Capital Brain and Spine

Capital Brain and Spine runs several practice entities and surgery centers under one roof, with clinic, billing, referrals, checkout, and surgery scheduling teams that each need to see the same patients from a different angle. When we started, the group was already on monday.com. The system had grown board by board, team by team, and had stopped holding together.

Boards for the different entities lived in separate workspaces. Mirrored columns and layered automations had slowed the platform to the point where lag was a daily complaint. Several teams still tracked their real work in Excel, in referral trackers, appointment trackers, checkout trackers, payables and receivables, cash logs, credentialing. Payor data (insurance lists, attorney lists, case managers, contacts) was duplicated across boards. Clinic logs and appointment trackers were kept by more than one team for the same patients. Practice management and billing lived in Tebra, and monday.com did not know what Tebra knew.

The ask was to make monday.com the operating layer for the whole group, connect it to Tebra properly, and get the spreadsheets out of the picture.

This was a monday.com implementation with an integration layer, not a custom application. We used to implement and support monday.com as a partner, and this is what that work looked like at its most involved.

The first phase was structural. We announced a maintenance window, moved every workspace into one centralized workspace, set folder and board permissions by team and by board privacy, reviewed and rebuilt the connections between boards, and merged the disparate entity boards into a single structure. Performance work ran alongside, reducing mirrored columns and breaking complex automations into simpler pieces until the lag went away.

The second phase was the operating layer. We designed the CRM architecture for patient management, financial tracking, and operational workflows, then built views for the Master Patient List and the Clinic Log, redesigned patient account and payor management so a payor lived in one place, redesigned implant and hardware tracking, and consolidated the duplicated clinic logs and appointment trackers into shared boards with permissions per team. The Excel trackers were migrated into monday.com boards with the automations that had been done by hand (reminders, status changes, assignments). Billing and collections got a centralized billing view and process, a unified billing and reduction tracker, and a unified collections tracker for payment posting and reconciliation. Each team got its own dashboard for appointments and payment trackers.

The third phase was the Tebra integration, built on MindCloud. Appointments and patient demographics sync in both directions between Tebra and monday.com. Later, at the client's request, we replaced hard-coded dropdown values in those workflows with master data boards for Service Locations, Appointment Reasons, and Providers, so that adding a provider or a location no longer meant editing automation logic. New workflows pushed patients created on the PT Referrals board into the Master Patient List and into Tebra, with duplicate checks and validation, and pulled providers, appointment reasons, and service locations from Tebra into their master boards on a schedule. When the group opened a new location, adding it was a small change order against those boards rather than a rebuild.

The group went from many workspaces to one, with permissions that match the org chart. Mirrored columns and heavy automations were thinned out to address the lag. Work that had lived in Excel moved into boards the teams actually used, and billing and collections went from per-team trackers to one process with one set of views. Managers and team leads sat in workflow discovery sessions (clinic log, billing, referrals, checkouts, surgery and injections) so the boards reflected how each team worked. With the Tebra sync in place, appointments and patient demographics move between the two systems instead of being re-keyed, and the master data boards let the group add providers, reasons, and locations without editing automation logic. The engagement ran from late 2024 into 2026, with the later work arriving as small, scoped change orders.

Given the same problem now, we would build Capital Brain and Spine a single system of their own that holds patients, appointments, billing, collections, implants, and referrals in one database, with Tebra as a first-class integration rather than a set of automation recipes, and no per-seat licensing for the front desk, billing, and clinical teams. The monday.com work was the right call at the time. The difference is that a custom, client-owned build removes the two things that made this engagement hard, platform performance limits and the layer of glue needed to make a general-purpose tool behave like a practice system.

The integration work was tracked as its own engagement, and the Tebra sync is the piece the project documents show delivered end to end.