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Field notes

On fixing fragmented care.

Essays, field notes, and arguments from the team building the intelligence layer for healthcare data. Discover deep dives into interoperability, patient ownership, and the future of connected care.

A two-column ledger of the CMS Health Technology Ecosystem's first year. Published: 800+ organizations pledged and 120+ building tools; CMS Aligned Network designations for Oracle Health in April 2026 and Connxus in May 2026; FlyteHealth reaching General Availability in July 2026; TEFCA at 21,000+ organizations, 96,000+ connections and 1.2 billion+ documents; new pledge categories announced July 27, with trade coverage differing on whether there were seven or eight. Not published: what each pledging organization delivered; first-quarter objectives by organization; which networks met the July 4 criteria; how sixty percent was calculated, against HHS's claim that 60% of patients can now reach their record, up from 5%; any verified count of patient use, against a self-reported campaign counter reading 13; any measure of what happens to a record after it arrives.
Policy
August 3, 2026·6 min read

Kill the Clipboard, one year in.

A year after 60 companies pledged to kill the clipboard, the pipes are measurably better and the scoreboard is empty. What CMS published, what it has not — including how sixty percent was calculated — and why the harder problem starts after the record arrives.

R
Rayman KhanCo-founder & Chief Legal Officer
The Metropolitan Cathedral and Mexican flag on the Zócalo in Mexico City, framed by out-of-focus branches
Portability
July 27, 2026·4 min read

Fifteen hours in a city full of hospitals.

A fever in Mexico City, a hospital chosen off a bad list, and a full medical history sitting in seven cities that couldn't reach the room. Why a record that exists still isn't real until it arrives.

Raj PatelRead
An empty highway at sunrise lined with autumn trees, running toward the horizon
Fragmentation
July 21, 2026·5 min read

When the chart doesn't follow the patient.

Every fall, the snowbirds head south on I-75 and their medical records stay behind. A story about Carol, two good doctors, and the layer that was never built.

Raj PatelRead
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The intelligence layer for healthcare data.

— Est. 2026 · New York City

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