Sanjay Siddhanti

I build software to improve the US healthcare system. CTO at @akasahealth. @stanford CS and AI

[Sanjay Siddhanti @siddhantis]

I wrote a post about deploying Python web apps on Lambda.

It includes practical guidance on how to migrate a DB, serve static files, store secrets, and use Docker. Captures my experience learning serverless architectures and initially being disoriented.

https://t.co/Z17iZudpYk

[Sanjay Siddhanti @siddhantis]

@nikillinit Nice! Do you ever host events in SF?

[Sanjay Siddhanti @siddhantis]

With all the excitement about Fable, here's how it affects healthcare companies:

TLDR Fable 5 is HIPAA compliant for *API usage* but not within Claude Code.

For API usage, you have to disable Zero Day Retention and possibly upgrade to a new type of BAA. They now require 30 day retention for Fable usage to flag safety issues, which is awkward at best for healthcare companies. They do commit to not training models on your data, which is good.

In general a lot of the best Claude features - including Cowork, remote control, and now Fable - are not fully HIPAA compliant. This is a huge bummer and I hope they make quick progress on this.

[Sanjay Siddhanti @siddhantis]

As someone who hates making slides, Claude has been a game changer. I've tried a few tools but this is the first one that's saving me a lot of time.

What's working for me recently:
- Claude Chat to research my Slack and Google Docs and iterate on the talking points
- Claude Powerpoint plugin to build the slides. I find it works *much* better when I give it a skeleton deck with the right fonts / colors already baked in
- Upload back to Google slides when done

Uploading back and forth to Google Slides is annoying, but it works so much better than the Gemini integration in Google Slides right now, so it's worth the friction

[Sanjay Siddhanti @siddhantis]

@julesyoo @vinaysethmohta Amazing! I bet you can do it at higher quality too. I used to deal with so many entity resolution issues (is Dr. J Smith the same as James Smith, MD?) that are way easier with LLMs now

[Sanjay Siddhanti @siddhantis]

Spent the day at the Pragmatic Summit in SF hosted by @GergelyOrosz . We're seeing a fundamental change in what it means to be an engineer and how we build teams. Here are a few of my takeaways:

1. Generalists > specialists

Everyone has read Karpathy's post on hiring for agency. In product development, that's a full stack generalist who can use AI tools effectively. PMs and designers should be building prototypes and shipping code, not writing PRDs and mocks.

People who love the craft of writing code by hand need to adapt rapidly and refocus on the increased business impact they can now deliver.

2. Smaller, flatter teams

The traditional "two pizza team" concept needs to shrink. We are seeing more 1-3 person teams that can move faster due to less overhead. Teams should push more ownership to the engineers; having a manager in the loop on every decision will slow down velocity.

3. Single player -> multi player

Most of us have had our "Claude code moment" and have achieved immense productivity improvements for solo or greenfield work. Now we need to scale that across multiplayer, multi-repo projects. The frontier labs have a head start which we can learn from.

First, teams need to expose the agents to critical context that often lives elsewhere (design docs, product requirements, etc).

Second, teams should invest in shared repositories of skills, tools, and workflows that every developer can benefit from. Find the early adopters and codify their workflow into something that everyone else can use.

4. Execs should do IC work again

More than ever, leaders and execs need to ship code again. We all use our experience as builders (often many years ago) to gut check technical approach, output, and velocity. Those mental models need to be rebuilt in today's world. Fortunately, it's never been easier to get back into writing code and everybody should be doing it.

[Matt Shumer @mattshumer_]

https://t.co/ivXRKXJvQg

[Sanjay Siddhanti @siddhantis]

Ashby feature request: expose an MCP server so customers can talk to an LLM about pipeline strength, candidate feedback, speed to offer, etc.

I'm hiring for 20+ roles and this capability could replace multiple meetings at my company. Seems like a great opportunity for building something "your CTO will use" 🙂

Your support team told me that API keys cannot be scoped to specific roles, so I can't let an EM pull data without giving them access to all roles at the company. @benjaminencz is this on your roadmap? Happy to provide feedback if so!

[Sanjay Siddhanti @siddhantis]

@nikil Interesting! Were these high profile individuals with lots of info on the internet?

I tried this for a batch of new hires at work. Asked for summary of work experience and education.

I don’t have Cowork access yet but Claude and GPT performed poorly. Gemini slightly better.

[Sanjay Siddhanti @siddhantis]

@ankurnagpal Any advice on how to implement direct indexing without a bunch of maintenance?

For me a benefit of buying an ETF is I can set it and forget it.

[Sanjay Siddhanti @siddhantis]

@clairevo Thanks for writing this up!

I'm curious about the format of the huddles. Are you sharing screen? Is everyone just doing their own work? etc.

[Sanjay Siddhanti @siddhantis]

@pitdesi @_laurenmessner Where do you get them in SF?

[Sanjay Siddhanti @siddhantis]

@erikrtn @Armieey Great posts! No attribution needed :)

[Sanjay Siddhanti @siddhantis]

@Suhail Thanks! How do you evaluate the soft skills?

[Sanjay Siddhanti @siddhantis]

So awesome to see the next generation of engineers and data scientists in @akasahealth swag!

[Rich Kick @kickrg]

Thank you @siddhantis for your incredible kindness and generosity. Sharing your knowledge and experience with APCSA students was more than enough. The t-shirts and chocolate were well above expectations!

[Sanjay Siddhanti @siddhantis]

@DRMacIver I liked Waking Up with Sam Harris better than headspace

[Sanjay Siddhanti @siddhantis]

It was so fun to go back to my high school and visit the AP CS classes! @kickrg was a huge positive influence in my life and his classes led me to start thinking about studying CS and becoming a software engineer

[Rich Kick @kickrg]

Thank you @siddhantis for providing valuable insights into your experiences at Newbury Park HS, @Stanford , and the work you have done in the software development industry. #APCSA #APCSP #PantherPrideNPHS @NPProwler @NPHSPantherTV @nphsyb @CSforCA @CSforALL @CSForIL @exploringcs

[Sanjay Siddhanti @siddhantis]

@kickrg Such great times!!