The care plan shouldn't go dark between visits

A child in developmental follow-up may see six or more specialists in one afternoon, then not return for six to twelve months. The national average wait for a developmental pediatrician is about six months. So much of what shapes the outcome — therapy started or stalled, referrals completed or lapsed, confusion or confidence at home — happens where the care team can't see it.

The existing answer, the patient portal, systematically misses the families with the most at stake: Medicaid-covered, limited-English, low-digital-access households for whom one more password is one more barrier.

After each visit, the family gets a secure text link to a plain-language recap — the big picture, top next steps, and each specialist's instructions, in English or Spanish. Over the months that follow, seven short text check-ins each ask for a single number in reply. Deterministic rules turn concerning answers into flags on the care team's pre-visit summary; everything else stays quiet. No new inbox, no message triage.

It's live — open an example family's recap or watch the check-in journey.

Every ambulatory encounter ends with a plan executed unseen until the next one — roughly a billion US visits a year. Analysts price the software layers serving that gap (patient engagement, care management, remote therapeutic monitoring) in the tens of billions of dollars combined, growing at double-digit rates. Our differentiated slice is every setting where a text-first, no-login experience beats a portal — the populations health systems are now measured on reaching.

Entry point: pediatric developmental follow-up at academic centers — a concentrated, referenceable network with an acute need and a mission fit. Already pulling us outward: neurodevelopmental providers and surgeons have expressed interest unprompted; surgical follow-up compresses the same journey into 30–90-day episodes with readmission economics attached. The full long-term roadmap →

• Reimbursement: remote therapeutic monitoring codes now pay for structured between-visit check-ins and their review — this activity can fund itself.
• Equity accountability: health systems are formally measured on reaching exactly the families portals miss.
• Workforce scarcity: with under 1,000 developmental-behavioral pediatricians nationally, leverage between visits is the only scalable relief.

EHR engagement runs through portal login — the exact barrier our population can't cross — and no-login-by-design works against that architecture, not within it. EHR vendors ship configuration toolkits; we ship the opinionated clinical layer (recap structure, check-in cadence, explainable flag rules, bilingual parity) co-designed with the clinicians who use it. And we integrate rather than compete: ingest the after-visit summary, write flags back. It's the same complement position from which the strongest health-IT companies operate inside EHR-run health systems.

No personal health information ever travels by text — enforced mechanically, not by policy. Recap pages carry instructions, not identifiers: no birth dates, record numbers, or diagnosis codes. Sensitive layers (visit history, family notes) require step-up verification; links are signed, revocable in seconds, and every open is audit-logged. We treat the phone as a low-assurance channel and engineer so that low assurance is enough.

• Working product — family recaps, the full check-in engine, flags, and a care-team dashboard — co-designed with a UW Medicine principal investigator through structured feedback rounds.
• Bilingual (English/Spanish) from day one; clinical content checked against published milestone guidance.
• Inbound interest beyond the launch specialty: neurodevelopmental and surgical follow-up.

A grant-funded academic pilot produces outcomes data and references. Programs then subscribe annually — priced well under the cost of the coordinator hours the tool saves — spreading through the tight academic network of developmental-medicine programs. The scale story is reimbursement alignment (each enrolled family can generate monitoring revenue for the clinic) and per-episode pricing in surgical follow-up.

We're raising a pilot round of grant and institutional support: one clinic, 50–150 families, 6–12 months, HIPAA-eligible infrastructure, and a rigorous readout. We're also seeking PI partners in developmental, neurodevelopmental, and surgical follow-up.