⚕️ rails × healthcare

Ship healthcare on Ruby on Rails with sensible defaults.

Ruby on Rails is a Ruby workable choice for healthcare. GreatCTO auto-detects both — adds the healthcare archetype overlay, wires healthcare-specific gates, and runs 34 specialist agents around your existing Ruby on Rails workflow.

$ npx great-cto init ⚕️ See archetype →
What changes when GreatCTO joins your Ruby on Rails project

Detection → overlay → gates → reviewers.

1 · DETECT

Stack + archetype

GreatCTO reads your Gemfile and detects rails + healthcare archetype from signals: imports, file structure, env vars, README hints.

2 · OVERLAY

Archetype pack

Attaches the healthcare archetype overlay: HIPAA gates, BAA tracking, PHI encryption review, 21 CFR Part 11 audit-trail. Override if your specifics differ; the defaults are sensible for Ruby on Rails-style projects.

3 · GATES

Ruby on Rails-aware reviewers

qa-engineer runs rubocop / rspec / brakeman; security-officer flags mass assignment + N+1 ORM queries; performance-engineer checks ActiveRecord query hot paths.

4 · MEMORY

Cross-project lessons

Bugs you've hit before in other Ruby on Rails projects (connection-pool exhaustion, ORM N+1 queries, retry storms) — the agent's Step 0 includes the prior detection order. MTTR drops 94 % on second occurrence (methodology).

First 10 minutes

Concrete walkthrough.

$ cd my-rails-app && npx great-cto init
✓ scanning manifests… found manifest
✓ stack: rails (Ruby)
✓ archetype: healthcare
⚠ archetype + stack combo is unusual — review overlay manually
✓ 34 agents ready

$ /start "add HL7 patient resource endpoint"
▸ architect drafting ARCH-healthcare.md…
▸ pm decomposing into beads tasks…
⚐ gate:plan — your approval needed

Approve → 3 senior-devs run in parallel worktrees → 5 reviewers fan out in parallel → gate:ship → deploy. One real run walked stage-by-stage: /proof.

⚠ Honest caveat

Ruby on Rails (Ruby) is not a typical fit for healthcare. The archetype overlay still attaches, but you may want to override defaults more aggressively. Check the healthcare archetype page for the typical stack list and decide if your case is the right tool / right archetype.

Architecture

Every step of the pipeline, transparent.

No black-box "AI does it all" loop. GreatCTO is a deterministic state machine — 8 stages, 22 nodes, 2 human gates. Every node maps to a real agent on GitHub. Inspect the state machine →

Install

Ruby on Rails + GreatCTO in one command.

$ npx great-cto init

Free, MIT, runs locally. Works in Claude Code, Cursor, OpenAI Codex CLI, Aider, and Continue.