Engineering for virtual-care and healthcare companies
Healthcare software is a specific kind of hard.
Clinical workflows, HIPAA, EHR integration, and direct-to-consumer billing intersect in ways that general development shops routinely underestimate. That complexity does not show up in the estimate. It shows up as delays, rework, and architecture that does not survive contact with production.
We build in this space on purpose, and it is where nearly all of our work lives.
How every engagement starts
A two-week Launch Path, before anyone writes code
Fixed price, fixed scope. You get the architecture, the vendor decisions and real quotes, the workflow documentation, and a build plan you could hand to anyone — and you keep all of it whether or not you continue with us.
Who We Work With
Funded or revenue-generating virtual-care and digital health companies
Building or scaling patient-facing products on platform EHRs like Healthie or Canvas Medical. Venture-backed, physician-group funded, or self-capitalized — the round matters less than whether the roadmap is real. You have a clinical model and no engineering organization to execute it.
Companies replacing a stack that has run out of room
Something got built before there was budget for it to be built properly. It worked, it got you to revenue, and now every change costs more than the last one. You are not looking for a prototype. You are looking for someone who can replace load-bearing systems without taking the business offline.
Established healthcare businesses
Pharmacy, home health, care operations, medical devices. You have a working business and a software problem that general agencies keep getting wrong.
Medical device and healthcare consultancies
You take products to market and need a software partner who will stay in their lane and make you look good in it.
Who we are not for
- – Pure consumer brands with no clinical component
- – Enterprise programs that want a hundred-person systems integrator and a procurement process to match
- – Buyers shopping for offshore rates
We are a senior team and we price like one. If the deciding factor is hourly rate, we will not be the answer.
What We Do
Telehealth platforms, end to end.
Patient intake and health history, identity verification, provider scheduling and video consults, e-prescribing, pharmacy routing, order fulfillment, and the operations portal your clinical team works in.
EHR integration.
Healthie, Canvas Medical, and FHIR-based systems. Chart sync, clinical questionnaire data, order and prescription workflow, secure messaging, and the gaps in every API that only show up in production.
Membership, subscription, and D2C billing.
Tier entitlements, subscription lifecycle, one-time purchases, and the compliance questions that come with prescription billing.
Connected devices and remote monitoring.
Device data pipelines, clinician and caregiver dashboards, and alerting designed for signal rather than noise.
Replatforming and stack migration.
Moving a working business off software that has stopped scaling, in stages, without a cutover weekend that everyone spends the next month recovering from.
Engineering operations.
The part most shops skip. We stay on, own the platform, and handle what comes after launch.
The Integration Layer Is Where Projects Stall
A telehealth platform is mostly other people's systems, wired together correctly. That work is where estimates break, and it is the part we have done most.
These are systems we have shipped against in production — the failure modes, the rate limits, the fields that are documented but not populated, the webhooks that arrive twice.
EHR and clinical platforms
Healthie, Canvas Medical, FHIR-based systems
E-prescribing and pharmacy routing
DoseSpot, Surescripts, Lifefile, siCompound, Photon Health
Clinical data, labs, wearables, and devices
Junction, DrugBank
Identity, authentication, and MFA
Persona, Clerk, Auth0, Twilio Verify
Payments, subscriptions, and merchant accounts
Stripe, NMI, Chargebee
Patient intake and forms
Typeform, Feathery
Scheduling, booking, and video visits
OnceHub, doxy.me, MindBody, Nylas
Messaging, email, and patient notification
Twilio, SendGrid
Fulfillment, shipping, and mail
Shippo, PostGrid
CRM, support, and automation
Salesforce, Zendesk, Zapier
Content management
Contentful, WordPress, Orchard
Engagement, growth, and reviews
Braze, Trustpilot
AI and language models
Anthropic (Claude), OpenAI
Cloud, hosting, and observability
AWS, Azure, Azure Application Insights, IPStack
If you are evaluating a specific vendor, name it on the first call. We will tell you what we have hit, what the migration path looks like, and whether we would pick it.
What Makes Us Different
We operate what we build
More than five years operating a production telehealth system end to end, inside the business. Intake to prescriber to pharmacy to payments. That system alone helps more than 10,000 patients a month get the treatments they need. We are not learning the domain while we build yours.
We have already met your integrations
The vendor evaluations, the API gaps, the migration paths — we have run them before, in production, with patients on the other end. That experience is the difference between a six-week integration and a six-month one, and it is the single most common place a healthcare build goes over.
Security is part of the build, not the security review
Your PHI stays in infrastructure you own. Encryption at rest and in transit, role-based access enforced in the application, audit logging, and MFA on anything that reaches production. We publish what we do and what we do not claim, so your diligence process finds it before you sign rather than after.
How we handle PHI →HIPAA-native, integration-deep
PHI handling is the default, not a phase. The connective tissue between systems is our strongest work, and it is exactly where most digital health projects fail.
AI where it earns its keep
We build with it and we build it in. AI-assisted tooling runs through our research, evaluation, documentation, and code, and we have shipped Claude and OpenAI into client products in production — so the questions about latency, cost, prompt drift, and what a model is allowed to touch near PHI are ones we have already answered. What AI does not do is make the architecture, compliance, or clinical workflow calls. Senior engineers who have run these systems in production do.
Senior team, product judgment included
Product management sits alongside engineering. You are buying people who shape the work and make calls, not ticket-takers waiting on a spec.
How engagements start
Every one begins with a Launch Path: a two-week, fixed-price engagement that produces the architecture, the vendor decisions, the workflow documentation, and a build plan you could hand to anyone.