clinicians.dev

clinicians.dev

A community of clinical experts super-powered with skills in agentic engineering. Our roots are in coding and clinical medicine. We know how to create and supervise LLMs writing Python, SQL, R, JS, HTML. We love startups, regs, policy, UI/UX, data viz, project management, informatics. We want to create the medicine of the next 100 years.

✉ Email for Slack invite → Slack → Substack ↓ Next event
today · the wire

The Wire

What you'll be asked today — and what to say back. A couple that caught my eye this morning; the rest are on the wire.

Epic shipped an ERP, a staffing arm, and an AI that does analyst work. Is that a platform or a landlord?

Becker's Hospital Review · Aug 30, 2026

Three things came out of UGM at once: EpicOps, an ERP suite; Rangers, a long-term IT staffing program; and an AI tool that automates junior-analyst build work. CIOs are split on whether that's overreach or just a safer bet than assembling the same functions from point solutions — and both sides have a case, so the useful move is to skip the binary and ask what's actually being transferred. The analyst-automation tool doesn't just save build hours, it removes the training grade where your future application managers come from. Rangers is the answer to that gap, staffed by Epic on a long horizon, which is fine until you price what it costs to unwind. The MCP connector framework genuinely opens an application layer, but Chronicles, Clarity and Caboodle stay closed — and your shop is now the party configuring and activating each connector. That's not decentralization. That's franchising, with the liability moving to the franchisee.

HatersThe CIOs quoted as worried about Epic's expansion are, in most cases, the same CIOs who spent a decade consolidating onto Epic specifically so they'd have fewer vendors to manage. Congratulations. You got what you asked for and it turns out it also sells ERP.

Maryland wants $380 million back from Optum. Go read your own claims contract.

Fierce Healthcare · Aug 29, 2026

Maryland's attorney general says Optum's claims-management system for the state's behavioral health Medicaid program crashed on day one, went offline for eight months in 2020, and failed to catch what the complaint calls rampant, multi-million-dollar fraud. The state wants roughly $380 million back. Notice the shape of the ask — the outage is a service failure, but the missed fraud is a loss the system was specifically bought to prevent. Most claims and payment-integrity contracts cap vendor liability at fees paid over the trailing twelve months, which turns a system that fails at its core job into a rounding error for the vendor and a real loss for everyone else. Maryland is suing because the ordinary remedy wasn't enough. Worth pulling your own largest claims and payment-integrity agreements this quarter and checking whether the liability cap carves out the function you actually bought it for.

A hundred AI companies just told Washington that hospitals cannot defend themselves.

Becker's Hospital Review · Aug 30, 2026

OpenAI, Microsoft, Google, Anthropic and more than a hundred other firms signed a public letter on Aug. 27 warning that critical infrastructure faces a fast-approaching surge in AI-enabled attacks, asking governments to fund defense for essential services that can't fund it themselves. Read the letter for what it structurally is: the companies selling the offensive capability multiplier asking the public to subsidize the defense. That doesn't make it wrong — it's an admission the economics don't close at the hospital level, which every CISO at a community system already knew. The concrete version arrived the same week. Boston Scientific's Aug. 25 attack still has order processing disrupted globally, and while implanted cardiac devices and existing remote monitoring are unaffected, new remote-monitoring activations are on hold. A device manufacturer's IT outage became a limit on which patients can be enrolled in monitoring — and that vendor is almost certainly filed under procurement on your risk register, not clinical continuity.

80/20Skip the AI-attack framing and answer one question: for each of your top twenty vendors, what specifically stops if they go dark for two weeks? Almost nobody has that list. Everybody has a SOC 2 folder.

If the chart abstraction is automated, what is your research coordinator actually for?

npj Digital Medicine · Aug 27, 2026

Two npj Digital Medicine papers landed three days apart, and the common thread is that neither required training a new model. One builds structured clinical research databases straight from chart data with an LLM-mediated process; the other classifies breast ultrasound malignancy with an agentic, fine-tuning-free framework. Manual chart abstraction has been the rate limiter on retrospective research for thirty years, and the field has quietly organized around that constraint — grant sizes, timelines, how many hypotheses a group can test per year. Remove it and the bottleneck moves to whoever decides which questions are worth asking, a much smaller group than currently holds research jobs. The fine-tuning-free framing matters for a different reason: it's a claim about deployment cost. If competitive performance no longer requires a fine-tuning run and the data-governance process that comes with it, standing something up drops from a project to an afternoon. Both are single studies, neither prospectively validated — cite them as direction, not evidence.

A fake recruiter put a children's hospital on a North Korean target list.

Unhack with Drex DeFord, 2 Minute Drill · Aug 27, 2026

Security researcher Vangelis Stikas got inside the attackers' own infrastructure — they'd sloppily infected their own machines — and sat there for nearly two years watching. His count at Black Hat: 1,640 companies across 57 countries, seven or eight hundred compromised badly, and a pediatric hospital on the victim list. The entry point was the "contagious interview": a fake recruiter, a coding test that's actually malware. The hospital says it involved a former independent contractor's personal device and that access was disabled within hours. The number that should change your Monday is a different one — some freelance contractors held live access to as many as thirty companies simultaneously.

Read the full wire ↗
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Interactives

Companion experiences for the newsletter — don't just read about it, try it.

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from the substack

Builder's Briefing

The newsletter — what shipped this week, what it means, and what to build next. A couple of recent issues.

Read more on Substack ↗
Summer 2026 · Free · Virtual

What the Vibe

Saturday, May 30, 2026 · 12p–2p ET

Vibe coding changed everything. The barrier to building just disappeared. So what's the vibe? Is clinicians.dev dead? Does knowing how to code still matter when anyone can build? Four clinician-builders. Twelve minutes each. Show us what you made — vibe-coded, hand-coded, or somewhere in between.

Tentative speakers
Joe Izzo
First, Do No Harm — Especially With Your MVP: A CMIO's Advice in the Clinician-Builder Era
Patrick Damaso
Trajectories, Not Targets: Catching Reward-Hacked Diagnostic Reasoning One ICD Branch at a Time
Sam Wang
Silent Denials, Loud Insights: Visibility into the Payors Who Won't Show Their Work
Matt Segar
From Bedside to Buyout: An EP Fellow Path to Acquisition
  • 4 talks (12 min each)
  • 1:1 breakouts after each
  • Group discussion
  • Open community talk: "What the Vibe?"
RSVP on Luma →
01 · Learn

AI & agentic engineering

The foundational reads, the tools clinicians-who-code are actually using, and the loop that ships.

Context engineering — the foundation

Effective Context Engineering for AI Agents

Anthropic's foundational guide.

Building Effective Agents

When to use workflows vs. agents, and how to structure both.

2026 Agentic Coding Trends Report

How teams are actually shipping with agents.

Learn CLAUDE.md / AGENTS.md

The spec files that make agentic coding repeatable.
🔁 The Ralph Wiggum Pattern — the loop that ships. Tight spec → agent implements → you verify → adjust spec → repeat. Just keep going.

Tools of the trade

ToolBest forNotes
Claude CodeComplex multi-file work, architectureTerminal-native, large context. The power tool. Good for non-code tasks too.
CursorDaily coding with autocomplete + inline editsAI IDE, huge user base.
WindsurfBudget entry, Cascade collaborationAI-native editor.
Copilot / Codex CLIRepo-native GitHub workflowsTight GitHub integration.

Skills marketplaces

Claude Code Marketplace

Curated agent skills collection.

Claude Skills (232+)

Cross-agent skills for Claude Code, Codex, Gemini CLI, Cursor.

Awesome Claude Plugins

Plugin adoption metrics.

claudemarketplaces.com

4,200+ skills, 770+ MCP servers.

Healthcare MCPs

AWS HealthLake MCP

Amazon's healthcare data MCP server.

Agent Care

EMR integration with FHIR for agentic AI.

Keragon

300+ native healthcare integrations, FHIR protocol support.

Superpowers Framework

Agentic skills framework for coding agents.

Agentic frameworks & orchestration

  • CrewAI— multi-agent orchestration, clinical workflow pipelines
  • LangGraph— graph-based agent workflows with state
  • AutoGen— Microsoft's multi-agent conversation framework
  • MS Agent Framework 1.0— production .NET + Python
  • DSPy— programmatic LLM pipelines, good for clinical NLP
02 · Communities

Communities, courses, substacks

Where clinician innovators and clinician builders are hanging out.

X Primary Care

Substack.

Automate Faculty

AI.

HealthTechNerds

Active Slack, all different backgrounds.

Tuva

Active Slack community.

CodeRx

Pharma, healthcare, technology.

Mimilabs

Medicare data (paid).

DiMe

Research, clinical, digital medicine.

Design for Healthcare

UX, UI, healthcare products.

HealthDevHub

FHIR.

HealthTech Hang

Networking + resources.

Physician Innovator

Entrepreneurship, medical innovation.

SoPE

Healthcare, entrepreneurship, VC (paid).
03 · Build stack

EHRs, FHIR, fake patients

The pipes you'll need when you're actually building.

EHRs & FHIR

🔑 SMART-on-FHIR / OAuth flow — fhir.epic.com/Documentation?docId=oauth2

Generate fake patients

MakeData

Synthetic healthcare datasets — FHIR, JSON, CSV. Privacy-safe, immediate.

Patient Creator GPT

ChatGPT custom GPT for fake cases.

Synthea

MITRE's synthetic patient generator — the classic.

FHIR Personas

Synthea patients curated for interesting characteristics.
04 · Datasets

Clinical datasets worth knowing

From CXRs to genomes to ICU waveforms. Filter by name, modality, or license.

NameRelevanceLicense
ReXGradient-160K160k multi-site CXR + reports — vision-language radiology sandbox.Harvard DUA, non-commercial
CheXpert PlusLarge paired CXR–report set; benchmarked in many papers.Stanford DUA, free research
Endoscapes 2023Open laparoscopic chole frames — segmentation / CVS detection.CC BY-NC-SA 4.0
Surg-3M3M surgical frames powering "SurgFM" foundation model.TBA, expect research-only
AFRICAI RepositoryImaging sets from African centres — fairness & domain shift.Mixed open licenses
OpenOximetryWaveforms + skin-tone data for pulse-ox bias work.PhysioNet credentialed
DeepLesion32k CT slices with bounding-box lesions; detection / tracking.NIH DUA, research-only
BioASQ Synergy 2024Biomedical Q-A pairs — LLM eval set.CC BY 2.5
CliniFactClinical-trial fact-checking corpus — fine-tune retrieval / RAG.MIT
Hallucination AnnotationsDoctor- & LLM-written discharge summaries with token-level labels.PhysioNet credentialed
Clinical-Trial Eligibility QAQA pairs linking MIMIC-IV to apixaban RCT criteria.PhysioNet credentialed
PIFIRWearable PPG/ECG for arrhythmia-free interval prediction.PhysioNet restricted
GREGoR R02Rare-disease genomic + phenotypic harmonised data.dbGaP controlled
Synthetic Rare-Disease EHRsBenchmark synthetic EHRs for low-prevalence conditions.CC BY
Korea4K4k Korean genomes — ancestry diversity for variant calling.EGA controlled
OpenNeuro20k+ public neuro-imaging sessions; BIDS-ready.CC0 / CC BY-SA
Bridge2AI-VoiceMultimodal speech (voice, vitals) for health AI.PhysioNet restricted
PMDB Pain MonitoringWearable IMU + self-report pain diary.CC BY 4.0
DREAMT Wearable SleepApple Watch PSG pairs for sleep-staging models.PhysioNet restricted
MC-MEDMulti-condition medical dialogue (GPT / human).PhysioNet credentialed
Wearable Stress DatasetSmartwatch vitals + stress labels — mental health ML.PhysioNet restricted
MIMIC-IV v3.1Flagship 380k-patient de-id EHR; ED + ICU tables.PhysioNet credentialed + CITI
MIETICItalian clinical-notes corpus with entity spans.PhysioNet credentialed
ODD (Opioid Behavior)Annotated notes for opioid-related behaviour NLP.PhysioNet credentialed
UK Biobank500k UK adult cohort — EHR, surveys, genetics.Controlled access
All of Us (NIH)1M-goal US cohort — EHR, surveys, genomics, wearables.Registered + Controlled tiers
TCGA~11k patients across 33 cancer types — multi-omics + clinical.Partially open
AmsterdamUMCdbFirst open European ICU DB — 23k admissions.DUA required
ADNILongitudinal Alzheimer's — serial MRI/PET, clinical, biomarkers.Free non-commercial
ABCD Study10k youths — neuroimaging, cognitive, mental health, genetic.NIMH controlled access
NHANES (CDC)US national survey — health, nutrition, lab data.Public domain
CheXpert (original)224k chest X-rays, 65k patients — labeled findings.Free non-commercial
EchoNet-Dynamic10k+ cardiac ultrasound videos with EF + ventricle volumes.Non-commercial
SyntheaRealistic synthetic patient records — full EHR.MIT
1000 GenomesWGS from ~2,500 diverse individuals — human variation reference.Open access
DementiaBank (Pitt)Speech recordings + transcripts from Alzheimer's patients + controls.Consortium access
VitalDB6,300+ surgeries with continuous high-freq vital sign waveforms.Open, registration + DUA
Medical Segmentation Decathlon10 open datasets for 3D medical image segmentation.CC BY-SA 4.0
PANDA10k+ prostate biopsy WSIs with Gleason grades.CC BY 4.0
05 · Conferences

AI & health conferences

Borrowed from Raihan Faroqui's healthcare AI resource guide. Filter to find your tribe.

06 · Jobs

Job boards that don't suck (as much)

What they are. Not endorsements — just the lay of the land.

07 · Startup

So you want to build a startup

But don't know anything about tech/stack, marketing/sales, finances, management.

1984 VC

Scrub Capital

Redesign Health

Flagship Pioneering

08 · Life

Life hacking / survival

Because clinician-builders need to not burn out.

09 · Experiments

LLM matrix tests (alpha)

Testing out LLMs with fake patient scenarios generated by GPTs.

LLM Rubric

GPT fake case #1

Sepsis markdown (Claude)

Healthcare AI resources

10 · Archive

Past events

Where we've been.

Fall 2025 Conference
TimeSpeakerTalk
1:00pTBDWelcome
1:10–1:22pJosh Mandel, MDConversational Interoperability for Prior Auth and Beyond — MCP, A2A, and the Unreasonable Effectiveness of Making Data Accessible
1:35–1:47pJung Hoon Son, MDData CPR: How LLMs Revive Buried Clinical Insights
2:00–2:12pJason Theobald, MDContain Multitudes: A Docker Intro
2:25–2:37pCalvin Johnston, MDSoftware Design and Family Medicine: Overlapping skill sets
2:50pTBDWrap-up
Summer 2025 Conference
TimeSpeakerTalk
1:00pKevin Maloy, MDWelcome
1:10–1:22pVishnu Ravi, MDDigital Health that Ships: An Open Framework You Can Use Today
1:35–1:47pAlex Dummet, MDTopic TBD
2:00–2:12pPawan Jindal, MDStartup Survival 101: A Clinician's Guide
2:25–2:37pOmar Usman, MDChange Data Capture (CDC): A Defiant Approach
2:50pKevin Maloy, MDWrap-up
Fall 2024 Conference (Nov 9, 2024)
TimeSpeakerTalk
1:00pKevin Maloy, MDWelcome
1:10–1:22pPaulius Mui, MDFrom 0 to 1: Becoming a Clinician Who Codes
1:30–1:42pBrian Fung, PharmDPath of the Clinician Engineer
1:50–2:02pJoe Izzo, MDThe Coding CMIO — it's okay to get your hands dirty
2:10–2:22pKarambir Khangoora, MDLearning to Code as a Clinician: Building Medagogy
2:30–2:42pJoey LeGrand, PharmDOne Brain Can Be Better Than Two
2:50pKevin Maloy, MDWrap-up
Podchat — Should Hospitals Mandate GenAI Training? (Aug 29, 2024)

Listen to a short podcast, then talk about whether it's right or wrong. Original from Bill Russell at This Week Health. → Meetup event