Josh Mandel, MD
@josh.mandel.md
Physician, programmer, and would-be pâtissier/poet. Chief Architect for Microsoft and SMART Health IT.
Health tech policy, interoperability, FHIR, AI, web.
Health tech policy, interoperability, FHIR, AI, web.
Now with the full set of nearly a thousand comments on the CMS RFI: joshuamandel.com/regulations....
Comment Analysis Dashboard
joshuamandel.com
June 28, 2025 at 12:47 AM
Now with the full set of nearly a thousand comments on the CMS RFI: joshuamandel.com/regulations....
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...
Demo+Deep Dive: youtu.be/pgoaZjYMGJY
Article: linkedin.com/pulse/better...
Source: github/jmandell/shl...
W3C Digital Credentials Demo: SMART Health Wallet!
YouTube video by Josh Mandel
youtu.be
May 15, 2025 at 10:15 PM
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...
Demo+Deep Dive: youtu.be/pgoaZjYMGJY
Article: linkedin.com/pulse/better...
Source: github/jmandell/shl...
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...
Article: linkedin.com/pulse/evalua...
Output and code: github.com/jmandel/fhir...
GitHub - jmandel/fhir-diff
Contribute to jmandel/fhir-diff development by creating an account on GitHub.
github.com
May 10, 2025 at 12:54 PM
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...
Article: linkedin.com/pulse/evalua...
Output and code: github.com/jmandel/fhir...
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!)
Write-up: linkedin.com/pulse/mcp-pr...
Video: youtu.be/AMPuz56qhx4 (sorry for poor audio!)
MCP for EHR: Discussion with Aledade Team
YouTube video by Josh Mandel
youtu.be
May 7, 2025 at 3:49 PM
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!)
Write-up: linkedin.com/pulse/mcp-pr...
Video: youtu.be/AMPuz56qhx4 (sorry for poor audio!)
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
Article: www.linkedin.com/pulse/mcp-yo...
Video with Demo: youtu.be/_VuMRotKbV8
MCP postMessage Transport: Secure, Local AI Tools In Your Browser (Demo)
YouTube video by Josh Mandel
youtu.be
May 5, 2025 at 5:34 PM
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
Article: www.linkedin.com/pulse/mcp-yo...
Video with Demo: youtu.be/_VuMRotKbV8
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...
Web app: chatgpt.com/canvas/share...
Blog post: www.linkedin.com/pulse/o3-mee...
May 1, 2025 at 10:07 PM
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...
Web app: chatgpt.com/canvas/share...
Blog post: www.linkedin.com/pulse/o3-mee...
New Perspective: The EHR Association's push to remove foundational data access is misguided & harmful for health innovation. www.linkedin.com/pulse/ehr-as...
May 1, 2025 at 12:50 PM
New Perspective: The EHR Association's push to remove foundational data access is misguided & harmful for health innovation. www.linkedin.com/pulse/ehr-as...
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/BRX7HUBlEqw?...
www.linkedin.com/pulse/conver...
Live Demo: Conversational Interop for Prior Auth (LLMs, A2A, and MCP)
YouTube video by Josh Mandel
youtu.be
April 25, 2025 at 5:45 PM
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/BRX7HUBlEqw?...
www.linkedin.com/pulse/conver...
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.)
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.)
December 4, 2024 at 5:25 AM
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.)
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.)
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.
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.
December 1, 2024 at 7:26 PM
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.
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.
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...
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...
November 26, 2024 at 10:47 PM
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...
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...
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
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
November 23, 2024 at 7:50 PM
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
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
❤️ 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
joshuamandel.com/birth-analysis
November 18, 2024 at 3:52 PM
❤️ 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
joshuamandel.com/birth-analysis
@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.)
(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.)
November 17, 2024 at 4:16 PM
@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.)
(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.)
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...
No silver bullets, but real progress is possible.
User stories & principles: hackmd.io/@jmandel/hin...
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).
hackmd.io
October 18, 2024 at 7:34 PM
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...
No silver bullets, but real progress is possible.
User stories & principles: hackmd.io/@jmandel/hin...
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...
Quick enough to complete btw boarding + takeoff to #FHIR #DevDays
Output: joshuamandel.com/nexercise
Chat: chatgpt.com/share/7fac01...
Whiplash Recovery Exercise Tracker
joshuamandel.com
June 9, 2024 at 9:10 PM
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...
Quick enough to complete btw boarding + takeoff to #FHIR #DevDays
Output: joshuamandel.com/nexercise
Chat: chatgpt.com/share/7fac01...
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.)
This diagram shows only users & tasks mentioned at least 10 times. (Task labels generated by GPT-4, based on Epic's EHI schema.)
February 15, 2024 at 3:11 AM
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.)
This diagram shows only users & tasks mentioned at least 10 times. (Task labels generated by GPT-4, based on Epic's EHI schema.)
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
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
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.
www.nature.com
January 30, 2024 at 5:45 PM
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
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
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
A strained analogy between online grocery shopping & clinician-facing order entry. youtu.be/447C-f9MJw8
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...
youtu.be
January 18, 2024 at 5:18 PM
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
A strained analogy between online grocery shopping & clinician-facing order entry. youtu.be/447C-f9MJw8
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
I'd love your feedback to hone this 3-minute presentation.
youtu.be/umn2bPbD8SA
January 9, 2024 at 4:40 PM
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
I'd love your feedback to hone this 3-minute presentation.
youtu.be/umn2bPbD8SA
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://...
For example...
Source
kingarthurbaking.com/recipes/mult...
Extraction
ld.fly.dev?url=https://...
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!)
(But you'll have to wrestle the fountain pen from my grip!)
ChatGPT - Reci-pop!
Recipe as wall of text → •🤏 short •🍬sweet (Inputs: free-text, URL from NYT/King Arthur/etc)
chat.openai.com
January 6, 2024 at 9:55 PM
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://...
For example...
Source
kingarthurbaking.com/recipes/mult...
Extraction
ld.fly.dev?url=https://...
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!)
(But you'll have to wrestle the fountain pen from my grip!)
ChatGPT - Reci-pop!
Recipe as wall of text → •🤏 short •🍬sweet (Inputs: free-text, URL from NYT/King Arthur/etc)
chat.openai.com
January 6, 2024 at 9:53 PM
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!)
(But you'll have to wrestle the fountain pen from my grip!)
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...
www.healthit.gov/topic/laws-r...
December 21, 2023 at 3:09 AM
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...
www.healthit.gov/topic/laws-r...
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!
It's a rough prototype but already helping me make sense of the 900+ page rule. Enjoy!
December 17, 2023 at 8:07 PM
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!
It's a rough prototype but already helping me make sense of the 900+ page rule. Enjoy!
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...
In 2023, things are messy and could use CMS attention.
Summary in🧵
Details at hackmd.io/@jmandel/ins...
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.
hackmd.io
September 28, 2023 at 3:39 PM
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...
In 2023, things are messy and could use CMS attention.
Summary in🧵
Details at hackmd.io/@jmandel/ins...