The Contents of That Dumpster Are Private

Nikhil Krishnan wrote a great piece recently arguing that open source is healthcare's moment. The business models exist (Red Hat, GitLab). AI is lowering the contribution barrier. The ecosystem is ready. He's right. But there's a punchline missing from the open-standards conversation that anyone who's actually built against healthcare APIs knows intimately: The standard exists. Nobody follows it the same way. FHIR (Fast Healthcare Interoperability Resources) is the anointed standard. ONC mandates it. CMS requires it for payer Patient Access APIs. Every major EHR vendor will tell you they support it. And technically, they do — the way a restaurant "supports" vegetarians by offering a side salad. Same Patient, Different Reality Flexpa recently published a fascinating comparison: the same patient's health data pulled through two different API pathways . The results should make anyone building healthcare software nervous: TEFCA path : 192 FHIR resources, but only 1 condition — "pain in thr