Clinical System Build · 2025 – present
A behavioral health practice
Three production systems for one behavioral health practice over two years: a clinical assessment platform, a full EHR with insurance claims submission, and an in-session data collection tool, all operated under a signed Business Associate Agreement.
Client name withheld under agreement.
- therapists using it daily
- 40therapists using it daily
- rented subscriptions replaced
- 3rented subscriptions replaced
- clinician-reported issues fixed in one round
- 20clinician-reported issues fixed in one round
What I walked into
The practice was renting its entire clinical stack: a commercial behavioral-health EHR, plus separate off-the-shelf tools for assessments and for ABA session data. Three monthly subscriptions, and not one of them could be shaped to fit. Each worked the way its vendor had decided a practice ought to work, which was not how this practice actually worked, so clinicians spent their time working around the software instead of with it.
They did not want a fourth product to rent. They wanted something built the way they think.
So I built them a demo of what that would look like. It went into production, and I have been building on it ever since.
What I did about it
Three systems, built and shipped in sequence, each one solving a problem the last one exposed.
The assessment platform administers standardised clinical instruments (PHQ-9, GAD-7, PCL-5, ASRS-v1.1, CAGE-AID) with a configurable scoring engine that handles sum, average and rule-based methods, then maps raw scores into interpretation bands. Assessments reach clients through tokenised respondent links or scheduled email invites, so a clinician never has to chase paperwork. Every submission is written as a new immutable record rather than an update, which means the full longitudinal history of a client's scores is preserved and nothing can quietly overwrite a prior result.
The EHR carries the clinical day-to-day: client records with auto-generated MRNs, session notes, intakes, treatment plans, a 13-field Mental Status Exam, colour-coded risk assessment, calendar and scheduling, and inline signature capture for provider, client and co-signer so nothing requires a second trip to another screen. It submits insurance claims through a clearinghouse integration, with proper CPT coding across both psychotherapy and adaptive-behaviour services.
The data collection tool covers what happens inside the session itself: continuous session timing, per-programme measurement, wellness check-ins, and graphed output for review.
On the compliance side, and this is the part that actually matters: PHI is encrypted in transit, access is role-based so each user reaches only their assigned clients, two-factor authentication is supported, sessions time out automatically, and access to client records is audit-logged. Identifying information is deliberately excluded from third-party error monitoring, a deliberate decision to accept thinner debugging data rather than let PHI leave the compliance boundary through a side door nobody thinks to check.
“He understood the compliance side before we had to explain it. We've come back three times since.”
Next case study
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