This episode of Out of the FHIR features Paulius Mui, MD, a family physician and entrepreneur, exploring the critical intersection of clinical medicine, technology, and data standards. Dr. Mui shares his journey from residency to becoming a tech-savvy clinician and advocate for primary care, discussing the challenges of quality measurement, the evolving healthcare workforce, and how technologies like FHIR and AI scribes are transforming or failing to transform clinical practice.

🌶️ Spicy Takes

* The Quality Measurement Farce: Gene points out the absurdity of current metrics, like ADHD “management” only requiring two follow-up visits a yeah a bar so low it’s practically meaningless.

* The AI Scribe Illusion: A recent study suggests AI scribes don’t actually save physicians time; they just shift the workload from documenting during a visit to reviewing and editing after it.

* The NP Training Gap: Dr. Mui highlights the concern over the “boom” in nurse practitioner programs with minimal in-person training compared to the rigorous, repetitive clinical hours required in traditional residency.

* “Vibe Coding” vs. Healthcare Reality: While AI-assisted prototyping (vibe coding) is great for front-end ideas, the back-end healthcare infrastructure remains notoriously difficult and rigid.

💡 Key Takeaways

* Innovation via Proximity: The most effective solutions come from those closest to the problem. Clinicians who understand both medical and technical workflows are best positioned to fix healthcare’s bottlenecks.

* Skills-Intelligence for Quality: Healthcare should move away from just “checking boxes” and toward measuring specific competencies (like pattern recognition or antibiotic stewardship) to identify where clinicians need support.

* Stop Reinventing the Plumbing: Healthtech startups shouldn’t have to rebuild back-end infrastructure (FHIR connectivity, etc.) from scratch. Standardized “plumbing” allows for faster innovation.

* The Power of a “Beginner’s Mind”: Dr. Mui encourages experts to lead with inquiry. Writing and sharing simple questions often leads to deeper insights than trying to maintain an “expert” persona.

* Sustainability is the Goal: With healthcare spending nearing a third of the US GDP, technology’s primary role must be to create a sustainable model that actually improves patient experience and clinical outcomes.

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