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.

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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.

The White House sits down with OpenAI, Anthropic, Google, and Meta today — about the models inside your EHR

Becker's Hospital Review · Aug 4

Today's meeting is about building a government review framework for frontier models before public release, extending the voluntary 30-day pre-launch access system from June's executive order. The open questions are the operational ones: how "frontier model" gets defined, and which office runs the review. If your ambient scribe, inbox drafts, and chart summarization all ride on these four labs' models, a pre-release review step quietly becomes part of your upgrade cadence — and your vendors' release notes just acquired a federal dependency.

80/20The review isn't the thing that matters — the definition is. Whoever writes the threshold for "frontier model" decides whether this touches two labs or every model sitting under your EHR integrations.

Amgen's patient data walked out of someone else's cloud

BleepingComputer · Jul 31

Amgen filed an 8-K saying attackers pulled patient health information and proprietary data out of multiple third-party cloud environments — detected in July, declared material on July 29. No cloud provider named yet, no headcount yet. The detail worth sitting with: the breach lived entirely in vendor clouds, not Amgen's own data center. Our real exposure is the BAA list — worth checking which of your third parties hold PHI, and when you last verified their controls instead of their attestations.

ONC wrote FHIR prior auth into the hospital payment rule — the pilot era is over

HealthIT.gov · Aug 2026

The Da Vinci prior-auth and payer-exchange implementation guides — PAS, CRD, DTR, CDex, PDex, plus CARIN Blue Button — are now adopted standards inside the FY2027 IPPS final rule, effective October 1, 2026. Electronic prior authorization has spent years in demo land. Putting these FHIR guides into the inpatient payment rule attaches them to how hospitals actually get paid, which is the only adoption mechanism that's ever worked in health IT. If your roadmap filed prior-auth APIs under 2027–2028, the effective date just moved into this fiscal year. Worth asking your EHR vendor this week which of the six guides they'll certify against, and when.

The $12,500 review that replaces the FDA

MIT Technology Review · Jul 30

Montana's expanded right-to-try law lets a company with a Phase I drug pay $12,500 for review by a private board, then sell the treatment directly to consumers — no FDA approval required, and no requirement that the buyer be terminally ill. The first review board, run by longevity-focused firm Infinita, has already received its first two applications: a neuropathy drug and a hearing-loss drug. Unlike FDA expanded access, companies set their own prices. Worth watching two things: whether patients start traveling for treatment, and whether malpractice carriers and health plans decide any of this is their problem.

SkepticA private board, funded by fees from the companies applying to it, reviewing drugs the FDA hasn't — at whatever price the market bears. The skeptic doesn't have to squint: it's a pay-to-play IRB with a state flag on it.

Don't license the algorithm

STAT News · Aug 3

Licensing bills for autonomous AI providers have already failed in Idaho and Iowa. Now the Federation of State Medical Boards' own leadership is arguing in STAT that AI shouldn't be licensed as a separate practitioner at all — it should sit inside existing physician accountability structures, with medical boards keeping a say, pointing to Utah's Doctronic prescription-renewal pilot as the test case. The translation for us: regulators intend for accountability to stay with the humans deploying the tools. That's us — so an AI oversight committee is the licensing board we actually control.

Read the full wire ↗

learn by doing

Interactives

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

Clinics Like Mine

August 5, 2026 · Source: Dr. Gigi Magan, “Zero Studies From Clinics Like Mine” (Aug 4, 2026) · MIMI Labs · HRSA Health Center Program UDS, 2024 vintage, 1,352 grantees / 32.3M patients

Every landmark ambient-scribe study ran at UCLA, Mass General Brigham, Emory, UCSF, Yale, UC Davis, Kaiser Northern California, Penn or Stanford — and none in a federally qualified health center. So here is the population that isn’t in the evidence, all of it on one scatter: every HRSA grantee in the country, panel size against the share of patients best served in a language other than English. 8,977,620 patients — 27.8% of the national panel — sit on that axis, and 190 grantees are above 50%. Stress test: the tilt reads r = 0.205 until you drag the minimum-panel filter to 20,000, at which point it collapses to 0.115 — it was the long tail of 552 rural grantees at a 3.4% median. Critical lens: the language field is self-reported and blind to accented English, the grain is the grantee not the clinic, and the zero is a hand-assembled absence — “none found,” not “none exist.”

Nine and 1,352

August 5, 2026 · Source: Dr. Gigi Magan, “Zero Studies From Clinics Like Mine” (Aug 4, 2026) · MIMI Labs · HRSA UDS 2024 · PNAS 2020 word error rates

1,352 health center grantees arrive as a cloud, sort themselves into a dot histogram by the share of patients best served in another language, the 499 above 25% light up — 16.4 million patients, half the national panel from a third of the dots — and then the nine academic settings where the evidence was actually generated slide in underneath with nothing above them. One animated field, no click-through; it plays itself and you can scrub back. Alongside: the PNAS audit of five commercial speech-recognition systems, word error rate 0.35 for Black speakers against 0.19 for white. Critical lens: one dot is one grantee, not one clinic and not one patient, so the tall left stack over-represents small rural organizations; the language field is blind to accent; the nine is an absence assembled by hand from 41 checked references.

Browse all interactives →

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.

Fetal AI lifts 22 points 🤰, Your devices already run AI 🕵️, Part D comes off the drip 💧

⚡ Around the Wards

Read on Substack →

Duke built its own chart reader 🔦, ~80 AnMed sites go dark 🕳️, Being safe vs feeling safe 🤔

⚡ Around the Wards

Read on Substack →

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

Tool	Best for	Notes
Claude Code	Complex multi-file work, architecture	Terminal-native, large context. The power tool. Good for non-code tasks too.
Cursor	Daily coding with autocomplete + inline edits	AI IDE, huge user base.
Windsurf	Budget entry, Cascade collaboration	AI-native editor.
Copilot / Codex CLI	Repo-native GitHub workflows	Tight GitHub integration.

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.

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

Clinical datasets worth knowing

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

Name	Relevance	License
ReXGradient-160K	160k multi-site CXR + reports — vision-language radiology sandbox.	Harvard DUA, non-commercial
CheXpert Plus	Large paired CXR–report set; benchmarked in many papers.	Stanford DUA, free research
Endoscapes 2023	Open laparoscopic chole frames — segmentation / CVS detection.	CC BY-NC-SA 4.0
Surg-3M	3M surgical frames powering "SurgFM" foundation model.	TBA, expect research-only
AFRICAI Repository	Imaging sets from African centres — fairness & domain shift.	Mixed open licenses
OpenOximetry	Waveforms + skin-tone data for pulse-ox bias work.	PhysioNet credentialed
DeepLesion	32k CT slices with bounding-box lesions; detection / tracking.	NIH DUA, research-only
BioASQ Synergy 2024	Biomedical Q-A pairs — LLM eval set.	CC BY 2.5
CliniFact	Clinical-trial fact-checking corpus — fine-tune retrieval / RAG.	MIT
Hallucination Annotations	Doctor- & LLM-written discharge summaries with token-level labels.	PhysioNet credentialed
Clinical-Trial Eligibility QA	QA pairs linking MIMIC-IV to apixaban RCT criteria.	PhysioNet credentialed
PIFIR	Wearable PPG/ECG for arrhythmia-free interval prediction.	PhysioNet restricted
GREGoR R02	Rare-disease genomic + phenotypic harmonised data.	dbGaP controlled
Synthetic Rare-Disease EHRs	Benchmark synthetic EHRs for low-prevalence conditions.	CC BY
Korea4K	4k Korean genomes — ancestry diversity for variant calling.	EGA controlled
OpenNeuro	20k+ public neuro-imaging sessions; BIDS-ready.	CC0 / CC BY-SA
Bridge2AI-Voice	Multimodal speech (voice, vitals) for health AI.	PhysioNet restricted
PMDB Pain Monitoring	Wearable IMU + self-report pain diary.	CC BY 4.0
DREAMT Wearable Sleep	Apple Watch PSG pairs for sleep-staging models.	PhysioNet restricted
MC-MED	Multi-condition medical dialogue (GPT / human).	PhysioNet credentialed
Wearable Stress Dataset	Smartwatch vitals + stress labels — mental health ML.	PhysioNet restricted
MIMIC-IV v3.1	Flagship 380k-patient de-id EHR; ED + ICU tables.	PhysioNet credentialed + CITI
MIETIC	Italian clinical-notes corpus with entity spans.	PhysioNet credentialed
ODD (Opioid Behavior)	Annotated notes for opioid-related behaviour NLP.	PhysioNet credentialed
UK Biobank	500k 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
AmsterdamUMCdb	First open European ICU DB — 23k admissions.	DUA required
ADNI	Longitudinal Alzheimer's — serial MRI/PET, clinical, biomarkers.	Free non-commercial
ABCD Study	10k 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-Dynamic	10k+ cardiac ultrasound videos with EF + ventricle volumes.	Non-commercial
Synthea	Realistic synthetic patient records — full EHR.	MIT
1000 Genomes	WGS from ~2,500 diverse individuals — human variation reference.	Open access
DementiaBank (Pitt)	Speech recordings + transcripts from Alzheimer's patients + controls.	Consortium access
VitalDB	6,300+ surgeries with continuous high-freq vital sign waveforms.	Open, registration + DUA
Medical Segmentation Decathlon	10 open datasets for 3D medical image segmentation.	CC BY-SA 4.0
PANDA	10k+ 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.

jobs.heyhealthtech.com
Rock Health Capital
MDisrupt
PharmDs in IT
AMIA
General Catalyst— surprisingly good for startups
Matchday Health
Wellfound
Look for Zebras
Fractional Jobs
HealthTech Nerds Jobs

07 · Startup

So you want to build a startup

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

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.

Past events

Where we've been.

Fall 2025 Conference

Time	Speaker	Talk
1:00p	TBD	Welcome
1:10–1:22p	Josh Mandel, MD	Conversational Interoperability for Prior Auth and Beyond — MCP, A2A, and the Unreasonable Effectiveness of Making Data Accessible
1:35–1:47p	Jung Hoon Son, MD	Data CPR: How LLMs Revive Buried Clinical Insights
2:00–2:12p	Jason Theobald, MD	Contain Multitudes: A Docker Intro
2:25–2:37p	Calvin Johnston, MD	Software Design and Family Medicine: Overlapping skill sets
2:50p	TBD	Wrap-up

Summer 2025 Conference

Time	Speaker	Talk
1:00p	Kevin Maloy, MD	Welcome
1:10–1:22p	Vishnu Ravi, MD	Digital Health that Ships: An Open Framework You Can Use Today
1:35–1:47p	Alex Dummet, MD	Topic TBD
2:00–2:12p	Pawan Jindal, MD	Startup Survival 101: A Clinician's Guide
2:25–2:37p	Omar Usman, MD	Change Data Capture (CDC): A Defiant Approach
2:50p	Kevin Maloy, MD	Wrap-up

Fall 2024 Conference (Nov 9, 2024)

Time	Speaker	Talk
1:00p	Kevin Maloy, MD	Welcome
1:10–1:22p	Paulius Mui, MD	From 0 to 1: Becoming a Clinician Who Codes
1:30–1:42p	Brian Fung, PharmD	Path of the Clinician Engineer
1:50–2:02p	Joe Izzo, MD	The Coding CMIO — it's okay to get your hands dirty
2:10–2:22p	Karambir Khangoora, MD	Learning to Code as a Clinician: Building Medagogy
2:30–2:42p	Joey LeGrand, PharmD	One Brain Can Be Better Than Two
2:50p	Kevin Maloy, MD	Wrap-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

clinicians.dev

The Wire

Interactives

Builder's Briefing

What the Vibe

AI & agentic engineering

Context engineering — the foundation

Learn CLAUDE.md / AGENTS.md

Tools of the trade

Skills marketplaces

Healthcare MCPs

Agentic frameworks & orchestration

Communities, courses, substacks

EHRs, FHIR, fake patients

EHRs & FHIR

Generate fake patients

Clinical datasets worth knowing

AI & health conferences

Job boards that don't suck (as much)

So you want to build a startup

Life hacking / survival

LLM matrix tests (alpha)

Past events

Learn `CLAUDE.md` / `AGENTS.md`