m a fan!), and you might want a cup of tea and a comfy seat…it’s layered! - Sam
The PEP Master Project: Medical Innovation Through Peer Production
The previous article on OVN theory suggests a use case for asset tracking. This one presents Sensorica’s PEP Master project, an open-source DIY therapeutic device and computer game being developed by a consortium including Sensorica, Sainte Justine Hospital, Breathing Games, and Ludociels. What makes this project remarkable is how it leverages localised peer production to increase access to medical equipment for rare health conditions worldwide, supporting the patients most underserved by profit-oriented healthcare models.
Operating within the Sensorica Open Value Network, first established in 2011, this project demonstrates how OVNs can evolve beyond engaging with traditional market structures to creating self-sustaining alternatives, bypassing market constraints entirely. A reliable supply of medical devices can be produced anywhere by enabling local production in Fab labs, using a library of instructions and testing protocols.
The PEP Master device is intended to reduce the symptoms of cystic fibrosis, a genetic disorder that affects an estimated 160,000 people worldwide. It causes severe damage to the sufferer's lungs, digestive system, and other organs through excess mucus production. Trapped bacteria can lead to frequent infections and progressive respiratory distress. Regular airway clearance is essential. Existing specialized PEP therapeutic devices, used to alleviate the condition, pose various challenges.
Motivation is a key engagement strategy for all therapies: it remains mostly unaddressed. Unfortunately, there’s also restricted access, not just to the devices, but to the medical professionals needed to support treatment plans in regions with under-resourced healthcare systems. The innovative PEP Master Instrument brings gamification of the therapeutic PEP approach, directly incentivising good therapeutic practices with minimal supervision from healthcare professionals. It offers an engaging, accessible, alternative using open-source design and distributed fabrication. It’s helping to reach patients who would otherwise lack access to these crucial therapeutic devices.
Progressing beyond prototyping, the team has been working on clinical studies involving 40 patients at Sainte Justine Hospital in Montreal. After several years of testing the device, a critical milestone has been reached, proving its efficacy, establishing credibility with traditional medical institutions. Crucially, the PEP Master has proven the potential of maintaining the open, collaborative nature of peer production, while delivering a reliable, safe and effective medical device.
The project now faces the challenge many peer-produced innovations encounter: scaling beyond their initial proof-of-concept (POC). Their approach is to advance in three dimensions:
Scaling Up: Building trust for the device through regulatory compliance, ISO standards, and validation methods that can satisfy medical authorities without compromising open-source and peer production principles.
Scaling Wide: Expanding the network of medical research environments across multiple countries that can adopt, adapt, and validate the instrument within their local contexts. The team plans to stimulate the adoption of the PEP Master Instruments by patients and medical doctors across the world.
Scaling Deep: Refining practices and adapting the technology to more precisely meet the needs of patients in a variety of socio-economic and cultural contexts, as well as addressing other rare respiratory diseases.
Why Cardano and ADAM Expand the Holochain/hREA Technology Stack
In our previous exploration of OVNs, we examined how Holochain, hREA, Ethereum and Mattereum can be used to create a foundation for peer production networks. The PEP Master project uses an alternate stack to include the Cardano blockchain and the ADAM interoperability layer instead of Ethereum + Mattereum. This stack becomes necessary when facing real-world healthcare applications requiring regulatory compliance.
The Agent-Centric/Data-Centric Hybrid Approach
The key innovation in this framework is the deliberate hybridization of two fundamentally different architectural approaches:
Holochain's Agent-Centric Model: Optimized for local peer collaboration, data sovereignty, and flexible governance.
Cardano's Data-Centric Blockchain: Provides immutable records and secure transactional capabilities.
Rather than treating these technologies as competing alternatives, the PEP Master integration recognizes their complementary strengths. Medical devices require both the collaborative development made possible by agent-centric systems and the trustable verification mechanisms of global data-centric blockchains.
The Role of ADAM: Bridging Different Worlds
The ADAM (Agent-Centric Distributed Application Meta-Ontology) layer serves as the crucial connective tissue in this integration. As a meta-ontology, ADAM:
Creates semantic mappings between different data models.
Enables "many-to-many" connections between user interfaces and underlying technologies.
Preserves context when translating between local Holochain networks and global Cardano transactions.
For the PEP Master project, ADAM allows medical credentials, device certifications, and validation processes to retain their meaning across different technological and geographical contexts.
Special Considerations for Medical Applications
The healthcare sector introduces unique requirements that are addressed by this technology stack:
Privacy and Regulatory Compliance: Midnight (Cardano's privacy-focused sidechain) enables zero-knowledge proofs for credential verification without exposing sensitive patient or practitioner data. Holochain complements this by providing privacy and data-sovereignty, at a local/agent-centric level.
Certification Portability: Credentials and certifications verified in one jurisdiction can be reliably transported to another through Cardano's immutable ledger.
Audit Trails: The combination of Holochain's transparent process records with hREA and Cardano's immutable transaction history creates a comprehensive audit trail suitable for medical device regulation.
Accessibility: The distributed nature of the PEP Master's peer production needs to support implementation in a variety of settings, utilizing a flexible framework that accommodates diverse resource constraints and technological capabilities.
This architecture represents a thoughtful synthesis designed specifically to overcome the regulatory and trust barriers that have traditionally prevented peer-produced solutions from scaling in healthcare contexts.
“With web 2.0, open collaboration has given the world Linux, Wikipedia and a myriad of open source digital and physical tools. Web3 and 3.0 add a layer of trust and transaction on top of open collaboration, allowing these open source tools to be produced sustainably and with verifiable quality.” - Tiberius Brastaviceanu
Building the Chain of Trust: A Technical Implementation
The PEP Master project demonstrates how hREA’s implementation of the ValueFlows modeling, in conjunction with immutable certifications and credentials, creates a complete "chain of trust" for medical devices—something far more complex than conventional product verification.
This workflow will be implemented using specific cryptographic methods across the integrated technologies:
Design: Utilizing Holochain for collaborative design processes, the contributions to the design efforts, the blueprints, the instructions, and the manuals (the design bundle) are stored on Holochain's DHT with immutable provenance, version control and public accessibility.
Verification: Scientific validation of an instrument design, based on the design bundle, is being conducted by medical and technical researchers at the St Justine Hospital and recorded through peer reviewed scientific papers. It anchors trust in sound scientific methodologies and accredited academic institutions.
Certification: Scientific validation is contextualized within local approval frameworks and included, as they are awarded by each regulator, with the design bundle. This combined certification bundle is tokenized on Cardano as a verifiable certificate or NFT. It now becomes an immutable record of compliance.
Fabrication: Physical manufacturing events require the use of the certification bundle, preserving a unique relationship between digital blueprints and physical instantiations or builds. A device passport, or Real World Asset (RWA), encapsulates the responsibility of the fabricator.
Valuation: Reputation systems implemented on top of the NFT marketplace capture qualitative assessments, incentivising best practice and standards for instrument designers.
Transaction: Smart contracts on Cardano automate the transfer of the certified design bundle and the distribution of tangible benefits to designers and other network stakeholders according to contribution records maintained in Holochain's hREA implementation. Equitable reward is available to all participants.
What makes this implementation particularly innovative is how it bridges the gap between decentralized development and traditional regulatory requirements. Each step creates verifiable digital artifacts that can be independently audited both by peer networks and traditional institutions.
Scaling Trust Mechanisms
Traditionally, medical devices gain adoption through institutional reputation and regulatory approval. For peer-produced alternatives, trust is anchored within traditional institutions and scientific methods, and technically engineered into the system itself. The Holochain/Cardano integration creates multiple layers of trust verification:
Blueprint Verification: The Instrument design bundle, combined with traditional peer-reviewed scientific papers, provides a transparent record, which anchors trust in traditional academic institutions.
Certification Tokenization: Cardano provides immutable records of regulatory approval of a verified design through non-fungible certifications as NFTs.
Fabrication Verification: RWA technologies provide a legally binding responsibility for the fabricator of the PEP Master Instruments by minting the device passports on-chain. ADAM's interoperability between the different digital languages and frameworks enables local verification of manufacturing quality to be globally recognizable.
This tiered approach demonstrates how traditional trust mechanisms can be enhanced by cryptographic p2p technologies to scale peer production.
“Building distributed economic networks with these technologies allows the harmonisation of local and global communities (glocal). With the mix of agent and data-centric technologies, we are opening the doors of the P2P paradigm more than ever before. Perhaps this kind of technology will enable us to access uncapturable commons at scale!” - Sacha Pignot
Scaling Wide Through Protocol-Based Coordination
The project's approach to lateral scaling represents a fundamental departure from traditional market distribution:
Federation Instead of Replication: Rather than creating identical copies of the original system, the technology stack enables local instances to federate while maintaining local autonomy and context.
Protocol-Based Governance: Shared peer protocols replace centralized control, with Holochain's DNA structure enabling consistent validation rules across diverse contexts.
Transactional Coordination: Cardano's blockchain ensures that rewards, credentials and certificates can flow between otherwise independent local OVNs.
Broad Interoperability: ADAM and hREA provide the framework through which local diversity can be afforded, while remaining responsive to macro-trends, best practice and collective resourcing.
This approach enables adaptation to local needs without fragmenting the network, balancing standardization with contextual flexibility.
Scaling Deep Through Edge Innovation
Perhaps most significant is how the technology stack enables "scaling deep"—continuously refining and adapting the technology based on real-world implementation experiences:
Edge-Driven Evolution: Holochain's agent-centric architecture pushes innovation to network edges rather than centralizing it.
Contribution Tracking Across Contexts: hREA allows innovations from various locations to be recognized and rewarded within the larger ecosystem.
Permissionless Adaptation: Unlike traditional medical devices with closed intellectual property, anyone can adapt the open-source design to address specific needs.
Economic and Governance Flexibility: Each OVN can adapt its own governance and economic flow. If their implementation is is wrapped by an ADAM language, they will stay interoperable with the other OVNs.
This aspect of the system demonstrates how open, collaborative approaches can rapidly accelerate innovation in fields traditionally dominated by slow-moving, centralized research and development.
Beyond Theoretical Models: Implications for Healthcare and Beyond
The PEP Master project represents more than just a technical achievement, it demonstrates how combining agent-centric and data-centric architectures can address previously intractable healthcare access problems. This "trust-based economic model" offers several profound implications:
Democratizing Medical Innovation
Traditional healthcare innovation requires massive capital investment, creating strong incentives to focus only on common conditions with large markets. Innovation requires stepping outside the inertia of institutional momentum to experiment at the edge, while still maintaining standards and trust. The PEP Master's distributed peer production methodology offers a transformational approach to achieve this balance.
By contrast, the PEP Master approach:
Distributes development costs across a collaborative network.
Creates transparent validation methods that don't rely solely on capital-intensive clinical trials.
Enables "long-tail" innovation focused on rare conditions underserved by profit-driven models.
Encourage designers and engineers to conceive, build and test medical devices in an open-source way.
Rethinking Regulatory Approaches
Perhaps most significantly, this integrated approach offers a new model for regulators that balances safety with innovation:
Provides cryptographically verifiable evidence of testing and validation.
Creates audit trails that are more comprehensive than traditional documentation.
Enables regulatory oversight without requiring centralized control.
The PEP Master project's engagement with Canadian regulators through clinical trials at Sainte Justine Hospital represents a breakthrough in how peer-produced medical innovations can interface with traditional healthcare systems. This collaboration has not only validated the device's capabilities under medical supervision but also created unprecedented transparency into what have traditionally been opaque regulatory processes.
Diligently logging this journey, the team is establishing a replicable pathway for other open-source medical projects to follow, effectively demystifying the regulatory hurdles that often prevent grassroots innovations from reaching patients. This engagement creates a template that demonstrates how decentralized development can meet rigorous safety standards without sacrificing the collaborative, open nature that makes peer production valuable.
The most recent round of funding supports the project’s work toward Health Canada approval, it's setting precedents that could fundamentally change how medical device regulation accommodates community-driven innovation. All of the project’s entire document library, code, budgeting and spending are transparently shared on the Sensorica website - open-source in action!
A Pioneering Synthesis
By bringing together Holochain, hREA, ADAM, and Cardano, the PEP Master project demonstrates a pioneering synthesis that moves beyond theoretical models into practical implementation. This approach doesn't replace traditional institutions but offers new ways for them to interface with peer production networks—the best of both worlds.
As material peer production continues to evolve, this hybrid architecture provides a compelling template for collaborative creation that maintains high standards of safety and trust without sacrificing autonomy or flexibility. The result isn't just a new way to produce medical devices, but potentially a new paradigm for how society can collaboratively meet its material needs.
The PEP Master project shows great potential to enhance access to medical treatment. With that potential comes challenges: integration complexity, satisfying regulatory requirements, adoption barriers, and the still emergent ecosystem of Holochain, hREA, ADAM, and Cardano’s Midnight Network. Sensorica is inviting developers and enthusiasts of the technologies to help them overcome the barriers!
Useful Links:
A New Economy The PEP Master Project is covered in this documentary
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Would you like to be there when we unveil the future of mobile telecommunications and the Internet? Would you like to be one of the first to learn about new developments in Volla hardware, software, supportive intelligence and distributed cloud computing? You are cordially invited to attend the Volla Communities 2025 event on June 14–15 in Remscheid, Germany, and via live webcast. It promises to be exciting.
We are expecting users, developers, partners, suppliers, retailers, and business customers. Come and discuss with us and meet the people behind Volla. Do you have an idea, an open source project, or a technology that would be a good fit for Volla? Write to us. Are you interested to make business with us or one of our partners? We will be happy to arrange a meeting for you.
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AI is taking the stage and is probably already a part of your life whether you are actively engaging or not.
How do you feel about it? How do you engage with AIs?
At darksoil studio, we are currently playing with some experiments on how AI can support in creating social fabric. Bringing people closer together and together in new ways.
Do you think that could be done? And how do you feel about sharing thoughts and feelings with an AI? What if that AI was run by your community? Would that change how you felt about it?
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