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A quick primer on the pros and cons of building a custom AI model, using off-the-shelf LLMs, or a hybrid approach. 

Custom LLM vs Off-the-Shelf: Navigating AI Platform Decisions

Deciding between a custom AI model, an off-the-shelf solution, or a hybrid approach? Each has trade-offs in cost, control, and scalability. Here’s how to choose the best option for your business needs and goals.

Building a proprietary LLM from the ground up.

 Full Control Over Capabilities & Optimization

Can be trained specifically on domain-specific data to outperform generic models.

Tailored fine-tuning for superior accuracy, relevance, and compliance.

Sensitive data remains within the company’s control.

Easier to meet stringent industry regulations (e.g., HIPAA, GDPR, SOC 2).

Proprietary AI can become a strategic moat.

Potential licensing or monetization opportunities.

Requires extensive compute resources, skilled talent, and infrastructure.

Training and inference costs can be significantly higher than off-the-shelf solutions.

Developing a high-quality model can take months or even years.

Requires iterative fine-tuning and evaluation.

Needs continual updates to remain relevant and competitive.

Risks of model drift, bias, and security vulnerabilities.

2. Off-the-Shelf LLMs (ChatGPT, Gemini, Claude, etc.)

Using pre-built AI models via APIs or cloud services.

No need to invest in expensive infrastructure.

Pay-as-you-go pricing with predictable costs.

Access to cutting-edge AI without having to train it.

Providers continuously update and improve their models.

Fine-tuning options are often restricted.

May not perform as well on niche or proprietary tasks.

Customer data is sent to third-party servers (potential compliance risks).

Control over data retention and security is limited.

Dependence on external providers for model updates and pricing.

Sudden changes in API costs or terms can impact business continuity.

Combining off-the-shelf models with proprietary data and fine-tuning.

Leverages pre-trained models while allowing customization.

Can fine-tune smaller, domain-specific models for performance gains.

Avoids the heavy lift of training from scratch.

Fine-tuning or using Retrieval-Augmented Generation (RAG) enhances domain relevance.

Sensitive operations can be handled in-house while still benefiting from cloud AI.

Hybrid deployment options (e.g., using an API for general queries but a local model for sensitive data).

Requires some ML/AI expertise for fine-tuning.

Ongoing model maintenance still needed, though less than fully custom models.

Requires careful orchestration between different AI components.

May need additional infrastructure to manage hybrid workflows.

Decision Framework: Which Approach is Best?

 Off-the-shelf solutions work best for rapid prototyping and cost-effective deployment.

 Hybrid approaches often strike the right balance between control and scalability.

 Fully custom models may be justified if AI is the core competitive advantage.

Interested in a more tailored analysis of what best suits your needs?

Get in touch

The modular approach for healthcare providers who have outgrown their EHR.

The Case for Headless EHRs | Foxbox Digital | Healthcare 

For healthcare providers who have outgrown their existing EHR, a new solution is emerging: 

Unlike traditional EHRs, which often bring high implementation costs, complex workflows, poor interoperability and extensive training requirements for clinicians, Headless EHRs provide an API-based infrastructure that can help clinical organizations finally close the gap between their ideal clinical workflows and the back-end operations that make patient-focused care possible.


While counterintuitive at first, Headless EHRs can help close that gap by actually decoupling the back-end infrastructure from the front end-interface, creating a modular design that delivers the flexibility, interoperability and efficiency that many mid-size providers  are lacking from the solutions they can currently afford. 


So for leaders looking for the best way to evolve how they manage patient data and clinical workflows, here’s our abbreviated case for going “headless,”  what to expect from leading platforms, and why the Headless EHR could be the modular approach midsize healthcare providers have been searching for.

Headless EHRs enable real-time data synchronization between different care teams. This promotes efficient communication and faster decision-making, leading to reduced wait times and more responsive care. As the system can adapt to user needs, patients can benefit from updates and new features more quickly, improving their overall satisfaction.


 - Flexible API - Out-of-the-box, Healthie’s API is designed to make it easy to go live quickly, with options for partial or full white-label custom branded solutions for easy flexibility that scales along with your practice.

The API-first approach enables the integration of patient-centric tools such as personalized patient portals, telehealth solutions, and AI-driven virtual assistants. By offering a user-friendly interface that can be easily customized, providers can ensure patients have smoother access to scheduling, medical histories, and care plans.


 - Future-Ready Architecture: In addition to HIPAA and SOC2 compliance out of the box, anything built on Medplum inherits FHIR API access and which can be extended to partners, maximizing interoperability between care providers. 


Cost control is obviously a major consideration in EHR selection, particularly for midsized providers. The modular nature of headless EHRs means leaders can select only the components they need, minimizing upfront investments. The cloud-based infrastructure common to headless EHRs enables better scalability, and more manageable upgrades, as providers can roll out new features incrementally rather than undertaking costly system overhauls.

- Unified patient experiences:   Because it’s directly integrated with their other service offerings, Oystehr’s API can support insurance validation, claims submissions, diagnostic test processing, telemed calls and SMS chat, all from one system.

Like any new technology investment, the EHR 2.0 that’s right for your organization will only be as effective as it is properly thought through from the beginning. For leaders curious about what to do next, here’s where we would start:


 about the solutions that are right for your unique circumstances.

At Foxbox, we're actively working with providers of all shapes and sizes to make the transition to “headless" as efficient, painless and future-focused as possible.      

If you’d like to learn more about what we can help unlock within your organization, we’d 

The Case for Headless EHRs

Elliott Torres joins Foxbox as CTO, new headway in healthcare, 3x Inc 5000 Honoree, and some overdue in-person collaboration. 

Founder's Update - Fall 2024 | Foxbox Digital

For a company like Foxbox, there’s simply no replicating the value of seasoned technical leadership. 

Which is why I’m thrilled to have Elliott on board to help serve our clients and propel our business forward. Elliott brings over 20 years of experience in artificial intelligence, machine learning and software architecture to our team. He’s known for his impressive track record in healthcare, including his most recent executive positions at Anthem Inc, Hydrogen Health and K Health. Elliott was also instrumental in building the AI practices at companies like Deloitte and KPMG.

As a former three-time Foxbox client, he knows our team well and has hit the ground running in leading our engineering teams, upskilling developers and shaping how we use AI to build indispensable digital products. And as anyone who’s worked in Elliott’s orbit can attest, he’s as good as it gets. And we’re lucky to have him on board.

Led by Elliott’s experience, we’re sharpening our ability to serve our healthcare clients. Building upon our track record developing patient-centered digital products for ambitious organizations, we’re leaning into our experience and developing highly-tailored 

 searching for ways to do more with less.

Whether it’s building custom electronic health records (EHR) systems to help providers strike improve patient engagement and backend efficiency, or helping tech leaders build 

we’re evolving our services and solutions to meet the needs of a rapidly changing industry. 

If you know someone in healthcare who is looking to build a new product, improve an existing one or start developing true AI-ready infrastructure, 

Foxbox made the Inc. 5000 for the third year in a row

! It’s been a wild ride since we first set up shop, and I couldn’t be more proud to still lead a team that wants to show up and do great work for our clients. While technically a measure of Foxbox growth as a business, I always think of recognitions like the Inc. 5000 as a testament to our people.

3x Inc 5000 Honoree

Speaking of team Foxbox, I’d be remiss not to celebrate the simple post-pandemic joy of spending time with a coworker you know well, but have yet to meet in person. Karina López has worked on our finance team for four years. Now thanks to an energizing visit to Chicago, Karina and I were finally able to connect properly - no virtual meeting links in sight.

Founder's Update - Fall 2024

A simple yet transformative technique for Product Managers 


Dig Deeper with the “5 Whys” 

A simple yet transformative technique for Product Managers

In the world of Product Management, assumptions can be your worst enemy. It's easy to jump to conclusions about what users need or why they're struggling, only to find out later that you missed the mark. That's where the "5 Whys" technique comes into play. This simple yet powerful method helps you get to the heart of user problems, leading to solutions that truly resonate. 

Let's break down how you can effectively use this approach to uncover the real issues users face and create a more user-friendly product. 

The "5 Whys" technique is straightforward: when confronted with a problem, ask "why?" five times to dig deeper into the issue. 

Each "Why?" peels back another layer of the problem, moving you closer to the root cause. For example, if users are struggling to complete a task in your app, the first "Why?" might reveal that the navigation is confusing. 

The second "Why?" could uncover that important features are buried in submenus. By the time you reach the fifth "Why?", you might discover that the app's design doesn't align with user expectations, or that the onboarding process failed to clarify key functions. 

This process helps you move beyond surface-level symptoms and develop solutions that address the core of the problem. A few things to keep in mind if you give it a shot:

The success of the "5 Whys" technique hinges on how it's introduced and adopted within your team or organization. You can't simply start a meeting and bombard everyone with "Why?" questions—this could be perceived as confrontational. Instead, present the "5 Whys" as a structured methodology. Start small, gradually incorporating it into conversations and decision-making processes. Over time, this approach will become second nature, fostering a culture of curiosity and deeper problem-solving.

A well-formed "Why?" is specific and directly related to the problem at hand. Vague or general answers to "Why?" questions may indicate that the problem isn't clearly defined yet. To get to the root cause, ensure each "Why?" is targeted and builds on the previous one. This will lead to a more accurate diagnosis of the issue and, ultimately, more effective solutions.

While the technique is called the "5 Whys," the number is less important than the depth of understanding you achieve. Sometimes, you'll reach the root cause after three or four "Whys," while other times, you may need more than five. The goal is to dig deep enough to uncover the fundamental issue before investing significant time and resources into solving it.

Using the "5 Whys" technique in product management can be a game-changer. By systematically challenging assumptions and digging deeper into user problems, you can 

create products that truly meet user needs.

 Remember, it’s not just about asking questions—it’s about fostering a mindset of curiosity and a culture that values understanding the real issues before jumping to solutions.

A new company rallying cry, streamlined services and the latest episode of Foxbox Live

Foxbox Founder's Update - Summer 2024 | Foxbox Digital

My espresso machine has become a more significant pillar of my life than I’d care to admit. It’s the cornerstone of my morning routine, my reliable rescue for sleepy afternoons, and my favorite ritual to perform for guests around our kitchen table.

Would I survive without my espresso machine? Arguably yes. Am I interested in such experiments? Absolutely not. To me, it’s become 

Which is the exact rare distinction any digital product should aim for. With that in mind, Foxbox is rallying around a new north star that guides both how we approach our work, and what we encourage anyone spearheading a digital product to do: 

In short: When a product becomes indispensable to customers, it becomes indispensable to the business that built it. For us, it’s more than a tagline, but a built-in way to ensure we approach our work with intention, enthusiasm and an eye on creating long term impact.

Everything we do is about building digital 

 that businesses and their customers can’t live without. With that in mind, we’ve reoriented our services to map to the stages any world-class product depends on:


Define what’s worth building. Build it properly. Maintain it proactively. If you’re interested in learning more about any of the above, click through for more info and let us know 

We hosted our third episode of Foxbox Live with the brilliant Zac Siegel in a deep dive conversation about Kotlin Multiplatform, the flexibility and efficiency it provides to tech leaders building across mobile platforms, and why it’s uniquely suited for industries like 

Sincerely grateful and debatably over-caffeinatedRob Volk, Foxbox Founder & CEO

Foxbox Founder's Update - Summer 2024

Product mindsets, espresso machines and what makes technology stick.


Aim for indispensable | Foxbox Digital

Would I survive without my espresso machine? Arguably yes. Am I interested in such experiments? Absolutely not. To me, it’s

Which is the exact rare distinction any digital product should aim for. Whether it’s a telehealth app to make checking symptoms easy and fast, or a digital key to your apartment door, the goal should be to deliver people something that becomes so ingrained in their routines that they can’t imagine life without it.

The kind of consistent, hyper relevant reliability whose absence is felt, and whose value becomes hard to replace.

In any project, it’s good to debate how success should be measured. But we should always aim for something that’s hard to replace.

When a product becomes indispensable to customers, it becomes indispensable to the business that built it.

Staples for customers = growth engines for you. No matter the industry or how narrow the   target user, I believe it to be the North Star that’s always worth following. For us at Foxbox, it’s is far more than a tagline, but rather a built-in way to ensure we:

Understand your customers on a human level

Delivering a product customers feel like they “can’t live without,” is only possible if we first understand how they live. Not just how they perform a single isolated task, or their preferred menu screen, but who they are, what they care about, and what type of experience they’re longing for, even if they can’t articulate it yet.

Finding the answers to those questions is 

 of any digital product. It makes strategists, designers and developers hyper aware of points of friction in a user’s journey, the kind that are easy to overlook or accept as “the nature of the beast.”

Good UX researchers, designers and product leaders just know how to keep digging. Because the good stuff rarely lies at the surface.

Since our founding, our development philosophy hasn’t changed but only gotten sharper: Iterate constantly, build cross functionally, and treat things like CI/CD, automated testing, Agile, and user validation as 

non-negotiable pieces of every puzzle we solve for our clients.

It’s how we ensure we’re not only testing early assumptions about users, but also every key development decision that will actually bring the product to life. Why? Because harmony between user expectations, technical performance, and measurable business value isn’t always struck on the first chord.

Shortsighted, rushed products find their way to the recycling bin just as quickly as they’re built. Building a product that delivers sustainable long-term value means nobody loses sight of the bigger picture.

It means building platforms, products and systems that are designed for both immediate performance and long-term scalability and flexibility.

It means leveraging things like continuous delivery, scrum and automation to deliver with ease and working meticulously to address  intricate security and privacy requirements unique to our clients’ business. It’s also why 

 to delivering on promises to customers, proactively identifying issues and ensuring processes are in place to resolve issues and respond to user requests.

As the pages of barely used apps on my phone can attest, all it takes is a brief dip in functionality for a digital product to be put on the proverbial shelf. Like any relationship, trust between users and a product is earned over weeks, months and even years. But it can be lost in mere moments. So plan accordingly.

If you can deliver your customers an experience that lives up to that standard of “indispensable”, the product itself takes on the same role within your business.

It becomes much more than just a product. It becomes the beating heart of your organization, the stalwart foundations that sustains new opportunities, revenue sources, insights, and invaluable industry advantage.

Indispensable is not easy to reach. But it should always be the direction that tells us where to go 

If you agree, and want to define what indispensable looks like for your customers and your business, 