Scaling PVS Integrations and Embedded Finance at Nelly Solutions

Nelly Solutions is a Berlin-based healthtech/fintech startup (Series B, €50M, backed by Lakestar and Cathay Innovation) building a platform that digitises patient intake, e-signatures, and payments for medical and dental practices. Over 1,200 practices rely on it. More than 2 million patients have moved through it. The ambition was clear: replace clipboards and fax machines with software that plugs directly into the practice management systems (PVS) clinics already use.

Germany's PVS landscape is fragmented. Charly, InSuite, and dozens of others, each with its own data model and update cadence. Every new connector meant weeks of custom work, and when one broke, practices lost trust fast. Onboarding stalled. Expansion was impossible until this was solved.

The integration programme I led introduced versioned APIs with stable contracts, semantic versioning, and a deprecation policy that gave partners predictability. A sandbox environment with conformance test suites let PVS vendors self-certify, cutting onboarding cycles dramatically. SLOs per connector, tracked through dashboards for sync time and failure rates, turned reliability from a hope into a measurable commitment. A tiered partner programme with release calendars and early-access channels kept the largest PVS vendors close.

The old intake flow leaked. Forms were rigid, consent tracking was manual, and staff spent hours chasing unsigned documents. The redesigned flow introduced dynamic forms in 30+ languages with conditional paths, mobile-first validation, and QR-based remote pre-check with save-and-resume. E-signatures feed into a consent ledger with purpose limitation, revocation handling, and timestamped audit trails. Staff tooling now surfaces missing fields, triggers auto-reminders, and queues unsigned documents, so nothing slips through.

Practices needed to get paid faster without leaving their existing systems. Payments via Adyen (POS, payment links, Apple Pay, Google Pay, SEPA) now reconcile automatically back to the PVS. Factoring with intake-linked risk checks offers one-click enrolment and 24-hour payouts, in both recourse and non-recourse models. Patient installment plans run up to 36 months, tied to treatment plan acceptance, with multi-invoice consolidation. Daily accounting journals and VAT summaries export directly to tax advisors.

Scaling to Italy and Spain meant resisting the urge to fork. Italy launched first, targeting dental practices (high self-pay share) with local language support, Italian tax and invoicing rules, local IBANs, and Adyen acquiring. Spain preparation covered SEPA mandates, receipt formats, data residency, and consent text in Spanish. Reusable "country packs" handle toggleable features, price books, notification templates, and legal copy, so the next market doesn't require reinventing the architecture.

Product, Engineering, Risk, Legal, Operations, and banking partners all had to ship together. Monthly release trains with freeze windows for critical connectors gave everyone a shared rhythm. Every release required a passed DPIA and approved consent copy. Incident playbooks covered connector rollback, message replays, and partner communication. Joint steering with major PVS partners, shared KPIs, and quarterly audits kept accountability mutual.

1,200+ practices connected with faster integration cycles and measurably higher connector reliability. Intake completion rose and unsigned consents dropped. Practices saw shorter time-to-cash through factoring and cleaner reconciliation in their PVS. Italy went live, Spain stood ready, both built on reusable country packs. Support load fell as observability and partner self-serve replaced manual firefighting.