quality_assurance · healthcare · workflow

Cara ships 66-ticket architecture epic autonomously using Claude Code and RePPITS structured agent methodology

Cara had 25 scaffolds as a flat list with no composition model, making every scaffold combination manual, and the AI agent safety architecture was missing — LLMs were making clinical routing decisions that should have been deterministic.

How it works
Common implementation structure
How this type of workflow is generally built, generalized across documented cases — not tied to any one vendor's stack. Click any stage to read what happens there. Specific products that implement these stages appear in “Tools commonly seen” below.
Stage 1 · Architecture and ticket planning
The human technical co-founder designed the full architecture and created 66 Linear tickets with blocking dependencies, interface definitions, and acceptance criteria before any code was written.
Tools used
Claude CodeClaude Opus 4.6GPT-5.4Gemini 3.1 UltraLinear · partnerMCPVS CodeCursorKubernetes
Outcome

A Claude Code agent autonomously executed 66 software tickets across 2 repositories in under 4 hours, writing 536 tests and approximately 20,000 lines of code to deliver a 5-layer composable architecture; two security audits found 10 total issues including 2 safety-critical bugs, all fixed immediately with none deferred.

What failed first

The pre-existing system lacked a composition model, requiring every scaffold combination to be assembled manually, and LLMs were autonomously making clinical routing decisions that should have been deterministic code paths.

Results
Time savedunder 4 hours
Volume66
Source

https://widal.substack.com/p/we-shipped-a-66-ticket-architecture

How we source this →

Grounding & classification
Source type: technical build writeup
45 fields verified against source quotes.
agentic workflowai agentcode generationmulti agent workflowcode diff prknowledge basebuilder submittedfailure mode describedmetric backedproduction runtime claimedtools describedworkflow describedhealthcaresoftwareautomation rateerror reductionthroughput increasetechnical build writeupquality assuranceagentic task executionai draft human approval