Practicing in the Cloud — book cover. Heavy white display type on a deep blue sky over a cumulus cloud. Yellow author byline.

First Edition · November 2025

Practicing
in the Cloud

Building, Scaling, and Optimizing
B2B Enterprise Telemedicine Ventures

By Robb Vaules

Foreword by Paul E. Berger, MD — Founder & former CEO, NightHawk Radiology Services

The telemedicine market is exploding while a majority of telemedicine ventures will fail. The difference? They lack the systematic infrastructure advantages contained in these pages.

Buy on Lulu Also on Amazon

$150.00 · Hardback · 640+ pages · ISBN 979-8-9933158-0-5

From the Preface

The telemedicine gold rush is over.
The land grab has begun.

This book is for healthcare executives and physician-entrepreneurs who need to build or transform Direct Clinical Service Provider organizations in the next 18 months. Not consumer apps. Not platforms. Clinical service businesses that healthcare enterprises pay $100K–$2M annually to access.

You'll learn how TeleSpecialists grew from $225K to $50M in eight years while Babylon Health burned through $2B before declaring bankruptcy. The difference wasn't technology or funding — it was understanding the seven capability domains that multiply competitive advantages rather than merely add them.

Who this book is for

Pick your path. Three distinct routes through the material — each designed for a specific stage of business growth.

№01

The Bootstrap Pioneer

Running on fumes with less than $5M in revenue. Every dollar matters. Competing against funded competitors with 10× your resources.

  • 30 days: First B2B contract signed ($15–25K monthly)
  • 60 days: Three active enterprise clients
  • 90 days: $75K monthly recurring revenue

№02

The Funded Growth Leader

$5–25M annually with funding or strong cash flow. Growth is happening, but it's chaotic. Resources without systematic frameworks. Big enough to matter, small enough to be acquired.

  • 30 days: Operating margins improve 5–8%
  • 60 days: $2–5M in new enterprise pipeline
  • 90 days: Domain integration score above 70

№03

The Enterprise Transformer

$25M+ operation or part of a health system. Resources, talent, and market presence — but the organization moves like molasses. Innovation strangled by committees while nimble competitors eat market share.

  • 30 days: $500K+ saved from eliminated redundancies
  • 60 days: First integrated service line at 40% margins
  • 90 days: Market leadership in one specialty vertical

Foreword

What makes this book essential is its refusal to romanticize the journey. It shares the actual numbers — the 73% failure rate, the 18-month runway requirements, the 50–70% physician adoption thresholds. These aren't cautionary tales. They're battlefield intelligence meant to keep you alive long enough to win.

Stop protecting yesterday's practice model.
Start building tomorrow's market leader.

Paul E. Berger, MD

Founder & Former CEO, NightHawk Radiology Services

What's inside

Three sections. Seventeen chapters. One transformation blueprint.

Section I

The Strategic Foundation

Choose your path. Understand the patterns. Assess your opportunity.

  1. 01 Two Roads Diverged
  2. 02 From Whence We Came
  3. 03 The Pattern Playbook
  4. 04 The Cloud Advantage
  5. 05 The Opportunity in Front of You

Section II

The Seven Capability Domains

Master the operational capabilities that create competitive advantage.

  1. 06 Financial Architecture
  2. 07 Revenue Engineering
  3. 08 Organizational Transformation
  4. 09 Technology Infrastructure
  5. 10 Quality Governance
  6. 11 Strategic Partnerships
  7. 12 Capital Optimization

Section III

Integration & Execution

Multiply value through systematic integration. Execute your 90-day transformation.

  1. 13 The Integration Multiplier
  2. 14 The Transformation Divide
  3. 15 Integration Architecture
  4. 16 Quick Wins
  5. 17 The 90-Day Roadmap

The numbers

$104.64B

Telemedicine market size in 2024

73%

Of digital health ventures fail within five years

27×

Value multiplication from the 7-domain framework

$2B

Babylon Health burned before bankruptcy in 24 months

$225K → $50M

TeleSpecialists' growth in 8 years

18mo

Strategic window before industry structure locks in

Robb Vaules — author photo by Jennifer McDowell.

About the author

Robb Vaules

Robb Vaules built, operated, and marketed telemedicine companies before most executives knew what telemedicine was. Over 30 years in advertising, technology, and healthcare — including 23 years transforming teleradiology from experimental concept to standard practice — he has seen every mistake, survived every crisis, and learned exactly what separates winners from failures in digital health.

Born and raised in Arizona, Robb spent years crisscrossing the country working in telemedicine operations before returning home to Scottsdale, where he now runs Yellowcross Healthcare Commerce and guides healthcare organizations through B2B telemedicine transformation.

He wrote Practicing in the Cloud because too many brilliant physicians fail at telemedicine for preventable reasons. This book contains the frameworks, warnings, and shortcuts he wishes someone had given him $50 million ago.

LinkedIn Yellowcross

Endorsements

What healthcare leaders are saying about Practicing in the Cloud.

Robb's book is immensely practical for guiding you to start and grow a successful health care venture. As a former CIO and leader of telemedicine, I can say this guide will help you focus on building the right foundation and avoiding dangerous pitfalls. As an investor, I can say this book can help you fund growth while aligning with your leadership and exit goals. You'll find engaging personal stories and a deeply researched, tailored path for an entrepreneurial journey.

Scott Whyte

Partner, Health Enterprise Partners

As a teleradiology executive with over twenty years of experience, I can say I have never seen such a comprehensive assessment of the challenges facing the industry today. I was able to follow our own practice path from startup to growth to market leader, nodding in agreement at each description of and solution to the obstacles facing practices in each of these developmental phases. The portrayals of market forces are accurate, and the solutions provided are easily applied. I highly recommend this publication and wish it had been written twenty years ago.

Benjamin W. Strong, MD

Chief Medical Officer, Virtual Radiologic

After two decades building and scaling telehealth enterprises, I've learned that success isn't just about the tech. It's about disciplined execution and the people who make it real. *Practicing in the Cloud* distills that truth into a structural playbook for every stage of growth. Robb Vaules doesn't just describe how to build a telemedicine business; he lays out the frameworks, choices, and cultural imperatives that separate the winners from the well-funded failures. This is the operator's guide our industry has been missing.

Shannon Werb

CEO, Array Behavioral Care

*Practicing in the Cloud* is a strategic playbook written for healthcare executives and physician-entrepreneurs building business-to-business telemedicine platforms. The book laser-focuses on enterprise-grade clinical service rather than consumer-facing telehealth apps. Robb Vaules insightfully emphasizes operational excellence, strategic clarity, and integration over the "latest and greatest" technology hype.

Kenneth L. Serra, MD

Chief Medical Officer, Yellowcross Healthcare Commerce

Get the book

The infrastructure exists.
The enterprise buyers are ready.
Your competitors are already implementing.

Buy on Lulu Also on Amazon

$150.00 · Hardback · ISBNs 979-8-9933158-0-5 (hardback) / 979-8-9933158-1-2 (paperback)

Frequently asked

Details, formats, and how to get it into your team's hands.

What formats is the book available in?
Hardback (ISBN 979-8-9933158-0-5) and paperback (ISBN 979-8-9933158-1-2). Available now through Lulu and Amazon. Ebook editions are under consideration; sign up below to be notified.
Where do I get the best value — Lulu or Amazon?
Both retailers carry the same edition. Buying directly from Lulu supports the author and publisher most. Amazon ships faster for Prime members in the U.S. Either way you're reading the same book.
How long is it?
Roughly 640 pages across three sections and seventeen chapters, plus a comprehensive glossary, glossary of acronyms, references, and index. Designed to be navigated by section depending on your stage of business growth — see the three reader paths above.
Do you offer bulk orders for organizations or board distribution?
Yes. Lulu offers volume pricing for orders of 25+ copies. For larger orders or custom requests (signed copies, branded inserts, company-wide rollouts), contact info@yellowcross.com.
Is this for patients or for clinicians?
Neither. Practicing in the Cloud is for the business side of telemedicine — healthcare executives, physician-entrepreneurs, practice managers, and investors who are building or transforming B2B clinical service organizations. It's not a clinical reference and it's not a patient-facing book.
Who is the publisher?
Yellowcross Healthcare Commerce, a Practice Management Organization based in Scottsdale, Arizona, founded by the author.