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Blink Health·Software Engineer·Onsite - System Design / Architecture·Senior

Senior
May 2026

Summary

System design round at Blink Health where I had to write a full approach doc and AI execution plan for a duplicate patient detection system. Pretty deep cut for a software engineer interview, felt more like a staff-level architecture exercise than anything I'd prepped for.

Questions Asked (6)

Q1

Which patient attributes would you use to detect duplicate records, and why does each one matter?

System DesignData Modeling
Author's notes

I started with the obvious ones: name, date of birth, SSN, MRN.

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AI HintsAI Generated

Suggested Approach

Start by framing the problem: duplicate detection is about identifying records that refer to the same real-world patient. Then discuss a tiered approach using a combination of identifiers, demographic attributes, and fuzzy matching, explaining why each attribute matters and its trade-offs.

Pro tip: Mention that no single attribute is perfect, so a weighted scoring system with thresholds is often used, and that you should consider the cost of false positives vs. false negatives in a healthcare context.

1. Identify unique identifiers

Discuss attributes like SSN, MRN, or insurance ID that are designed to be unique. Explain that they are strong signals but may be missing or have errors.

2. Use demographic attributes

Cover name, date of birth, address, phone number, and gender. Explain how these can be combined and that some are more stable than others (e.g., DOB vs. address).

3. Apply fuzzy matching

Explain that names and addresses can have variations (typos, nicknames, formatting), so fuzzy matching techniques like Levenshtein distance or phonetic algorithms are needed.

4. Consider context and trade-offs

Discuss how the importance of each attribute depends on data quality and the cost of false positives (merging different patients) vs. false negatives (missing duplicates).

5. Propose a scoring system

Suggest a weighted scoring approach where each attribute contributes to a similarity score, and a threshold determines if records are duplicates.

Key Points to Mention

  • Unique identifiers (SSN, MRN) are strong but may be missing or inconsistent.
  • Demographic attributes like name, DOB, address, and phone are commonly used but require normalization.
  • Fuzzy matching is essential for handling variations and errors in data.
  • Weighted scoring balances precision and recall, and thresholds can be tuned.
  • Healthcare context: false positives can lead to safety issues, so high precision is often prioritized.
  • Data privacy and compliance (HIPAA) must be considered when using patient attributes.

AI-generated suggestions, not part of the candidate's original notes. May be inaccurate — verify before relying on them.

Q2

How would you score and rank confidence in potential duplicate matches? Walk through your approach to deterministic vs probabilistic matching, blocking, fuzzy string similarity, and weighted attribute scoring.

System DesignAlgorithms & Data StructuresTechnical Trade-offs
Author's notes

This was the part where I felt most out of my depth.

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AI HintsAI Generated

Suggested Approach

Start by framing the problem as a classic record linkage pipeline: first apply deterministic rules for high-precision matches, then use probabilistic scoring for the rest. Walk through each stage—blocking, fuzzy similarity, weighted scoring—and explain how you'd calibrate thresholds and rank candidates by confidence. Emphasize trade-offs between precision and recall, and how you'd validate with labeled data.

Pro tip: Mention that you'd treat the confidence score as a calibrated probability (e.g., via logistic regression or Platt scaling) so thresholds can be set based on business cost of false positives vs false negatives. This shows you understand that ranking is not just about raw scores but about decision-making under uncertainty.

1. Deterministic Matching

Apply exact-match rules on high-confidence identifiers (e.g., SSN, email, exact name+DOB) to catch obvious duplicates with 100% precision. These matches bypass scoring and are auto-merged or flagged as high confidence.

2. Blocking / Candidate Generation

Partition records into blocks using one or more keys (e.g., first 3 letters of last name, zip code) to reduce the comparison space. Explain that blocking keys should be chosen to balance recall (not missing true matches) and efficiency.

3. Fuzzy String Similarity

For each candidate pair within a block, compute similarity scores on individual attributes using metrics like Jaro-Winkler, Levenshtein, or token-based (e.g., Jaccard) for names and addresses. Normalize scores to a 0-1 range.

4. Weighted Attribute Scoring

Combine attribute-level similarities into an overall match score using weights that reflect each attribute's discriminative power (e.g., name weight > address weight). Weights can be learned via logistic regression on labeled pairs or set by domain experts.

5. Ranking and Thresholding

Rank candidate pairs by their composite score and apply thresholds to classify as match, non-match, or review. Use precision-recall curves to choose thresholds that align with business goals (e.g., minimize false merges in healthcare).

Key Points to Mention

  • Deterministic vs probabilistic matching: deterministic uses exact rules for high precision; probabilistic uses statistical models to handle uncertainty and partial matches.
  • Blocking techniques: e.g., sorted neighborhood, canopy clustering, or multiple pass blocking to reduce O(n^2) comparisons while maintaining recall.
  • Fuzzy string similarity metrics: Levenshtein, Jaro-Winkler, Soundex, and token-based methods; discuss when to use each (e.g., Jaro-Winkler for short strings like names).
  • Weighted scoring: assign weights to attributes based on importance and reliability; consider using TF-IDF or mutual information to derive weights from data.
  • Threshold selection: use labeled data to plot precision-recall and choose thresholds based on cost of false positives vs false negatives; consider a 'review' band for manual inspection.
  • Evaluation metrics: precision, recall, F1, and area under ROC curve; also mention the importance of a gold standard dataset for validation.

AI-generated suggestions, not part of the candidate's original notes. May be inaccurate — verify before relying on them.

Q3

How would you minimize false positives in the duplicate detection system, and what role does human review play?

System DesignTechnical Trade-offs
Author's notes

Said you set a high precision threshold for auto-merging and route borderline cases to a review queue.

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AI HintsAI Generated

Suggested Approach

Start by defining what a false positive means in the context of duplicate detection and its impact on user experience and data quality. Then, outline a multi-layered strategy combining algorithmic improvements (e.g., threshold tuning, feature engineering) and human-in-the-loop review, emphasizing trade-offs between precision and recall. Conclude by explaining how human review can be integrated efficiently to continuously improve the system.

Pro tip: Frame the discussion around the business context: in healthcare, false positives can lead to patient safety issues or data integrity problems, so it's crucial to balance automation with human oversight. Mention that human review should focus on borderline cases and provide feedback to retrain models, creating a virtuous cycle.

1. Define False Positives and Impact

Clarify what constitutes a false positive in duplicate detection (e.g., incorrectly flagging two distinct records as duplicates) and discuss the consequences such as user frustration, data loss, or compliance risks.

2. Algorithmic Strategies to Reduce False Positives

Describe techniques like adjusting similarity thresholds, using ensemble methods, incorporating domain-specific features, and leveraging active learning to improve model precision.

3. Design Human Review Workflow

Explain how to route ambiguous cases to human reviewers, set up a queue with prioritization, and provide tools for efficient decision-making (e.g., side-by-side comparison).

4. Feedback Loop and Continuous Improvement

Detail how human decisions are fed back into the model as labeled data to retrain and refine the algorithm, reducing future false positives.

5. Measure and Monitor

Discuss metrics to track (precision, recall, human review rate) and how to monitor system performance over time to ensure false positives remain low.

Key Points to Mention

  • Precision-recall trade-off and how to choose thresholds based on business needs
  • Use of human-in-the-loop for edge cases and ambiguous matches
  • Active learning to prioritize uncertain cases for review
  • Domain-specific rules (e.g., healthcare identifiers) to reduce false positives
  • Feedback mechanisms to retrain models with human-labeled data
  • Metrics like precision, recall, and F1-score to evaluate performance

AI-generated suggestions, not part of the candidate's original notes. May be inaccurate — verify before relying on them.

Q4

How does your system handle fuzzy or ambiguous situations like typos, missing fields, and address variations?

System DesignAdaptability & Ambiguity
Author's notes

Talked about edit distance for typos, address normalization via a third-party service, and treating missing fields as a soft miss rather than a hard disqualifier.

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AI HintsAI Generated

Suggested Approach

Start by clarifying the specific system and data flow, then walk through a layered strategy: input normalization, fuzzy matching, validation, and fallback mechanisms. Emphasize how you balance accuracy, performance, and user experience, and mention any trade-offs or metrics you'd track.

Pro tip: Show that you think about ambiguity not just as a technical problem but also as a product and compliance issue—especially in healthcare where incorrect data can have serious consequences. Mention how you'd surface low-confidence matches to users for confirmation rather than silently guessing.

1. Clarify the context and requirements

Ask about the specific data types (e.g., addresses, drug names), volume, latency requirements, and tolerance for errors. This shows you tailor solutions to constraints.

2. Describe input normalization and preprocessing

Explain how you standardize inputs: lowercasing, trimming, removing punctuation, expanding abbreviations, and using libraries like libpostal for addresses.

3. Outline fuzzy matching and validation techniques

Discuss algorithms like Levenshtein distance, Jaro-Winkler, or phonetic matching (Soundex, Metaphone) for typos, and rule-based or ML-based validation for missing fields.

4. Explain fallback and user feedback loops

Describe how you handle low-confidence matches: suggest alternatives, ask for user confirmation, or log for manual review. Mention continuous improvement via feedback.

5. Highlight monitoring and iteration

Talk about tracking metrics like match rate, false positive rate, and latency, and how you'd iterate on thresholds and models based on real-world data.

Key Points to Mention

  • Use of fuzzy matching algorithms (e.g., Levenshtein, Jaro-Winkler) and libraries (e.g., fuzzywuzzy, libpostal)
  • Normalization techniques: case folding, abbreviation expansion, address parsing
  • Handling missing fields via default values, inference from other fields, or user prompts
  • Confidence scoring and thresholds to decide when to auto-accept vs. ask for confirmation
  • Trade-offs between precision and recall, and how to choose based on business impact
  • Monitoring and logging for continuous improvement, including user feedback integration

AI-generated suggestions, not part of the candidate's original notes. May be inaccurate — verify before relying on them.

Q5

What should the system do when its confidence in a match is low?

System DesignTechnical Trade-offsAdaptability & Ambiguity
Author's notes

Queue it for review, mark it as suspected duplicate, or prompt for additional input at the point of care.

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AI HintsAI Generated

Suggested Approach

Start by clarifying what 'low confidence' means in the context of the system (e.g., a match score below a threshold) and the potential impact of a wrong match. Then, propose a tiered response strategy that balances automation with human oversight, and discuss how to measure and improve confidence over time.

Pro tip: Emphasize that low-confidence matches should be treated as opportunities for learning—log them, analyze patterns, and feed them back into the model or rules to reduce future ambiguity. This shows you think beyond immediate fixes and consider long-term system health.

1. Define low confidence and its consequences

Establish a clear threshold or range for low confidence and assess the risk of false positives vs. false negatives in the specific domain (e.g., patient data matching at Blink Health).

2. Choose a fallback action

Decide on a safe default behavior, such as flagging for manual review, requesting additional data, or returning a 'no match' result, based on the cost of errors.

3. Design for human-in-the-loop

If manual review is chosen, outline how to route low-confidence cases to human experts, provide them with context, and capture their decisions to improve the system.

4. Implement monitoring and feedback

Set up logging and metrics to track low-confidence occurrences, their outcomes, and use that data to refine confidence thresholds or model retraining.

5. Communicate uncertainty to users

If the system interacts with users, design UI/UX to transparently convey low confidence (e.g., 'We're not sure—please verify') to set appropriate expectations.

Key Points to Mention

  • Threshold tuning: How to set and adjust confidence thresholds based on precision/recall trade-offs.
  • Fallback strategies: Options like manual review, additional data collection, or graceful degradation.
  • Human-in-the-loop: Leveraging human judgment for ambiguous cases and using feedback to improve the model.
  • Monitoring and logging: Tracking low-confidence events to identify patterns and drive iterative improvements.
  • User communication: Designing interfaces that clearly indicate uncertainty without causing alarm.
  • Domain-specific risks: Considering regulatory or safety implications (e.g., healthcare) when deciding on actions.

AI-generated suggestions, not part of the candidate's original notes. May be inaccurate — verify before relying on them.

Q6

How would you decompose this plan into tasks for an AI coding assistant, including prompts, quality gates, and verification steps?

System DesignTechnical Trade-offsAdaptability & Ambiguity
Author's notes

Honestly the strangest part of the whole thing.

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AI HintsAI Generated

Suggested Approach

Start by clarifying the plan's goals and constraints, then break it into small, independently verifiable tasks with clear prompts and quality gates. Emphasize iterative development, automated verification, and human review at critical points to ensure correctness and maintainability.

Pro tip: Treat the AI assistant as a junior engineer: provide precise context, define 'done' criteria upfront, and always include a rollback or fallback plan for each task. This shows you balance speed with safety, a key trait for high-stakes healthcare software.

1. Clarify the Plan and Define Success Criteria

Understand the overall goal, constraints (e.g., compliance, performance), and what 'done' looks like for the entire plan. Identify key milestones and risks.

2. Decompose into Atomic, Testable Tasks

Break the plan into small tasks that can be completed and verified independently. Each task should have a clear input, output, and acceptance criteria.

3. Craft Effective Prompts for the AI Assistant

For each task, write a prompt that includes context, specific requirements, examples, and constraints. Use iterative prompting to refine outputs.

4. Define Quality Gates and Verification Steps

For each task, specify automated checks (e.g., unit tests, linters, type checks) and manual reviews (e.g., code review, security scan) that must pass before proceeding.

5. Iterate and Integrate with Human Oversight

Run tasks in sequence, verify outputs at each gate, and integrate successful results. Adjust prompts and tasks based on feedback and failures.

Key Points to Mention

  • Task decomposition: breaking down into small, independently verifiable units with clear acceptance criteria.
  • Prompt engineering: providing context, examples, constraints, and expected output format to the AI assistant.
  • Quality gates: automated tests (unit, integration), static analysis, and manual code reviews at each stage.
  • Verification steps: running tests, validating against requirements, and checking for edge cases and security issues.
  • Iterative development: using feedback loops to refine prompts and tasks, and handling failures gracefully.
  • Human oversight: ensuring critical decisions and final validation are done by humans, especially in regulated environments.

AI-generated suggestions, not part of the candidate's original notes. May be inaccurate — verify before relying on them.