HEALTH-TECH FOUNDERS
A fractional CTO who still writes code
Architecture, build-versus-buy and EHR integration strategy, security and vendor-review readiness, hiring plans, and hands-on engineering when that is the fastest way forward.
Healthcare & health tech
Healthcare AI engineering, led by a working health-tech CTO.
Foundry 41 builds EHR integrations, patient-facing apps, and human-approved AI workflows for health-tech founders, digital-health startups, and practices, clinics, and MSOs. The work is led by Anthony, CTO at a healthcare technology company, who also serves as a fractional CTO for healthcare and AI SaaS companies.
PHI stays in your environmentBAA before any PHI accessA person approves consequential steps
Last updated
Who this is for
Which healthcare teams does Foundry 41 work with?
Three kinds: founders building a health-tech product who need senior technical leadership, digital-health startups that need EHR integrations and AI features shipped carefully, and practices, clinics, and MSOs that want administrative work prepared by AI and approved by staff.
DIGITAL-HEALTH STARTUPS
Integrations and AI features that hold up
EHR integration adapters, FHIR APIs, patient-facing web apps on AWS, and AI features with evaluation and human review designed in from the start.
PRACTICES, CLINICS & MSOS
One administrative workflow at a time
Patient intake, prior authorization, or chart audits—prepared by AI, approved by your staff, and running in your environment.
Outside healthcare, the same team does product design and development, AI engineering and company brains.
Who you'll work with
Who is Anthony?
Anthony is CTO at a healthcare technology company and the founder of Foundry 41. He works as a fractional CTO for healthcare and AI SaaS companies and is Expert-Vetted on Upwork, with more than $200K earned there.
His work centers on the parts that decide whether healthcare software ships: EHR integrations, data flows that respect PHI boundaries, AWS environments with narrow access, and AI features a clinician, coder, or front-desk lead can check before anything changes.
Foundry 41 is a small, senior engineering boutique led by Anthony. The work is senior-led and AI-assisted, and you work directly with the people building it.
- Current role
- CTO at a healthcare technology company
- Fractional CTO
- Healthcare and AI SaaS companies: architecture, roadmap, vendor and integration decisions, and engineering leadership.
- FHIR
- Reading and writing FHIR resources through EHR and platform APIs.
- EHR vendor APIs
- Vendor APIs, including the partner or developer programs each EHR requires.
- AWS
- Account structure, IAM least privilege, encryption, logging, and environments that keep PHI inside the client's boundary.
- AI workflows
- Agents that prepare work, evaluations that check it, and approval gates before anything consequential happens.
Use cases
What can AI do in a healthcare workflow?
AI can prepare the repetitive, rule-bound parts of healthcare work—collecting, checking, drafting, and flagging—so staff spend their time on decisions. In every use case below, the agent prepares and a person approves.
| Use case | What the agent prepares | What a person decides | Systems usually involved |
|---|---|---|---|
| Patient intake | Checks intake forms for missing or inconsistent fields, matches insurance details, and drafts follow-up requests to the patient. | Front-desk staff confirm and send. Nothing writes to the chart without approval. | EHR or practice-management system, intake forms, eligibility checks |
| Prior authorization | Assembles the packet from the chart and the payer's rules, flags missing documentation, and drafts the submission. | Staff or the clinician reviews, corrects, and submits. | EHR, payer portals or APIs, document storage |
| Documentation and coding audits | Compares each day's charts with the CPT codes that were billed and lists likely mismatches with the supporting note text. | A coder or biller works each flag and decides on any correction. | EHR notes, billing and claims data |
| Care navigation | Drafts next-step outreach, reminders, and referral follow-ups from the care plan and schedule. | A care coordinator edits and approves each message. | EHR, patient messaging, scheduling |
| EHR integration adapters | Engineering work: adapters that move data between your product and EHRs over FHIR or vendor APIs, with retries, logging, and reconciliation. | Your team approves field mappings and each release. | FHIR endpoints, EHR vendor APIs |
| Patient-facing web apps | Engineering work: intake, scheduling, education, and portal-style apps on AWS, connected to the EHR where needed. | Your team approves content, access rules, and releases. | Your product, EHR integration, AWS |
An example workflow
What does a daily chart audit look like?
Each morning the agent compares yesterday's documented visits with the CPT codes that were billed and prepares a review list. A coder works the list; nothing in the EHR or the claim changes until they approve.
CHART AUDIT · ILLUSTRATIVE · FICTIONAL DATA
One review list, one owner, every morning.
The agent reads, compares, and explains. The coder decides. The record keeps the note excerpt, the billed code, the flag, and the decision together.
46ENCOUNTERS READ
5FLAGGED FOR REVIEW
0CHANGES WITHOUT APPROVAL
1CODER
AUDIT RUN · ILLUSTRATIVEOWNER · CODING LEAD
01
Read yesterday's encounters
COMPLETERead-only access to signed notes and the codes submitted for billing.
02
Compare documentation with billed codes
COMPLETEEach flag cites the note text and the rule it was checked against.
03
Coder reviews the flags
REVIEW REQUIREDAccept, dismiss with a reason, or send back to the clinician.
04
Approved corrections go to billing
PENDINGOnly after approval; dismissals feed the next rule review.
PHI, BAAs, and control
How is PHI handled?
PHI stays in your environment. We sign a Business Associate Agreement (BAA) before any PHI access, work through delegated access you can revoke, and design each workflow so the agent sees only the minimum data the task needs.
We build compliance-minded architecture; we do not certify HIPAA compliance. Your compliance program, policies, and vendor reviews determine that, and we support their review with data-flow diagrams, access matrices, and run records.
Talk through the architecture- BAA before PHI
No PHI access until a BAA is signed. Before that, we work with synthetic or de-identified data.
- Your environment, your keys
Systems run in your cloud account. Logs, records, and outputs stay with you.
- Minimum necessary access
Scoped, revocable credentials per workflow, read-only unless a write step is approved in the Blueprint.
- Approved providers only
PHI goes only to model and API providers you have approved under your own agreements.
- A person approves
Anything that writes to the chart, changes a claim, or messages a patient waits for a named person.
- A record of every run
Inputs, outputs, flags, decisions, and approvers are kept with the work.
Working together
How does a healthcare engagement start?
With a short fit call. From there it is either a fractional CTO engagement, or a paid, fixed-scope Workflow Blueprint for one workflow, followed by a build and validation targeted at 30 business days from Blueprint kickoff.
The 30-business-day window is a design-partner target that depends on access, integration readiness, and your security review; it is not a promise. We do not publish prices; scope and fee are agreed before any paid work starts.
LEADERSHIP
Fractional CTO
Senior technical leadership for a health-tech or AI SaaS company, part-time.
- Architecture and roadmap
- EHR integration and vendor decisions
- Security and vendor-review readiness
- Hiring, process, and hands-on build
PAID · FIXED SCOPE
Workflow Blueprint
Diagnose one workflow before committing to a build. Useful on its own.
- Current workflow, exceptions, and owner
- Systems, PHI flows, and permissions
- Approval points and autonomy levels
- Acceptance cases, recovery, scope, and budget
BUILD AND VALIDATE
Implementation
Build the workflow or integration in your environment and prove it against agreed cases.
- Integration adapters and scoped access
- Human approval before write-back
- Monitoring, rollback, and runbook
OPTIONAL
Operate or hand over
Foundry runs the agreed scope under revocable access, or your team takes over with the runbook.
- Reviewed changes and releases
- Incident handling and recovery
- Model performance and cost review
Questions
Frequently asked questions about healthcare work
Do you offer fractional CTO services for healthcare startups?
Yes. Anthony, CTO at a healthcare technology company, works as a fractional CTO for healthcare and AI SaaS companies: architecture, roadmap, EHR integration and vendor decisions, security and vendor-review readiness, hiring, and hands-on engineering.
Which EHRs and standards do you integrate with?
We build against FHIR APIs and EHR vendor APIs. Access programs differ by vendor, so the Workflow Blueprint confirms what each EHR allows before a build.
Will you sign a BAA?
Yes. We sign a Business Associate Agreement before any PHI access. Until it is signed, we work only with synthetic or de-identified data.
Is your work HIPAA compliant?
We do not claim or certify HIPAA compliance. We build compliance-minded architecture: PHI kept in your environment, least-privilege access, audit records, and human approval. Your compliance program, policies, and vendor reviews determine compliance, and we support that review.
Where does PHI live?
In your environment. Systems run in your cloud account under your keys, PHI goes only to model and API providers you have approved under your own agreements, and logs and run records stay with you.
Can the AI change the EHR or a claim on its own?
Not in the workflows we build by default. The agent prepares drafts, flags, and packets; anything that writes to the chart, changes a claim, or messages a patient waits for a named person's approval. Autonomy levels are set in the Workflow Blueprint and change only with the workflow owner's approval.
Which healthcare workflows make good first projects?
Repetitive, rule-bound work that crosses systems and already has a person who checks it: patient intake, prior authorization packets, daily chart audits against billed CPT codes, care-navigation follow-ups, and EHR integration adapters.
Have you built this for healthcare customers before?
Anthony builds healthcare software as CTO at a healthcare technology company. Foundry 41's own AI workflow references, Sky and Olivia, are internal deployments for our own companies, not healthcare customer deployments, and we do not show client work without the client's permission.
How do we start?
Email hello@foundry41.com for a short fit call. Tell us the workflow or technical decision, the systems involved, and who owns the outcome. The call decides whether a fractional CTO engagement, a Workflow Blueprint, or neither is the right next step.
Bring one workflow or one technical decision
Start with a fit call.
Tell us the workflow, the systems involved, and who owns the outcome. A short call tells both sides whether it is a fractional CTO engagement, a Workflow Blueprint, or not a fit.