Josh Mandel, MD
@JoshCMandel
physician, programmer, and would-be pâtissier/poet. Chief Architect for #MicrosoftHealth and for @SMARTHealthIT. Bsky: http://josh.mandel.md
Which healthcare regulations should we kill? Yesterday, the comment period closed on the Agency for Healthcare Research and Quality RFI titled "Ensuring Lawful Regulation and Unleashing Innovation to Make America Healthy Again." The RFI asked stakeholders to pinpoint specific…
Hey,@grok, who were the ten most famous people to visit my profile? Don't need to be mutuals, don't tag them, just say who they were.
A uniform truth that will play true: in three to five years, we will look back at the infrastructure we're building today and say "how stupid were we". HL7v2, CDA, FHIR...whatever we think is "the" solution will be superseded. And we'll certainly do that about FHIR. Each…
The new USCDI (v6) is here: view.connect.hhs.gov/?qs=be1e7eea4f…
Big news: SMART Health Cards and Links is now a formal HL7 standard 🎉 This standard gives people a simple, secure way to carry and share their health data using QR codes or copy/pasteable web links. Whether it’s a summary of care, a digital insurance card, or a vaccine history…
OK, I've migrated Heardle away from glitch -- the old URL forwards to joshuamandel.com/heardle/ so please update your bookmarks if you've got a Heardle habit :-)
@JoshCMandel is heardle (our beloved phneardle) down for good? Say it ain't so...
Commenters in 2022 were *not enthusiastic* about CQL -- what's the vibe today? joshuamandel.com/regulations.go…
OK, I'm coming up to speed with the 2022 ePA RFI ;-) joshuamandel.com/regulations.go… has an overview on this theme. Re: Cigna's comment... whether rules are set by Cigna or a self-insured employer, transparency would make the rules visible/comparable, no?
There is more to it. As Cigna said in its ePA comments to CMS, it has no control over most decisions of the health plans (ERISA self-insured) that use its network. They are free to ignore the Cigna “medical necessity” policy.
These are even better in real life ;-) Madison's @frescoopera does some amazing stuff including last summer's driveway-staged 8-bit Opera.
"[video game] as a community theater production" may be one of the most delightful Veo 3 Fast prompts Please enjoy, in order: GTA, Pokemon, Mario Kart, The Witcher 3, Stardew Valley, Tetris, Mortal Kombat, The Sims, & Death Stranding(!) Yes, the whole prompt was the one above.
The Prior Auth API is a Trap! The Da Vinci DTR Implementation Guide aims to reduce prior authorization friction by standardizing the format for asking and answering clinical questions. It is a well-engineered specification for a "computable clipboard," a significant improvement…
>The user's feedback is valuable. I'll bet. I would *really* like to know what the underlying thought trace said here ;-)
HHS wants to deregulate. Fixing prior authorization through deregulation presents a paradox. # Background The White House is clear: slash the number of federal regulations. Executive Order 14192 demands a "10-for-1" repeal ratio. Another order aims to deconstruct the…
Summer is in full swing and UGM’s coming up fast. Five thoughts on my mind as we prepare for August:
One organ donor can save up to eight lives. In the US, early adopters of this feature have seen thousands of donation registrations through MyChart in just a couple of months.
The first hospitals are live on MyChart's new organ donor registration option through @DonateLife. Surveys show that 90% of Americans support donation, yet only 50% have registered. Here's how quickly you can do it in MyChart.
This is why almost every serious LLM Chat app offers "edit" buttons on previous user turns, and "regenerate" buttons on previous assistant turns. (With one notable exception: t's a mystery that @GeminiApp doesn't do this.)
Think about it: when the model takes a wrong turn, it's not working with a blank slate anymore. It's trying to reconcile your corrections with its own generated assumptions. It's like trying to merge back onto a highway from a field. The context is already polluted.
Deregulation of Certified Health IT: Cuts to Real World Testing (Personal note: The value proposition of regulation and deregulation is full of trade-offs. My personal take is that the Real World Testing cuts are a reasonable, pragmatic place to ease off on requirements, opening…
Voices from the CMS RFI: Attitudes Toward the Health System In the summer of 2025, CMS sought public input on building a patient-centered digital health ecosystem. Patient voices reveal fundamental worldviews about trust, power, and survival in America's healthcare system. #…
Props to @zakkohane for being the first person to put in an analysis request for my CMS RFI MCP stack. I had Claude 4 Opus code do "/analysis-workflow" to find and analyze 125 comments from patients, then asked Gemini 2.5 Pro to write up a report based on these. (I ran out of…
CMS RFI MCP: Now It's Your Turn to Analyze 10k Pages ;) A few weeks ago, I shared an interactive dashboard summarizing public comments on the CMS Health Tech Ecosystem RFI. Now for the next step: make the underlying data more amenable to new, dynamic analyses. Toward this end,…
I've been delighted with the ergonomics of Claude Code's custom slash commands. x.com/JoshCMandel/st… showcases a set I made yesterday for working with my @CMSGov RFI MCP. These commands make it easy for anyone to analyze comments from regulations.gov.
New Claude Code updates are here: custom slash commands are getting an upgrade!
CMS RFI MCP: Now It's Your Turn to Analyze 10k Pages ;) A few weeks ago, I shared an interactive dashboard summarizing public comments on the CMS Health Tech Ecosystem RFI. Now for the next step: make the underlying data more amenable to new, dynamic analyses. Toward this end,…