Interop Blog

There is a lot of pressure right now to improve prior authorization.

Tomorrow, we are launching a new Argonaut project: SMART Permission Tickets.

For the full analysis of 97 submissions to regulations dot gov, see my Regulatory Comment Browser.

Last summer I shared an MCP server that let AI tools query public comments on federal regulations.

To unleash healthcare innovation, the federal government is targeting “unconscionable” contracts.

Guest post from Gemini Pro analyzing HTI-5 comments on the theme of artificial intelligence / robotic process automation, sourced from my regulations.gov comment browser on HTI-5.

Every patient in the US has the right to a complete electronic copy of their medical record.

Imagine walking into your local public library to check out a book, only to be handed a third-party disclosure form designed for an insurance company.

This is the technical companion to "I Graded Every EHR's Patient Data Export Documentation."

A caveat up front: Evaluating EHI export documentation is hard.

Under §170.315(b)(10), certified health IT must be able to export all electronic health information stored by the product.

This is a follow-up to 7,000+ Clicks to Register a FHIR App.

I'm building Health Skillz, a patient-facing app that helps people bring their healthcare data securely into their browser from provider systems -- and, from there, share it with an AI of their choice, with end-to-end encryption so only the AI can decrypt…

TL;DR: I built Health Skillz to help patients connect their health records to an AI assistant.

The CMS Interoperability Framework asks CMS-Aligned Networks to deliver appointment and encounter notifications using FHIR Subscriptions.

(Guest Post by Shelley / Exe.dev, via Claude Opus 4.5 with access to Zulip.

The Hype The "Ralph Wiggum loop" went viral in early 2026.

(Guest post authored by ChatGPT 5.2 Pro -- if you think this slop, call me out!)

When a task is too big for one context window, the answer (in mid-January 2026) is more agents, not a bigger window.

Back in 2016, I pushed back against the idea of "Custom Resources" in FHIR.

The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) sets the right goals: reduce administrative burden, speed access to care, and save an estimated $15 billion over ten years.

The latest proposed rule from ASTP/ONC frames a significant deregulation of the Health IT Certification Program as a necessary pivot toward a "FHIR-forward future."

TL;DR: I built Health Skillz, a Claude Skill that fetches your health records directly from your patient portal using SMART on FHIR.

The IETF recently published RFC 9901, standardizing Selective Disclosure for JSON Web Tokens (SD-JWT).

When we designed the SMART Backend Services specification, we deliberately left flexibility for implementers to handle authorization logic below the OAuth layer.

The CMS Interoperability Framework aims to "Kill the Clipboard," enabling patients to digitally share health records, insurance data, and other paperwork with providers.

Few initiatives represent the gap between promise and reality quite like the Appropriate Use Criteria (AUC) program for advanced diagnostic imaging.

The 21st Century Cures Act set a clear north star: a patient’s electronic health information must be reachable “without special effort” through “APIs or their successor technologies.”

Speeding Spec Development by Making AIs Argue ============================================= Standards are supposed to bring clarity.

Big tech companies spend a lot of time thinking about privacy design before they release anything that touches personal information.

A thought experiment on making healthcare outreach smarter and more balanced. --- Every Monday morning, clinics across the country print out the "care gaps" list—a long spreadsheet of patients overdue for screenings, check-ins, or medication reviews.

The Rural Health Transformation Program (part of the “One Big Beautiful Bill,” Public Law 119–21) dedicates $50 billion over five years.

Imagine two AI agents, one representing a clinician buried in paperwork, the other a remote registry for a rare disease, exchanging messages in plain English to figure out exactly what patient data needs to be shared—and in what format—before a report can…

The Problem with Form Letters In prior work, I built a tool to analyze thousands of public comments.

Based on https://joshuamandel.com/regulations.gov-comment-browser/AHRQ-2025-0002-0001//themes/4.4 "This will kill people."

A July 2025 HHS reinterpretation of PRWORA (8 U.S.C. §1611) reverses nearly three decades of practice by newly classifying programs like Federally Qualified Health Centers and Head Start as “federal public benefits.”

The Da Vinci DTR Implementation Guide aims to reduce prior authorization friction by standardizing the format for asking and answering clinical questions.

HHS wants to deregulate.

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."

Personal note: The value proposition of regulation and deregulation is full of trade-offs.

In the summer of 2025, CMS sought public input on building a patient-centered digital health ecosystem.

A few weeks ago, I shared an interactive dashboard summarizing public comments on the CMS Health Tech Ecosystem RFI.

It is a significant undertaking to maintain and document a modern EHR database spanning diverse clinical domains and workflows.

Epic's Argument: Nobody Uses It, and Nobody Wants It In their recent response to CMS and ONC's "Health Technology Ecosystem" RFI, Epic Systems stated: "EHI Export has not achieved widespread adoption as a data-exchange mechanism and therefore may have lim…

Build a Tool When the government asks for public comment on a new policy, it can get an overwhelming response.

This is the first in a short series of articles drawing on themes, attestations, and conflicts surfaced in the CMS Health Tech Ecosystem RFI, which closes in two days.

The ongoing rollout and evolution of the Trusted Exchange Framework and Common Agreement (TEFCA) – a framework designed to enable different health information networks to connect and share data across the country – brings patient data rights to the forefr…

Disclaimer: The views and opinions expressed here and on the linked collaborative sites are my own and do not necessarily represent the views or positions of Microsoft.

Josh Mandel Explores New Presentation APIs for Digital Health Data.

As the FHIR community steers towards our R6 release, a key objective is to provide stable, mature resources.