Transformational Blueprints

Most healthcare systems have no usable API. Somewhere in every clinic, hospital, and services company, a person is logging into one system, reading a screen, and retyping what's there into another screen. A thousand times a day.

David Mlcoch is co-founder and CEO of Asteroid, a YC W25 company building AI-powered computer use agents for healthcare. Asteroid's agents log into EHRs, payer portals, government registries, and legacy desktop systems, and do the workflow a trained employee would do. At scale, with guardrails, and with humans approving every high-risk action.

David's background is in AI from Edinburgh University, autonomous agents, robotics, and space tech. He co-founded Asteroid in 2024 with Joe Hewett, who previously used LLMs at Netcraft to disrupt hundreds of millions of dollars of fraud. The company is backed by Y Combinator, Entrepreneur First, and angels from OpenAI and Hugging Face.

Mario talks to David about why he pivoted from building an AI oversight layer to being the agent itself, what it's actually like to automate a portal nobody fully understands anymore, and why prior authorisation was the hardest category to crack. They also get into the self-healing experiment that went wrong, why David would rather an agent fail than produce a false positive, and what stops OpenAI and Anthropic from doing what Asteroid does.

This episode directly connects to the problems described in previous episodes. Data not moving. Systems not talking. Humans being the integration layer. David is building the infrastructure underneath all of it.

Timestamps

• The problem in plain terms. Someone in every clinic is reading one screen and retyping it into another, a thousand times a day
• What makes a great software engineer in 2026.
• Startup engineers are different.
• Advice for software engineers right now. If your company won't let you use Claude Code or Cursor, leave immediately
• The connection to previous episodes. Data not moving because nothing connects. Asteroid sits underneath both problems
• How Asteroid started as a supervision layer and pivoted to being the agent. Why customers kept asking "can you build the agents instead?"
• "The developer who wrote the system is not even alive now." What it's actually like to automate a healthcare portal nobody fully understands. Systems from 2009, Citrix-served pixels, sessions that expire every 10 minutes
• Asteroid Integrate. Hundreds of pre-built healthcare connectors. Why prior auth was the hardest category to crack: high-branching forms, no sandbox, one try per case, a thousand payers changing criteria constantly
• What self-heal actually means in a HIPAA environment. Why Asteroid minimises AI during execution and requires human approval for every significant step
• The hybrid approach. DOM-based parsing versus screenshot-based computer use. The 13-digit number that only read 12, and why eliminating false positives matters more than completion rate
• If every EHR opens proper APIs, does Asteroid become unnecessary? Why David would love that but isn't betting on it
• How EHR vendors feel about browser agents bypassing their $2-per-call APIs. Why Asteroid acts on the customer's authority to reach data they're already entitled to
• What stops OpenAI and Anthropic from doing this? Why general-purpose browsing agents are features, not companies. Why OpenAI deprecated Operator
• Build versus buy for Series A/B CTOs. Build when you have one or two portals. Buy when you're spending 18 months and three engineers on plumbing instead of product
• What healthcare back office looks like in five years if Asteroid succeeds.
• The workflow that's still too hard today but won't be in 12 months.
• The self-healing experiment that went wrong. Why fully autonomous agents rewrote themselves for a temporary error and broke two days later
• Advice for early-career technical founders.
• Where Asteroid is investing in 2026.

Watch the episode on YouTube: https://www.youtube.com/@SynaxiaGroup

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Extra Stuff:

Extra Stuff:

For hiring teams

Answer five short questions about the engineer you need. You see profiles of digital health engineers who match, with a live salary guideline for the role. Pick the profiles you like and we introduce you. It takes under 60 seconds. It covers founding engineers, full-stack engineers, AI engineers, engineering leaders and CTOs.

For engineers and market watchers

Digital Health Startup Careers tracks 550+ digital health companies and their open roles. Browse the Market Overview, Companies, Live Roles, Funding Radar and Salary Guide pages. The data refreshes every Friday. Engineers register to get matched to roles, including roles not listed publicly.

Do you want a copy of our Startup Engineering Market Report?

What's in the report?

1. Who's hiring the most engineers in your region/industry?
2. Gender diversity statistics
3. Is demand for engineers increasing or decreasing?
4. What are the key trends in the startup market?

-------------------------

Get in touch: https://www.linkedin.com/in/mario-michaels/

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Follow the Podcast: https://www.linkedin.com/company/transformational-blueprints-podcast/

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Follow Synaxia Group: https://www.linkedin.com/company/synaxia-group/

People with ADHD have twice the rate of death before age 46. Optimists live 11 to 15% longer. And poor social relationships increase your mortality risk by 50%, double the impact of high blood pressure.

Dr. Srini Pillay is a Harvard-trained psychiatrist, brain imaging researcher, executive coach, and co-founder of Reulay, an AI-powered platform delivering visual therapeutics grounded in neuroscience. He's worked with leaders at McKinsey, Harvard Business School, and Duke, and was named one of the top 20 movers and shakers in leadership development globally.

Mario talks to Srini about why the brain is the most under-invested asset in any organisation, what nine specific mindsets are scientifically linked to how long you live, and why the most pragmatic leaders are often the ones making the worst decisions under pressure.

They also get into what makes a great engineer in 2026 (hint: it's not programming), why Srini would hire for reinvention over adaptability, and the one mental shift he thinks every founder and technical leader should make today.

We cover;

• Srini's path from psychiatry and brain imaging at Harvard to biotech, executive coaching, AI music, and co-founding Rulai
• Why separating the brain from the body is the fundamental mistake in mental health
• What Reulay builds. AI-generated visual therapeutics using nature, geometry, and fractals, with a patent and preliminary results from Mayo Clinic and Blue Shield of California
• The nine mindsets scientifically linked to longevity. Focus, optimism, confidence, awe, body awareness, connection, autonomy, resilience, and empowerment
• What makes a great engineer now. Why the job has shifted from programming to overseeing systems, speaking across domains, and integrating AI agents
• Why emotional regulation is the hidden performance variable in technology teams. How stress hijacks the thinking brain and forces linear thinking when you need complexity
• Beyond resilience: anti-fragility. The flower delivery company that pivoted during COVID, and why "psychological Halloweenism" unlocks creativity your normal self can't access
• How Srini changed an insurance company's entire strategy in one day by walking their leadership team through possibility thinking before the strategy meeting
• Why Reulay isn't Calm or Headspace. Higher adherence, multi-platform deployment, deeper science, and a thesis built on the mind-body connection rather than relaxation alone
• Why AI won't replace an empathic brain. Human intelligence runs on the brain, the gut, the heart, and the immune system. AI is built on cognitive architecture alone
• Is the market ready for psychogenic longevity? Why Srini thinks he's ahead of demand and why that might be the right place to be
• The reality of selling wellbeing to enterprise. HR budget constraints, solution fatigue, and why Srini believes Reulay is fundamentally a consumer product
• Digital therapeutics took serious hits after the Pear collapse. What makes Reulay different and why agility at small scale is an advantage, not a weakness
• Where mental health funding is going wrong. Most investors are ignoring the mind-body connection and funding linear solutions to nonlinear problems
• The biggest mistake leaders make right now. Over-focusing. Why the default mode network only activates when you stop concentrating, and why your best ideas come in the shower
• How to hire for reinvention. Why Srini would favour liberal arts exposure, watch for non-verbal rigidity, and run imaginary scenarios to test cognitive flexibility
• The career advice Srini wishes he'd received earlier. Distribution beats product, and intentional networking beats networking for its own sake

Watch the episode on YouTube: https://www.youtube.com/@SynaxiaGroup

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Extra Stuff:

Extra Stuff:

For hiring teams

Answer five short questions about the engineer you need. You see profiles of digital health engineers who match, with a live salary guideline for the role. Pick the profiles you like and we introduce you. It takes under 60 seconds. It covers founding engineers, full-stack engineers, AI engineers, engineering leaders and CTOs.

For engineers and market watchers

Digital Health Startup Careers tracks 550+ digital health companies and their open roles. Browse the Market Overview, Companies, Live Roles, Funding Radar and Salary Guide pages. The data refreshes every Friday. Engineers register to get matched to roles, including roles not listed publicly.

Do you want a copy of our Startup Engineering Market Report?

What's in the report?

1. Who's hiring the most engineers in your region/industry?
2. Gender diversity statistics
3. Is demand for engineers increasing or decreasing?
4. What are the key trends in the startup market?

-------------------------

Get in touch: https://www.linkedin.com/in/mario-michaels/

-------------------------

Follow the Podcast: https://www.linkedin.com/company/transformational-blueprints-podcast/

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Follow Synaxia Group: https://www.linkedin.com/company/synaxia-group/

Matt Solnit spent 26 years in enterprise technology before walking into healthcare knowing almost nothing about it. He's now CTO of Pearl Health, a value-based care platform supporting over 10,000 providers and a quarter of a million Medicare beneficiaries across 40+ states.

Mario talks to Matt about why US healthcare data access is shockingly poor in 2026, how Pearl uses predictive models to tell doctors which patients need attention before they end up in hospital, and what it took to get an entire engineering team to a 96% Claude Code acceptance rate. Matt also gets into why he thinks humans will stop writing code within 18 months, how Pearl built an AI on-call agent that cut analyst ramp-up time in half, and why identity remains an unsolved problem in American healthcare.

In this episode, we discuss;

• Where the data comes from.
• Day-to-day as CTO. Identifying where to apply technology, guiding the board, and why ChatGPT's launch five months after he joined changed everything.
• What makes a great engineer in 2026.
• Startup engineers versus enterprise engineers.
• Why Matt chose healthcare.
• The 96% Claude Code acceptance rate. How a $20,000 Anthropic credit led to company-wide standardisation, and why command-line tools converted the holdouts.
• Balancing technical skill and cultural fit.
• Building culture in a remote-first company.
• The AI on-call agent.
• Where AI stops and humans start.
• The identity problem in US healthcare.
• Advice for new CTOs.
• What Matt would tell his 2022 self.

Watch the episode on YouTube: https://www.youtube.com/@SynaxiaGroup

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Extra Stuff:

Extra Stuff:

For hiring teams

Answer five short questions about the engineer you need. You see profiles of digital health engineers who match, with a live salary guideline for the role. Pick the profiles you like and we introduce you. It takes under 60 seconds. It covers founding engineers, full-stack engineers, AI engineers, engineering leaders and CTOs.

For engineers and market watchers

Digital Health Startup Careers tracks 550+ digital health companies and their open roles. Browse the Market Overview, Companies, Live Roles, Funding Radar and Salary Guide pages. The data refreshes every Friday. Engineers register to get matched to roles, including roles not listed publicly.

Do you want a copy of our Startup Engineering Market Report?

What's in the report?

1. Who's hiring the most engineers in your region/industry?
2. Gender diversity statistics
3. Is demand for engineers increasing or decreasing?
4. What are the key trends in the startup market?

-------------------------

Get in touch: https://www.linkedin.com/in/mario-michaels/

-------------------------

Follow the Podcast: https://www.linkedin.com/company/transformational-blueprints-podcast/

-------------------------

Follow Synaxia Group: https://www.linkedin.com/company/synaxia-group/

Peter Csiba has spent twenty years building infrastructure that can't afford to be wrong. Web search at Google. Platform engineering at Robinhood, handling roughly a billion dollars a day in transactions. Now he's Engineering Manager at Assort Health, leading the team responsible for EHR interoperability at a company that just hit unicorn status, a $120M Series C from Menlo Ventures, $222M raised total, revenue up 20x in fifteen months.

Mario talks to Peter about what actually breaks when you try to write data back into Epic without disrupting a health system's workflow, why he moved too fast with EHR partners early on and had to rebuild that trust, and what the Robinhood outage of January 2021 taught him about engineering for systems where the cost of being wrong is high. Peter also gets into the "write-only code era," the tension between flashy AI-generated demos and real engineering rigor, and why he thinks getting your first EHR integration right is a people problem before it's a technical one.

For any CTO or VP of Engineering thinking about their first healthcare data integration, or any engineer wondering what actually predicts a good hire in a fast-scaling startup, this one's dense with specifics.

• What Makes Great Engineers
• EHR Interoperability with Epic
• Scaling Integrations Seed to Unicorn
• AI Code Output vs Healthcare Rigor
• Lessons from Robinhood Outages
• Risk vs Compliance Balance
• Outages and Shipping Speed
• EHR Interop Edge Cases
• API Limits and Monetization
• Voice AI Startup Lessons
• Founder Stress and Volatility
• First EHR Integration Advice
• Finance vs Healthcare Mindset

Watch the episode on YouTube: https://www.youtube.com/@SynaxiaGroup

-------------------------

Extra Stuff:

Extra Stuff:

For hiring teams

Answer five short questions about the engineer you need. You see profiles of digital health engineers who match, with a live salary guideline for the role. Pick the profiles you like and we introduce you. It takes under 60 seconds. It covers founding engineers, full-stack engineers, AI engineers, engineering leaders and CTOs.

For engineers and market watchers

Digital Health Startup Careers tracks 550+ digital health companies and their open roles. Browse the Market Overview, Companies, Live Roles, Funding Radar and Salary Guide pages. The data refreshes every Friday. Engineers register to get matched to roles, including roles not listed publicly.

Do you want a copy of our Startup Engineering Market Report?

What's in the report?

1. Who's hiring the most engineers in your region/industry?
2. Gender diversity statistics
3. Is demand for engineers increasing or decreasing?
4. What are the key trends in the startup market?

-------------------------

Get in touch: https://www.linkedin.com/in/mario-michaels/

-------------------------

Follow the Podcast: https://www.linkedin.com/company/transformational-blueprints-podcast/

-------------------------

Follow Synaxia Group: https://www.linkedin.com/company/synaxia-group/

In this episode of Transformational Blueprints we speak with Doug Nissinoff, the founder of Intelligent Ventures, a pre-seed to Series A VC focused on AI and healthcare.

Doug shares his path from biology and clinical research to biotech investor relations, startup consulting across 25+ life sciences companies, and launching a $1M fund with 25 hands-on LPs and five investments, plus a 10-week accelerator offering $25K checks and a NYC demo day. He explains how they assess founders—especially “grit,” coachability, and traction like LOIs and early angels—and why clinicians on the committee better judge workflow fit and real demand.

Doug discusses why most AI healthcare startups default to SaaS, why regulated diagnostics/devices are underbuilt, how to spot AI-washing via weak data strategy and superficial partnerships, and predicts growing agentic AI, consolidation, and fewer “me too” products like scribes.

We discuss;

- Doug’s Early Career Path

- Startup Breakthrough Story

- From Consulting to VC Fund

- Accelerator Program Launch

- What Makes a Great Founder

- Why Healthcare SaaS Dominates

- Avoiding Me Too Products

- Clinicians in Deal Review

- Funding Filter Signals

- LOIs and Angel Proof

- Data Moat Not Wrappers

- Pitch Fine Print Traps

- Passing on a Weird Bet

- Team Changes the Read

- Signals and Hiring Advice

- 2027 Agentic AI Outlook

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Get in touch: https://www.linkedin.com/in/mario-michaels/

-------------------------

Follow the Podcast: https://www.linkedin.com/company/transformational-blueprints-podcast/

-------------------------

Follow Synaxia Group: https://www.linkedin.com/company/synaxia-group/

Watch the episode on YouTube: https://www.youtube.com/@SynaxiaGroup

-------------------------

Extra Stuff:

Extra Stuff:

For hiring teams

Answer five short questions about the engineer you need. You see profiles of digital health engineers who match, with a live salary guideline for the role. Pick the profiles you like and we introduce you. It takes under 60 seconds. It covers founding engineers, full-stack engineers, AI engineers, engineering leaders and CTOs.

For engineers and market watchers

Digital Health Startup Careers tracks 550+ digital health companies and their open roles. Browse the Market Overview, Companies, Live Roles, Funding Radar and Salary Guide pages. The data refreshes every Friday. Engineers register to get matched to roles, including roles not listed publicly.

Do you want a copy of our Engineering Market Report?

What's in the report?

1. Who's hiring the most engineers in your sector?
2. Gender diversity statistics
3. Is demand for engineers in startups increasing or decreasing?
4. What are the key trends in the startup market?

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Enterprise Architecture looks neat on paper — until reality hits.

In this episode of Transformational Blueprints we sit down with Jon Hill, VP of Enterprise Architecture, Data, and Analytics at Alvotech, to strip away the theory and talk about what really makes architecture work in the real world.

With over two decades in the field, Jon brings pragmatic insight into how EA can align with business growth, foster innovation through diversity, and stay grounded in outcomes rather than buzzwords.

You’ll learn:

• Why the best enterprise architects think like business strategists
• How to balance governance, agility, and AI innovation without killing momentum
• The overlooked soft skills that make EA actually stick
• How to build diverse, high-performing teams that challenge convention
• What it takes to earn stakeholder trust and deliver transformation that lasts

No frameworks. No fluff. Just the straight talk on what it takes to make enterprise architecture work.

05:17 – The Role and Value of EA

10:00 – Practical Skills for Real-World Architecture

20:17 – Choosing the Right Team and Company

25:20 – EA in Successful Digital Transformations

26:57 – The Importance of Diversity in EA Teams

29:30 – Developing Well-Rounded Solution Architects

31:40 – Challenges in Architectural Leadership

39:53 – The Impact of AI on EA

Watch the episode on YouTube: https://www.youtube.com/@SynaxiaGroup

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Extra Stuff:

Do you want a copy of our Architecture Market? 

What's in the report?

1. Who's hiring the most architects in your region?
2. Gender diversity statistics
3. Is demand for architects increasing or decreasing?
4. What are the key trends in the architecture market?

-------------------------

Get in touch: https://www.linkedin.com/in/mario-michaels/

-------------------------

Follow the Podcast: https://www.linkedin.com/company/transformational-blueprints-podcast/

-------------------------

Follow Synaxia Group: https://www.linkedin.com/company/synaxia-group/

Enterprise Architecture is evolving—fast. In this episode, we break from tradition and dive into what modern architecture really needs to look like: pragmatic, relevant, business-aligned, and AI-augmented.

🎯 We explore:

• Why so many architects are disillusioned with rigid frameworks—and what to do instead
• What the “full-stack architect” of the future looks like
• How to build adaptive “town plan” roadmaps that survive real-world volatility
• What it means to lead with cultural awareness, business value, and technical fluency
• How AI will elevate—not replace—the architect

Whether you're new to architecture or leading transformation at scale, this is the conversation we all need right now.

Watch the episode on YouTube: https://www.youtube.com/@SynaxiaGroup

-------------------------

Extra Stuff:

Do you want a copy of our Architecture Market? 

What's in the report?

1. Who's hiring the most architects in your region?
2. Gender diversity statistics
3. Is demand for architects increasing or decreasing?
4. What are the key trends in the architecture market?

-------------------------

Get in touch: https://www.linkedin.com/in/mario-michaels/

-------------------------

Follow the Podcast: https://www.linkedin.com/company/transformational-blueprints-podcast/

-------------------------

Follow Synaxia Group: https://www.linkedin.com/company/synaxia-group/

In this episode of Transformational Blueprints, we welcome Sam Slade, Head of Group Software Architecture at BPP Education Group, to discuss the journey 'From Monoliths to Event-Driven Architecture.'

Sam shares his career path from software engineering to architecture, the challenges of transforming large tech stacks, and real-world insights on implementing event-driven architecture. He covers key aspects like the importance of anti-corruption layers, handling failures, and maintaining strategic alignment in enterprise architecture.

Additionally, Sam provides valuable advice for newly appointed chief architects and reflects on the impacts of emerging technologies like generative AI on the industry. Tune in for expert strategies, practical lessons, and an in-depth look at modernizing legacy systems.

• Sam's Journey in Software and Architecture
• BPP's Global Expansion and EA Team Insights
• The Role of a Great Architect
• Event-Driven Architecture: Key Considerations
• Real-World EDA Implementation: A Case Study
• First 100 Days as Head of Group Software Architecture
• The Importance of Anti-Corruption Layers

Watch the episode on YouTube: https://www.youtube.com/@SynaxiaGroup

-------------------------

Extra Stuff:

Do you want a copy of our Architecture Market? 

What's in the report?

1. Who's hiring the most architects in your region?
2. Gender diversity statistics
3. Is demand for architects increasing or decreasing?
4. What are the key trends in the architecture market?

-------------------------

Get in touch: https://www.linkedin.com/in/mario-michaels/

-------------------------

Follow the Podcast: https://www.linkedin.com/company/transformational-blueprints-podcast/

-------------------------

Follow Synaxia Group: https://www.linkedin.com/company/synaxia-group/

In this episode of Transformational Blueprints, we engage in a deep conversation with Jason Baragry, Ardoq's Chief Enterprise Architect, who shares over 30 years of experience in the field of enterprise architecture.

Jason discusses his background, the unique aspects of his current role, and offers insights into what makes a successful architecture team. They delve into KPIs, the importance of sales skills for architects, and the impact of automation and AI on enterprise architecture. Jason provides practical advice for newly appointed chief architects and explores how AI can help lift junior talent and augment architects' tasks.

The episode also includes a discussion on how to effectively engage with vendors and the anticipated changes in the market over the next five years.

• Principles of Modern Architecture Practice
• The Role of Design in Architecture
• Challenges in Scaling Architecture
• Simplifying Complexity in Architecture
• Adapting Tools to Organizational Needs
• Starting Small for Big Success
• KPIs and Measuring Success in Architecture
• Improving Prioritization and Benefit Realization
• Embedding Architecture Thinking into Vendor Roadmaps
• Levels of Detail in Architecture Discussions
• AI for EA: Supporting Enterprise Architecture with AI
• Current and Future AI Applications in Architecture
• Advice for New Chief Architects

Watch the episode on YouTube: https://www.youtube.com/@SynaxiaGroup

-------------------------

Extra Stuff:

Do you want a copy of our Architecture Market? 

What's in the report?

1. Who's hiring the most architects in your region?
2. Gender diversity statistics
3. Is demand for architects increasing or decreasing?
4. What are the key trends in the architecture market?

-------------------------

Get in touch: https://www.linkedin.com/in/mario-michaels/

-------------------------

Follow the Podcast: https://www.linkedin.com/company/transformational-blueprints-podcast/

-------------------------

Follow Synaxia Group: https://www.linkedin.com/company/synaxia-group/

In this episode of Transformational Blueprints, we discuss the reasons why many transformation programs fall short and explores solutions with Anthony Sneed, Chief Technology Architect at the Hilti Group.

Anthony shares insights from his 30-year career in tech, detailing his journey from a C++ developer to his current leadership role. He discusses the importance of balancing technical proficiency with leadership skills, the strategies for building a cohesive architecture practice, and techniques for developing a technology roadmap aligned with business outcomes.

The conversation also covers critical aspects like governance, change management, and leveraging AI in technology development.

• Building a Modern Architecture Practice
• The Role of an Architect
• Transitioning from Developer to Architect
• Building Trust in a Distributed Company
• Courage and Risk-Taking in Leadership
• Modernizing Applications: A Case Study
• Tying Architectural Roadmaps to Business Outcomes
• The Importance of Metrics and Observability
• Continuous Delivery and Agile Practices
• Technology Acquisition and Evaluation
• Governance and Roadmap Execution
• Adapting to Rapid Technological Change
• Advice for New Chief Architects
• Navigating Company Politics
• Future of Talent and AI Integration

Watch the episode on YouTube: https://www.youtube.com/@SynaxiaGroup

-------------------------

Extra Stuff:

Do you want a copy of our Architecture Market? 

What's in the report?

1. Who's hiring the most architects in your region?
2. Gender diversity statistics
3. Is demand for architects increasing or decreasing?
4. What are the key trends in the architecture market?

-------------------------

Get in touch: https://www.linkedin.com/in/mario-michaels/

-------------------------

Follow the Podcast: https://www.linkedin.com/company/transformational-blueprints-podcast/

-------------------------

Follow Synaxia Group: https://www.linkedin.com/company/synaxia-group/