Physician and enterprise product leader. Author of the Agentic AI for Product Leaders series. Writes on AI, healthcare, and what changes when software starts acting. 15+ years at SAP, Walmart, and regulated health tech.
Healthcare is slow, regulated, fragmented, and over-documented. That's exactly why it's the best AI proving ground in the world. The field that everyone called a laggard has been running the most rigorous AI experiment for decades. The rest of us are just starting to catch up.
We evaluated AI health tools by removing the very mechanism that makes diagnosis work, measured what happened, and called it a safety problem. It is not just a safety problem. It is a design problem. Medicine knew this in 1975
Two studies this week, one from Google and one from Microsoft, are being celebrated as evidence that healthcare AI has arrived. Read them together and they reveal something more uncomfortable: AI is filling a gap that healthcare created long before any of us started building AI for health.
Twenty years of customer interviews, workshops, and journey maps. Then agentic AI arrived, and every framework I trusted turned out to share one assumption I had stopped noticing: that the human is always smarter than the tool. Here's what breaks when that stops being true.
The clinical reasoning pattern hasn't changed since Hippocrates. The vessels carrying it have, from paper charts to cloud EHRs. For fifty years, every vessel moved the data without understanding it. AI breaks that pattern for the first time. Not a better vessel. One that thinks.
I still read NEJM and BMJ cover to cover. Lately they are filled with elegant AI breakthroughs: models that promise to transform diagnosis, prediction, resource allocation. The deeper I build enterprise software, the more critical I get. A paper is a demo. A scaled deployment is a different problem.
This week I read three papers that made me happy. JAMA. NEJM. Nature Medicine. All randomized trials. All showing AI outperforming standard care. Then I read the methodology. None of them LLMs. The AI winning in top journals in 2026 was built before the hype cycle. The blueprint was always there.
A Nature study shows LLMs achieve 94.9% accuracy on benchmarks but only 34.5% when laypeople use LLMs on physician-created scenarios. The gap reveals something deeper: We measure the model in isolation. We deploy to a human in distress. The system fails at the intersection.
The physician's job has always been data synthesis. Fragments, approximations, family filters, descriptions of pill geometry. Consumer health AI was built for a different patient. One that has never walked through a clinic door.
For 20 years, I translated between customers and engineers. Now I architect decision systems with AI. But here's the catch: you're designing for two customers: humans and their AI agents. Design for one, forget the other, and it fails.
Everyone talks about governance. Nobody agrees on what it means. Data governance, AI governance, master data governance: they're not separate programs. They're one spectrum. And most enterprises already have 70% of what they need. They just can't see how the pieces connect.
MVP was meant to test ideas, not become architecture. Now, we’ve started stacking prototypes into production systems nobody designed as systems. When one layer fails, the whole structure drifts silently. In medicine, that’s not technical debt. It’s patient risk.