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The power of predictability, helping healthcare leaders get more out of AI, and a worthwhile visit to Atlanta.

Foxbox Founder's Update - Spring 2025 | Foxbox Digital

As we navigate 2025, one thing is clear: stability and predictability have never been more valuable. In a world of economic uncertainty, companies that focus on consistent, proactive product maintenance are reaping the rewards.

Product Maintenance: A Strategic Advantage

We’ve always believed that product maintenance is more than just fixing bugs—it’s about ensuring reliability, improving performance, and keeping products aligned with evolving customer needs. Our clients are proving that a 

leads to higher user engagement, fewer costly disruptions, and a foundation for future innovation.

One of our healthcare clients recently revamped their product maintenance approach, shifting from a reactive model to a proactive one. The result? Faster feature releases, fewer production issues, and better provider adoption rates. It’s a reminder that 

 isn’t just about survival—it’s a competitive edge.

We’ve been weaving AI into nearly every aspect of our business, from how we build and maintain products to how we 

help our clients leverage AI responsibly.

Healthcare organizations, in particular, are looking for guidance on AI integration. Our team is helping clients navigate AI with confidence—whether that’s through predictive analytics, automation, or patient-facing AI solutions. It’s not just about innovation, it’s about creating practical, compliant, and ethical AI applications that drive real impact.

Healthcare: Engaging Providers & Patients

Healthcare remains a core focus at Foxbox, and we’re seeing a growing demand for better digital experiences for both providers and patients. Our team is tackling these challenges head-on, from reimagining provider workflows to building consumer-grade patient experiences.

One thing we’re particularly excited about is how  

 are enabling organizations to modernize their systems without being locked into a monolithic EHR vendor. Additionally, our 

 are helping healthcare clients explore how AI can enhance their operations, from administrative automation to personalized patient engagement.

I was lucky to spend some quality time with Elliott Torres and Brett Ryan in Atlanta. Special thanks to Bala Balakrishnan and Vio Balanoiu for helping carve us out some space to make the most of it. I worked closely with Bala, Vio, and of course Elliott at Anthem building 

. Always great to collaborate together the old fashioned way.

Speaking of reasonable things to do - we took a home-made airplane for a test drive. Thankfully it was built by a friend whose engineering brain I trust implicitly. Thanks 

As we look ahead, we’re doubling down on building products that are not just innovative, but also scalable, maintainable, and future-proof. If you’re curious to explore more of what that looks like for your business, let’s talk.

Founder's Update - Spring 2025

"Sometimes, the best compliment is being 'out-of-sight, out-of-mind.' At Foxbox, we’ve learned that true success isn’t just about high-visibility projects—it’s also about seamless, reliable execution that keeps our clients’ teams moving forward without friction."

Product maintenance, the power of predictability and the advantage of going unnoticed

I want projects with high visibility as much as the next guy.

But as Foxbox has evolved, I’ve come to equally embrace the other side of that equation.

“Honestly, you guys are completely out-of-sight, out-of-mind.”

It was a routine quarterly review with the VP of Engineering of an ongoing product maintenance client. Unlike the iconically devastating line from Don Draper in Mad Men, it was intended as a compliment. And it was received as one.

When the goal is predictability, routine problem-solving, and the ability to keep our clients’ engineering teams pointed in the right direction, off-the-radar is not a bad place to be.

service at Foxbox is designed to provide. We step in to handle the ongoing upkeep, bug fixes, and iterative improvements that keep digital products running smoothly—so our clients don’t have to think about it. No firefighting. No disruptions. Just dependable, proactive maintenance that keeps their teams focused on innovation rather than troubleshooting.

High-profile launches are exciting, but sustained success depends on what happens after the initial release. Without a solid maintenance strategy, even the best-built products degrade over time. Technical debt creeps in, performance lags, security vulnerabilities emerge. 

That’s where we come in—ensuring the 

long-term stability and scalability of the products our clients rely on

So when a client tells us we’re “out-of-sight, out-of-mind,” we take it as proof that we’re doing our job right. Because in product maintenance, the best work is often the work that goes unnoticed.

Want to keep your product running at peak performance without the headaches? 

The value in staying "off-the-radar"

A quick primer on the pros and cons of building a custom AI model, using off-the-shelf LLMs, or a hybrid approach. 

Custom LLM vs Off-the-Shelf: Navigating AI Platform Decisions

Deciding between a custom AI model, an off-the-shelf solution, or a hybrid approach? Each has trade-offs in cost, control, and scalability. Here’s how to choose the best option for your business needs and goals.

Building a proprietary LLM from the ground up.

 Full Control Over Capabilities & Optimization

Can be trained specifically on domain-specific data to outperform generic models.

Tailored fine-tuning for superior accuracy, relevance, and compliance.

Sensitive data remains within the company’s control.

Easier to meet stringent industry regulations (e.g., HIPAA, GDPR, SOC 2).

Proprietary AI can become a strategic moat.

Potential licensing or monetization opportunities.

Requires extensive compute resources, skilled talent, and infrastructure.

Training and inference costs can be significantly higher than off-the-shelf solutions.

Developing a high-quality model can take months or even years.

Requires iterative fine-tuning and evaluation.

Needs continual updates to remain relevant and competitive.

Risks of model drift, bias, and security vulnerabilities.

2. Off-the-Shelf LLMs (ChatGPT, Gemini, Claude, etc.)

Using pre-built AI models via APIs or cloud services.

No need to invest in expensive infrastructure.

Pay-as-you-go pricing with predictable costs.

Access to cutting-edge AI without having to train it.

Providers continuously update and improve their models.

Fine-tuning options are often restricted.

May not perform as well on niche or proprietary tasks.

Customer data is sent to third-party servers (potential compliance risks).

Control over data retention and security is limited.

Dependence on external providers for model updates and pricing.

Sudden changes in API costs or terms can impact business continuity.

Combining off-the-shelf models with proprietary data and fine-tuning.

Leverages pre-trained models while allowing customization.

Can fine-tune smaller, domain-specific models for performance gains.

Avoids the heavy lift of training from scratch.

Fine-tuning or using Retrieval-Augmented Generation (RAG) enhances domain relevance.

Sensitive operations can be handled in-house while still benefiting from cloud AI.

Hybrid deployment options (e.g., using an API for general queries but a local model for sensitive data).

Requires some ML/AI expertise for fine-tuning.

Ongoing model maintenance still needed, though less than fully custom models.

Requires careful orchestration between different AI components.

May need additional infrastructure to manage hybrid workflows.

Decision Framework: Which Approach is Best?

Want to explore more about building a tailored  LLM & AI strategy  for your business?   

Get in touch

The modular approach for healthcare providers who have outgrown their EHR.

The Case for Headless EHRs | Foxbox Digital | Healthcare 

For healthcare providers who have outgrown their existing EHR, a new solution is emerging: 

Unlike traditional EHRs, which often bring high implementation costs, complex workflows, poor interoperability and extensive training requirements for clinicians, Headless EHRs provide an API-based infrastructure that can help clinical organizations finally close the gap between their ideal clinical workflows and the back-end operations that make patient-focused care possible.


While counterintuitive at first, Headless EHRs can help close that gap by actually decoupling the back-end infrastructure from the front end-interface, creating a modular design that delivers the flexibility, interoperability and efficiency that many mid-size providers  are lacking from the solutions they can currently afford. 


So for leaders looking for the best way to evolve how they manage patient data and clinical workflows, here’s our abbreviated case for going “headless,”  what to expect from leading platforms, and why the Headless EHR could be the modular approach midsize healthcare providers have been searching for.

Headless EHRs enable real-time data synchronization between different care teams. This promotes efficient communication and faster decision-making, leading to reduced wait times and more responsive care. As the system can adapt to user needs, patients can benefit from updates and new features more quickly, improving their overall satisfaction.


 - Flexible API - Out-of-the-box, Healthie’s API is designed to make it easy to go live quickly, with options for partial or full white-label custom branded solutions for easy flexibility that scales along with your practice.

The API-first approach enables the integration of patient-centric tools such as personalized patient portals, telehealth solutions, and AI-driven virtual assistants. By offering a user-friendly interface that can be easily customized, providers can ensure patients have smoother access to scheduling, medical histories, and care plans.


 - Future-Ready Architecture: In addition to HIPAA and SOC2 compliance out of the box, anything built on Medplum inherits FHIR API access and which can be extended to partners, maximizing interoperability between care providers. 


Cost control is obviously a major consideration in EHR selection, particularly for midsized providers. The modular nature of headless EHRs means leaders can select only the components they need, minimizing upfront investments. The cloud-based infrastructure common to headless EHRs enables better scalability, and more manageable upgrades, as providers can roll out new features incrementally rather than undertaking costly system overhauls.

- Unified patient experiences:   Because it’s directly integrated with their other service offerings, Oystehr’s API can support insurance validation, claims submissions, diagnostic test processing, telemed calls and SMS chat, all from one system.

Like any new technology investment, the EHR 2.0 that’s right for your organization will only be as effective as it is properly thought through from the beginning. For leaders curious about what to do next, here’s where we would start:


 about the solutions that are right for your unique circumstances.

At Foxbox, we're actively working with providers of all shapes and sizes to make the transition to “headless" as efficient, painless and future-focused as possible.      

If you’d like to learn more about what we can help unlock within your organization, we’d 

The Case for Headless EHRs

Elliott Torres joins Foxbox as CTO, new headway in healthcare, 3x Inc 5000 Honoree, and some overdue in-person collaboration. 

Founder's Update - Fall 2024 | Foxbox Digital

For a company like Foxbox, there’s simply no replicating the value of seasoned technical leadership. 

Which is why I’m thrilled to have Elliott on board to help serve our clients and propel our business forward. Elliott brings over 20 years of experience in artificial intelligence, machine learning and software architecture to our team. He’s known for his impressive track record in healthcare, including his most recent executive positions at Anthem Inc, Hydrogen Health and K Health. Elliott was also instrumental in building the AI practices at companies like Deloitte and KPMG.

As a former three-time Foxbox client, he knows our team well and has hit the ground running in leading our engineering teams, upskilling developers and shaping how we use AI to build indispensable digital products. And as anyone who’s worked in Elliott’s orbit can attest, he’s as good as it gets. And we’re lucky to have him on board.

Led by Elliott’s experience, we’re sharpening our ability to serve our healthcare clients. Building upon our track record developing patient-centered digital products for ambitious organizations, we’re leaning into our experience and developing highly-tailored 

 searching for ways to do more with less.

Whether it’s building custom electronic health records (EHR) systems to help providers strike improve patient engagement and backend efficiency, or helping tech leaders build 

we’re evolving our services and solutions to meet the needs of a rapidly changing industry. 

If you know someone in healthcare who is looking to build a new product, improve an existing one or start developing true AI-ready infrastructure, 

Foxbox made the Inc. 5000 for the third year in a row

! It’s been a wild ride since we first set up shop, and I couldn’t be more proud to still lead a team that wants to show up and do great work for our clients. While technically a measure of Foxbox growth as a business, I always think of recognitions like the Inc. 5000 as a testament to our people.

3x Inc 5000 Honoree

Speaking of team Foxbox, I’d be remiss not to celebrate the simple post-pandemic joy of spending time with a coworker you know well, but have yet to meet in person. Karina López has worked on our finance team for four years. Now thanks to an energizing visit to Chicago, Karina and I were finally able to connect properly - no virtual meeting links in sight.

Founder's Update - Fall 2024

A simple yet transformative technique for Product Managers 


Dig Deeper with the “5 Whys” 

A simple yet transformative technique for Product Managers

In the world of Product Management, assumptions can be your worst enemy. It's easy to jump to conclusions about what users need or why they're struggling, only to find out later that you missed the mark. That's where the "5 Whys" technique comes into play. This simple yet powerful method helps you get to the heart of user problems, leading to solutions that truly resonate. 

Let's break down how you can effectively use this approach to uncover the real issues users face and create a more user-friendly product. 

The "5 Whys" technique is straightforward: when confronted with a problem, ask "why?" five times to dig deeper into the issue. 

Each "Why?" peels back another layer of the problem, moving you closer to the root cause. For example, if users are struggling to complete a task in your app, the first "Why?" might reveal that the navigation is confusing. 

The second "Why?" could uncover that important features are buried in submenus. By the time you reach the fifth "Why?", you might discover that the app's design doesn't align with user expectations, or that the onboarding process failed to clarify key functions. 

This process helps you move beyond surface-level symptoms and develop solutions that address the core of the problem. A few things to keep in mind if you give it a shot:

The success of the "5 Whys" technique hinges on how it's introduced and adopted within your team or organization. You can't simply start a meeting and bombard everyone with "Why?" questions—this could be perceived as confrontational. Instead, present the "5 Whys" as a structured methodology. Start small, gradually incorporating it into conversations and decision-making processes. Over time, this approach will become second nature, fostering a culture of curiosity and deeper problem-solving.

A well-formed "Why?" is specific and directly related to the problem at hand. Vague or general answers to "Why?" questions may indicate that the problem isn't clearly defined yet. To get to the root cause, ensure each "Why?" is targeted and builds on the previous one. This will lead to a more accurate diagnosis of the issue and, ultimately, more effective solutions.

While the technique is called the "5 Whys," the number is less important than the depth of understanding you achieve. Sometimes, you'll reach the root cause after three or four "Whys," while other times, you may need more than five. The goal is to dig deep enough to uncover the fundamental issue before investing significant time and resources into solving it.

Using the "5 Whys" technique in product management can be a game-changer. By systematically challenging assumptions and digging deeper into user problems, you can 

create products that truly meet user needs.

 Remember, it’s not just about asking questions—it’s about fostering a mindset of curiosity and a culture that values understanding the real issues before jumping to solutions.