Brandt Welker · Essays
Thirty years building systems people's lives depend on — at NASA, at the VA, and in the software that runs a hospital.
I'm a healthcare technology executive who writes about how these systems actually work: where the incentives point, why good engineering is mostly subtraction, and what changes — and what doesn't — when the tools get smarter.
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.
Start here
If you're new, these two are the argument in miniature: how the money works, and what rigor means now.
- 01
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.
- 02
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.
More essays
All essays →- Building 30
- Stop Auditing the Phrases
- Culture Doesn't Shape Behavior. Incentives Do.
- Raising the Bar: Why AI Doesn't Erode Rigor, It Redefines It
- The Power of Simplification: Lessons from Spacecraft Design
- The Denial Machine
- Are You in an Abusive Relationship with Your EHR?
- Don't Let Health IT Go Extinct
- Care Coordination on FHIR: The Case for API-Based Exchange