Policy Maker by Day, Doctor by Night | Dr. Thomas Keane

Dr. Tom Keane — the National Coordinator for Health Information Technology — brings a rare dual perspective: he writes the policy by day and lives with its consequences at the bedside. Our conversation covers the history of the ONC, the HITECH Act and the Cures Act, the three levers driving interoperability (TEFCA, standards, and information-blocking enforcement), the difference between data blocking and "functionality blocking," real-time drug pricing and cash-pay tools like Trump Rx and Cost Plus Drugs, behavioral health data sharing, and a market-first vision for governing AI in medicine — from AI scribes and stroke detection to agentic AI that finally puts patients in control of their own records. Healthcare Trailblazers is sponsored by CareCo: Turn admin time into patient time with clinical AI for care teams. Timestamps:0:00 — Cost-conscious medicine and the price of non-compliance1:35 — Welcome and introducing Dr. Tom Keane2:20 — From radiology to government5:05 — How policy and bedside practice inform each other8:02 — Care Conference: the care you'd give your own family9:27 — Treating the full context of a patient's care11:03 — The CareCo vision: a shared "brain" that directs care14:26 — Care coordination then vs. now (Johns Hopkins to Maryland)17:33 — Interoperability and who really owns patient data19:05 — A short history of the ONC: HITECH and the Cures Act21:32 — Three tools to free the data: TEFCA, standards, info blocking23:45 — Enforcing the information-blocking rule24:30 — Data blocking vs. functionality blocking and the G10 API27:56 — When incentives align: the HTI-4 rule and real-time drug prices31:04 — Cash-pay pricing: Trump Rx, Cost Plus Drugs, GoodRx32:43 — The secondary-insurance blind spot34:40 — Where government doesn't belong36:21 — Governing AI without strangling it37:25 — Why AI rules should be national, not a 50-state patchwork40:41 — Behavioral health IT grants and 42 CFR Part 243:09 — Project Hope in Huntington, West Virginia44:11 — Lessons from HITECH for the AI era (and the PACS contrast)47:04 — AI in practice: scribes and stroke detection49:40 — The next ten years of healthcare52:11 — Two big AI use cases: administrative and clinical54:01 — Patient empowerment and agentic AI56:44 — Closing thoughts