Episodes

  • The Information Exchange: Hot Dog CarePlan Resource Edition

    The Information Exchange: Hot Dog CarePlan Resource Edition
    Jul 4 2026
    Fresh off that sweet, sweet USA win and headed into the long weekend, the full crew assembled for our most patriotic episode yet. Have you ever yearned for a podcast with Fourth of July interop trivia? Look no further, friend.Beyond that, we do (eventually) get to the real agenda:* The ONC awarded a TEFCA auditing contract to Alliance Global Tech, a DC contracting firm nobody in the health tech bubble had heard of. * We work through what the contract actually covers, why the RCE was probably as surprised as everyone else, and whether an outside auditor with no industry baggage is a feature or a bug. * Along the way we review AGT’s website redesign, which traded glorious 2000s-era stock-photo patriotism for AI slop on the eve of the country’s 250th birthday.From there, predictions. Does information blocking enforcement land by end of year? Who gets hit first? Plus Brad’s corp dev forecast for a pre-midterms consolidation rush, year two of the CMS Health Tech Ecosystem, and what HTI-6 might absorb from the pledge-a-thon.Fair warning: none of us are lawyers and none of this should be construed as legal advice. There is, however, a defensible argument that a hot dog is a medication. As promised:{ "resourceType": "CarePlan", "id": "hot-dog-care-plan", "status": "active", "intent": "plan", "title": "Hot Dog Care Plan", "subject": { "display": "Joey Chesnut (DOB 1983-11-25)" }, "period": { "start": "2026-07-04", "end": "2026-07-04" }, "activity": [ { "detail": { "kind": "NutritionOrder", "status": "scheduled", "code": { "text": "Hot dog (frankfurter), oral route. OMD in HL7v2, NutritionOrder in FHIR, a nurse and a side web panel in reality." }, "dailyAmount": { "value": 70.5, "unit": "hot dogs", "system": "http://unitsofmeasure.org", "code": "{hot_dogs}" }, "description": "Ask upon order entry: what do you want on it? Mayo permitted for documented sickos only. Fax to hot dog guy." } }, { "detail": { "kind": "ServiceRequest", "status": "scheduled", "code": { "coding": [{ "system": "http://hl7.org/fhir/sid/icd-10-cm", "code": "Y93.G2", "display": "Activity, grilling and smoking food" }] }, "description": "Pursue Y93.G2. Do not pursue W39.XXXA (Discharge of firework, initial encounter). Ask Jason Pierre-Paul." } } ], "note": [{ "text": "Supportive therapy: one schnatton of water per hot dog. UCUM does not define the schnatton. Neither do we." }] }Let’s dig in. Relevant Articles* Murica: The European mind cannot even begin to comprehend* June Monthly Review: The Unusual Suspect: The full writeup on Alliance Global Tech, from the contract record and credential wall to the case studies that are secretly job postings.* Outgoing Diet Orders HL7v2 Specification: Receipts for the hot dog segment. Diet orders are real, and there's an interface for them.* The Information Exchange: The TEFCA Report Card: Last time we graded TEFCA itself; this week the network got a new proctor.* SEC Budget: Government agency, not the NCAA conference. Actually $1.9 billion.* The Arena Expands: Abridge's land grab across the clinical copilot jobs to be done, background for Brad's consolidation prediction.* The Shape of 2026: Circling back on some HTI-6 predictions Chapters* Intro and the Most American Standard (0:00 – 4:01): Fourth of July interop trivia. Brad nominates fax, Ryan makes the melting-pot case for CCDA, and Pryce disqualifies HL7 on governance grounds.* Prescribing a Hot Dog (4:01 – 8:43): Pryce builds a SMART app for condiment selection, Brad gets caught Googling, and diet orders turn out to exist: OMD in HL7v2, NutritionOrder in FHIR. Joey Chestnut’s chart may require careful unit validation.* ICD-10s for the Fourth (8:43 – 10:42): W39.XXXA, discharge of firework, initial encounter. The one to pursue instead: Y93.G2, grilling and smoking food, which absolutely Pryce nails.* TEFCA’s New Hall Monitor (10:42 – 16:50): The ONC awards a TEFCA auditing contract to an outsider and half the industry misreads it as Sequoia being replaced. The $1.8M contract, the 70-hospital letter, and Brad asking why thirteen QHINs exist if nobody polices their own network.* Alliance Global Tech, Reviewed (16:50 – 22:31): Who won, the TEFCA support page they posted and pulled, and the promise of AI-assisted fraud detection. A moment of silence for AGT’s old website. Impartiality costs expertise, but at least someone is taking a shot on goal.* Information Blocking: Who Gets Enforced First? (22:31 – 31:52): Will enforcement land by end of year? Brendan predicts end of summer with Epic as the politically satisfying target, though the egregious blocking lives down market. Plus whether PointClickCare’s preliminary injunction counts as a proven case (it doesn’t).* The Homer Defense (31:52 – 35:03): Why Epic is the most accused and least guilty information blocker, per aggregate client experience with the Manner Exception. Pryce invokes Hanlon’s Razor. Nobody on this call is being paid by Epic under the table, allegedly.* ...
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    41 mins
  • The Information Exchange: What Is Treatment?

    The Information Exchange: What Is Treatment?
    Jun 9 2026
    Should The Information Exchange be renamed Interoperability Office Hours? Last episode we graded TEFCA. This time we’re reviewing homework of our good friends Quinn Emmanuel and Cravath in Particle v. Epic and answering some of the meatiest health information exchange questions of our time.After Judge Buchwald let some claims survive Epic’s motion to dismiss last fall, she did something unusual: rather than open the floodgates to full discovery, she carved out a limited Phase I focused entirely on market definition. But when time was up at the end of May and that didn’t really solve the problem, she doubled down and handed both Particle and Epic a take-home exam.So Pryce, Brad, and I sat down to read each student’s answers:* What is a payer platform, and is there even a market for one (that just includes Particle and Epic)? * What separates a payer from a payvider from a provider, and does anyone actually like the word “payvider”? * When do operations and treatment converge, and why does the pricing gap between the two distort everything around it? We work through all ten questions, the redactions hiding the spicy parts, and what we think Buchwald does next.Fair warning: none of us are lawyers and none of this should be construed as legal advice. However, there’s a sustained rant about arbitrage, and at least one antitrust doctrine gets renamed the “Pryce Ancona break-things” test. Let’s dig in.Relevant Articles* The Take-Home Exam: Summarizing the assignment from Judge Buchwald to Particle and Epic a few weeks ago.* The Doggy-Bag Era of Content: On LLM verbosity and the need for brevity in this era* A River Runs Through It: * Particle v. Epic: The Grandaddy Lawsuit Returns: The first post after Phase I concluded, looking ahead at what’s to come* Older related content* Epic v. Particle: The original summary of Epic and Particle’s Carequality dispute* Epic v. Particle 2: The Problem of Secondary Use: A followup to the above that focused on secondary use and its role in the conflict* The Particle v Epic Casebook: A summary of the case proceedings in October* Amber, Stenotypes, and Antitrust: Epic losing its motion to stay discovery in CureIS, which we were sure Epic was jealous ofChapters* Intro and the Take-Home Exam (0:00 – 4:49): The crew swaps the usual format for a graded exam. Background on Particle v. Epic since September 2024, the surviving antitrust and tortious interference claims, and why Buchwald, skeptical of the alleged market, wants five pages from each side in plain English.* Q1: What Is a Payer Platform? (4:49 – 11:39): Whether Epic Payer Platform and Particle’s product are substitutes in a single market. Pryce’s CDA-to-chart-summary walkthrough, payers paying out the wazoo for treatment-rail data, and the hammer-versus-mallet question of whether a product market exists at all.* Q2: Payer, Payvider, Provider (11:39 – 16:31): Provider is the easy one, payer is the financial risk bearer, and payvider is the term nobody will commit to under oath. Epic disowns the word, the Apple hardware-or-software analogy, and the two-instances-of-Epic compliance boundary.* Q3–Q5: Customer Mix and Active Role (16:31 – 21:24): Particle claims 100% VBC payers and payviders; Epic backdates 23 payer customers plus provider users as a wrinkle. Q4 discovery is a wash, and Q5 on whether a pure payer takes an active role in member health is really question two in disguise.* Treatment, Operations, and the Arbitrage Rant (21:24 – 29:38): The trench-coat problem with payvider, the HIPAA operations definition and HEDIS, and Pryce’s river separating treatment from operations. Brendan’s side quest on pricing treatment exchange at zero while operations pays market rate, and the incentive to abuse the networks.* Q7–Q8: Same Customers, Same Products? (29:38 – 33:44): Whether EPP and Signal serve different customers in different ways. Particle says any differences are implementation detail; Epic says Signal runs one-way over Carequality for treatment while EPP can’t even reach Oracle or Athena. Barrier to entry and whether explaining it this simply undercuts the two-player market.* Q9–Q10: Purpose of Use and the Break-Things Test (33:44 – 37:18): Whether HIPAA purpose of use defines a product market. The Pryce Ancona break-things test on reasonable interchangeability, Epic turning Particle’s Innovaccer argument back on EPP, and the extra-credit treatment question buried under redactions.* Grading the Exam (37:18 – 40:46): Buchwald as philosopher of treatment and operations. Brad finds Epic’s market definition more compelling, Pryce thinks they’re splitting hairs, and Brendan predicts summary judgment against the antitrust claim with the tortious interference count surviving to narrower discovery.* Spurs, Knicks, and Sign-Off (40:46 – End): Playoff trash talk and a closing nod to the underdog in both the court case and the NBA.TranscriptWe ran the transcript ...
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    41 mins
  • The Information Exchange: The TEFCA Report Card

    The Information Exchange: The TEFCA Report Card
    May 26 2026
    We are back, but we’re trying something a bit different this time. Given a little Memorial Day lead-up lull afflicting the industry, we decided to give a primer and run-down on the successes and failures of America’s only statutorily blessed nationwide health data exchange: TEFCA two years in, with what's actually working, what isn't, and what the rails really do at this point. Lot of fun this not-a-pod:* The first iteration of our new “Pryce Transparency” segment* Brad as a Trusted Exchange Guinea Pig* Five generations of patient access policy and technology in five minutes* Where Epic stands alone on a FHIR flow that's now an exhibit in active antitrust litigation.* The authentication vs. authorization debate that's becoming the most consequential architectural question in patient access.* Diagnostic imaging’s role in all this (and interop broadly)And of course, what we’re putting on our Memorial Day burgers. Hiring NoticeHTD is hiring! We are looking to bring on Associates to our Interoperability Practice.If you have experience with EHRs, interoperability, and/or consulting and want to:* Work on the deepest, darkest arts of integration and health information exchange* Help the full range from startups to the largest tech companies in the country understand and play in the interoperability landscape* Help EHRs become their better selves (both via collaboration and pressure)* Learn and use regulation deeply as a strategic lever to enable the businesses we work with* Collaborate with a scaled development team across multiple geographies (US, Poland, Argentina)Then respond to this email with your resume and the one big interoperability problem in America you’d solve if you were a policy maker.Relevant Articles* HTI-5: When the Scorpion Learns to Swim: We briefly discuss how HTI-5 is proposing to remove the main “incentive” to join TEFCA, the TEFCA Manner Exception.* Individual Access Services Open Forum: An oldie but goodie primer on how Individual Access Services works and the history behind it.* The Rise of Consumer Health On-Ramps: Detail about the “Big 4” consumer health and patient access on-ramps* Epic’s IAS Implementation: A rant from a year ago about frustrations with Epic’s Individual Access Services implementation* JG Wentworth: Pryce’s mention was like a sleeper activation codeword for me. Real nostalgia rush.* Authorization Tradeoffs: A chart I made when discussing the tradeoffs of different authorization architectures* SMART Imaging Access: Josh Mandel’s reference implementation for patient access to diagnostic images that we talk about* Much Ado about Diagnostic Images: Discussion of the ONC’s RFI on Diagnostic Imaging and a detailed overview of the space* AADJ v. Epic: The Motion to Dismiss: The antitrust case against Epic related to TEFCA IASChapters* Intro and HTD Hiring PSA (0:00 – 0:44): Brendan, Pryce, and Brad pitch HTD’s interoperability associate roles across EHR integration, HIE, payers, clearinghouses, and information blocking strategy.* Pryce Transparency (0:44 – 3:19): A foundational walkthrough of the Trusted Exchange Framework, QHINs as the Verizon and AT&T of federated clinical data, and the difference between treatment queries and Individual Access Services.* Measuring TEFCA Against Itself (3:19 – 8:06): Adoption looks lukewarm next to Carequality on document volume, but two years ago IAS was zero. Pryce’s broken query to his Athena PCP illustrates the fingerprinting problem when something fails and no one can tell whose fault it is.* Five Generations of Patient Access (8:06 – 15:35): From HIPAA right of access through View Download Transmit, scrapers, Cures Act G10 APIs, and now IAS. Each generation solved the prior bottleneck and surfaced the next. Portalitis, Kristen Valdez’s term, and why IAS still falls back to G10 like Apple Pay falls back to cash.* Diagnostic Imaging and the Limits of TEFCA (15:35 – 21:31): Brad’s CD-to-NYU story opens the question of whether new data types ride TEFCA or get their own networks. PACS unregulated, files enormous, 30 competing standards, proprietary vendor incentives. The Dutch precedent with XDS-I and TWIIN shows it can be done, and there are real reasons clinicians want pixels not just reports.* Authentication vs. Authorization (21:31 – 27:39): Pryce walks through how IAS jams identity proofing and data-release consent on rails not designed for the distinction. Epic alone runs the FHIR redirect flow, every other QHIN hands back the treatment CDA with an IAS header, and the antitrust litigation against Epic now treats that architectural choice as an exhibit.* The HIPAA Liability Math (27:39 – 30:37): Why Cleveland Clinic’s general counsel sees only downside without OIG safe harbor. The CMS Health Tech Ecosystem is pushing authentication out anyway, leaving authorization as the more interesting question, including what hospital-side authorization could have unlocked for proxy and ...
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    34 mins
  • The Information Exchange: Lumon on Steroids

    The Information Exchange: Lumon on Steroids
    May 18 2026
    Make sure to follow and listen to The Information Exchange on the podcast app of your choice! For instance, you can find the Spotify version here. The stars have aligned. The crew is back, full strength and four-deep, with (somehow) no one traveling, sick, or on a plane. We covered some choice material pondering the nature of not just Epic, but systems of record, antitrust, information blocking, and competition writ large. Some highlights:* Judy did Freakonomics and Katie Couric (after Acquired and Forbes in the past year). We dig into why a company that spent 40 years letting the work speak for itself is suddenly hiring marketing people and putting its 82-year-old founder in front of podcast mics.* API counts don’t measure openness. Why athenahealth’s developer experience runs circles around Epic’s, and why information blocking changes the co-opetition math for every system of record vendor.* Epic Cinematic Litigative Universe mini-tour: Particle sits waiting for a potential motion for summary judgment in a May of rapid litigative developments. Plus the SSNIP test and why antitrust law is structurally a bad fit for systems of record.* CMS announced electronic prior auth as a new pledge category. The pledging networks (b.well, CommonWell, eHealth Exchange, Kno2) are all clinical data networks. Were clearinghouses snubbed? Why CMS just tipped the X12/FHIR scales with seven months left on CMS-0057.Also: a fashion heat check from our local New York correspondent, Patagonia as Epic’s spirit animal, and the case for Judy on Joe RoganRelevant Articles* How Leeds avoided relegation: We’re happy for Brad. MOT.* Judy Gets Her Freakonomics On: Discussion of the Freakonomics interview and the insights it brings into Epic* Katie’s one-on-one with Judy Faulkner of Epic Systems: A longer interview by the famous journalist that pushed on Judy a bit harder* Organic Beer by Patagonia Provisions: I can’t believe this exists. Please comment on quality if you’ve tried.* Epic Opens the Door Wider for Developers: A post from last September about Epic’s incremental progress in changing how they treat developers* The Prodigal EHR: A previous article about how athenahealth leads the pack in terms of developer experience* The Iceberg Fallacy: Some further discussion of the cool developer experience and features athenahealth is releasing beyond the basics * AADJ v. Epic: Antitrust case referenced briefly in the episode. Epic’s motion to dismiss was filed on Friday, as mentioned.* 2025 EHR KLAS Report: Fierce Healthcare’s summary of the annual EHR research, which mentions how many Oracle Health customers want to switch but can’t. Mentioned in the article in reference to the SSNIP test.* Epic Litigative Universe: Prior article explaining all the lawsuits against Epic.* Electronic Prior Authorization in CMS Health Tech Ecosystem: Announcement of the new category and early adopters* CMS-0062: An Intra-Agency Cold War Goes Hot: Previous discussion of how prior authorization sits in the middle of the Venn diagram between administrative and clinicalChapters* Intro and Travel Catch-Up (0:00 – 0:44): The crew reunites after time apart and trades notes from Palm Springs, the NBA playoffs, and a trip across the pond.* Judy’s Media Tour (0:44 – 5:16): Judy Faulkner’s recent Freakonomics and Katie Couric interviews mark a sharp break from Epic’s historical posture of silence, raising questions about what’s driving the shift.* Epic Projects Outward (5:16 – 7:20): Why a company that long relied on word-of-mouth is suddenly investing in external messaging, and who inside (or outside) the company might be pushing it.* APIs, Co-opetition, and Athena (7:20 – 12:13): Counting APIs is the wrong measure of openness. A look at what real developer-friendliness looks like and why information blocking changes the economic calculus for system-of-record vendors.* Defense or Real Change? (12:13 – 16:27): Are Epic’s recent openness efforts durable, or a defensive crouch that ends if the lawsuits do? The crew debates how much of the company’s posture toward outside developers is cultural versus strategic.* Boomerangs and the Chief Meme Officer (16:27 – 18:16): Predictions on where Epic’s external-facing energy goes from here, plus a modest proposal for a certain alumnus to make a triumphant return.* The Epic Cinematic Litigative Universe (18:16 – 23:11): A tour of the active litigation against Epic, with attention to why antitrust law is poorly suited to systems of record and where information blocking gives plaintiffs more to work with.* The New Prior Auth Pledge Category (23:12 – 27:22): CMS adds electronic prior authorization to the Health Tech Ecosystem pledge structure, with conspicuous decisions about who’s invited and who’s left out.* Administrative vs. Clinical Rails (27:22 – 29:12): Prior auth has always lived at the intersection of two standards worlds, and the new pledge structure tips the...
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    32 mins
  • The Information Exchange: Russian Dolls and Headless Tractors

    The Information Exchange: Russian Dolls and Headless Tractors
    Apr 22 2026
    The Information Exchange does not sleep¹, because, well, CMS is absolutely dialed in lately:* Brad recaps the CMS Aligned Networks launch event in DC: CLEAR, ID.me, TEFCA rails, and Humana’s senior care demo all got stage time, but the question is what happens on the non-patient-access tracks before July* ACCESS approved its first cohort. Brendan plays optimist on CMMI’s willingness to swing big on outcome-aligned chronic care payments while Brad plays pessimist on lemon-dropping and the 50% withhold that could empty out year two. A Polymarket line gets opened at 60%.* CMS-0062 was supposed to be a tidy little drug rule. It is not. We walk through why it’s bigger than 0053, layers onto the 2024 prior auth rule, and in some places contradicts the claims attachments rule from three weeks ago, including the buried RFI to certify payer technology (HTI-2’s ghost returns)* Russian doll payers, Succession-level CMS subplots: why a single payer name hides 15 claims systems, why ERISA keeps TPAs out of reach no matter how well you wire things up, and whether HIIG and the HIPAA standards group are copacetic or knife-fighting over X12 vs. FHIR* John Deere lost its right-to-repair fight. Brad flagged it and Brendan connects it straight to the antitrust and information blocking playbook, diabetes device jailbreaking, and every system of record’s eventual discovery of platform rent extraction* Salesforce went headless. Agentforce opens the UI, APIs, and MCP layer. Brendan argues it’s a per-token pricing play, not altruism. Brad counters with the DoorDash problem and why Epic’s moat is the hospital’s local politics, not the software. Brendan plays foil: in some fraction of the multiverse, this looks as dumb in retrospect as cable companies building streamers.Are you curious about Brad’s Wisconsin farming roots? Wondering about the novel gambling-based business model for the podcast? Or wondering why Missingno is in your inbox? Listen to hear more.¹ Aside from the two week breaks between episodesRelevant Articles* CMS Health Tech Ecosystem First Wave Event* ACCESS Model Accepted Applicants* CMS-0062: The Entrée Has Arrived* CMS-0062: Same Drug, Two Standards* CMS-0062: An Intra-Agency Cold War Goes Hot* “Have you heard about the Pope?”* The Great Beheading Begins* The Infinite Rare Candies Glitch (Missingno)* The Door Dash Problem* How Interoperability Won on the FarmChapters* CMS Aligned Networks Takes the Stage (00:00): Brad reports back from Amy Gleason’s DC showcase, where CLEAR, ID.me, and a parade of startups demoed patient identity, TEFCA-powered history pulls, and QR-code check-ins. Payers and EHRs showed up, Humana ran a senior care coordination demo, and the crew reads the tea leaves on how much of the non-patient-access agenda is actually moving ahead of July.* ACCESS Approves Its First Cohort (03:20): CMMI’s outcome-aligned chronic care model (Advancing Chronic Care with Effective Scalable Solutions) lands its first participants. Brendan plays optimist on why ambitious failure is the point; Brad plays pessimist on lemon-dropping and the 50% withhold pushing providers out in year two. A Polymarket line on success gets opened at 60%.* CMS-0062, Not Just a Drug Rule (09:14): The rule that was supposed to be a tidy RTPB cleanup turns out to be bigger than 0053, layering onto the 2024 prior auth rule and contradicting the claims attachments rule from three weeks prior. The gang maps the scope: Medicare Advantage, Medicaid, CHIP, parts of ACA, and why ERISA keeps employer plans out of reach no matter how well the TPAs wire things up.* Payers as Russian Dolls (13:16): Why a single payer name can hide fifteen claims systems and five acquired Medicaid plans, why PBM and plan rails look nothing alike, and why CPT-2 codes keep haunting Brad’s career. Pryce makes the case for shifting regulatory focus from EHRs to the entities actually holding the risk and the purse strings.* Certifying Payer Tech (16:14): : The ghost of HTI-2 returns! An RFI buried in 0062 proposes extending health IT certification to payer technology, a ZombieHTI-2 idea that would turn payer vendors into potential information blocking actors. Brad and Pryce go thumbs up; Brendan predicts a deafening “no way in hell” from payer tech comment letters.* Step Therapy, ADT, and Succession-Level CMS Subplots (22:28): The other RFIs get a quick pass: step therapy portability as the killer payer-to-payer use case, ADT notifications getting another look, and the telling fact that 0062 tells you to use FHIR Da Vinci for prior auth while 0053 just blessed X12 for attachments. HIIG vs. the HIPAA standards group: copacetic swap or internal knife fight?* John Deere and the Right to Repair (23:59): A Wisconsin boy’s late-night text turns into a clean antitrust parallel. Farmers buying forty-year-old tractors to escape dealer lock-in, diabetes devices getting jailbroken, and why every system of record eventually rediscovers ...
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    37 mins
  • The Information Exchange: The O-PIMP Episode

    The Information Exchange: The O-PIMP Episode
    Apr 4 2026
    We're back after a few weeks off, and we came in hot:* OpenEvidence landed its first B2B deal at Mount Sinai! So we talk about what happens when a PLG darling tries to grow enterprise muscles, the competitive landscape as they do so, and whether the real moat is product or sales. * Then we pivot to MEDVi and the New York Times piece that has everyone talking: can you really vibe code a billion-dollar telehealth business for $20K? (And should you?) * We wrap with some wonkery — the ONC is the ONC again, the O-PIMP is born, and I walk us through why the Henry Schein v. Vyne case might redraw the line on what counts as a health information network in America.And yeah, you’ll have to listen to understand why this exists (and why it goes so hard):Relevant Articles* OpenEvidence Announcements* Mount Sinai to integrate OpenEvidence AI enterprise-wide* OpenEvidence and Tandem Partner to Streamline Evidence-Based Prescribing and Prior Authorizations* OpenEvidence launches Coding Intelligence* Abridge and clinical decision support* OpenEvidence’s Gambits: Some analysis of where OpenEvidence might go after PLG from last summer, including the enterprise motion* From Alert Fatigue to Approval Fatigue: An oldie showing how it was always logical ambient scribes would infuse CDS, another attempt beyond the pop-up* When Horizontal Meets Healthcare: A piece about OpenAI and how their healthcare business model differs and threatens different players* One Copilot to Rule Them All: The copilot convergence, which OpenEvidence is now rapidly joining* Abundance and Agent: A discussion of how AI-powered software development’s marginal costs mean players sprinting to build it all* The PLG Trap: The OpenEvidence v Doximity cases shows how the sword of openness (PLG) cuts both ways, as we discussed on the show* How A.I. Helped One Man (and His Brother) Build a $1.8 Billion Company: The NY Times article on MEDVi* Healthcare at Internet Scale: An article from last summer about the OpenLoop lawsuit that mentions MEDVi* Rik Renard’s MEDVi post* Death to ASTP, Long Live ONC* The Battle for the Soul of HIE (or at Least the Definition)Chapters* OpenEvidence’s Enterprise Pivot (00:00) - OpenEvidence lands its first B2B sale with an enterprise-wide deployment at Mount Sinai, embedded directly into Epic. The crew unpacks the tension between product-led growth and enterprise sales in healthcare (BAAs, PHI access, institutional sign-off) and how this move finally brings OpenEvidence into UpToDate/Wolters Kluwer’s competitive set for real.* The Great Convergence: Scribes, CDS, and RCM Collide (04:28) - Abridge partnering with Availity and UpToDate, back-office co-pilots moving upstream, front-office co-pilots moving downstream. Brad flags clinical trials enrollment as the next obvious adjacency, and the group debates who wins the “wedge into the chart” race.* PLG in Healthcare and the BAA Problem (08:21) - Why product-led growth has historically been almost impossible in healthcare because of PHI and HIPAA. OpenEvidence may be the closest thing to a Figma for healthcare, but the harder, more valuable use cases require enterprise contracts — and that’s a different muscle entirely.* Vibe Coding the Roadmap: OpenEvidence’s Shipping Velocity (13:03) - OpenEvidence is announcing something major every month. The group attributes this to LLM-assisted development and frames it as a wake-up call: if you’re not adopting Claude Code or Codex-type tools, you’re behind. But speed cuts both ways — if anyone can build an LLM wrapper on the same corpus, is velocity a moat or a vulnerability?* MEDVi, OpenLoop, and the GLP-1 Gold Rush (18:40) - A deep dive into MEDVi, a telehealth front-end on OpenLoop’s white-label MSO infrastructure reportedly generating $1.8B in revenue. Brendan connects it to an older lawsuit alleging fraudulent oral tirzepatide marketing. The real question: when website creation, content generation, and national distribution all approach zero marginal cost, harm scales faster than regulation can respond.* AI Doctors and the Guardrail Question (25:51) - If the provider layer also becomes marginal cost — AI doctors on top of white-label infrastructure — the need for guardrails becomes existential. The group draws parallels to Cerebral, opioids, and the recurring pattern of technology outpacing oversight.* ONC Is Back: ASTP Reverts to Its Original Name (28:25) - The ASTP is reverting to the Office of the National Coordinator. The mission doesn’t change, and the pattern is familiar — Democrats expand, Republicans slim down. Pryce mourns the logo, reveals the internal Office of Policy is now the Office of Programs and Implementation (”the O Pimp”), and the group riffs on missed merch opportunities.* What Is an HIE/HIN? Vyne Dental v. Henry Schein One (34:50) - The episode’s deepest policy cut. Henry Schein withdrew from ONC certification, arguably to dodge information blocking. Vyne is trying to ...
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    45 mins
  • Cat Pits, Reddit Death Threats, and Stipulated Agreements

    Cat Pits, Reddit Death Threats, and Stipulated Agreements
    Mar 16 2026
    Healthcare’s biggest conference has come and gone, so the team is back (down a man or two) to bring you some updates there, as well as every twist and turn of a very busy week in the courts.* HIMSS 2026 felt smaller but more productive…and the sentiment was surprisingly pro-HIMSS over ViVE* AI headlined as expected, but the real conversations were about data normalization and cleanliness underneath the agentic hype* Epic subtly debuted Willow Pharmacy Network, a new “With the Patient at the Heart” product that could signal a long-term play against Surescripts* The American Association for Disability Justice filed antitrust and information blocking claims against Epic over MyChart’s fragmented login experience* A surprise stipulated agreement from GuardDog Telehealth reshapes the Epic v. Health Gorilla case ahead of April’s motion to dismiss hearing* Ryan recaps a guest lecture at Johns Hopkins and the malpractice risk thread that explains more about healthcare’s data reluctance than most people realizePlus we mentioned rumblings of a bonus class action lawsuit, which came true later that afternoon as Fox, Edward v. Epic, Beaudreau, Edgar v. Epic, and Banh, Priscilla v. Epic all kicked off. While on paper it’s not great for Epic, there’s potential upside if they’re able to consolidate effectively.Relevant Articles* Epic's AI announcements: The baseline announcements from Epic at HIMSS which were very AI focused* Introducing Copilot Health: Microsoft’s buzzy announcement of a consumer health product powered by HealthEx, paralleling ChatGPT Health and Claude Health* Epic Beyond the Provider Empire: This article explained Health Grid products and waxed hypothetical about a future pharmacy oriented product, which we saw at HIMSS via Willow Pharmacy Network* Down the Disability Data Rabbit Hole: The strange fruit of minot investigational journalism into a beef tallow influencer’s medical records videos, including one that targeted Epic* Ryan’s post on data quality: Pipes are only half the battle. As access becomes ubiquitous, it’s about what you do with it (if you even can).* AADJ v. Epic: The unexpected lawsuit that launched during HIMSS with disability advocates and patients claiming antitrust, information blocking, and disability violations, which explained Mr Beef Tallow Influencer above* Epic's TEFCA IAS plans: This details their MyChart Central / unified login plans, which seemingly contradict the AADJ claims* Epic v. Health Gorilla: GuardDog Rolls Over: The bombshell of one of the defendants in the Health Gorilla lawsuit turning tail and entering into consent by admitting various violations* Epic Lawsuit-ception: After recording Friday, the lawsuits we alluded to came to light as three separate templated class action lawsuits were filed against Epic for inappropriately disclosing PHI to Health Gorilla.Chapters* HIMSS Recap: Overall Impressions (00:00) - Brendan’s on-the-ground take from HIMSS in Vegas — attendance trends, booth culture, the cat pit, and general sentiment versus ViVE.* AI Announcements: From Chatbots to Agentic (02:48) - Epic’s Art/Penny/Emmy rollout, Microsoft’s patient access chatbot with HealthEx, Agent Factory, and the gap between clean demo environments and messy real-world data.* Data Normalization and the Infrastructure Layer (05:19) - The wave of companies tackling data cleansing, parsing, and augmentation as TEFCA and information blocking rules make data movement easier.* The Under the Radar Announcement of Epic’s Willow Pharmacy Network (06:16) - A new “With the Patient at the Heart” network product targeting specialty pharmacy workflows — and what it signals about Epic’s beachhead strategy into pharmacies and potentially e-prescriptions.* New Lawsuit: Disability Access and MyChart (09:07) - The American Association for Disability Justice files antitrust and information blocking claims against Epic over fragmented portal logins, plus analysis of why the legal claims face uphill battles.* TEFCA, IAS, and Health Tech Ecosystem Updates (16:23) - Kill the Clipboard demos, digital identity with CLEAR and ID.me, and Clover Health joining as the first payer in health information networks (plus the Wall Street Bets subplot).* Ryan’s Week: Teaching FHIR at Johns Hopkins (20:22) - A Q&A with grad students on interoperability trends, wearable data, and the signal-to-noise problem with smartwatch data flowing into clinical workflows.* Malpractice Risk as a Hidden Driver (22:28) - Why the fear of liability shapes provider attitudes toward data volume, RPM, AI summarization, and even HTI-5’s auditability certification debate.* Epic v. Health Gorilla: The GuardDog Settlement (26:35) - A surprise stipulated agreement from co-defendant GuardDog Telehealth changes the dynamics of the case, potentially undermining Health Gorilla’s procedural defenses ahead of the April hearing.TranscriptWe ran the transcript through an LLM to smooth it out. So...
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    31 mins
  • The Information Exchange: Galaxy Brains & Gardening Tips

    The Information Exchange: Galaxy Brains & Gardening Tips
    Mar 3 2026
    Well, well, well. March came in hot. I was out thanks to the unending vortex of daycare-induced illness that plagued my home all February. So Pryce, Brad and Ryan had to carry the load - and carry it they did.On top of that, they tackle:* Jack Dorsey’s Block layoffs: 10,000 down to 6,000 at a profitable, growing company, because the AI tools made the headcount unnecessary* The SaaS-mageddon question: are we watching the first domino fall, or is the “AI replaces everyone overnight” narrative still overblown?* FDA deregulation and Harrison AI’s push to skip premarket review: speed vs. safety in a domain where the stakes are human lives* Glyphosate, Roundup, and the MAHA contradiction: how do you push preventive health on one hand and subsidize empty calories on the other?* The ACCESS Model’s brutal reimbursement math: $15/patient/month doesn’t exactly scream “invest in behavioral health infrastructure”* A galaxy brain segment on whether AI opens the door to a thousand little EHRs (spoiler: the interop team would never sleep again)Relevant Articles* Steve Posnack’s LinkedIn post: Brad mentions the episode was “inspired by” it.* Jack Dorsey’s post on X: About Block’s reduction in force from ~10,000 to ~6,000 employees, specifically citing AI/agentic tools as the reason despite the company being profitable and growing. Ryan describes it in detail.* An Epic Anthropic Alliance: Pryce references something Brendan “just wrote” about discovering Epic is leaning into Claude usage on campus for internal code development.* THE 2028 GLOBAL INTELLIGENCE CRISIS by Citrini Research: A hypothetical 2028 scenario where AI-driven unemployment triggers economic collapse, mortgage market failure, etc. Pryce notes there are “cracks in its argument” and it’s somewhat sci-fi in tone.* AI Transformation Is a Workforce Transformation: Brad cites a stat breakdown: 10% is the model’s capabilities, 20% is what you’re introducing it into, and 70% is operationalization/teaching people how to use it.* Harrison AI’s FDA exemption request: Ryan discusses Harrison AI (and possibly others) seeking exemptions from the FDA’s pre-market review process for AI devices.* Trump’s executive order on phosphorus/glyphosate production: Pryce references a signed order increasing domestic glyphosate (Roundup) production, and RFK’s subsequent cosigning of it.Chapters* Introduction and Conference Takes (0:00 - 4:30): Brad recaps ViVE, where every booth pitched identical agentic AI solutions. Ryan and Price weigh in on the real value of industry conferences.* Block Layoffs and the AI Employment Shockwave (4:30 - 9:00): Ryan breaks down Jack Dorsey’s decision to cut 4,000 employees from a profitable, growing company because AI tools made them redundant. The group asks: is this the first domino?* AI Hype vs. Economic Reality (9:00 - 14:00): Price and Brad debate whether AI will pull the rug out from the economy or diffuse slowly enough to avoid catastrophe. Brad drops a BCG stat — 70% of AI implementation is workflow, not the model — and predicts an explosion of custom software.* AI in Healthcare: Scribes, Code, and Patient Safety (14:00 - 19:30): Ryan draws a line between AI that removes friction (scribes) and AI that replaces humans writing safety-critical code. The group reflects on Epic’s patient safety escalation culture and whether AI-generated code can meet that bar.* FDA Deregulation and Harrison AI (19:30 - 24:00): The group examines the FDA’s loosening of premarket review for AI devices, distinguishing between probabilistic recommendations that need scrutiny and interface-level AI that may not.* Glyphosate, Nutrition, and the MAHA Contradiction (24:00 - 30:00): Price goes full gardener, connecting Roundup subsidies to nutrient-depleted industrial farming and questioning how HHS can push preventive health while enabling cheap empty calories.* A Thousand Little EHRs? (30:00 - 33:00): Brad asks whether AI enables a proliferation of bespoke EHRs. Ryan sees job security for interop folks; Price would rather see a million provider groups than a million EHRs.* Competition, Single Payer, and the ACCESS Model (33:00 - 37:00): Ryan puts on the socialist brain to argue healthcare competition doesn’t optimize for health outcomes. Brad closes hot on the ACCESS Model’s $15/patient/month reimbursement math and what it means for behavioral health.TranscriptWe ran the transcript through an LLM to smooth it out. So it’s a rough approximation of the conversation (and in many cases significantly clearer than our rambling), but notably diverges from the word-by-word blows quite a bit.Brad Thorson [00:00]welcome to another edition of the information exchange sponsored by HDD Health. Can you believe our employer is sponsoring us? I am back from Vive this week and this is a very special edition inspired by Steve Posnack’s LinkedIn post, no Brendan Keeler today. So, boys, you got a lot of explaining to do ...
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    48 mins