For 37 years, Charlie Harp heard the same thing from healthcare organizations: "Our data quality is fine." They were right — for billing and scheduling. But AI changed the equation. Harp, founder of Clinical Architecture, built the PIQI framework to measure patient data quality across four dimensions: availability, accuracy, conformance, and plausibility. His PIQXL Gateway scores data on a 1-100 scale before it enters your systems — not after. Early deployments reveal uncomfortable truths: lab data averages 70% quality against USCDI standards, and one facility coded every blood test to a single LOINC code. The framework is now going through HL7 balloting as an open national standard.