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Ground-up build · Small business · 2024

Alta Family Clinic

Patient intake on clipboards, retyped into two systems by a front-desk staff of two. We replaced the clipboards, not the staff's process.

  • Rails
  • PostgreSQL
  • Tailwind
11 min → 3 min
average new-patient check-in
1 system
of record, instead of double entry into two
0
patient records left in a spreadsheet

The challenge

A two-provider family clinic collected new-patient history on paper, then staff retyped it into the practice management system, and again into a spreadsheet used for follow-up reminders. Transcription errors were routine, and the spreadsheet held protected health information on a shared drive.

What made it hard

  • The compliance bar was not optional

    Anything we built would hold protected health information, which set hard requirements on access control, audit logging, and where data was allowed to live. These were entry conditions, not later phases.

  • The existing practice management system had no usable API

    We could not integrate the way we would have preferred, which constrained the design from the start.

  • Staff had no appetite for a new system to learn

    Any solution that added steps to their day would have been abandoned inside a week — correctly, since their day is already full.

What we built

  1. 1

    Scoped it to intake only

    We deliberately did not try to replace their practice management system. The smallest change that removed the clipboards and the spreadsheet, and nothing beyond it.

  2. 2

    Built a tablet form patients fill out themselves

    Branching questions, so a patient only sees what applies to them, and it saves as they go. Front-desk staff stopped being transcriptionists.

  3. 3

    Added audit logging and role-based access in the first commit

    Not bolted on before launch. Every read of a patient record is logged from the beginning, because retrofitting an audit trail is how you discover you can't.

  4. 4

    Generated the one document staff actually needed

    A printable summary laid out the same way as the form they already read, so nobody had to learn to read something new.

  5. 5

    Retired the spreadsheet

    Follow-up reminders now come from the same system of record, and the protected health information came off the shared drive entirely.

The smallest useful thing

Alta’s first ask was a full practice management replacement. That would have been a much larger engagement, and we’d have been glad to have it.

It also would have failed. Replacing a practice management system means migrating years of records, retraining both providers and all staff, and running two systems in parallel for months — for a clinic with no technical staff and no slack in its schedule. The likely outcome is an abandoned rollout and a lot of spent money.

What was actually hurting was narrower: double entry and a spreadsheet full of PHI. Intake was the part on paper, so intake was the part to build. Everything else worked well enough.

Two years later they’re still using it, and their practice management system is still their practice management system. That’s the engagement working correctly, not us leaving revenue on the table.

“The part I appreciated was being told what not to build. We came in asking for a system to replace everything and left with something much smaller that we actually use.”

[Client name], [Title], Alta Family Clinic

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