The medical checklist was one of the greatest safety innovations in modern medicine. It was created to guard against human fallibility and to make sure nothing vital was missed when lives were on the line. But over time, its use has drifted.

Today, checklists are no longer primarily about protecting patients from error; they are about keeping up with the administrative complexity of care. Across hospitals and ambulatory surgery centers, 100% of facilities rely on thousands of manual tasks such as reviewing forms, locating faxes, and cross-checking codes to deliver and bill for care. These tasks now account for more than $166 billion in administrative waste every year, and over 30% of cases are derailed because of missing or incomplete documentation. Each derailment ripples through the system, blocking OR time, reducing throughput, and costing facilities an average of $5,000 in lost margin per case.

Nurses, schedulers, and billing staff spend hours deciphering documentation, reconciling notes, and checking payer criteria. The work has become more about managing systems than serving patients. Non-clinical teams are asked to interpret clinical documentation, while clinical staff are buried under administrative tasks. Burnout is widespread. Every missing lab, unsigned H&P, or outdated authorization not only delays care but compounds financial strain.

We believe that while some of the checklist’s role will always be to safeguard human error, much of it has become mechanical, repetitive, and ready for automation. That is where ExactRx comes in.

ExactRx’s mission is to restore balance by letting humans focus on judgment, empathy, and care while software manages the routine verification steps that slow down every clinical and financial workflow. The platform transforms static, manual checklists into autonomous systems that validate documentation, flag gaps, and ensure readiness across pre-op, prior authorization, and claims preparation. In short, ExactRx automates the parts of the checklist that no longer require human cognition so people can do the work that only they can do.

The Product: Checklists That Check Themselves

ExactRx embeds autonomous, compliance-validated checklists directly within existing EMR workflows, converting the manual work of readiness and claims preparation into a continuous, intelligent process. Instead of human staff checking whether a patient’s documentation is complete, the system knows. It cross-validates orders, labs, and notes against more than 6,000 payer and clinical rules to prevent derailments and lost revenue.

The platform’s architecture includes a Modular Orchestration Engine that pre-generates rule sets offline and then applies them in real time. A layered NLP pipeline with a human “checkpoint” improves output accuracy while reducing cost. This structure allows ExactRx to scale efficiently while maintaining defensibility and precision.

The platform’s accuracy has been validated through large-scale clinical testing. In a CoPilot-style review, clinicians were asked to either approve or override ExactRx’s recommendations. Across 3,145 surgical decisions, clinicians approved 96% of recommendations at the individual criterion level, demonstrating reliability across complex medical cases and confirming its ability to automate chart-level validation at scale.

The product’s design compounds with scale: the more sites ExactRx serves, the smarter and stickier the platform becomes. It learns each facility’s bottlenecks, captures undocumented workflows, and identifies documentation patterns that consistently lead to payer approval, driving both margin expansion and customer retention.

Traction and Market Opportunity

ExactRx targets management service organizations (MSOs), multi-site provider groups, and high-volume procedural networks that manage centralized billing and shared infrastructure across multiple sites. These buyers control scale and demand measurable efficiency gains across operations. Each contract includes a base network license, per-case overage, and success fee tied to recovered or protected revenue, aligning incentives and expanding margins as volume grows. The company is pursuing a $3B TAM across procedural care, with an initial $72M serviceable market concentrated in ASCs, MSO-affiliated practices, and large provider groups.

Over the past five months, ExactRx has developed 85 qualified opportunities (~$10M potential), 25 late-stage discussions (~$2.9M), and 7 pre-pilot commitments totaling $750K, with pilots launching in Q1 2026 to generate live data and conversions by Q2 2026.

The Team

Few early-stage teams in healthcare AI combine this depth of domain, technical, and commercial expertise.

1. Athena Doshi, CEO – A two-time digital health founder with a prior exit and a $3B book of business in healthcare. Former product leader at Omada Health (250% year-over-year growth) and enterprise operator at Steer Health. Named to Inc. 500 Female Founders 2025 and advisor to the NYC Empire AI initiative.
2. Dr. Jan Krumsiek, PhD, Head of AI – Professor at Weill Cornell Medicine and a pioneer in biomedical AI, systems modeling, and large language models for clinical research.
3. Ellard Li, CTO – Veteran engineering leader with 15+ years of experience building and scaling infrastructure at companies such as Course Hero and Omada.
4. Dr. Gina Cocos, PharmD, Director of Clinical Intelligence – UCSF-trained pharmacist and clinical researcher who bridges payer policy, evidence-based medicine, and automation.

Advisors include senior leaders from Ethicon (J&J), Novo Nordisk, and Stanford Medicine, along with practicing surgeons and anesthesiologists from Weill Cornell, Texas Health Surgery Center, and Heartbeat Health.

The Vision

The future of healthcare is not just paperless; it is effortless.

ExactRx envisions a world where every healthcare facility operates as a smart care system, where every checklist, policy, and task validates itself in real time. Where the cognitive load of remembering, double-checking, and documenting is offloaded to software that is as reliable as the clinicians it supports.

Our team believes:

“Checklists were designed to protect patients from human error. Today, they should protect clinicians from systemic error.”

ExactRx’s purpose is to return time, focus, and financial health to the people who deliver care by ensuring that every checklist checks itself.

Future projections are not guaranteed.