Digital Health · Pre-seed 2024 Delivered

Fractional CTO Engagement

0→1 architecture design and engineering hire plan for a pre-seed digital health startup. Defined the full technical stack and interview process from scratch.

0→1
Architecture defined
3
Engineers hired
8wk
Engagement
Stack ArchitectureHiringNext.jsPostgresAWSHIPAA

The Problem

A pre-seed digital health startup had a founding team of two — a domain expert and a business lead. They’d raised a small friends-and-family round and needed to build their first product. Neither founder had technical depth.

They needed someone to make the critical early decisions: what to build on, how to structure the team, and how to avoid the traps that kill early-stage technical orgs.

What I Did

Week 1–2: Technical Discovery

Deep-dive into the product roadmap, compliance requirements (HIPAA), target user behavior, and integration landscape. Output: a 20-page architecture brief covering data model, API design, infrastructure, and compliance posture.

Week 3–4: Stack Decision

Led a structured evaluation of 6 potential stacks. Key constraints:

  • HIPAA compliance required (BAAs, audit logging, encryption at rest/transit)
  • Budget: AWS credits available, no expensive managed services
  • Team: would hire 2 engineers with 2–4 years experience

Final stack: Next.js (monorepo, web + mobile via Expo), FastAPI for AI features, Postgres on RDS with row-level encryption, AWS infrastructure (ECS, ALB, RDS, S3), GitHub Actions for CI/CD.

Week 5–6: Hiring Process Design

Wrote the engineering job descriptions, defined the interview loop (take-home → technical screen → system design), and created the evaluation rubrics. Screened the first 40 candidates.

Week 7–8: Handoff

Hired 3 engineers, set up the monorepo, wrote the engineering handbook (coding standards, PR process, deployment runbook), and handed off to the incoming senior engineer.

Why This Matters

Early technical decisions compound. The wrong database choice at pre-seed costs 6 months of migration at Series A. The wrong hiring bar costs 2× in re-hires. These decisions deserved a senior engineer — not a guess.

Deliverables

  • Architecture decision record (ADR) document
  • Infrastructure-as-code (Terraform) baseline
  • Monorepo scaffold with CI/CD
  • Engineering handbook (30 pages)
  • Interview process + rubrics
  • 3 hired engineers, fully onboarded
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