CHALLENGE · 01
Interoperability that actually works
HL7 v2 → FHIR R4 → USCDI v3. Every EHR vendor's flavour. The standard is real; the implementations are not.
FHIR R4 + USCDI v3Industry · 03 of 06 · Provider · Payer · Pharma
Give clinicians their evenings back. Give patients a record that travels with them.
Healthcare data is fragmented, regulated and high-stakes — and clinicians are paying for it with pajama time. We build the FHIR fabrics, AI scribes and decision-support tools that let the work disappear back behind the work.
8 h/wkBack to each clinician
−72%Prior-auth turnaround
< 500msPatient timeline · p95
FHIR · patient record · v4.0.1LIVE · ENC #4421
AR
Anita R.MRN 88-21-447 · F · 62 · T2DM · CKD-3
CONSENTED118/74BP · mmHg
72HR · bpm
8.4HbA1c · %
97%SpO₂
Today · 09:41 · Endocrinology · GLP-1 titrationScribed by ETY ambient · accepted
Yesterday · Lab · HbA1c 8.4 → care-gap alertAuto-ordered fasting glucose · prior-auth submitted
4 days ago · Home BP cuff · 14 readingsMQTT · device id BPM-1188
11 days ago · Ophthalmology consult closedCross-site EHR · SMART-on-FHIR
3 sites · 1 record🛡 PHI · E2E encrypted
The reality on the ground
What clinical software actually looks like in 2026.
Twenty-three logins. Three EHRs that don't talk. A pager that still uses 2G. And the only person who can fix the chart is the one who's already two patients behind. We don't add another system — we make the ones you have feel like one.
FACT · 012 h/day
Average pajama-time per physician — charting after clinic hours. Burnout's leading software-side cause.
FACT · 02$300B
Spent globally on EHR systems that still can't reliably share a single patient record across two hospitals.
FACT · 0372%
Of prior-authorization decisions delay care by a week or more. Most are answerable from the chart in seconds.
FACT · 0414
Average number of clicks to document a routine visit in a top-3 EHR. Half of them are vendor-mandated.
The hard problems
What keeps a CMIO & Chief of Clinical Operations awake at 02:00.
A doctor doesn't want a better dashboard. They want fewer windows open. Every challenge below maps to a window we can close.
CHALLENGE · 02
Clinician documentation burden
The chart is the leading reason physicians leave medicine. Voice + AI can absorb 70% of it — when scoped right.
Ambient scribeCHALLENGE · 03
Prior authorization as a care delay
The evidence is in the chart. The form is in the payer portal. The patient is in the lobby. We close the loop.
Da Vinci CRD/DTR/PASCHALLENGE · 04
Remote patient monitoring at scale
Devices come and go, MQTT brokers drop frames, and a glucose reading off by 30% is dangerous.
Device-cert · QCCHALLENGE · 05
Clinical decision support without alert fatigue
High-sensitivity rules drown clinicians. We tune for precision and put the signal where they look.
CDS HooksCHALLENGE · 06
PHI security · in a clinical workflow
BAAs, encryption-in-use, break-glass access, audit. None of which can slow the bedside.
HITRUST CSFWhat we build · and own
Six modules. One FHIR-native spine.
Built on the standards your EHR vendors already speak — HL7 FHIR R4, USCDI, SMART-on-FHIR — and deployed inside your cloud, under your BAA.
Module · 01
FHIR-native data fabric
One patient timeline across EHRs, labs, imaging, wearables and claims. SMART-on-FHIR apps, bulk export, Da Vinci payer-provider exchange — out of the box.
- HL7 v2 → FHIR R4 normalize
- USCDI v3 conformant
- Bulk Data Access · NDJSON
- Cross-site record linkage
Module · 02
AI ambient scribe
Multi-speaker visit capture, structured note draft, ICD-10 + CPT coding suggestions — accepted in the EHR with one keystroke. The clinician owns every edit.
- Whisper-class ASR
- Speaker diarization
- SOAP / DAP / DAR templates
- EHR-native acceptance flow
Module · 03
Clinical decision support · CDS Hooks
Guideline-aware prompts that fire at the point of care, deferred to the clinician, tuned for precision over sensitivity. No alert fatigue.
- CDS Hooks 2.0
- Evidence retrieval
- Sepsis · stroke · OB
- Override-reason capture
Module · 04
Prior authorization automation
Pull evidence from the chart, format the payer's form, submit, track status — Da Vinci CRD/DTR/PAS where supported, fax-bridge where it isn't.
- Da Vinci PAS · payer APIs
- Auto-populated DTR forms
- Status webhook + escalations
- Appeals letter drafting
Module · 05
Remote patient monitoring
Device ingestion (BLE / cellular / MQTT) at clinical-grade reliability — frame-loss detection, drift quality control and alert routing the right way up.
- BLE · cellular · Wi-Fi
- Frame-loss + drift QC
- Threshold + trend alerts
- Care-team triage queue
Module · 06
Population health & risk
HCC capture, care-gap closure, readmission risk and the actuarial workflow your value-based-care contract was built around.
- HCC + suspecting
- Care-gap workflow
- Readmission ML
- VBC contract reporting
Reference architecture
From EHR event to clinician action, the path is six steps.
Six steps between a lab posting and a clinician's next move — none of which involve a fax machine.
STEP · 01IngestEHRs · labs · devices · payers ingested as HL7 / FHIR / NDJSON.
STEP · 02NormalizeMapped to FHIR R4 · USCDI v3 · de-duplicated · record-linked.
STEP · 03ReasonCDS Hooks fire · models score risk · scribe drafts note.
STEP · 04SurfaceEmbedded in the EHR via SMART-on-FHIR — no new login.
STEP · 05ActOrder, refer, prior-auth — initiated from inside the chart.
STEP · 06AuditEvery PHI access, model output and clinician decision sealed.
Tools we reach for
Battle-tested stack. No buzzword tax.
Clinical data & standards
HL7 FHIR R4USCDI v3SMART-on-FHIRCDS Hooks 2.0DICOMwebDa Vinci IG
Platform
AWS HealthLakeAzure for HealthSnowflake · HIPAAPostgresKafkaMQTT
AI / ML
WhisperMed-PaLM 2Claude · BAAPyTorchTritonMONAI · imaging
Security
HIPAA · BAAHITRUST CSFSOC 2 · Type II21 CFR Part 11Vault · HSM
Where we've shipped in healthcare.
Across the care continuum — from solo clinics to ten-hospital systems, payers, life-sciences and the digital therapeutics building on top of all of them.
Hospital & health systemsMulti-site clinic groupsPayers & MCOsPharma & life sciencesMedical devicesDigital therapeuticsTelehealth providersPublic health & gov programs
Case study · in production
How a multi-site clinic group got eight hours per clinician back.
Twelve clinics, three EHRs, one network of doctors burning out from documentation. We layered the FHIR fabric, the ambient scribe and the prior-auth automation. Inside a quarter, the documentation backlog was gone and prior-auth turnaround dropped by 72%.
ClientMulti-site clinic group
Sites12 clinics · 3 EHRs
Clinicians186 active
Timeline14 weeks · phased
8 h/wkBack to each clinician
−72%Prior-auth turnaround
< 500msPatient-timeline query · p95
94%Clinician scribe-adoption · 30d
Compliance · built-in
Audit-ready by default. Not by sprint.
Healthcare is where compliance is a clinical-safety issue, not just a legal one. Every artefact we ship has the audit trail to prove it's safe to use at the bedside.
HIPAA · BAAPHI · uses + disclosures · audit
HITRUST CSFCertified controls library
21 CFR Part 11GxP electronic records
GDPR · DPDP · NHSEU + UK + India data residency
SOC 2 · Type IIContinuous controls
ONC USCDI v3Certified Health IT
HL7 FHIR R4Reference-implementation grade
NIST 800-66Healthcare cybersecurity baseline
Questions you’ll probably ask
The short version of the kick-off call.
Does the AI scribe replace the clinician's judgement?+
Where does PHI live?+
Can you connect to our EHR (Epic / Cerner / Athena / Meditech / etc.)?+
What does your AI risk management look like?+
How long until we see clinician adoption?+
Can you support our value-based-care contracts?+
Healthcare · provider · payer
Tell us about the pager time. We'll show you the path back.
A 60-minute working session with a senior engineer and a clinical-informatics lead. We'll review your EHR landscape, your documentation burden and the three things we can move first.