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.

Did ChatGPT just walk into Epic — or climb in through a side window?

OpenAI · Sep 1, 2026

It's read-only, it's the USCDI slice, and it can't write back — that's not a clinical workflow, it's a viewer. The integration lets a clinician pull a patient's data into ChatGPT alongside public sources like ClinicalTrials.gov, RxNorm, DailyMed, and PubMed, but it doesn't come through Epic's sanctioned integration path, doesn't get the full longitudinal record, and there's no write-back — find something and you have to click out and re-enter Epic to act on it. OpenAI's own terms disclaim clinical use, which is exactly what people want to use it for. Worth keeping in mind: a badly-designed agent can fire dozens of API calls into a production Epic instance and slow the EHR down for everyone.

HatersThe "game over" takes came from people who've never had to keep a production EHR responsive on a Tuesday morning. Every health system in this conversation is already paying for tokens through Abridge, Ambience, or Epic itself — all running the same frontier models, just with a harness, a contract, and someone to call. The novelty isn't access. It's that OpenAI's name is on it.

The AI productivity number your CFO isn't going to like is 2.8 percent.

Doug Fullington, MD, AI from the Exam Room · Sep 6, 2026

We spent real money on ambient AI, and the extra visits never showed up — and they shouldn't have been budgeted for. UCSF looked at 1,565 physicians across 1.2 million encounters and found AI adoption moved visit volume by 2.8 percent, nowhere near the tenfold claims from conference stages. What we bought was note time and inbox time, and that shows up as retention and burnout, not throughput. If you want throughput, that's a staffing and protocol question, not a software one.

80/20The number that actually matters in Fullington's piece isn't productivity — it's the NEJM AI trial where physician diagnostic accuracy fell from 84.9% to 73.3% when the AI's suggestion was wrong, despite 20 hours of AI-literacy training. Automation bias survived the training. Any deployment plan that assumes "the clinician will catch it" is budgeting against that number.

Who actually owns the physician at a venture-backed clinic chain?

California Attorney General · Sep 2026

California just turned corporate practice of medicine from a structuring footnote into an enforcement action. The CPOM doctrine says a corporation can't employ physicians or control clinical judgment; the standard workaround is a friendly-PC structure where a physician nominally owns the practice and a management company runs everything else. California's AG went straight at that structure with a first-of-its-kind settlement against Carbon Health. For anyone building a clinical service — especially anyone layering AI into triage, refills, or protocol-driven care — the question stops being whether the model is good enough and becomes who the licensed decision-maker of record actually is, and whether they can say no.

BuilderIf your product makes a clinical recommendation and your business model depends on that recommendation being followed, you've quietly built a CPOM exposure. Write down, today, the specific step where a licensed human can override your system and what happens operationally when they do. That paragraph is now a diligence artifact.

A Maryland health system is back on paper, a week after OpenAI announced $1B for hospital cybersecurity.

Becker's Hospital Review · Sep 2026

The offer on the table is subsidized access to OpenAI's Daybreak models plus training, piloted through MS-ISAC, aimed at systems that can't fund a real SOC. Take the meeting, not the dependency. Luminis Health disclosed its cyber event September 1 and is still rerouting patients and charting on paper, with no restoration timeline and at least one cancer patient's radiation postponed. None of that is a model problem — it's downtime procedures, backups, and whether your clinicians have ever actually run a paper day.

If your agent agrees to something, are you the one on the hook?

Nate B Jones, Nate's Newsletter · Sep 6, 2026

Probably, yes — and that's the least surprising part. Agency law already covers people acting on your behalf, and there's no obvious reason it stops at software. The practical shift is that the middle of the job disappears: you write a short spec at the front, make a judgment call at the back, and everything in between is decisions you never saw.

BuilderThe line worth stealing: the last 2% of trust is where the money is. Getting an agent from 98% to 100% reliable is what determines whether an enterprise hands it a workflow at all — and in healthcare that threshold is higher than in any vertical you're benchmarking against.
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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