Josh Mandel, MD
@JoshCMandel
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physician, programmer, and would-be pâtissier/poet. Chief Architect for #MicrosoftHealth and for @SMARTHealthIT. Bsky: https://t.co/gZapxtia3H
Madison
Joined June 2012
RT @__apf__: I recently quit a beloved engineering leadership role to become an IC at DeepMind. I want to become an expert again. the first….
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It is adorable how LLM Planners estimate task time in weeks while executing in minutes. "✔ Phase 1: Foundation (Week 1)"."✔ Phase2: Core Refactoring (Week 2)" .
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Hey @nickaturley @kevinweil — I’ve run into a UX issue with ChatGPT 5 Pro on the web. Background: . * Short prompts work fine. * Medium-length prompts submit but are silently truncated — instructions I add near the end are ignored, and follow-up questions confirm the model never.
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Following up on discussion about CMS Interop Framework and "CMS-Aligned Networks". it's clear that true national-scale interoperability needs more than just federated identity. The vision of "no per-site interactions" highlights a deeper architectural gap. For years, networks.
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I built FloodGate as an open-source prototype to explore the double-edged sword of AI in advocacy: its power to supercharge a real supporter's ability to be heard, versus its potential to be weaponized for anonymous spam that overwhelms the entire process. Demo:.
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"This will kill people.". A physician at a community health center said this. He wasn't being dramatic. "I’m sick to my stomach," wrote another provider, "knowing I have to turn away my patients because of their 'legal status.' That will forever mean nothing to me.". A new rule.
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~Everyone (Including Rural and Red-State America) Rejects HHS’s "Personal Responsibility and Work Opportunity" Reinterpretation. A July 2025 HHS reinterpretation of PRWORA (8 U.S.C. §1611) reverses nearly three decades of practice by newly classifying programs like Federally.
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RT @AndrewArruda: there’s the pre GPT use of the em dash and then there’s the post GPT use of the em dash.
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"You're absolutely right! A getter method shouldn't have side effects like updating the database.".
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WebDev Arena is so boring now that the summits have packed their bags. I'm ready to climb in earnest. .
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Hey,@grok, who were the ten most famous people to visit my profile? Don't need to be mutuals, don't tag them, just say who they were.
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RT @healthapiguy: A uniform truth that will play true: in three to five years, we will look back at the infrastructure we're building today….
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Big news: SMART Health Cards and Links is now a formal HL7 standard 🎉. This standard gives people a simple, secure way to carry and share their health data using QR codes or copy/pasteable web links. Whether it’s a summary of care, a digital insurance card, or a vaccine history.
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OK, I've migrated Heardle away from glitch -- the old URL forwards to so please update your bookmarks if you've got a Heardle habit :-).
@JoshCMandel is heardle (our beloved phneardle) down for good? Say it ain't so. .
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Commenters in 2022 were *not enthusiastic* about CQL -- what's the vibe today?
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OK, I'm coming up to speed with the 2022 ePA RFI ;-) has an overview on this theme. Re: Cigna's comment. whether rules are set by Cigna or a self-insured employer, transparency would make the rules visible/comparable, no?.
There is more to it. As Cigna said in its ePA comments to CMS, it has no control over most decisions of the health plans (ERISA self-insured) that use its network. They are free to ignore the Cigna “medical necessity” policy.
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These are even better in real life ;-) Madison's @frescoopera does some amazing stuff including last summer's driveway-staged 8-bit Opera.
"[video game] as a community theater production" may be one of the most delightful Veo 3 Fast prompts. Please enjoy, in order: GTA, Pokemon, Mario Kart, The Witcher 3, Stardew Valley, Tetris, Mortal Kombat, The Sims, & Death Stranding(!). Yes, the whole prompt was the one above.
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