Most healthcare systems have no usable API. Somewhere in every clinic, hospital, and services company, a person is logging into one system, reading a screen, and retyping what's there into another screen. A thousand times a day.
David Mlcoch is co-founder and CEO of Asteroid, a YC W25 company building AI-powered computer use agents for healthcare. Asteroid's agents log into EHRs, payer portals, government registries, and legacy desktop systems, and do the workflow a trained employee would do. At scale, with guardrails, and with humans approving every high-risk action.
David's background is in AI from Edinburgh University, autonomous agents, robotics, and space tech. He co-founded Asteroid in 2024 with Joe Hewett, who previously used LLMs at Netcraft to disrupt hundreds of millions of dollars of fraud. The company is backed by Y Combinator, Entrepreneur First, and angels from OpenAI and Hugging Face.
Mario talks to David about why he pivoted from building an AI oversight layer to being the agent itself, what it's actually like to automate a portal nobody fully understands anymore, and why prior authorisation was the hardest category to crack. They also get into the self-healing experiment that went wrong, why David would rather an agent fail than produce a false positive, and what stops OpenAI and Anthropic from doing what Asteroid does.
This episode directly connects to the problems described in previous episodes. Data not moving. Systems not talking. Humans being the integration layer. David is building the infrastructure underneath all of it.
Timestamps
- The problem in plain terms. Someone in every clinic is reading one screen and retyping it into another, a thousand times a day
- What makes a great software engineer in 2026.
- Startup engineers are different.
- Advice for software engineers right now. If your company won't let you use Claude Code or Cursor, leave immediately
- The connection to previous episodes. Data not moving because nothing connects. Asteroid sits underneath both problems
- How Asteroid started as a supervision layer and pivoted to being the agent. Why customers kept asking "can you build the agents instead?"
- "The developer who wrote the system is not even alive now." What it's actually like to automate a healthcare portal nobody fully understands. Systems from 2009, Citrix-served pixels, sessions that expire every 10 minutes
- Asteroid Integrate. Hundreds of pre-built healthcare connectors. Why prior auth was the hardest category to crack: high-branching forms, no sandbox, one try per case, a thousand payers changing criteria constantly
- What self-heal actually means in a HIPAA environment. Why Asteroid minimises AI during execution and requires human approval for every significant step
- The hybrid approach. DOM-based parsing versus screenshot-based computer use. The 13-digit number that only read 12, and why eliminating false positives matters more than completion rate
- If every EHR opens proper APIs, does Asteroid become unnecessary? Why David would love that but isn't betting on it
- How EHR vendors feel about browser agents bypassing their $2-per-call APIs. Why Asteroid acts on the customer's authority to reach data they're already entitled to
- What stops OpenAI and Anthropic from doing this? Why general-purpose browsing agents are features, not companies. Why OpenAI deprecated Operator
- Build versus buy for Series A/B CTOs. Build when you have one or two portals. Buy when you're spending 18 months and three engineers on plumbing instead of product
- What healthcare back office looks like in five years if Asteroid succeeds.
- The workflow that's still too hard today but won't be in 12 months.
- The self-healing experiment that went wrong. Why fully autonomous agents rewrote themselves for a temporary error and broke two days later
- Advice for early-career technical founders.
- Where Asteroid is investing in 2026.
Watch the episode on YouTube: https://www.youtube.com/@SynaxiaGroup
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Get in touch: https://www.linkedin.com/in/mario-michaels/
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