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A Workable Proposal for Migrating a 20-Year-Old HIS to SMART on FHIR, One Strangler Fig at a Time
This is the English version of a full, executable migration proposal I wrote for a very concrete situation. We already hold three cards in hand: a legacy Hospital Information System that has run for more than 20 years, a FHIR Server we have already stood up, and the ability to build SMART on FHIR apps with Rails plus AI coding. The proposal argues against both extremes, do not replace the whole thing at once, and do not let old and new coexist forever. The middle path is the strangler-fig strategy, wrap a FHIR facade around the old HIS, grow every new feature on the FHIR side, let a standard interface take over the old functions one block at a time, and let the old HIS recede into a pure data source until it can finally be retired. It covers why gradual beats big-bang, the target layered architecture, a five-phase roadmap, the very first proof of concept you can start this week (exposing one read-only resource through a FHIR facade), PHI security and governance built in from step one, and the review discipline AI coding needs on critical medical systems (Spectra plus a criticality spectrum). The core claim is that the hard part of migration was never the technology, it is sunk investment, downtime risk, and vendor incentives, so every step of the route must be able to ship on its own, roll back on its own, and produce value on its own.
What Is Loop Engineering?
Take on the new term loop engineering (the shift from prompt→context→harness→loop, traced to Boris Cherny and Peter Steinberger), put on one table with TDD/SDD. TDD/SDD are the source of truth; loop engineering is the wiring of the iteration, and TDD/SDD are exactly the verify-and-stop step inside the loop. Maps onto my own Spectra (SDD plus a human reviewer) and Rails (the substrate that makes loops converge). Closes with the honest doubt: is this just hype to make you burn more tokens? Answer: it cuts both ways. The marketing version (more autonomy) burns tokens, the engineering version (faster convergence, stop when you should) saves them.
Taiwan's HIS Proprietary Lock-in, and Why SMART on FHIR Is the Only Way Out
This is the English version of a piece about something I deal with every day in a hospital IT office, that every hospital in Taiwan runs its own Hospital Information System, each incompatible with the next. I call this phenomenon proprietary lock-in, which most people would recognize as data silos. Each hospital has its own data model and an interface only its original vendor understands, so you cannot pull records across hospitals, and adding any new feature means going back to that vendor, which is slow and expensive, and AI and innovation simply cannot get in. I argue you cannot solve this by wiring up one more interface, the only way out is to converge the data model and the access method onto an open standard, namely FHIR. But FHIR alone is not enough. What actually breaks vendor lock-in is SMART on FHIR, which adds OAuth2 authorization and an app-launch mechanism on top of FHIR's data and API, so any standard-compliant app can attach safely to any hospital's system, write once and run anywhere. The US used the 21st Century Cures Act to mandate that EHRs open this API, Epic and Cerner both support it, and it is already the de facto standard. Taiwan has the MOHW's TW Core IG as a foundation, so the direction is right, what blocks us is sunk investment and vendor incentives. The piece explains where lock-in came from, what it costs, why standardization is the only fix, and why it is SMART on FHIR and not just FHIR, and it is honest about the real obstacles to landing this in Taiwan.
Sega on AI EP1, Annotated: Is Taiwan an AI Superpower or an AI Foundry?
A conversation between iKala founder Sega Cheng and Dr. Lee-Feng Chien, former MD of Google Taiwan. From the Computex-fueled Capital Island phenomenon through whether AI is a bubble, the agent era as a hard requirement, a projected 24x jump in token consumption by 2030 and hardware optimization, US East vs West views, Taiwan's five shortages and internationalization by acquisition, luckily Taiwan's software was weak, Agentic Commerce and the Zero-Click economy with GEO, and R&D compressed from ten years to six months. Closes with the Ask / Use / Manage / Build framework for becoming the 1%.
The Digital-Transformation Evangelist: Making a Hospital's IT Quietly Better
I half-jokingly call myself the hospital's digital-transformation evangelist. Preaching here is not shouting slogans on a stage. It is quietly getting electronic records, FHIR interoperability, security, and AI assistance right, one piece at a time, until clinicians and patients suddenly notice things got smoother.
Hand-Grinding and the Sweet Finish: The Latte After a Week of Rest
I hand-grind an Italian espresso blend from a small local roaster. After a week of resting the beans, the latte finally pours stable. A quick engineer's test of the claim that plain water makes coffee taste sweeter, and a note on tidying up variables and handing the rest to time.
Talk Notes: SMART on FHIR Meets LINE Bot, a Privacy-First Medical AI Architecture
My write-up of the talk I gave at the 2026 AI Enterprise Summit (iThome). People in Taiwan live inside LINE, so if patients are ever going to read their own records, the records have to reach them there. I walk through the identify, confirm, authorize identity chain behind that simple wish, and why the security ceiling is set by the weakest anchor, the in-hospital binding, not by the cryptography.