The 229 Podcast

October 14, 2026: Jim Jacobs, President and CEO at MediQuant, sits with Bill Russell. Cold storage looks cheap until a team has to open the file. The last 3 years of MediQuant's own archive are greater than the previous 20-odd years, back to 1999. Bill asks what it costs a health system to leave an old system running.

Jim has seen the monthly bill go up after too much data moved to the cheap tier. The use case has to be planned before the data moves. Older revenue-cycle data can sit for retention. Imaging, DICOM, and sleep studies are a different cost decision. Leaving an old system on has a second login, a repeated test, and unpatched software when a team stops paying maintenance.

Guest: Jim Jacobs (MediQuant)

Key Points:

0:00 Margin Pressure on Both Lines

2:46 Not All Data Is Equal

3:25 MediQuant

5:09 Get Out Your Checkbook

9:28 Last 3 Years

11:48 What It Costs to Leave a System On

14:14 Just Turn It Off

16:56 A Good Engagement

19:08 Close

LinkedIn: 229Project

Donate: Alex's Lemonade Stand: Foundation for Childhood Cancer

October 8, 2026: Michal Nedoszytko, Member of Clinical Staff at Abridge, sits down with Bill Russell. He is a cardiologist. He practiced in Belgium and Poland for 17 years. As an intern he was making 50 lab sheets a day. He says a PDF generator took that from 25 minutes to about 2 minutes, and the cardiology department started using it. In 2013 the Ministry of Health in Poland required reimbursement amounts on paper prescriptions, from a spreadsheet of about 15,000 medications. He built a site for that. He says about 100,000 doctors a month still use it, almost 15 years later. He says 13,000 people applied to an Anthropic hackathon and he finished third with a post-visit tool he built between patients. He says Abridge shipped real-time voice chart pull about a month before this recording, and he credits Eric Topol with the term Keyboard Liberation. He says the clerical work should leave the visit, and the decision stays with the patient and the doctor.

Key Points:

0:00 Doctors who build

2:31 50 sheets a day

5:57 Between the STEMIs

7:33 15,000 medications

9:54 Still used, almost 15 years later

13:31 One hackathon, 13,000 applications

29:36 Keyboard Liberation

32:49 The patient and the note

35:35 The clerical work leaves the visit

37:29 The decision stays human

LinkedIn: 229Project

Donate: Alex's Lemonade Stand: Foundation for Childhood Cancer

October 7, 2026: Yaw Fellin, Senior Vice President and General Manager, Clinical Decision Support and Provider Solutions at Wolters Kluwer Health, sits with Bill Russell. Clinicians used to come to UpToDate for an answer. He is building that evidence into the workflow, including Epic's Art, with 7,500-plus expert contributors behind it. Bill asks what a CIO puts in place so every agent lands on one version of clinical truth.

At Becker's, a clinician using one of the large AI suites thought she knew every medication that patient was on. The system found one in the chart that was not on her radar. She changed the care plan.

Yaw's answer for a CIO is governance first, then room to experiment, as long as the experiments stay safe and get narrowed to the systems that can hold that layer. The closer is cognitive scaffolding: support a resident and a clinician who has been at it for 20 years, and leave the thinking with the person.

Guest: Yaw Fellin (Wolters Kluwer)

Key Points:

0:00 7,500+ Experts, One Clinical Truth

1:32 From a Destination to the Workflow

3:54 Wolters Kluwer

4:17 Evidence Inside Art

13:08 How the Clinician Knows

16:45 What a CIO Puts in Place

20:00 Translation in Five Years

22:50 Cognitive Scaffolding

25:17 Close

LinkedIn: 229Project

Donate: Alex's Lemonade Stand: Foundation for Childhood Cancer

October 1, 2026: John McDaniel, CIO at Trinity Health in Minot, North Dakota, sits down with Sarah Richardson. Trinity is the first acute system on Epic Orchard. The region is rural, about a 120-mile radius, and recruiting and educating an implementation team was the hard part. Epic handles the third-party contracts and the upgrades. Discovery replaced an RFP. More than 300 people, about 10 percent of the organization, took part. John says 97.9 percent chose Epic. He also says undercoded care was about $36 million a year. He chairs the AI council and can say no.

Key Points:

0:00 The first acute system on Orchard

4:16 Luma Health

5:32 Epic handles the contracts and the upgrades

7:38 Clearsense

8:26 Discovery instead of an RFP

10:02 A 10-year case approaches a billion dollars

10:29 About $36 million a year undercoded

13:06 Data owners sign off

13:58 The AI council can say no

16:03 $5 to $10 per encounter

19:43 Use the enterprise as an extension of DTG

LinkedIn: 229Project

Donate: Alex's Lemonade Stand: Foundation for Childhood Cancer

September 30, 2026: Christopher Tyne, Chief Engineering Officer at Health Catalyst, sits with Bill Russell. Health systems are being sold AI that demos well and does not move an outcome. Chris puts $2.8 billion in validated outcomes on the table, then the test: do not just shine a flashlight at the fire. Hand them the extinguisher. Then check whether it is still burning.
Guest: Christopher Tyne (Health Catalyst)
Key Points:
0:00 $2.8 billion. Did it do anything

0:06 Chris Tyne, Health Catalyst

2:04 AI without the healthcare lexicon

4:03 Health Catalyst

4:34 100 million Americans without primary care

6:10 Mix of experts

7:44 Coumadin

10:00 The medical record starts giving back

12:08 Clients, exploration, trained models

13:48 Don't just shine a flashlight

15:52 Close

Donate: Alex's Lemonade Stand: Foundation for Childhood Cancer
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