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September Monthly Review: Health MCP Guy?
For all the time I spend talking about APIs and data exchange, this newsletter has had embarrassingly little interoperability of its own. It’s old-school SaaS, baby - UI or bust. Not all of that is my fault! Substack, for all its popularity, is (as mentioned before) really frustrating as my system of record. The primary user it optimizes towards is the reader, whose attention feeds the app, the Notes feed, and the recommendation network that Substack is actually selling. Health API Guy is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Subscribe They’re falling into the same trap that Medium once sprinted into, albeit at a much more glacial speed. Younger generations may not remember (or never knew) it, but Medium once lured publications like The Ringer and Signal v. Noise onto its platform, only to lose them as it rebuilt itself around a paywall and an algorithmic feed. Substack’s original pitch circa 2020 was the antidote (you own your list), but every new feed feature chips away at it. I get it: writers are generic supply in the eyes of the Substack product team. Generic supply follows demand, so the consistent pressure on the PMs is to generate demand, which leads to every product cycle going toward discovery (Notes, recommendations, the app, live video). The end result lackluster author tools (laggy and broken analytics are truly crippling) all despite the premium price point. The archive is where it crosses from authorial gripes to actual reader impact, though. Across Substack and LinkedIn, I’ve published 1,218 posts and nearly 900,000 words since 2018. Substack’s native search can see only the 464 posts that live on Substack, and even there it’s woefully inadequate at surfacing relevant content (even for the guy who wrote it)! Readers have the same problem, writ large. Ask the Archive Fixing search (for both my readers and my own use) turned out to be extremely non-trivial, unfortunately: There’s no public API for readers to access content RSS exists for new content notification, but it only carries the 20 most recent posts and cuts paid ones off at the preview The only Substack MCP is an admin tool for analytics The export exists for authors, but it’s painfully awkward and slow. So I built something to work around that: the Health API Guy MCP. It’s a private MCP server holding the full text of everything I’ve written across Substack and LinkedIn. Add it to Claude or ChatGPT as a connector and you can ask things like: It pairs keyword search (for acronyms and case names, of which we have many) with semantic search. Every post is also labeled by topic, form, and court case, so you can pull a lawsuit’s (or multiple cases’) entire docket across Substack and LinkedIn in one query: Hail, Healthapiguyhydra This is also a bit of me eating my own cooking. I’ve spent the year arguing that headless healthcare is arriving and that developers want primitives over abstractions. Last week in Hail, Benihydra, I watched Salesforce plug its platform into Claude and bet that the records underneath outlive whatever interface sits on top: Salesforce must believe that the Hydra’s immortal head is the records, permissions, and business logic (in that they will survive whatever happens to the interface). It felt a bit hypocritical to keep my own archive behind a Substack search bar. The archive is the body. Substack is one head, and now whatever tool you might use is another. Will the EHRs follow my lead? Probably not imminently, but one can hope! Why Founding Members Only The MCP is available to Founding Member subscribers. A few reasons: It costs money and time to run. Hosting, the database, Clerk usage and AI compute for search and labeling are significant operational costs (that increase with usage). Substack gives me no way to automate access. There’s no API to check whether someone is a paid subscriber, so every user is manual operations for now. It’s a beta. We’ll need to improve things and parts will break. I’d rather they break for a small group of dedicated readers who will tell me about it. The Founding tier deserved a real benefit. Until now it was mostly a generous tip. Now it comes with something. If you’re already a Founding Member, reply to this email with the address you’d like provisioned. If you’re not and want in, upgrade here. Larger teams (such as companies) can get access too: group subscriptions at the Founding tier come with the group discount. The admin for the subscription can reply with the list of addresses to provision. Get 20% off a group subscription Pricing Founding membership is now a flat $200 a year, replacing the old suggested $150 that readers could adjust. Existing Founding Members will have access grandfathered in at their previous rate. Month in Review Articles Published Make Networks Dumb Again (Sep 11): AI is making old analog networks cheaper to use and flooding them with machine traffic in the process. A plea for agent-native rails with the intelligence at the endpoints, and for Washington to drag them to ubiquity. Interoperability, Unbuttoned (Sep 29): Interoperability is a series of workflows in a trenchcoat, and this post finally takes the trenchcoat off. A color-coded map shows which provider workflows went digital, which are fragmented, and which still run on fax. Video Content Antitrust’s System of Record Problem (Sep 3): The FTC’s investigation into Epic prompted a ninety-minute webinar, now posted with chapters and a smoothed transcript. We get into why market definition, missing B2B share data, and the SSNIP test leave antitrust poorly suited to systems of record, plus why information blocking may be doing more than any pending lawsuit. The Information Exchange: Cerner Milking Edition (Sep 18): This was so fucking fun. Ryan Tucker, Ryan Brickner, Brad Thorson, and I try an Around the Horn format, complete with points, penalties, and a mute button. We debate whether Oracle Health is dead, who would actually buy Cerner (IBM enters the chat), p(Doom), and why the front desk still hands you a clipboard. Regulatory Ask Not What Your Network Can Do (Sep 23): CDC’s RFI on public health data intermediaries lists use cases already served, unevenly, by eCR, lab reporting, IZ Gateway, and syndromic surveillance. The real opportunity sits in one question about AI: a network that can handle the next emergency without another interface project. Court cases Particle v. Epic: The Naughty Schoolteacher (Sep 4): After a summer-long vigil, the answer on Epic’s early summary judgment bid is two paragraphs and a remedial assignment. Particle advances to the next grade, and market definition gets another year of discovery. The Epic Discovery Files (Sep 8): Texas’s motions to compel arrive with a 251-page appendix of requests, objections, and meet-and-confer letters with Cravath. Inside: Epic using generative AI for document review, denied interoperability requests in scope, and Noerr-Pennington raised against lobbying discovery. Epic v. Health Gorilla: “Working as Designed” (Sep 9): Epic wants nothing to do with the data breach MDL, and explaining why puts fresh discovery on the public docket. The spiciest allegation: Health Gorilla told GuardDog to scrub its law firm business from its website instead of cutting off access. Veeva v. Epic: Legal Bypass Surgery (Sep 15): Veeva asks the Wisconsin Supreme Court to skip the Court of Appeals, while law professors and three policy groups line up as amici. Meanwhile, Epic’s lawyers apologize for another round of citation errors, including a quote that never existed. Texas v. Epic: Behind the Black Bars (Sep 17): The court portal served up Epic’s unredacted filings, revealing a $5 million document review budget and the AI workflow behind it. Also inside: the 200-plus company names Texas wants searched, and one very expensive Zoom invitation. OpenEvidence v. Doximity: Consequences Will Follow (Sep 25): OpenEvidence tells the court it will not comply with a discovery order, and its own lawyers at Quinn Emanuel say they won’t defend the choice. Add years of Slack reported unrecoverable, and Rule 37 sanctions come into view. Health Tech Keeps Choosing Violence (Sep 28): Doximity moves to end OpenEvidence’s case, Epic asks Texas to show its work, and a sleepy Audacious Inquiry patent fight sprouts antitrust and information blocking counterclaims. The main event is a long-sealed Cognizant v. Infosys ruling that hints where system of record antitrust claims can survive. EHRs One Verb for Oracle Health (Sep 14): Oracle’s earnings call quantifies every data center to the decimal point, while Oracle Health gets a single verb: “accelerate.” Panning the few healthcare mentions turns up an agentic care management system, a research-to-care ledger play, and the question of whether healthcare gets Larry’s patience. Epic’s Forretress Under Siege (Sep 30): Judy Faulkner tells a panel Epic paused hundreds of projects to harden its software and calls it a “shame,” while a spokesperson insists the roadmap hasn’t changed. Project Glasswing, a Pokémon-branded QAN sprint, and a trove of Jodel grievances reconcile the two Epics and preview the Jevons paradox coming for all software. Industry Analysis Scanning for a Network (Sep 1): Scan.com raises $220M to build the imaging network labs never got, speedrunning Zocdoc’s consumer-to-B2B pivot. Its wedge to network density may be the most American one available: personal injury litigation. The Front Desk Wants the Damn Whole Building (Sep 16): Hello Patient buys Converse Health, pushing its AI front desk into referrals, chart work, and prior auth. The copilot categories keep blurring, and your distribution partner is still your final boss. Cross-industry Comparisons A Different Patchwork Quilt (Sep 10): Healthcare loves to envy open banking, but the US version has no mandate, a toll booth at Chase, and data quality problems of its own. The grass isn’t greener; it’s another American patchwork quilt, and perhaps a worse one. Hail, Benihydra (Sep 21): Salesforce brings its platform into Claude, Slack, and its own agent, inviting the interfaces that might replace it. Cut off one head and more grow back, so long as the records underneath stay put. Living on A Trade Secret Prayer (Sep 22): Six credit unions are suing Fiserv, the Epic of core banking, by claiming their own member records as trade secrets. Banking has no Cures Act, so its lawyers reach for legal alchemy that healthcare has already tried. Other News None this month External Media Nabla Accelerate NYC: I kicked off fall conference season at Nabla’s Accelerate event in New York, where Delphine Groll opened by asking the room to picture the company it wants to become and the one it doesn’t. I liked her framework of bureaucracy, fear, and ego as the blockers. I also love vendor conferences/events in general - different vibe than industry biggies. Healthcare 101 with Nikhil Krishnan: I briefly guest lectured Out-Of-Pocket’s Healthcare 101 class. Appreciated Nikhil’s takeaways cover whether AI doctors can query HIEs, why healthcare’s data-liberation rules beat most industries’, and the hi-res graphic is in the comments. HCN: Epic Probed by the FTC: I joined the HCN guys to talk through the FTC’s investigation into Epic. Cedric’s new hairdo was an unexpected plot twist. The episode also covers MFN drug pricing, healthcare M&A and Eli Lilly’s acquisition streak. Fall Conferences: At eHealth Exchange’s Annual Meeting in Austin on Oct 27, I’ll moderate a panel on the tensions between AI, HIEs, and timely patient access with Jean Ross (Primary Record), Therasa Bell (Kno2), Byron Crowe (Doctronic), and Michael Marchant (Freenome). Here’s the rest of my schedule if you want to meet up: CommonWell (Redwood Shores, CA): Oct 13-14 Will be participating in a fun Jeopardy event Open@Epic (Madison, WI): Oct 20-23 Will be enjoying Verona, Willy Street, and other local adventures eHealth Exchange and Sequoia Project (Austin, TX): Oct 27-29 Yeehaw HLTH (Vegas): Nov 15-18 Groundhog Day, Venetian Edition RSNA (Chicago): Nov 30-Dec 2 See me at “Governing AI in Breast Imaging: What Health Systems Are Actually Doing” Digital Health Counsel 2026 AI Summit (Seattle): December 2-3 Will likely be speaking to a bunch of lawyers about information blocking Posts I Liked ChatGPT’s Epic integration: game changer or nothing burger?: Joshua Liu, MD offers five thoughts on OpenAI’s Epic launch, starting from the point that it rides the same open APIs available to anyone. He argues read-only access leaves ordering to Art and the ambient startups, and asks why HCA is piloting it alongside Commure. He’s sorta a must-follow at this point - consistently excellent, thought-provoking takes. Epic, Lilly, and the Discovery pass: Seth Chaney reads Epic’s first major Discovery deal (with Eli Lilly), as well as its revised developer terms on commercial displays, as the pipe finally opening between EHRs and pharma. Life sciences and health continue to collide. Scott Rossignol on EHR payer platforms and ePA fees: Scott argues the top ambulatory EHR vendors are turning the prior auth mandate into a per-member-per-year toll on payers, for an API whose operating cost has nothing to do with covered lives. His fix is two lines of regulatory text: put the CRD/DTR/PAS certification criteria in the Base EHR definition, and bring payer-facing ePA connectivity under § 170.404’s cost-based fee rules. It’s a good solution. Health API Guy is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Subscribe
The Science Behind Greener, Healthier Lawns
A healthy, green lawn can be the envy of any neighborhood, but how does someone cultivate a yard like that? Assistant Professor of Ecosystem Science Amber Churchill has been getting her hands dirty and digging into the science behind it.
A Girlhood Museum: Look into ‘Warm, Cozy and Whimsy’ Bedroom
A giant beanbag chair sits in the corner of Emily Arjune’s bedroom, positioned just at the perfect angle to face her television. Nearby, a furry red Spider-Man lamp casts a warm glow over a collection of artwork, greenery, completed puzzles and knickknacks. The room is more than a place to sleep between classes at the …
The science behind greener, healthier lawns
A healthy, green lawn can be the envy of any neighborhood, but how does someone cultivate a yard like that? Assistant Professor of Ecosystem Science Amber Churchill has been getting her hands dirty and ...
World Business Chicago announces design contest winners with shared vision for greener city
Competing but complementary proposals to restore Chicago’s tree canopy and natural habitat shared the top prize in World Business Chicago’s inaugural “Horizon Lines” design contest to find the city’s next big idea.
Former Texans Cornerback Skips Town to Join 49ers in Shuffle
One former Houston Texans player departed for greener pastures, while another had no say in the matter but is hoping for the same. The post Former Texans Cornerback Skips Town to Join 49ers in Shuffle appeared first on HEAVY.
New Science Says Scrapping A Working Gas Car For An EV Is Usually Greener
New lifecycle research finds that scrapping some working gasoline cars early and replacing them with EVs can substantially cut cumulative emissions.
Bamboo toilet paper intrigued me. Reality turned out to be messy
What makes a greener wipe? Researchers have more to say about bamboo's ecological risks, given limited carbon footprint data.
Scientists put the “recycling is a distraction” claim to the test
Recycling, greener diets, and other personal climate choices do not seem to distract people from supporting major environmental reforms. A four-year study of nearly 2,800 Australians found that these habits neither increased nor reduced later political engagement.
The greenest goodbye: Human composting and the science of becoming soil
In 2020, Recompose was the first U.S. company to develop the technology needed for the commercial composting of human bodies, disrupting a funeral industry that had been largely unchanged for decades. Now 14 states have legalized the climate-friendly practice and more than a dozen others are considering it. Additional startups have launched to offer a greener goodbye and all are looking to scale.
Y! Sports Biz: The grass is always greener
The turf war between the NFL and its players rages on...
🏈 Y! Sports Biz: The grass is always greener
The turf war between the NFL and its players rages on...
Leaftronics: greener electronics learnt from leaves
Hans Kleeman describes how inspiration from leaves will enable a new generation of sustainable, biodegradable electronics.
When regulation is good for business
By now, I think I have established both my view that I am a fan of ESG investing and the benefits of regulating what is and isn’t a sustainable investment, and my view that in Europe, ESG regulation has gone too far and become too costly. It almost feels like the old Aristotelian maxim of doing things in moderation that leads to the best outcomes is valid in regulatory efforts as well. To give you an example, let’s look at a study by the National Bank of Belgium on the impact of the EU’s Sustainable Finance Disclosure Regulation (SFDR) on fund flows of conventional and ESG funds. The SFDR was announced on 27 November 2019 and came into effect on 10 March 2021. It was implemented in several stages and split funds marketed in the EU into three broad categories: (i) Art. 6 funds that are basically conventional funds without any specific ESG integration, (ii) Art. 8 funds that ‘promote environmental or social characteristics’, which must provide additional reporting how they do that, and (iii) Art. 9 funds that are impact funds. The gaps between the announcement and the phased implementation give us an idea of how fund flows were affected by the regulation. It is clearly visible in the figure below that once the new regulation was announced and when it was initially implemented, fund flows in Art. 8 and Art. 9 funds increased significantly. Conventional Art. 6 funds also saw more inflows, but the increase was not statistically significant. I should add that the data below is pure fund flow, cleaned of performance effects and of any reclassified funds that moved from one classification to another. Note also that once the initial rush in ESG funds was over, additional, stricter regulatory requirements didn’t create that many new flows. This implies that with additional regulation, the funds incurred higher costs to comply but didn’t benefit in terms of new inflows and higher assets under management. Fund flows as the SFDR regulation was implemented in the EU Source: Emiris et al. (2026) When examining the drivers of these flows, the authors of the study found that institutional investors were more likely to switch to ESG funds and particularly so in countries where concerns about sustainability are culturally more accepted. In a society where buy-in into environmental and social risks is higher, private investors were shifting more of their assets into ESG funds as the regulation made it clear which funds are really green and which ones are not. And institutional investors in these countries did so as well, given the societal pressures and reputational risks of sticking with conventional funds. Meanwhile, fund managers reacted to the changing regulatory environment as well. Many funds that were mildly green before the regulation was announced became greener and more sustainable as the regulation was introduced to attract new assets and new investors. Cleverly, and unsurprisingly, these ESG funds also charge on average higher fees, which means that not only did fund managers gather fresh assets, but their profitability increased as well.
Tuesday's Headlines Stay Healthy
More walkable neighborhoods would ease the burden on our overtaxed health care system, according to MIT.
Maryland's first 'human composting' facility is open for business
Maryland's first 'human composting' facility is turning human remains into soil, considered a greener alternative to cremation or traditional burial
How urban design leads to better wellness
A new big-data analysis of the U.S. shows how urban design aids the health of city residents — especially when cities provide walking opportunities, greenery, and mixed-use streets with a blend of commercial and residential activity.
A record heat wave is gripping Europe. Could hemp make homes cooler and greener?
Hemp is a natural building material that advocates say could help keep buildings cool, and reduce their carbon footprint.
Scientists just found a hidden weakness in forever chemicals
Researchers discovered that hydrogen radicals generated by intense UV light can break down stubborn PFAS “forever chemicals” without added chemicals. The breakthrough reveals a key mechanism that could lead to greener and more effective technologies for permanently destroying these pollutants.
Georgia State Preparing Next Generation of Sustainable Scientists
From redesigned experiments to more sustainable habits, a new case study outlines how greener practices can be incorporated into student labs and learning.
From garage startup to community staple: Greener Good opens new ‘creative reuse hub’ in Arlington Heights
Amanda Moller can hardly believe the business she co-founded with her mom in her garage nearly seven years ago has grown tenfold. Now, Moller and her mother, Beth Parsons, have shifted their operation...
The Asian workers keeping Greenland in business
Marinel Garciano dislikes winter, and that's tough when it lasts nine months in Ilulissat, Greenland.But behind the glass there was no greenery -- just the pristine white of a blizzard enveloping the ...
How GCSTIMES Thinks About Greener Hotel Choices During Business Travel
GCSTIMES outlines its internal sustainable business travel guidelines, encouraging employees to prioritize GSTC-aligned certifications like Green Key and LEED, and to adopt eco-conscious habits during stays.
New York Is Working on a Blueprint for Greener Buildings
The city is investigating just how much carbon it takes to build its famous skyline, from the concrete foundations all the way up to the glass that frames skyscrapers.
Scientists unlock fungi's secret chemistry, offering a greener path to crop protection
Pesky pests can wreak havoc on plants by chewing leaves, boring into stems, and sucking sap from trees. Beyond the direct damage, they also spread harmful bacteria, viruses, and fungi that can infect and ultimately kill the ...
Scientists unlock fungi's secret chemistry, offering a greener path to crop protection
Pesky pests can wreak havoc on plants by chewing leaves, boring into stems, and sucking sap from trees. Beyond the direct damage, they also spread harmful bacteria, viruses, and fungi that can infect ...
Tanzania’s purpose-built Star Homes brighten health outcomes
The houses’ architecture is both cleaner and greener
Conscious spending can unlock greener science
This Greening Chemistry column explores how to find savings in the lab and the false economy of buying supplies on sale
A 67-year-old “crazy” theory about vitamin B1 has finally been proven
Scientists have achieved the unthinkable by stabilizing a highly reactive molecule in water, confirming a decades-old theory about vitamin B1’s role in the body. The breakthrough not only solves a scientific mystery but could revolutionize greener chemical manufacturing.
The pros and cons of switching from Kindle to Kobo e-readers
Some BookTokers have declared they're finally ready to leave the Amazon Kindle ecosystem. But the grass isn't always greener.
A new way to deliver faster, greener wireless connections indoors
Modern life depends on fast and reliable wireless connections. Video calls, streaming services, virtual reality, and smart devices all place growing demands on networks that already serve billions of ...
Newly discovered coffee compounds beat diabetes drug in lab tests
Roasted coffee may do more than wake you up—it could help control blood sugar. Researchers discovered several new coffee compounds that inhibit α-glucosidase, a key enzyme linked to type 2 diabetes. Some of these molecules were even more potent than a common anti-diabetic drug. The study also introduced a faster, greener way to uncover health-boosting compounds in complex foods.
Comet 3I/ATLAS is getting greener and brighter as it approaches Earth, new images reveal
New images taken with the Gemini North telescope in Hawaii confirm that the interstellar comet 3I/ATLAS has gotten brighter and greener since its close flyby of the sun in October.