Dave Elkins is a senior principal engineer and fractional CTO who has spent his career building healthcare software at scale — from co-founding a startup that sold to UnitedHealth Group, to architecting cloud platforms at Optum serving millions of members.
At a Glance
In 2011, I co-founded HealthPost — a white-label consumer healthcare scheduling platform — built it from scratch as a solo engineer, grew the team and client base, and led a successful acquisition by The Advisory Board Company in 2014. That company eventually became part of UnitedHealth Group, where I spent the next several years as Director and then Senior Principal Engineer at Optum.
At Optum, I led the cloud architecture for Consumer Acquisition Services — a large-scale AWS platform — and served as architect on enterprise integration programs on Azure connecting major health systems. Most recently at HarmonyCares, I'm leading integration platform architecture across Salesforce, Athena, and CareLink for one of the country's largest in-home primary care organizations.
FenoHLTH is how I bring that depth to organizations that need senior technical expertise without a full-time hire — for a focused project, a fractional CTO role, or anything in between.
From HIPAA-compliant cloud infrastructure to agentic AI systems built for clinical workflows — every engagement is scoped around what your organization actually needs, not a standard package.
01 — New Capability
Modernize your software development lifecycle with AI at every stage — requirements, architecture, coding, testing, and deployment. I help engineering teams adopt AI-assisted development practices, integrate LLM-powered tooling into existing workflows, and build the governance guardrails that regulated healthcare environments require. Ship faster without cutting corners on compliance.
02 — New Capability
Design and build autonomous AI agents that work within healthcare workflows — prior authorization automation, care gap identification, clinical decision support, and operational process agents. I architect multi-agent systems with the reliability, auditability, and compliance controls that healthcare demands. From proof-of-concept through production deployment on compliant infrastructure.
03
HIPAA-compliant infrastructure on AWS or Azure. Architecture reviews, migration planning, IaC with Terraform, and cost optimization — based on real experience building at Optum scale.
04
Connect healthcare systems using HL7, FHIR R4, and direct vendor APIs. Deep hands-on experience with eClinicalWorks, Epic, Athena, Cerner, and custom integration agents for clinical workflows.
05
Strengthen your security posture for HIPAA, HITECH, and SOC 2. Risk assessments, zero-trust architecture, WAF configuration, incident response planning, and audit preparation.
06
Senior technology leadership on a part-time basis. Own your tech roadmap, manage engineering teams, evaluate vendors, and represent technology at the executive and board level — without the full-time cost.
07
Automated, secure delivery pipelines for healthcare software. CI/CD, container orchestration, secrets management, and security scanning built in from day one — not bolted on later.
08
Technical assessment for investors and acquirers evaluating healthcare technology companies. Architecture, security posture, scalability, team capability, and compliance readiness — delivered in plain language.
The best fit is organizations that need experienced technical leadership — on a project basis, temporarily, or as a long-term fractional partner. Series A/B digital health companies are a particular sweet spot.
Digital Health Startups
Fractional CTO and architecture advisory for Series A/B companies building clinical tools, platforms, or integrations.
Health Systems & IDNs
Cloud migration, EHR integration, and security hardening for regional and national health systems.
Healthcare SaaS Vendors
SOC 2 readiness, HIPAA compliance programs, and integration strategy for software companies selling into health systems.
Payers & Managed Care
Claims data infrastructure, provider data exchange, and HIPAA compliance programs for health plans.
Private Equity & Investors
Technical due diligence, post-acquisition assessment, and CTO-on-demand for healthcare portfolio companies.
Specialty Care Organizations
Right-sized cloud infrastructure, EHR integrations, and security programs for multisite specialty practices.
You work with me directly — not a team of junior consultants. Every engagement is specific, time-bounded, and tied to a clear outcome.
01 — Discover
A focused technical discovery to understand your architecture, risks, team capabilities, and constraints — no boilerplate assessments.
02 — Scope
Deliverables, timeline, and success criteria agreed before any work begins. No open-ended retainers unless that's what you need.
03 — Build
Architecture, implementation, or executive leadership — embedded with your team, accountable to outcomes, not hours billed.
04 — Transfer
Documentation, runbooks, and knowledge transfer so your internal team can own and operate everything we built together.
Whether you need a security assessment, a cloud migration plan, an agentic AI system, or a part-time CTO — the first conversation is always free.