Reframe time, money, and mojo for people who build things and also take call.
New here? Every Saturday I take the weekâs best idea in each of three buckets and cut it down to something you can read between patients.
I read the week so you donât have to.
Iâve talked to many of you offline and you know I love Dan Hewittâs Three Wins, so I thought to try to use that format on Saturdays for a bit.
Letâs go.
â Kevin
1. TIME
The part that didnât get faster.
On Friday the FDA published three pages in the federal code â 21 CFR 870.2380 â describing what a cardiac AI has to prove.
The device that started it, Viz.aiâs Viz HCM, was authorized on August 3, 2023.
Three years. Three pages.
Now look at whatâs actually in them. A test set independent from training. At least three geographically separate sites you didnât train on. Performance reported per demographic subgroup, per site, per acquisition device. Human-factors testing for whether a tired person over-trusts the output.
None of that is engineering time.
Thatâs contracts, IRBs, enrollment, adjudication, waiting. Calendar time. It has not moved in twenty years and it is not going to move because you have a better model.
Hereâs the uncomfortable arithmetic. The build got 100x faster. The evidence got 1x faster.
That gap is the whole opportunity, and itâs also the whole trap.
The trap is obvious once you say it out loud: you can now build fifty prototypes in the time it takes to validate one. So you will. Fifty weekends, fifty demos, nothing that anyone is allowed to use on a patient.
The opportunity is the same fact, held the other way round. Everyone can build it. Almost nobody will spend three years proving it.
So the scarce resource isnât the idea anymore. Itâs the willingness to still be working on the same idea in 2029.
Pick the one thing youâd stay with that long.
Then build it on a Saturday.
A win.
(Words: 251. A minute.)
âThe test dataset must include a minimum of three geographically diverse sites, separate from sites used in training of the model.â â 21 CFR 870.2380
Dig deeper: the order itself. Itâs three pages. Read it once and youâll never write a validation plan the lazy way again.
2. MONEY
Youâre not competing with the problem. Youâre competing with a line item.
This week Mayo Clinic licensed CareCast â a workforce-demand forecaster it built inside its own walls â to the staffing company Trusted Health, for sale to other health systems. Mayo disclosed a financial interest.
Hold that next to something Ernest Grant, PhD, RN said the next day. Grant was the first man elected president of the American Nurses Association in its 130-year history, now a vice dean at Dukeâs nursing school.
Nursing, he said, is âfolded in on the room and board.â
Every other profession there bills for what it does. Nursing is priced into the bed.
Which explains a decade of confusion: nurse-facing software is the most obviously needed software in the hospital, and the hardest to sell.
No line item, no buyer.
Mayo didnât solve that. Mayo went around it â selling the forecast to the company whose line item is labor, instead of a CFO with nowhere to book it.
Thatâs the move.
The pressure is real. Russ Branzell, who runs CHIME and hears from more health-system CIOs than almost anyone, said last week that systems have ârun out of options from a financial pressures perspectiveâ â several are working out how to offshore, or âeven lay off hundreds or thousands of people.â His guest Andy Smith, who founded Impact Advisors, gave the other half: zero to 360 associates in Mexico City in three years.
So âsaves a nurse thirty minutesâ isnât priced against a nurse. Itâs priced against a nearshore associate at a third the cost.
Before you build, name the line that goes down.
A win.
(Words: 271. A minute, and a bit.)
Nobody buys a solution. They move money from one line to another and hope you were worth it.
Dig deeper: the Mayo/Trusted announcement. Read it as a distribution story, not a staffing story.
3. MOJO
All the work nobody asked for.
In 2008, Stephen Smith â an emergency physician at Hennepin County Medical Center in Minneapolis â started posting ECGs on a blog.
Not the obvious ones. The subtle occlusions â where the artery is blocked, the machine says normal, and the patient goes back to the waiting room.
Nobody assigned it. There were no RVUs. He just kept noticing the same thing getting missed, and kept writing it down.
Eighteen years. Thousands of cases, one at a time.
Last week the FDA authorized a device built on that judgment â Powerful Medicalâs Queen of Hearts, which Smith trained to catch what the standard criteria miss. It came through de novo: the long door, the one only a handful of AI devices go through in a year.
Hereâs what I keep turning over.
He wasnât building a dataset. If youâd told him in 2008 that the blog was the moat, heâd have laughed, because in 2008 the moat was the model and the model didnât exist yet.
He was just a guy who couldnât stop noticing.
Thatâs the part you canât buy, canât prompt, and canât catch up on. Compute is rentable. Engineers are hireable. Eighteen years of paying close attention to one specific way that people get hurt is not available at any price.
So the question isnât what you should build.
Itâs this: what have you been noticing for years that nobody asked you to notice?
Write that down. Publicly. Badly, at first.
You are already ten years into something. You just havenât called it a dataset yet.
A win.
(Words: 265. A minute, just about.)
The stuff you do because you canât help it is the only part of you that isnât for sale.
Dig deeper: the blog. Start anywhere. Itâs still going. And the authorization write-up, if you want the regulatory side of the same story.
Love this format for Saturdays? Hate it? Thinking âI wish it were _______â? Let me know at kevin@clinicians.build â I read every one.
â Kevin & AI
(please verify content for yourself, partially AI generated and may contain errors)