iiinova — where your digital self keeps evolving

Josh Mandel, MD @josh.mandel.md · 28/06/2025

Now with the full set of nearly a thousand comments on the CMS RFI: joshuamandel.com/regulations....

Josh Mandel, MD @josh.mandel.md · 15/05/2025

New live demo+deep dive! "What's next for sharing SMART Health Cards & FHIR bundles?" We explore W3C Digital Credentials API, browser-mediated presentation, & path beyond "show me your QR". Demo+Deep Dive: youtu.be/pgoaZjYMGJY Article: linkedin.com/pulse/better... Source: github/jmandell/shl...

youtu.be

W3C Digital Credentials Demo: SMART Health Wallet!

YouTube video by Josh Mandel

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Josh Mandel, MD @josh.mandel.md · 10/05/2025

FHIR is evolving! I prototyped an LLM-driven analysis to diff R4 vs. R6 resources and study downstream effects on IGs like US Core. The goal: explore automated methods for spec insight. Article: linkedin.com/pulse/evalua... Output and code: github.com/jmandel/fhir...

github.com

GitHub - jmandel/fhir-diff

Contribute to jmandel/fhir-diff development by creating an account on GitHub.

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Josh Mandel, MD @josh.mandel.md · 07/05/2025

Great discussion with Farzad Mostashari and the Aledade, Inc. team on applying Model Context Protocols (MCPs) for LLM-EHR interaction! We touc on data access, authorization & the future of AI in healthcare. Write-up: linkedin.com/pulse/mcp-pr... Video: youtu.be/AMPuz56qhx4 (sorry for poor audio!)

youtu.be

MCP for EHR: Discussion with Aledade Team

YouTube video by Josh Mandel

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Josh Mandel, MD @josh.mandel.md · 05/05/2025

New Proposal: "MCP postMessage transport" using browser sandbox for security, privacy + zero-install MCPs. See my EHR data demo & read the proposal. Article: www.linkedin.com/pulse/mcp-yo... Video with Demo: youtu.be/_VuMRotKbV8

youtu.be

MCP postMessage Transport: Secure, Local AI Tools In Your Browser (Demo)

YouTube video by Josh Mandel

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Josh Mandel, MD @josh.mandel.md · 01/05/2025

I used 50 leftover o3 credits to test ChatGPT’s vision capabilities on cryptic crossword grids. Pure vision failed; combining vision with code got there. Web app: chatgpt.com/canvas/share... Blog post: www.linkedin.com/pulse/o3-mee...

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Josh Mandel, MD @josh.mandel.md · 01/05/2025

New Perspective: The EHR Association's push to remove foundational data access is misguided & harmful for health innovation. www.linkedin.com/pulse/ehr-as...

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Josh Mandel, MD @josh.mandel.md · 25/04/2025

What if, instead of pre-specifying every data field and every possible workflow step, we could enable conversations between capable systems? Prior auth and beyond! youtu.be/BRX7HUBlEqw?... www.linkedin.com/pulse/conver...

youtu.be

Live Demo: Conversational Interop for Prior Auth (LLMs, A2A, and MCP)

YouTube video by Josh Mandel

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Josh Mandel, MD @josh.mandel.md · 04/12/2024

... then Claude hit a token output limit while finishing transcribing the solution into a web app. So I spent a third turn saying "Continue," and it emitted the final HTML tags. I'm counting this as a moral success, but it technically violates my pre-specified terms.

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Josh Mandel, MD @josh.mandel.md · 04/12/2024

Day 4: ⭐ ⭐ (*) claude.site/artifacts/f5... On Part 2, Claude took 4 code analyzer blocks to fully debug its algorithm. (It's rare in my experience that broken code gets fixed after three failed attempts, so this was a pretty impressive feat.)

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Josh Mandel, MD @josh.mandel.md · 01/12/2024

My running total score: 2 ⭐ (100%) claude.site/artifacts/d1...

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Josh Mandel, MD @josh.mandel.md · 01/12/2024

Fine print: web app artifacts allowed, w/ paste + one click only. Per adventofcode.com/2024/about, wait until the daily adventofcode.com leaderboard is full before submitting LLM-generated solutions! Of course, feel free to use ChatGPT custom instructions, static prompts, etc :-)

adventofcode.com

About - Advent of Code 2024

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Josh Mandel, MD @josh.mandel.md · 01/12/2024

New Challenge: "Advent of Claude"! Write a Claude(dot ai) custom style to solve Advent of Code puzzles within Claude's UI. Score: # adventofcode(dot com) stars earned in 2 daily conversation turns.

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Josh Mandel, MD @josh.mandel.md · 26/11/2024

turkeydown: a markdown-shaped, LLM-powered prompt flow for meal prep and more 🦃 🎉 My Thanksgiving 2024 template, defining processing logic: github.com/jmandel/turk... Output including prep plan, shopping list, & full recipe set for everything we're cooking this Thursday: github.com/jmandel/turk...

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Josh Mandel, MD @josh.mandel.md · 23/11/2024

Outputs. All recipes: gist.github.com/jmandel/5ace... Shopping list: claude.site/artifacts/2a... Prep plan: claude.site/artifacts/57...

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Josh Mandel, MD @josh.mandel.md · 23/11/2024

Prompt 5. Now prepare a combined shopping list organized by grocery department and all duplicate ingredients combined to create totals, but listing the dishes and subquantities where they're used in parens. use check boxes interact app that is formatted for easy printing.

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Josh Mandel, MD @josh.mandel.md · 23/11/2024

Prompt 4. Now output an artifact containing each recipe with detailed ingredients including quantities, with prep steps written clearly and with quantities repeated inline. Don't bother to confirm with me first, just use your judgment and output all recipes. Separate with ---

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Josh Mandel, MD @josh.mandel.md · 23/11/2024

Prompt 3. Output a web app with this in a giant table

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Josh Mandel, MD @josh.mandel.md · 23/11/2024

Prompt 2. Now output a table where the rows are days and each column represents a different dish, so that we can see what prep steps should happen at which cell. (Notes: Focus Sunday on Turkey alone.)

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Josh Mandel, MD @josh.mandel.md · 23/11/2024

Begin by outputting a recipe sketch for each dish. When a recipe is supplied, you should use it as the basis of your sketch. If no recipe is supplied, begin with the recipe sketch that you output so that we understand the overall process.

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Josh Mandel, MD @josh.mandel.md · 23/11/2024

We're going to make: wild rice soup, salad, green beans, broccoli rabe, turkey, herbed gravy, rutabaga stuffing, sage biscuits, apple tart, pumpkin Bundts.

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Josh Mandel, MD @josh.mandel.md · 23/11/2024

Sequential prompts. Prompt 1. Our eventual goal is to create a prep schedule starting Sunday night through mealtime Thursday, emphasizing make ahead where it improves or doesn't detract from quality -- while also consolidating prep steps smartly.

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Josh Mandel, MD @josh.mandel.md · 23/11/2024

Thanksgiving prep with LLMs. Here's my recipe: 0. Decide what to cook 1. Put all recipes (or dish ideas) in project context 2. Request * 4 day prep plan * All recipes with consistent formatting * All ingredients in a combined shopping list

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Josh Mandel, MD @josh.mandel.md · 18/11/2024

❤️ CDC's NVSS: It's *amazing* that anyone can download 200MB .zip with ~all 3.6M USA births in 2023, including dozens of row-level attributes to answer questions like "when and how did women deliver, given specific assumptions for age, educational status, BMI?" joshuamandel.com/birth-analysis

This graph shows birth outcomes data after 33 weeks of pregnancy, broken down by delivery method and induction status. The data spans weeks 34-42, with filters for age groups (15-50 years), BMI categories, and education levels.

Key observations:
1. Peak births occur around week 39 (approximately 32% of total births)
2. Most common delivery method is Vaginal Non-Operative (both induced and non-induced)
3. C-section rates are relatively consistent across weeks, with slight increases in later weeks
4. Birth rates drop significantly after week 40

The weekly statistics show a progressive increase in births from week 34 (1.7% of total) to week 35 (2.5%) and week 36 (4.7%), with most deliveries being vaginal non-operative. C-section rates remain relatively low but show slight increases in later weeks.

The graph shows both elective and medically indicated procedures through the color-coding of induced vs. non-induced deliveries for each method.

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Josh Mandel, MD @josh.mandel.md · 17/11/2024

@bsky.app feature request: include a "following back" button inline in the "New user followed you" notification screen. (Right now, new follows are grouped into a drop-down, but as you click each one to review — and follow back — the drop-down group is re-filtered and needs to be re-expanded.)

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Josh Mandel, MD @josh.mandel.md · 18/10/2024

Healthcare data access vs. privacy tensions aren't zero-sum. Better-designed Health Information Networks can bend the tradeoff curve, enabling convenience AND control. No silver bullets, but real progress is possible. User stories & principles: hackmd.io/@jmandel/hin...

hackmd.io

Princinpled (Q)HIN Design: Convenience AND Control - HackMD

All stories feature Elena, a 42-year-old marketing executive whose healthcare providers participate in AcmeConnect, a Health Information Network (HIN).

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Josh Mandel, MD @josh.mandel.md · 09/06/2024

ChatGPT, act as physical therapy consultant && web developer to design neck exercises, write a web app to track daily progress, & ramp up difficulty. Quick enough to complete btw boarding + takeoff to #FHIR #DevDays Output: joshuamandel.com/nexercise Chat: chatgpt.com/share/7fac01...

joshuamandel.com

Whiplash Recovery Exercise Tracker

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Josh Mandel, MD @josh.mandel.md · 15/02/2024

EHI Export insight: >100 individual users (i.e., provider org staff) contributed to some aspect of my EHI in the past 6 years of ambulatory care. This diagram shows only users & tasks mentioned at least 10 times. (Task labels generated by GPT-4, based on Epic's EHI schema.)

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Josh Mandel, MD @josh.mandel.md · 10/02/2024

Sure thing! Are you game for a conversation that we record and share openly? I find these topics can be of much broader interest than they initially appear.

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Josh Mandel, MD @josh.mandel.md · 30/01/2024

Just out: www.nature.com/articles/s41... Health AI integration requires workflow & data access. @SMARTHealthIT experience: it takes products, pragmatics, open standards... and regulations. Better alignment & precision on "jobs to be done" => (much) faster timeframes! @mandl @gotdan

nature.com

Integration of AI in healthcare requires an interoperable digital data ecosystem - Nature Medicine

Electronic health information, including from electronic health records, is needed to develop AI tools for health, but the seamless flow of data will require standards and interoperability.

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Josh Mandel, MD @josh.mandel.md · 18/01/2024

Ah, a fhir.org/guides/acme/... shout-out :-)

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Josh Mandel, MD @josh.mandel.md · 18/01/2024

Wait, a recipe that includes coffee? Or trying to choose one coffee among many? Say more 🙂

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Josh Mandel, MD @josh.mandel.md · 18/01/2024

Beyond Split Pea Soup: #ChatGPT 1) assembles order sets on-the-fly from primary source 2) controls my web browser through a focused API 3) applies common sense + quantitative reasoning. A strained analogy between online grocery shopping & clinician-facing order entry. youtu.be/447C-f9MJw8

youtu.be

Automating EHR Order Entry, or Shopping for Split Pea Soup with ChatGPT

Beyond Split Pea Soup: #ChatGPT 1) assembles order sets on-the-fly from a primary source; 2) controls my local browser through a focused API; 3) applies sens...

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Josh Mandel, MD @josh.mandel.md · 09/01/2024

Preview "lightning talk" I'm giving this Thursday re: hopes for AI in health interop & the role of government in getting us there. I'd love your feedback to hone this 3-minute presentation. youtu.be/umn2bPbD8SA

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Josh Mandel, MD @josh.mandel.md · 06/01/2024

It was very cool to see how widely supported #JSON-LD is for recipe content. I wrote a 10 line proxy to extract this content for LLMs. For example... Source kingarthurbaking.com/recipes/mult... Extraction ld.fly.dev?url=https://...

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Josh Mandel, MD @josh.mandel.md · 06/01/2024

Recipes: when I find a keeper, I condense & transcribe (in ink) on a 3x5 card. Which made me wonder... can a custom GPT come close? After 30m fiddling with prompts and proxies: yes, but you be the judge! chat.openai.com/g/g-bdnABvG9... (But you'll have to wrestle the fountain pen from my grip!)

chat.openai.com

ChatGPT - Reci-pop!

Recipe as wall of text → •🤏 short •🍬sweet (Inputs: free-text, URL from NYT/King Arthur/etc)

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Josh Mandel, MD @josh.mandel.md · 28/12/2023

At least GPT-4 takes a real stab: chat.openai.com/share/869fab...

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Josh Mandel, MD @josh.mandel.md · 21/12/2023

Deciphering Health IT regulations is like spelunking through a C codebase — federal register publishes a giant patch to the CFR; comments can be cryptic; and internally everything is pointers. Navigate wisely :-) www.healthit.gov/topic/laws-r...

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Josh Mandel, MD @josh.mandel.md · 17/12/2023

Fun with #GPT-4 in hierarchical summary of US Regulations: joshuamandel.com/regview/#ful... summarizes every (sub(sub(sub)))section of ONC's "HTI-1 Final Rule" for Health Tech Interoperability (parts I-VI). It's a rough prototype but already helping me make sense of the 900+ page rule. Enjoy!

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Josh Mandel, MD @josh.mandel.md · 28/09/2023

developer.cms.gov/marketplace-... is a *fabulous* resource, and shows how productive a focused, end-to-end-managed federal initiative can be. We'll need similar programs to manage FHIR requirements if we expect to see similar results.

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Josh Mandel, MD @josh.mandel.md · 28/09/2023

The messy state of FHIR deployments is especially painful given that (in a nearby parallel universe) CMS oversees a *pristine* data resource for insurance plans on the federally-facilitated exchanges, with hyper-specific (non-FHIR) data formats + central aggregation of endpoints.

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Josh Mandel, MD @josh.mandel.md · 28/09/2023

Despite the CMS requirement for open, public-access APIs w/ insurance plan details, industry support is inconsistent. When insurers do host APIs, the data are variable and the ability to retrieve full content is limited. It's not clear how CMS intends to enforce rules.

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Josh Mandel, MD @josh.mandel.md · 28/09/2023

A CMS mandate went into effect in 2021 to ensure that many health plans publish their network details (Provider lists, etc) with a #FHIR API for interoperability. In 2023, things are messy and could use CMS attention. Summary in🧵 Details at hackmd.io/@jmandel/ins...

hackmd.io

Insurance Plan Interop: A Cautionary Tale - HackMD

A CMS mandate went into effect in 2021 to ensure that health plans offer #FHIR APIs for their Provider Directory. Let’s explore how things are going.

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Josh Mandel, MD @josh.mandel.md · 01/09/2023

I've been pondering how #Interoperability will change as AI advances. Video: youtu.be/32a7WWMhXd0 Key Points: 1. #chatgpt4 Advanced Analysis Mode is impressive with @HL7 #FHIR data inputs... but 2. Free text can work just as well, using #GPT4 to guide on-the-fly abstraction!

youtu.be

Automating clinical data analysis with on-the-fly data abstraction

In this video, I explore automated capabilities for analyzing clinical data. We begin by running ChatGPT's Advanced Data Analysis tool against a FHIR Bundle,...

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Josh Mandel, MD @josh.mandel.md · 07/06/2023

OK, that was slightly broken in giving everyone *my* interests. Fixed now :-)

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Josh Mandel, MD @josh.mandel.md · 07/06/2023

Fun with custom feeds: bsky.app/profile/did:plc:gr52g3xuvv… reads your BlueSky profile, generates a list of relevant topics via GPT, and filters posts by these topics. Your feed starts empty + gains new messages as they happen. Just testing; needs a home

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Josh Mandel, MD @josh.mandel.md · 07/06/2023

Test message about healthcare standards, to see if it shows up in my personal custom feed :-)

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Josh Mandel, MD @josh.mandel.md · 06/06/2023

For @atproto.com team: how likely is it that high quality custom feeds can be developed / optimized without access to "client-internal" stats like dwell time, link clicks / engagements, etc?

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Josh Mandel, MD @josh.mandel.md · 05/06/2023

Has someone already written a feed generator that matches user profiles to posts, using a language model to generate scores? It'd work like this... Example input: @jay.bsky.team Transcript: chat.openai.com/share/53e040b9-5b83… Example output: Relevance 9, Quality 8

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Josh Mandel, MD @josh.mandel.md · 05/06/2023

TFW you open the hotel stairwell door expecting dingy utility vibes and are greeted with a brilliant wall of sunlight.

Hotel stairwell lit with sunlight streaming through a glass wall.

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