Peter Embi has spent his career at the intersection of medicine and informatics: coining the term "algorithmovigilance," serving as the nation's first Chief Research Information Officer, and leading AI work at Vanderbilt. He is also a patient. A rare adrenal tumor took nearly 15 years and a self-diagnosis to catch, and it nearly killed him. In this conversation, Embi connects that diagnostic odyssey to the case for monitoring clinical AI the way we monitor drugs: continuously, in the real world, across a network of institutions. The discussion runs from zebras and missed diagnoses to VAMOS, the "air traffic control tower" his team built to keep deployed models honest.

Interoperability has been healthcare's twenty-year broken promise, but something genuinely changed. Mika Newton, CEO of xCures, explains how provider data exchange jumped from roughly 30% to 85–90% in just two years, and why that's only half the story. Moving records, it turns out, was never the hard part. As Newton puts it, "records travel, but they don't translate" — most of a record arrives as duplicated notes and scanned images that still have to be made usable. Steve and Leon dig into the honest limits of AI parsing, the card-network model behind nationwide exchange, and why the patient is becoming the real access point to their own data.

In their sixth Reflections episode, Steve and Leon look back across five conversations (Sarah Rossetti, Jeff Smith of ONC, Hugo Campos, Fred Bennett, and Zak Kohane) and decide, deliberately, not to force a single grand theme. What surfaces anyway is one question asked five ways: as AI gets genuinely capable, what still has to be human, and what makes it trustworthy? They cover Rossetti's CONCERN system that models the nurse instead of the patient, ONC giving AI agents patient-like data rights, the tension between patient empowerment and black boxes you don't understand, the Minimum Trustable Product, and Kohane's method for measuring the values a healthcare AI actually acts on. A practical tour of where good is starting to look real.