Notes on building in digital health
Practical guides on launching, running and switching compliant care programs: architecture, compliance, pharmacy and unit economics. New posts every week.
Building on Lithos, Part 3: event-driven integration with webhooks
Why polling breaks care products, the event sequence from encounter.created to order.completed, thin payloads you fetch on receipt, and the idempotent handler pattern that keeps your app and the clinical pipeline in sync.
ReadRunning a telehealth program at scale, Part 5: migrating a live patient base without a refill gap
For programs with thousands of active patients: the risk register, the data you export first, why prescriptions are re-established rather than ported, wave-by-state cutover timed to refill dates, and the metrics that prove the switch worked.
ReadRunning a telehealth program at scale, Part 4: the refill lapse problem
A lapse is a patient running out before the next shipment. It is the most expensive event in a subscription program and the least measured. How to compute it, what causes it, and the cadence engine that closes the gap.
ReadBuilding on Lithos, Part 2: adding prescriptions to an existing app
For fitness, wellness, supplement, and women’s-health products that want to offer real treatment: the integration path from your existing user to a shipped prescription, in weeks.
ReadRunning a telehealth program at scale, Part 3: clinician capacity planning and a realistic turnaround SLA
The capacity arithmetic from encounters per month to clinician-hours, coverage by state, queue and escalation design, and the turnaround SLA you can actually promise.
ReadRunning a telehealth program at scale, Part 2: eight signs you’ve outgrown your platform
Turnaround drifting with volume, state expansion blocked, data you can’t export, lapses you can’t see. The symptoms operators report, what each costs, and how to tell a platform problem from a process problem.
ReadBuilding on Lithos, Part 1: the four integration patterns
Which integration pattern fits which team — from a fully custom patient app on the API to a forked portal template to an AI assistant ordering care — and what every pattern includes.
ReadRunning a telehealth program at scale, Part 1: unit economics at 1,000 encounters a month
Cost per encounter is the unit that matters once you have volume. The fixed and variable lines, how they move from 300 to 1,000 encounters a month, and the five levers that change margin.
ReadWhat is agentic healthcare? How AI agents deliver care in 2026
The shift from AI that answers to AI that acts — what agents can do in a care program, where clinicians must decide, and the infrastructure that makes it lawful.
ReadCan AI prescribe medication? How AI prescriptions actually work
AI cannot legally prescribe in any US state — but it can do almost everything around the decision. The rules, the workflow, and how to build “prescribe using AI” the right way.
ReadRefill medication with AI: how an agentic refill runs from request to doorstep
Why refills are the first job for a healthcare agent, the eligibility and follow-up checks it runs, the clinician authorization step, and what the patient sees.
ReadHow to start a peptide business in 2026: the compliant playbook
The clinical model that makes a peptide program lawful, the pharmacy bench that supplies it, what you can market today, and how to build for the bulks list.
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