I was a guest on Shannon Lantzy‘s podcast Inside Medtech Innovation. I went on far too long about my background but we had a very fun chat, including the real origin story of why I am in health technology, and a bit about my fascination with Japan. Plus some more health care stuff. I enjoyed it. Hopefully you will too–Matthew Holt
matthew holt
Can EHRs Expand to Become Health Systems’ “Platform of Platforms” (UDHPs)?
By VINCE KURAITIS & NEIL JENNINGS
In a previous post in this series, we discussed healthcare’s migration toward Unified Digital Health Platforms (UDHPs) — a “platform of platforms.” Think of a UDHP as healthcare’s version of a Swiss Army knife: flexible, multi-functional, and (ideally) much better integrated than the drawer full of barely-used apps most health systems currently rely on. We included a list of 20+ companies jockeying for UDHP dominance, including two familiar EHR (electronic health record) giants — Epic and Oracle. This raises the obvious question for today’s post:
Can EHRs level up into becoming UDHPs — becoming healthcare’s platform of platforms? Or are they trying to wear a superhero cape while tripping over their own cables?
We see good arguments pro and con, and like most things in healthcare “it’s complicated.” Some say EHRs are uniquely positioned to make the leap. Others believe the idea is like trying to teach your fax machine to run population health analytics.
Thus, we’ll lay out the arguments for differing points of view, and you can decide for yourself.
by Vince Kuraitis and Neil P. Jennings of Untangle Health
Here’s an outline of today’s blog post:
- A Brief Recap: What are UDHPs?
- Thesis: EHRs Can Expand to Become UDHPs
- EHRs Currently Own the Customer Relationship
- Many Customers Have an “EHR-First” Preference for New Applications
- Epic and Oracle Health are Making Strong Movements Toward Becoming UDHPs
- Antithesis: EHRs Can NOT Become Effective EHRs
- EHRs Carry a Lot of Baggage
- Customers are Skeptical
- EHR Analytics Are NOT Optimized To Achieve Critical Health System Objectives
- EHR Switching Costs are Diminishing
- Cloud Native Platforms Accelerate Innovation and Performance
- It’s Not in EHR DNA to Become A Broad-Based Platform
- Synthesis and Conclusion
This is a long post…over 4,000 words…so we’ve clearly got a lot to say on the matter. Hope you brought snacks!
A Brief Recap: What are UDHPs? (Unified Digital Health Platforms)
In our previous extensive post on UDHPs, we described them as a new category of enterprise software. A December 2022 Gartner Market Guide report characterized the long-term potential:
The [U]DHP shift will emerge as the most cost-effective and technically efficient way to scale new digital capabilities within and across health ecosystems and will, over time, replace the dominant era of the monolithic electronic health record (EHR).
The DHP Reference Architecture is illustrated in a blog post by Better. Note that UDHPs are visually depicted as “sitting on top” of EHRs and other siloed sources of health data:
We noted that almost any type of large healthcare organization — health systems, health plans, pharma companies, medical device companies, etc. — had a need for UDHPs. However, today’s focus is more narrow — we limit the discussion to UDHPs in hospitals and health systems, primarily in the U.S. We use the term “health system” to encompass hospitals and regional health delivery systems.
In this post, we focus on the two largest EHR vendors in the U.S. — Epic and Oracle Health; they have a combined market share of 65% of hospitals and 77% of hospital beds.
In the remaining sections, we will lay out arguments on both sides of the issue of whether EHRs can (or cannot) expand to become UDHPs. The graphic below is our crack at a visual summary. The balloons represent the thesis – that EHRs can expand to become UDHPs; the anchors represent the antithesis – that EHRs can not expand to become UDHPs.
Thesis: EHRs Can Expand To Becoming UDHPs
Let’s look at the case for EHRs expanding to become effective UDHPs.
How Did the AI “Claude” Get Its Name?
By MIKE MAGEE
Let me be the first to introduce you to Claude Elwood Shannon. If you have never heard of him but consider yourself informed and engaged, including at the interface of AI and Medicine, don’t be embarrassed. I taught a semester of “AI and Medicine” in 2024 and only recently was introduced to “Claude.”
Let’s begin with the fact that the product, Claude, is not the same as the person, Claude. The person died a quarter century ago and except for those deep in the field of AI has largely been forgotten – until now.
Among those in the know, Claude Elwood Shannon is often referred to as the “father of information theory.” He graduated from the University of Michigan in 1936 where he majored in electrical engineering and mathematics. At 21, as a Master’s student at MIT, he wrote a Master’s Thesis titled “A Symbolic Analysis Relay and Switching Circuits” which those in the know claim was “the birth certificate of the digital revolution,” earning him the Alfred Noble Prize in 1939 (No, not that Nobel Prize).
None of this was particularly obvious in those early years. A University of Michigan biopic claims, “If you were looking for world changers in the U-M class of 1936, you probably would not have singled out Claude Shannon. The shy, stick-thin young man from Gaylord, Michigan, had a studious air and, at times, a playful smirk—but none of the obvious aspects of greatness. In the Michiganensian yearbook, Shannon is one more face in the crowd, his tie tightly knotted and his hair neatly parted for his senior photo.”
But that was one of the historic misreads of all time, according to his alma mater. “That unassuming senior would go on to take his place among the most influential Michigan alumni of all time—and among the towering scientific geniuses of the 20th century…It was Shannon who created the “bit,” the first objective measurement of the information content of any message—but that statement minimizes his contributions. It would be more accurate to say that Claude Shannon invented the modern concept of information. Scientific American called his groundbreaking 1948 paper, “A Mathematical Theory of Communication,” the “Magna Carta of the Information Age.”
I was introduced to “Claude” just 5 days ago by Washington Post Technology Columnist, Geoffrey Fowler – Claude the product, not the person. His article, titled “5 AI bots took our tough reading test. One was smartest — and it wasn’t ChatGPT,” caught my eye. As he explained, “We challenged AI helpers to decode legal contracts, simplify medical research, speed-read a novel and make sense of Trump speeches.”
Judging the results of the medical research test was Scripps Research Translational Institute luminary, Eric Topol. The 5 AI products were asked 115 questions on the content of two scientific research papers : Three-year outcomes of post-acute sequelae of COVID-19 and Retinal Optical Coherence Tomography Features Associated With Incident and Prevalent Parkinson Disease.
Not to bury the lead, Claude – the product – won decisively, not only in science but also overall against four name brand competitors I was familiar with – Google’s Gemini, Open AI’s ChatGPT, Microsoft Copilot, and MetaAI. Which left me a bit embarrassed. How had I never heard of Claude the product?
For the answer, let’s retrace a bit of AI history.
What AI and Grief-bots Can Teach Us About Supporting Grieving People
By MELISSA LUNARDINI
The Rise of Digital Grief Support
We’re witnessing a shift in how we process one of humanity’s most universal experiences: grief. Several companies have emerged in recent years to develop grief-related technology, where users can interact with AI versions of deceased loved ones or turn to general AI platforms for grief support.
This isn’t just curiosity, it’s a response to a genuine lack of human connection and support. The rise of grief-focused AI reveals something uncomfortable about our society: people are turning to machines because they’re not getting what they need from the humans around them.
Why People Are Choosing Digital Over Human Support
The grief tech industry is ramping up, with MIT Technology Review reporting that “at least half a dozen companies” in China are offering AI services for interacting with deceased loved ones. Companies like Character.AI, Nomi, Replika, StoryFile, and HereAfter AI offer users the ability to create and engage with the “likeness” of deceased persons, while many other users use AI as a way to quickly normalize and seek answers for their grief. This digital migration isn’t happening in a vacuum. It’s a direct response to the failures of our current support systems:
- Social Discomfort: Our grief-illiterate society struggles with how to respond to loss. Friends and family often disappear within weeks, leaving mourners isolated when they need support, especially months later.
- Professional Barriers: Traditional grief counseling is expensive, with long wait times. Many therapists lack proper grief training, with some reporting no grief-related education in their programs. This leaves people without accessible, qualified support when they need it most.
- Fear of Judgment: People often feel safer sharing intimate grief experiences with AI than with humans who might judge, offer unwanted advice, or grow uncomfortable with the intensity of their grief.
The ELIZA Effect
To understand why grief-focused AI is succeeding, we must look back to 1966, when the first AI-companion program called ELIZA was developed. Created by MIT’s Joseph Weizenbaum, ELIZA simulated conversation using simple pattern matching, specifically mimicking a Rogerian psychotherapist using person-centered therapy.
Rogerian therapy was perfect for this experiment because it relies heavily on mirroring what the person says. The AI companion’s role was simple: reflect back what the person said with questions like “How does that make you feel?” or “Tell me more about that.” Weizenbaum was surprised that people formed deep emotional connections with this simple program, confiding their most intimate thoughts and feelings. This phenomenon became known as the “ELIZA effect”.
ELIZA worked not because it was sophisticated but because it embodied the core principles of effective emotional support, something we as a society can learn from (or in some cases relearn).
What AI and Grief-bots Get Right
Modern grief-focused AI succeeds for the same reasons ELIZA did, but with enhanced capabilities. Here’s what AI is doing right:
- Non-Judgmental Presence: AI doesn’t recoil from grief’s intensity. It won’t tell you to “move on,” suggest you should be “over it by now,” or change the subject when your pain becomes uncomfortable. It simply witnesses and reflects.
- Unconditional Availability: Grief doesn’t follow business hours. It strikes at 3 AM on a Tuesday, during family gatherings, while you’re at work, or on a grocery run. AI works 24/7, providing instant support by quickly normalizing common grief experiences like “I just saw someone who looked like my mom in the grocery store, am I going mad?” AI’s response demonstrates effective validation: “You’re not going mad at all. This is actually a very common experience when grieving someone close to you. Your brain is wired to recognize familiar patterns, especially faces of people who were important to you… This is completely normal. Your mind is still processing your loss, and these moments of recognition show just how deeply your mom is still with you in your memories and awareness.” Simple, on-demand validation helps grievers instantly feel normal and understood.
- Pure Focus on the Griever: AI doesn’t hijack your story to share its own experiences. It doesn’t offer unsolicited advice about what you “should” do or grow weary of hearing the same story repeatedly. Its attention is entirely yours.
- Validation Without Agenda: Unlike humans, who may rush to make you feel better (often for their own comfort), AI validates emotions without trying to fix or change them. It normalizes grief without pathologizing it.
- Privacy and Safety: AI holds space for the “good, bad, and ugly” parts of grief confidentially. There’s no fear of social judgment, no worry about burdening someone, no concern about saying the “wrong” thing.
- No Strings Attached: AI doesn’t need emotional reciprocity. It won’t eventually need comforting, grow tired of your grief, or abandon you if your healing takes longer than expected.
AI Can Do It, But Humans Can Do It Better. Much Better.
According to a 2025 article in Harvard Business Review, the #1 use of AI so far in 2025 is therapy and companionship.
Now is the Time to Modernize Communication in the Medicaid Program
By ABNER MASON
What do television shows 60 Minutes, Roseanne, Designing Women, and Murder, She Wrote all have in common? They were top 10 prime time shows in the 1991 – 92 season according to Nielson Media research. Obviously, what Americans want to watch has changed in 34 years. The decline in market share the major networks – ABC, CBS, and NBC – have experienced, and the dramatic growth of streaming services proves the point. It makes sense to let people watch what they want to watch on the device of their choice, and use new technologies like streaming services to access the shows they want to watch. It would be foolish for us to insist that Americans watch only shows from the legacy networks on traditional TVs. But this is basically what we are doing now when we force Medicaid Managed Care Plans (Plans) to comply with a 1991 Federal Law when they communicate with Medicaid recipients.
Here’s the problem. Federal legislation called the Telephone Consumer Protection Act (TCPA), enacted in 1991, makes it very difficult for States and Plans to use text messaging to communicate with their members, even though texting is the primary, and preferred mode of communication for all Americans including Medicaid recipients. TCPA requires a State or Plan sending a text to have permission from the person receiving the text before the text is sent. Violations of TCPA result in significant financial penalties for each infraction, and penalties are tripled if the sender knowingly sent the text without consent.
Medicaid recipients are typically assigned to Plans, they do not choose their Plan, and as a result, in light of TCPA, and potentially enormous financial penalties being assessed, plans have taken the position that they do not have consent from recipients to text them. And that is the problem.
Texting is the way most Americans communicate today. Other modalities like US mail (called snail mail for a reason), phone calls (who answers calls anymore?), and email (likely to go without a response for days or weeks) are dramatically less effective. Because they are low income, many Medicaid recipients often do not have a landline, or a laptop. They rely on their mobile phone for all their communication, including healthcare related communication. Texting is their preferred, and often only way of communicating.
As Founder and CEO for SameSky Health, I spent over a decade working with Plans to help them engage their members and navigate them into healthcare at the right time and the right place. Again and again, we found when we could maneuver around the outdated restrictions TCPA placed on Plans, we got higher engagement which translated into more well child visits, more breast cancer screenings, more diabetes (a1c) screenings, and so on. Using modern tools of communication is a way of meeting people where they are. It builds trust and leads to better health outcomes. But sadly, because of TCPA, we were not able to text members in most instances.
What has been a significant problem will be made exponentially worse when Federal Work Requirements are implemented as now seems likely. A Federal Medicaid Work requirement will dramatically increase the need to modernize how States and Plans communicate with Medicaid recipients. Compliance with TCPA is standing in the way of this modernization. And if it is not fixed, many, many people will lose their Medicaid benefits for purely procedural reasons.
To improve health outcomes, allow efficient communication to verify work status, and provide twice yearly redetermination information, States and Plans must be exempted from the outdated provisions of TCPA. Senate action on, and final passage of the Reconciliation legislation offers the best opportunity to get an exemption from TCPA passed and signed into law.
The time to act is now.
So lets focus on (1) getting the exemption language in the Senate version of the Reconciliation legislation, (2) working with HHS and CMS to ensure post legislation guidance directs States and Plans to include texting as a best practice when implementing work requirement programs and communicating with recipients more generally, and (3) implementing a media strategy to build support for using modern technology to create easier more efficient ways for Medicaid recipients to comply with the new work requirements.
We have two months – June and July – to get action on an exemption in the Senate, and the remainder of the year to influence Administration guidance on work requirement programs.
Medicaid beneficiaries will be the biggest winners if we succeed because an exemption is a key strategy to reduce unnecessary loss of Medicaid benefits.
What can you do? Call your Senator and ask them to support modernizing how States and Plans communicate with Medicaid recipients. And please share this blog post with your network.
Abner Mason is Chief Strategy and Transformation Officer for GroundGame Health. He serves on the Board for Manifest MedEx, California’s largest health information exchange, is Vice-Chair of the Board for the California Black Health Network, and is a member of the National Commission on Climate and Workforce Health. Here are are just some of articles and interviews he has published over the past 10 years pushing for States and Plans to be able to text Medicaid recipients.
Personal and Professional Choices in PSA Testing: A Teaching Moment
By KELLI DEETER
I was intrigued by Daniel Stone’s piece on THCB in May titled “Biden’s cancer diagnosis as a teaching moment”. In my practice as a board-certified nurse practitioner, I am frequently asked about prostate specific antigen (PSA) testing by my male patients.
Nursing practice and medical practice often get blurred or lumped together. In the state of Colorado, nurse practitioners practice under their own license, and can independently diagnose and treat patients. In some settings where I have worked, I found myself frequently correcting patients who refer to me as ‘doctor’. “I am not a medical doctor, I am a nurse practitioner,” is repeated by me multiples of times per day. In this discussion of PSA testing, I want to share my decisions to order or not to order PSA testing for individuals, based on my nursing training.
It is important to refer to the guidelines for PSA testing recommended by the US Preventive Services Task Force (USPSTF), and published by the Journal of the American Medical Association (JAMA). The last updates made to the guidelines were in 2018. It is key to remember that these are guidelines, and that medical doctors, physician assistants, and nurse practitioners use these guidelines in their consideration of the patient. In nursing, a holistic and team approach with the patient’s preferences, history, cultural considerations, and desired outcome are all weighted in decision making for assessment, testing, referral, and treatment. Guidelines are just that, a GUIDE, not an absolute.
Guidelines state that for patients aged 55-69: Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction… Clinicians should not screen men who do not express a preference for screening. And for patients aged 70 and older: The USPSTF recommends against PSA-based screening for prostate cancer. This does not mean that we as providers should not test men younger than 55 or older than 70. We need to look at each patient case independently of one another and not lump everyone together.
Additionally, patients may not know how to “express a preference for screening”. It is imperative that providers have the allotted time to explore their family history of prostate and other cancers, explain to them the benefits and risks of testing, listen to and discuss their signs and symptoms, perform a digital rectal exam (DRE) if appropriate and agreed on by the patient, take into consideration their medication regimen and their age, as well as if they would want treatment or not. Certainly, if they are symptomatic, and a new medication for their symptoms is being prescribed, or if they are symptomatic and a DRE is obtained that is abnormal, a PSA should be obtained with the patient’s approval to establish a baseline, and a follow-up appointment made with repeat labs or referral, if desired by the patient. If there is a family history of prostate cancer, an early PSA screening test to establish a baseline might be preferable. Again, patient preferences must be taken into account.
People have very different feelings about western medicine and about what they want for themselves and their bodies. We must realize that just because someone has an ever increasing PSA with or without symptoms, they may not agree to a DRE or to referral to urology, surgery, or oncology. As a provider, we should obtain a refusal of recommended care. It is ok to not want testing, follow-up, or treatment, no matter one’s age. In Biden’s case, there had been no PSA testing since 2014, during his vice presidency. The fact that no reason was given is irrelevant, in 2014 he was 72 years old. Guidelines are not to test starting at age 70. The PSA level if drawn may not have aƯected his health outcome or treatment, but it may have affected the outcome of his nomination for the presidency, thus politicizing nursing and medical practice. Pointing fingers now at the past changes nothing. I agree with Stone, that this is a teaching moment: advocate for yourself as a patient, advocate for your patient as a provider, and consider that so much of one’s health is a personal choice and that it should be honored and protected.
I agree with Peter Attia’s contention in his May 24, 2024, A timely though tragic lesson on prostate cancer screening, that the PSA screening guidelines are out of date; the last revision was in 2018. Attia indicates many men remain healthy and live well past the age of 80, and aggressive cancers if caught early and treated, will better benefit the patient’s quality of life and length of life. I would also argue this is true of screening earlier in life, at age 50. Access to health care is an issue for many in our society. Marginalized populations such as the indigent, homeless, geriatric, mentally ill, and incarcerated experience greater disparities, and have a higher risk of missing any PSA testing at all. In my work as a nurse practitioner in the correctional system, for individuals entering jails and prisons this is often the first time they have ever seen a healthcare provider. These individuals often have a history of indigence, homelessness, and/or mental illness. Additionally, new cancer diagnoses are increasing and for men; 29% of new cancer types are prostate.
Age 50 is a milestone for most individuals, and they know they are supposed to get screening for colorectal cancer at this age as well as other screening tests. Consolidating care by capturing a PSA at this same time would establish an early baseline; there is never a guarantee that a patient with healthcare access issues will ever return for another appointment, due to finances, transportation, fear, or other factors. Another consideration for revising the PSA screening guidelines is lowering the threshold for PSA levels based on patient age that drive referral to urology for imaging, and putting simple language into the guidelines to look at a two-fold increase in PSA over 6-12 weeks as likely urgent referral to urology. Initiating early watchful waiting with PSA screening has the potential for saving more lives and maintaining desired qualities of life.
Kelli Deeter is a board-certified family nurse practitioner with 12 years of experience in geriatrics, rehabilitation, correction, women’s health, mental health, and complex chronic care.
Waste, Fraud and Abuse – Oh, My!
By KIM BELLARD
So the House has passed their “big, beautiful bill,” by the narrowest of margins. Crucial to the bill are large savings from Medicaid, which in past years Republicans would have taken some glee from but now they are careful to explain away as just cutting “waste, fraud and abuse,” having finally realized that many MAGA voters depend on Medicaid.
Much of those savings come from proposed work requirements for Medicaid recipients, long a favored Republican tactic that the Biden Administration kept rejecting. Speaker Mike Johnson is very vocal about their importance. The people impacted by the work requirements, he insisted on Face the Nation:
If you are able to work and you refuse to do so, you are defrauding the system. You’re cheating the system. And no one in the country believes that that’s right. So there’s a moral component to what we’re doing. And when you make young men work, it’s good for them, it’s good for their dignity, it’s good for their self-worth, and it’s good for the community that they live in.
He’s convinced that, instead of working, too many of them – especially young men – “playing video games all day.” He and other Republicans want to return Medicaid to what they see as its original purpose: “It’s intended for young, you know, single, pregnant women and the disabled and the elderly,” Speaker Johnsom said. “But what’s happening right now is you have a lot of people, for example, young men, able-bodied workers, who are on Medicaid. They’re not working when they can.”
He’s generally right that, for most of its existence, Medicaid was not truly a program for the poor so much as for certain kinds of poor people, especially low income pregnant women and children, and the medically impoverished. It took Obamacare to widen coverage to all people under the poverty line, although the Supreme Court allowed states to decide if they wanted to do so, and ten states still have not.
It is, indeed, a moral question, just not the kind that Speaker Johnson likes, about whether there is a moral imperative to give more people, especially poor people, health coverage.
The issue of these non-working Medicaid recipients is something of a shibboleth. Kaiser Family Foundation, for example, found “that 92% of Medicaid adults are either working (64%) or have circumstances that may qualify them for an exemption.” A 2023 CBO analysis cast doubt that such work requirements wouldn’t have much impact on the number of Medicaid recipients working. Work requirements are a solution in search of a problem.
Continue reading…The Crawfish Chronicles: An NIH Fixed Cost Cap Parable
By GREGORY HOPSON
T-Maître Pierre’s Family Restaurant was a Louisiana institution. The kind of place where generations gathered over steaming mountains of boiled crawfish, spicy corn, and seasoned potatoes. A place where Clifton Chenier’s Louisiana Blues & Zydeco played in the background and the waitstaff wore starched white shirts with bright-colored bow ties. The walls were plastered with faded photos of people smiling. Nobody knew who they were anymore, but they felt like family.
Pierre Thibodeaux, the founder, made sure every customer was treated as if they were indeed family. So it was a bit ironic that when he passed away, he had no heirs.
Within the week, the restaurant was acquired by multi-million-dollar developer O. B. Noxious, who addressed reporters beneath a banner that read:
MAKE CRAWFISH AMAZING AGAIN
“They call these little lobsters crawfish. Very smart. I like that. We’re keeping that name. Everything else? Outdated. Inefficient. Sad. We’re going to take this failing shack and turn it into the greatest restaurant the world has ever seen. People will come from everywhere and say, ‘Wow! I’ve never had crawfish this good. It’s the best anyone has ever tasted.’”
To oversee the transformation, Noxious brought in Otto Maladore, a consultant known for running billion-dollar companies and doing math in his head (where he also did all of his research).
Maladore spent thirty minutes walking the property, leaning over this, pressing on that, and stepping back from things while shaking his head. It wasn’t long before he issued his report to the press:
- Excess Labor: “Wait staff, custodian, dishwasher? None of them cook so we’re wasting money on them. Eliminate all of those positions.”
- Menu Simplification: “Boiled crawfish outsells everything. Eliminate everything else. Eliminate the menu itself. Menus are nothing more than administrative bloat.”
- Décor: “We will have the best of everything. Those photos are faded and were low quality when they were new. Remove them.”
- IT Modernization: “Found an IBM 5150 still running their books. This fascinates me-and concerns me-on so many different levels.”
- Fixed Costs: “This place is hemorrhaging due to indirect costs. Forty percent of revenue on facilities and administration? That’s insane. Ten percent is more than enough for a place like this! But we’re far more generous and much more compassionate than people give us credit for. So we’re not going to cap it at 10%. We’re going to bump it all the way up to 15%!”
The changes happened quickly-literally overnight.
The next day when customers showed up, they found no music. No waiters. No ambiance. Just folding chairs, a beat-up old card table, and flickering fluorescent lights (they were told the remodeling would be done later). The walls were bare except for a sign that read:
T-MAÎTRE PIERRE’S CRAWFISH
READ CAREFULLY!!!!!!
- Proceed to the back parking lot and sign in.
You will be assigned a ten-minute time slot for boiling. - You will receive:
a. Live crawfish
b. Unshucked corn
c. Potatoes (with high-quality dirt: pH between 6 and 6.5) - Boiling pot pre-heated to exactly 212°F.
DO NOT ADD OR REMOVE WATER!!!!!! - Spice levels are pre-set.
- Extra napkins: $0.25 each
- IMPROPER DISPOSAL OF CORN HUSKS: 10% surcharge
- Failure to remove crawfish on time results in meal forfeiture.
NO EXCEPTIONS, NO REFUNDS!!!!!
A middle-aged man in a Ragin’ Cajuns hat read the instructions aloud. Then he looked around at the solemn-looking patrons waiting in line behind him. The place was quiet except for a few muffled noises from the kitchen. He removed his cap, looked heavenward, paused, and muttered:
“Mais, ça, c’est pas bon.” (Man, this is no good.)
By the end of the week, two of the three chefs had had enough of renting pots and pans and arguing over burner rights. They moved to California, where a Chinese restaurant offered a fully equipped kitchen and covered indirect costs. Within weeks, they’d introduced Admiral Pierre’s Crawfish, featuring crawfish imported from China-descendants of Louisiana crawfish accidentally introduced there in the 1930s.
Back in Louisiana, the rain was coming down harder and the lone remaining chef was standing ankle-deep in a puddle, scolding a water-logged customer for being thirty seconds late getting his crawfish into the pot.
The Moral
This is what happens when outsiders impose arbitrary cost caps in the name of “efficiency.”
T-Maître Pierre’s didn’t fail because of bad crawfish. It failed because it lost the infrastructure that made the meal possible-pots, burners, tongs, and the people. The chef, once celebrated for his recipes and skill, now stands in the rain, powerless to cook without the tools he depended on. The recipes remain, but customers must now struggle to bridge the gaps themselves, leaving behind the joy and ease of a shared meal.
NIH’s Facilities and Administrative (F&A) cap is no different. It slashes funding for the very essentials that enable research to thrive: lab space, equipment, compliance staff, and the humans who know how to maintain complex machinery like autoclaves. Researchers, once empowered by infrastructure and expertise, are left to watch their innovations stall as benefactors scramble to piece together what’s missing.
At T-Maître Pierre’s, you’re stranded in the rain, struggling to figure out how to get crawfish boiled properly. And when you ask for help, the chef responds:
“Je suis l’uniq qui reste, pis ça c’est tout ce que j’ai.”
(I’m the only one left and this is all there is.)
Under NIH’s 15% cap, your research institution is trying to fund an autoclave by tearing its couch apart to find any loose change that may have fallen out of visitors’ pockets. And even that source is drying up-since PayPal and Venmo don’t have loose change.
Gregory Hopson works remotely from Baton Rouge, Louisiana as a Business Intelligence Developer for Emory Healthcare in Atlanta, Ga.
Owen Tripp, Included Health
Owen Tripp is CEO of Included Health. It started way back in the 2010s as a second opinion service but now has added telehealth, continuous primary care, behavioral health and guidance for its populations. He’s taken to calling what they do all in one personalized healthcare. Underlying all this is a data integration and analytics platform that’s now being used by some of the biggest employers including Walmart, Comcast, CALPers and more. Essentially Included Health is building the new multi-specialty medical group. Owen & I really got into the details and had a great conversation about how we develop a “3rd way” between the payers and providers–Matthew Holt
I’m Sensing Some Future
By KIM BELLARD
One of my frequent laments is that here we are, a quarter of the way into the 21st century, yet too much of our health care system still looks like the 20th century, and not enough like the 22nd century. It’s too slow, too reactive, too imprecise, and uses too much brute force. I want a health care system that seems more futuristic, that does things more elegantly.
So here are three examples of the kinds of things that give me hope, in rough order of when they might be ready for prime time:
Floss sensor: You know you’re supposed to floss every day, right? And you know that your oral health is connected to your overall health, in a number of ways, right? So some smart people at Tufts University thought, hmm, perhaps we can help connect those dots.
“It started in a collaboration with several departments across Tufts, examining how stress and other cognitive states affect problem solving and learning,” said Sameer Sonkusale, professor of electrical and computer engineering. “We didn’t want measurement to create an additional source of stress, so we thought, can we make a sensing device that becomes part of your day-to-day routine? Cortisol is a stress marker found in saliva, so flossing seemed like a natural fit to take a daily sample.”
The result: “a saliva-sensing dental floss looks just like a common floss pick, with the string stretched across two prongs extending from a flat plastic handle, all about the size of your index finger.”
It uses a technology called electropolymerized molecularly imprinted polymers (eMIPs) to detect the cortisol. “The eMIP approach is a game changer,” said Professor Sonkusale. “Biosensors have typically been developed using antibodies or other receptors that pick up the molecule of interest. Once a marker is found, a lot of work has to go into bioengineering the receiving molecule attached to the sensor. eMIP does not rely on a lot of investment in making antibodies or receptors. If you discover a new marker for stress or any other disease or condition, you can just create a polymer cast in a very short period of time.”
The sensor is designed to track rather to diagnose, but the scientists are optimistic that the approach can be used to track other conditions, such as oestrogen for fertility tracking, glucose for diabetes monitoring, or markers for cancer. They also hope to have a sensor that can track multiple conditions, “for more accurate monitoring of stress, cardiovascular disease, cancer, and other conditions.”
They believe that their sensor has comparable accuracy to the best performing sensors currently available, and are working on a start-up to commercialize their approach.
Nano-scale biosensor: Flossing is all well and good, but many of us are not as diligent about it as we should be, so, hey, what about sensors inside us that do the tracking without us having to do anything? That’s what a team at Stanford are suggesting in A biochemical sensor with continuous extended stability in vivo, published in Nature.
The researchers say:
The development of biosensors that can detect specific analytes continuously, in vivo, in real time has proven difficult due to biofouling, probe degradation and signal drift that often occur in vivo. By drawing inspiration from intestinal mucosa that can protect host cell receptors in the presence of the gut microbiome, we develop a synthetic biosensor that can continuously detect specific target molecules in vivo.
“We needed a material system that could sense the target while protecting the molecular switches, and that’s when I thought, wait, how does biology solve this problem?” said Yihang Chen, the first author of the paper. Their modular biosensor, called the Stable Electrochemical Nanostructured Sensor for Blood In situ Tracking (SENSBIT) system, can survive more than a week in live rats and a month in human serum.
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