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.

Did Medicare just collapse the year-long wait between FDA clearance and coverage?

Federal Register · Aug 2026

CMS filed a procedural notice formalizing RAPID — a pathway that pairs FDA breakthrough-device authorization with a same-day proposed Medicare National Coverage Determination, cutting the clearance-to-coverage timeline from roughly a year to about two months. The reimbursement gap, not the clearance, is what has killed breakthrough devices: companies burned runway for a year-plus between FDA authorization and a coverage decision. RAPID synchronizes the two clocks — the day FDA authorizes, CMS proposes coverage. For anyone building an AI-enabled device or advising one, the coverage strategy conversation now starts before submission, not after clearance, because the NCD proposal will land the same day the authorization does.

BuilderIf breakthrough designation is on your regulatory roadmap, your evidence plan just became dual-use: the same package has to satisfy FDA and stand up a proposed NCD simultaneously. Teams that treated coverage evidence as a post-clearance problem should re-sequence now.

The biggest healthcare breach of 2026 didn't hit a hospital

Fierce Healthcare · Aug 2026

Unlimited Technology Systems, an Ohio revenue-cycle management vendor, is now confirmed at 3.8 million records — the largest healthcare breach reported in 2026, and it didn't happen at a hospital. RCM and clearinghouse vendors hold clinical plus financial data at hospital scale with a fraction of a hospital's security scrutiny, and that gap is exactly where this exposure lived. Worth an afternoon: a current inventory of every vendor that touches your billing data, what they actually hold, and when you last saw their security attestations — before a regulator or a plaintiff's firm asks for the same list.

Can a chatbot talk a vulnerable patient into a worse place?

Nature Medicine · Aug 2026

Yes, measurably: across 810 simulated conversations with 9 chatbots, Nature Medicine researchers found the bots often create "vulnerability-amplifying interaction loops" that stabilize or escalate psychiatric risk rather than de-escalating it. The finding is the failure mode, but the deliverable is the instrument: the study ships a clinically validated auditing framework for how chatbots handle vulnerable users. That moves the safety conversation from anecdotes — the cases that make headlines — to something a health system or vendor can actually run against a deployment before patients find the edge cases themselves.

80/20Skip the debate about whether chatbots "should" do mental health — patients are already using them. The one thing that matters: there is now a validated audit you can demand from any vendor whose product talks to your patients. Ask for their results.

Two health-IT lawsuits just vanished — and cleared the runway toward Epic

Brendan Keeler · Aug 6

Nothing is filed against Epic — but the docket just cleared in a way worth noticing. IntusCare v. RTZ, the case defining what a "health information network" means under information blocking, settled and disappeared. The eClinicalWorks qui tam collapsed on day four of trial after years of discovery sanctions. And the 94-page Vyne v. Henry Schein injunction opinion landed with Vyne reportedly winning. Brendan Keeler's read: this docket-clearing could set up a hypothetical FTC or DOJ case against Epic later this year. Watch it, budget nothing, re-architect nothing — but know that information-blocking claims now have real teeth in court.

Why is Eli Lilly paying for Vanderbilt's referral queue?

Vanderbilt Health News · Aug 5

Lilly gave Vanderbilt an 18-month, $600,000 grant to build an AI triage agent inside the EHR that cuts the weeks-long wait between an amyloid-positive referral and the first monoclonal-antibody infusion — summarizing charts, flagging missing information, and recommending routing priority, with clinician override on everything. This is pharma funding pull-through infrastructure: every week shaved off the referral pathway is a week sooner a patient starts Lilly's drug. The design is explicitly built for transfer to other health systems, and the grant proposal already contemplates follow-on agents for MRI safety reports and insurance-authorization tracking. Expect more of this pattern — drug makers paying to remove the operational friction between diagnosis and their therapy.

Read the full wire ↗

learn by doing

Interactives

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

Nine Point Nine Billion Dollars of Bandage

August 8, 2026 · Source: Zena Wolf, “Skin Substitutes: How a $10 Billion Business Is Buying Its Way Out of Medicare Reform”, Healthcare Uncovered, Aug 6, 2026 · CMS CY2026 PFS final rule · MIMI Labs · CMS Physician & Other Practitioners PUF, 2024

Medicare Part B paid $9.86 billion for skin substitutes in 2024 — more than for ambulances or anesthesia — up from $23.9 million across 16 codes in 2013. Here are the 600 highest-billing clinicians in the country, one dot each, plotted by square centimeters of graft against Medicare dollars allowed per square centimeter, with the CY2026 flat rate of $127.28/sq cm drawn near the floor. Filter by specialty, state or volume, then press “2026 flat rate” and watch the field drop onto the line: the same 2.9 million square centimeters, repriced from $4.39 billion to $369 million, a 91.6% cut with nothing clinical changed. Nurse practitioners are the largest single billing block at $1.64 billion across 372 clinicians. Critical lens built in: CMS suppresses every row covering ten or fewer beneficiaries, so only 47% of national spend is visible at clinician level; the patient counts double-count anyone treated with more than one graft, which the page says outright; and the volume slider is there to be pushed — watch the live correlation wander once you're fitting forty points instead of six hundred.

The Price Ladder

Sixty-nine skin substitutes, every one a sheet of processed tissue laid on a chronic wound, every one billed to Medicare in 2024 — on a single dot field, price per square centimeter against total spend, sized by patients treated. The spread runs from $30 to $4,160 per square centimeter. One button reprices the whole field at the CY2026 flat rate and $9.84 billion becomes $905 million, a 90.8% cut that lands within a point of CMS's own estimate. Underneath: twelve years of Apligraf's allowed amount sitting flat between $29 and $39 while Q4205 — the largest single code in the country at $1.44 billion — jumps from $349 to $1,424 in one year; and the national bars going from $23.9M across 16 codes in 2013 to $9,858M across 94 in 2024, with beneficiaries rising only tenfold. Critical lens: the repricing is arithmetic, not a forecast — it holds volume constant, which is exactly what the rule is designed to change. The takeaway generalizes past wound care: any payment methodology that derives a price from the seller's own reported price gets gamed, and the tell is always spending growing an order of magnitude faster than patients.

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`