I asked Brian K Fung a simple question: are you a one-man show, or do you have a team? It’s hard to say yes confidently, because I’m certainly taking advantage of a lot of AI assisted coding. I am, yes, one person, but AI changes that quite a bit with the amount of leverage it has. Brian is a pharmacist. He spent time at ONC. He now runs haau3, a product for family caregivers. What actually changed in December 2025 Brian started using Claude Code in April or May of this year. His description of the effect is blunt: it is very hard for him to just literally handwrite code anymore. But the more useful part is his account of why it became possible, and he puts a date on it. Something happened in December 2025 that completely changed the paradigm of AI coding. It wasn’t like you ask it something, it returns a response, back and forth, back and forth. They created a loop. The whole agentic looping of some sort of goal. Let’s say, write me a FHIR API. Well, that’s a goal. And then it would just keep looping and looping until it reaches that goal. The consequence he cares about is not speed. It is that the thing runs while he is not there. You can tell it to do that and then walk away, and it will just code for him. He is careful about the limit: it is not always right, which is where technical background or domain expertise helps. That caveat is the whole reason a pharmacist building for caregivers has an advantage over a generalist engineer building the same thing. He now teaches this to people with no coding background at all: dentists, nurses, physicians and pharmacists. The cost curve, stated plainly This is the part I have not seen anyone write down honestly, so here it is. Brian started on pay-as-you-go and burned through twenty dollars doing the most simple things within an hour or two. He moved to the twenty dollar subscription and hit the limits where they stop letting you work. He has settled on the hundred dollar plan. I think that might be too much, but hundred dollars might be the sweet spot. He has gone to two hundred when a deadline demanded it, and thinks that was more than he needed. If you are trying to budget this for a team, that is a more useful data point than any vendor page. The warning underneath the enthusiasm Both of us were sitting there enthusing about how fun this is. I described building at night while my wife watches her show. Brian agreed, and then did something I respect: he immediately turned it over. The spicy part is I am starting to hear some different podcasts out there that talk of other users that use it extensively. And their usage has begun to lead to burnout. And then the part that landed: You wake up and you just want to code. If you’re not coding, you feel like you’re not productive. He is not claiming he has reached that point. He is saying the vocabulary other people use to describe burnout matches the vocabulary he uses to describe having fun, and that is worth noticing early rather than late. Are we all about to get priced out Benji pushed on the economics. AI companies are operating at historic losses. That looks a lot like a familiar pattern: get the users first, worry about unit economics later. Brian analogy is the right one. Airbnb, Lyft and Uber Eats were cheap during a period when money was plentiful and interest rates were low. He does not really look at Airbnbs anymore. Those costs were heavily subsidized. I would not be surprised if they bump the prices of these things so astronomical that it is just not reasonable for us to use. His hedge is to keep his own ability to do the work by hand. He admits this is getting harder, for a reason familiar to anyone shipping fast: the codebases are growing large enough that he cannot always remember how something worked or where he put it. Does AI make standards obsolete This comes up every time now, and Benji had the cleanest rebuttal I have heard. The scare version goes like this: someone demonstrates two conversational AIs exchanging a patient’s clinical history in plain language, no formats, no implementation guide, and people conclude that standards are finished. AI is not here to replace FHIR or other data standards. It’s here to leverage those standards to make things even better, faster, more efficient. His argument is that models get more accurate when there is a deterministic data model underneath them, and that CQL is a good example precisely because it is a simple declarative language with one answer. Brian agreed on the principle and then complicated it, which is why he is a good guest. I’ve grown to believe that you will never get to a zero percent chance of hallucination. We always need to think about how we ground or make it as close to deterministic as possible. He then flagged a recent and contested paper suggesting that general frontier models outperformed grounded clinical tools on some benchmark. He was scrupulous about it: he has not dug into the methods. I am repeating it with the same caveat, because it is the kind of finding that gets stripped of its qualifiers the moment it hits a feed. My own take: we have run this argument before. When agent skills arrived, people declared MCP unnecessary. A year of actual adoption later, nobody seriously argues that. Standards do not die when a capability improves. They move. Why pharmacy never got wired up You can call an Uber. You can book an Airbnb. You cannot do the equivalent with your pharmacy, or with your own medication history. Why is pharmacy so far behind? Brian answer is one word. Incentives. Especially in America, we drive on incentives, payments, something like that. And one of the biggest payments in the last decade was the Meaningful Use, Affordable Care Act, HITECH Act, all those kinds of things. Lots of money, but it focused on providers and hospitals. What was left out, pharmacies. He watched the consequences directly. In 2020 he was at ONC reviewing public comments on pharmacy interoperability. All these mom and pop shops, these independent pharmacies saying you can’t enforce these standards because we don’t have the money for it. That is the whole story. Not a technical failure. A funding decision that was made once and then compounded for a decade. He is more optimistic now, because pharmacy is a named category in the CMS Health Tech Ecosystem. Benji drew the parallel to rural health, where a very large transformation fund is currently being divided among the states, and asked the obvious follow-up: is there going to be an equivalent for pharmacy? Nobody knows yet. It is the right question. Two things make the omission worse than it sounds. Pharmacists are the most accessible clinician in the country. As Brian puts it, you do not need an appointment, you just walk in. During the pandemic he estimates pharmacists were responsible for more than half of vaccinations. That physical network exists, it is staffed, and it is largely disconnected from the record. And on my side of it: I spent five years at Express Scripts, and medication reconciliation has been a Stars measure for as long as I can remember. Pharmacists get paid to call patients and do it. The patient never sees any of it. Why do payers have 150 person quality departments where nobody is actually doing anything about quality? They’re just abstracting charts. The fix here is not exotic. Send the discharge summary to the pharmacist. The patient is going to walk in for a refill anyway. Do the reconciliation there, in a conversation, instead of waiting for an annual visit that may not happen. The line I keep coming back to Brian closed with the framing that made the whole episode click, and it reframes caregiving as infrastructure. There are roughly 63 million family caregivers in the United States. What are they actually doing, mechanically? We think that caregivers are essentially serving as the interoperability layer on behalf of their loved ones. They advocate here. They take the appointment there. They carry the history in their heads between two systems that will not talk to each other. They are performing, unpaid and by hand, the exact function this industry has spent twenty years and enormous sums failing to automate. Once you hear it that way, haau3 stops looking like a caregiving app and starts looking like an interoperability product with an unusually clear-eyed view of who the user is. Their roadmap is public at haau3.com/roadmap, and the next big piece is scheduling, including scheduling on behalf of someone else. Which runs straight into the wall we always hit. I raised the USCDI comments where providers worry that publishing appointment availability lets competitors reroute their patients. Brian recognised the pattern immediately, because it is the same fear independent pharmacies have about sharing data with networks: those are your customers, and they might walk. That fear is not irrational. It is also the thing standing between 63 million people and a system that could stop making them do the work by hand. Where I landed Brian is one person with a pharmacy degree, a policy background, and a subscription. That combination produced a working product aimed at a real and enormous problem. The thing I want to sit with is the connection between the two halves of the conversation. The tooling that lets one domain expert build something real is arriving at exactly the moment we are admitting that the biggest interoperability gap in healthcare is being covered, for free, by exhausted family members. Chapters 00:00 Caregiver origin stories and Rosalynn Carter’s four types 02:12 One person, but AI changes the math 04:39 Teaching dentists and nurses to run Claude Code 06:40 Will an overnight run cost thousands in tokens 10:16 An addicting hobby you do instead of watching TV 12:12 The spicy flip side: coding toward burnout 15:53 Cheap Ubers and Airbnbs were subsidized too 21:00 The claim that AI killed standards, rebutted 22:33 Zero percent hal
