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Analysis

Independent coverage of the policy, procurement, and platform decisions shaping federal health IT.

103 articles · 5 episodes
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Industry Leader, Out of Scope

On May 29, 2026, VA posted RFI 36C10B26Q0485, market research for an enterprise AI buy meant to move a 540,000-person workforce from assistive tools to autonomous agents acting on veteran health data. The same document sends governance out of scope. Here is how VA earns the leadership it claims: sequence the agents by risk, put governance on the quarterly clock the price already runs on, and buy all four parts, the capability and the three preconditions that make it safe.

June 2, 2026 · 13 min read

DHA Is Replacing How It Buys. The Budget Already Voted.

On April 20, 2026, the Defense Health Agency replaced thirty years of how it buys medical capability. A new portfolio-based acquisition model, a requirements process built to kill 'bring me a rock,' and an FY2027 budget that already voted on where the money goes. Here is what changed, who runs it, and how it shows up in live contracts.

May 29, 2026 · 16 min read

A Researcher Talked a Clinical AI Out of Its Own Rules. DHA Is Fielding the Same Design.

No code. No exploit kit. Plain English. A security researcher pulled 60 pages of hidden instructions out of an AI doctor, rewrote them, made it triple a drug dose. The Defense Health Agency is fielding the same architecture in military exam rooms right now.

May 26, 2026 · 13 min read

The Workflow Was Designed to Deliver

A credentialed third party generated evidence before the read. Twenty-one years later, that is the architecture CMS is shutting other modalities down for not having. The 2:47 a.m. stroke scene that proves the primitive, the OpenAI/MCP pattern radiology operationalized two decades early, and the federal procurement vehicle that has not yet been built.

May 22, 2026 · 18 min read

What Anthropic Refused

When a federal contracting officer asks a language model a question, what makes the answer true? The Administration has an answer. So do the courts. They are not the same answer. GSAR 552.239-7001 lands in the next MAS refresh with a sixty-day acceptance window and no opt-out — and the fight over what it requires is the fight that put one frontier model provider outside the federal AI tent.

May 5, 2026 · 15 min read

The Architecture VA Asks For Is Not the Architecture VA Buys

On April 20, the VA Strategic Acquisition Center certified that only one source qualified to upgrade the National Teleradiology Program PACS. Three months earlier, five qualified sources had been delivering on a competing architecture. The procurement system that wrote one document and signed the other is the same system writing the EIS RFP right now.

May 1, 2026 · 14 min read

🎧 Fed UP Podcast

Episode 3

April 4, 2026 · 00:41:07

This month, Mary and Sara get into it — what integrity actually looks like inside federal health IT, why the healthcare revenue cycle is increasingly being handed to machines that don't understand the

🎧 Fed UP Podcast

Episode 2

March 1, 2026 · 00:39:09

The conversation covers the impact of circadian rhythm on health and productivity, as well as the geopolitical impact of technology and government decisions. It delves into the challenges of balancing

🎧 Fed UP Podcast

Episode 1: The Mission Behind the Mission

January 31, 2026 · 00:41:46

The conversation begins with an introduction and discussion about the podcast's mission and intent. It then transitions into a deep dive into the challenges and opportunities in the federal space, cov

🎧 Fed UP Podcast TRAILER

Introducing Fed UP (originally announced as Mission Meets Reality)

January 23, 2026 · 00:00:19

Introducing Mission Meets Reality... coming soon!

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