HealthTech engineering that respects the stakes.
HIPAA-aware engineering. Audit-ready by default. Calm under regulatory pressure.
Healthcare software fails differently. A bug here is not a degraded user experience — it is a HIPAA violation, a delayed diagnosis, or a missing audit trail at the worst possible moment. Sage Ideas builds HealthTech with the deliberate cadence the domain demands: BAAs in place before code is written, audit logging on every PHI access, encrypted transport and at-rest by default, and a paranoid attitude toward third-party dependencies.
Why Sage Ideas for Healthcare
What we solve
The specific operational challenges we've already debugged in the healthcare stack.
PHI leaking into logs and error reports
Sentry captures stack traces with request bodies. Datadog ingests structured logs with patient names. Cloudwatch retains everything for 90 days. Without explicit PHI scrubbing in the logging pipeline, you have a HIPAA disclosure waiting to be discovered. We build the redaction layer and prove it works.
Audit trails that do not actually audit
You log "user X read patient Y" — but not the IP address, the session ID, the application context, or whether the read was through the API or the admin tool. When the OCR asks for an access log next year, the gaps will be glaring. We design audit logs that map to the HIPAA Security Rule access requirements.
Third-party dependencies without BAAs
Your error tracker, analytics tool, customer support tool, or AI assistant might be touching PHI without a Business Associate Agreement. We map every subprocessor, identify where BAAs are required, and document the data-flow your privacy officer can defend.
EHR integrations that break at the worst time
HL7 v2 over MLLP, FHIR R4 with custom extensions, SMART on FHIR with vendor-specific scopes — every EHR is a special snowflake. We build defensive integrations with circuit breakers, dead-letter queues, and the boring fault-tolerance these interfaces actually require in production.
Recommended tiers
Productized engagements ordered by relevance to healthcare workloads.
Relevant work
Healthcare questions
Will you sign a BAA?
Yes — Sage Ideas will execute a Business Associate Agreement before any engagement that involves PHI access. We use a standard BAA template, but we are happy to use yours if your privacy team prefers. Note that you also need BAAs with every subprocessor that may touch PHI: AWS, the database host, error tracking, analytics, AI providers, and so on. Part of our Audit tier is mapping the subprocessor chain and identifying where BAAs are missing.
How do you handle PHI in logs and observability?
PHI never enters logs by default. Structured logging libraries are configured with field allow-lists rather than block-lists, request bodies are scrubbed at the middleware layer, and Sentry/Datadog/Honeycomb are configured to drop known PHI fields before transmission. We add unit tests that send synthetic PHI through the logging pipeline and assert it does not appear in the output. Error stack traces include only stable identifiers, never names, MRNs, or DOBs.
What does an audit log need to contain?
The HIPAA Security Rule requires you to record information system activity, but the practical requirement comes from breach response: when an incident happens, you need to answer "who accessed what PHI, when, from where, and why?" That means timestamps, user identifiers (not just internal IDs — the human-resolvable username), patient identifiers, the action (read/write/export/print), the request context (IP, session, app), and ideally the business reason. Audit logs are append-only, retained per your policy (typically six years), and tested by querying them in tabletop exercises.
Do you work with FHIR and HL7?
Yes — we have built FHIR R4 clients and servers, integrated with Epic, Cerner/Oracle Health, and Athena via SMART on FHIR, and parsed enough HL7 v2 ADT and ORU messages to know exactly how each vendor deviates from spec. The non-obvious work is fault tolerance — vendor endpoints time out, drop messages, and return malformed payloads. Our integrations include retry logic, dead-letter queues, replayable event logs, and human-readable failure dashboards because someone will need to explain why a discharge summary did not flow downstream.
Can you help with HITRUST or SOC 2?
We can help engineer the technical controls and produce evidence — IAM policies, encryption at rest and in transit, access reviews, vulnerability management, change management, and incident response — but we are not a HITRUST assessor or a SOC 2 auditor. The Audit tier surfaces gaps; the Build and Operate tiers implement the controls; an external assessor or auditor signs off. We coordinate with them tightly and have worked with several firms we can recommend.
Send us your audit log gaps, your missing BAAs, or the EHR integration that has been a roadmap item for two years.
Book a 30-minute discovery call. We'll talk through your healthcare stack and tell you directly which engagement — if any — is the right fit.
Book a Discovery Call