HCA Healthcare · Primly Community

HCA Healthcare senior system design interview: what to expect and what they actually care about

quietquit_quincy · 4 replies

posting the system design portion as its own thing since it deserves the detail. this was for a senior backend/platform role, so roughly L5-equivalent if you're mapping from big tech.

the prompt: they gave me a healthcare-specific scenario. something like: design a notification delivery system for clinical alerts, where a nurse or doctor gets a push notification, an in-app alert, AND a fallback SMS if they haven't acknowledged within 60 seconds. millions of hospital staff, high reliability requirement, needs audit logging for compliance.

the scenario isn't random. they seem to use variants of real problems from their systems. so it's worth thinking about healthcare-specific constraints before you go in: HIPAA compliance (what data can and can't go in a message payload) reliability > availability tradeoffs (hospitals can't miss critical alerts) audit logs are a hard requirement, not an afterthought legacy system integration is a real thing at a company this size

what they probed: the interviewer pushed pretty hard on failure modes. what happens if the push notification service is down? how do you guarantee delivery without double-sending? they also asked about how i'd handle the audit trail in a way that doesn't add latency to the critical path.

what mattered: thinking out loud, clearly. i drew the whole thing from scratch and narrated every decision. they seemed less interested in a perfect architecture and more in whether you could reason about tradeoffs. when i said "i'd use kafka for the event stream here," they immediately asked "why not a simple queue" and wanted me to articulate the tradeoff, not just say kafka.

what they didn't ask: nothing about ML, nothing about distributed consensus algorithms. no CAP theorem gotcha questions. more practical than academic.

duration: 55 minutes, then a few minutes for Q&A. felt like a reasonable amount of time.

if you're used to system design rounds at big tech companies, this is actually a bit more collaborative and less adversarial. the interviewer helped me when i got stuck on the SMS fallback piece rather than just watching me flounder.

4 replies

frontend_fran

the HIPAA constraint in the design is a good catch. i hadn't thought about that as a system design angle, i always think of it as a legal thing, not an architectural one. but yeah, what you can put in a push notification payload is actually constrained.

infra_ines

exactly. you can't put patient identifiers in the push notification body because it ends up in the device's notification center which isn't encrypted at rest. so you send a generic "you have a new clinical alert" and the detail is only in the app after auth. the interviewer seemed pleased when i brought that up without prompting.

mobile_mara

the double-send problem for critical alerts is nasty. idempotency keys at the delivery layer, but you also have to think about what "acknowledged" means when the same alert appears on 3 devices. curious how deep they went on that.

careerveteran

the collaborative vs adversarial dynamic is real. healthcare tech companies generally don't run gauntlet interviews. they want pragmatic engineers who understand constraints, not leetcode grinders who can't talk to a doctor.