Building 30
An office remodel put me in Mission Control on September 11th, the one room built so somebody can read a signal and know what it means. My wife called twice. I misread both.
Read →The archive
Essays
Writing on healthcare technology, systems, and incentives — some new, some republished from earlier work with its original date. Roughly one a month.
2026
Stop Auditing the Phrases
AI watermarks are shipping this month, and everyone is busy auditing the writing for an answer that was never there. You don't detect who wrote it like a fingerprint. It's an assertion made by the person willing to say, "I wrote this."
Read →2025
Culture Doesn't Shape Behavior. Incentives Do.
We praise Toyota's culture because it lets us pretend the magic was mindset. It wasn't. Toyota engineered consequences, and the culture showed up as a byproduct.
Read →Raising the Bar: Why AI Doesn't Erode Rigor, It Redefines It
Every major tool in history lowered one threshold and raised another. AI is no different — it resets the floor and forces excellence upward.
Read →The Power of Simplification: Lessons from Spacecraft Design
The Space Shuttle had 2,000 switches and stopped flying. The Soyuz had 63 and still flies. The most enduring systems keep only what is necessary.
Read →The Denial Machine
One in five claims gets denied on the first pass. A system that says no to a fifth of everything is not making mistakes. It is doing exactly what it was built to do.
Read →2016
Are You in an Abusive Relationship with Your EHR?
Clinicians spend more time clicking than caring, and everyone treats it as inevitable. It isn't. Good clinical UI is a design choice, not a law of nature.
Read →Don't Let Health IT Go Extinct
For too long, health IT vendors have replaced old technology with different outdated technology. Interoperability isn't impossible — some just profit from it staying broken.
Read →Care Coordination on FHIR: The Case for API-Based Exchange
Care coordination depends on every provider seeing the whole patient record. Document-based exchange can't get us there. API-based exchange on FHIR can.
Read →