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.

The Pentagon ran one query against the military EHR and built a separation list. Could ours do the same thing tonight?

UnHack with Drex DeFord · Sep 17, 2026

The Secretary of Defense's office searched the military's EHR — one system covering about 9.5 million people — for anyone with a gender dysphoria diagnosis, history, or symptoms, and separation proceedings followed. A July 31 internal Air Force email spelled out the search criteria in writing. Several hundred active duty and reserve members, service academy cadets and ROTC students got surfaced; one military justice attorney says he's now fielding roughly 25 calls a week from people facing involuntary separation. Drex DeFord leads with an Army major — Ranger tab, two Afghanistan tours — who sat a separation board five days short of the 18-year mark that unlocks retirement. His point for the rest of us: the machine doesn't evaluate motive. The same cohort query that flags every diabetic overdue for a retinal exam will build a roster off any diagnosis code you hand it.

80/20The one thing that matters is the approval path on population queries by diagnosis, not the privacy policy sitting on the intranet. Go find out today who in your shop can run one of these unsupervised, whether it needs a second signature, and whether anyone reviews the query log. If the honest answer is "the analytics team, and nobody" — that's the same exposure, and the second-order cost is patients who stop telling you the truth.

Congress just subpoenaed Larry Ellison over the VA's $27 billion EHR. Should that change anything for us?

Becker's Hospital Review · Sep 18, 2026

The House Committee on Veterans' Affairs voted 19-0 and served subpoenas compelling Oracle's executive chair and CEO to testify about the company's $27 billion VA EHR contract. A subpoena to a founder-chairman is what a committee reaches for once it's stopped believing the written responses — and it lands the same month Oracle widened its restructuring charge by another $700 million while still signing new health systems onto the platform. If you're mid-selection or mid-migration, this isn't a reason to switch vendors; congressional hearings have a poor record of predicting product roadmaps. It's a reason to check that your own contract's remedies are tied to delivered functionality and dated milestones, not to the vendor's standing in Washington.

HatersTwenty-seven billion dollars and six years in, and the accountability mechanism we've landed on is asking the world's fifth-richest man to explain himself to a committee. Anyone who's sat through a hearing knows how this ends: four hours, no findings, and the go-live slips a quarter for reasons that have nothing to do with any of it.

A hundred AI features just showed up in one routine platform upgrade. Is that quarterly now?

Becker's Hospital Review · Sep 18, 2026

UW Health had to review more than a hundred AI features that arrived bundled into a single vendor platform upgrade — and that's probably the new normal, not a one-time event. Every governance framework most of us built assumes a procurement event: someone wants to buy an AI tool, it goes to committee. What Madison just lived through is AI arriving as a line item in a release note, which flips the decision from "do we buy this" to "do we turn this off" — and the default is on. Two things follow. You need a triage tier so low-risk features don't consume the same review as an autonomous clinical recommendation, or the committee becomes the bottleneck and people route around it. And the next vendor contract should require feature-level disclosure and an opt-out ahead of release, not a list you discover after go-live.

The length-of-stay delay everyone blamed on consultants turned out to be weekend DME procurement. Worth $2.5M a year.

The Epic Edge · John Lee, MD · Sep 16, 2026

A hospital's length-of-stay analysis initially pointed at slow consultant sign-offs — until someone noticed two units had configured the "Nursing Ready for Discharge" milestone differently, which had been mis-attributing the delay the whole time. Once they standardized the milestone and swapped hand-entered estimated discharge dates — which hospitalists default to "tomorrow" under cognitive load — for Epic's Cosmos median length of stay, the real driver turned out to be weekend DME procurement: oxygen, mobility aids, the stuff that doesn't move on a Saturday. Modeled across 10,000 discharges at a 300-bed hospital, fixing it is worth about $2.5 million a year.

BuilderIf you're selling analytics into a health system, the demo everyone gives is the insight. The work nobody demos is proving the underlying field means the same thing across units — and that's where the trust actually gets won or lost. A product that surfaces configuration drift before it surfaces a conclusion would sell itself to every informatics team that's been burned by a confidently wrong dashboard.

CMS is now the payer testing whether an Oura ring plus AI triage earns a Medicare rate. That's the real story.

Fierce Healthcare · Sep 18, 2026

Counsel Health is bringing Oura into CMS's ACCESS model, a voluntary Medicare payment model that just expanded past musculoskeletal into heart failure, COPD, substance use disorder, and tobacco cessation — about 160 organizations signed, roughly 40 live. The ring isn't the interesting part. What matters is that CMS is now the payer testing whether continuous passive data plus AI triage produces outcomes it will pay for, which converts a category that's lived on employer and cash-pay budgets into something with a Medicare-anchored rate attached. The real question isn't whether to buy a wearable program. It's whether you'd rather be a participant generating the outcomes data while the payment rules are still being written, or a buyer of whatever the model settles into three years from now.

Read the full wire ↗
clinical AI product decisions

Clinical AI Labs

Work through the decisions behind a clinical AI product: what to measure, what to trust, and when to release.

Screenshot of Would you ship this AI scribe?

· 5 min

Would you ship this AI scribe?

Find an unsupported claim in an AI-generated note, test a release rule, and see why zero observed errors may not be enough evidence.

Evaluation & release decisions

Try the lab →

Browse all AI Labs →

learn by doing

Interactives

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

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.

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