SAAS Products I Use

Products I use to run my (regulated, enterprise) business

Reshma Khilnani
4 min readApr 7, 2014


I’m Reshma, Co-Founder of MedXT, a web and mobile RIS/PACS (diagnose patients remotely using medical imaging like X-Ray, CT Scan etc).

MedXT is enterprise medical software (read: lots of regulatory requirements.) Not only do we have to be HIPAA compliant, but we also have FDA Class II Medical Device clearance (510K). Uptime is critical for us because we serve hospital Emergency Departments (ED) and critically ill people need to be diagnosed and treated quickly.

Selling MedXT also requires a “Enterprise Sale” where clinical staff, finance and IT need to understand the feature set and agree to the purchase. It is not an impulse purchase.

With all these things in mind, we think really carefully about our SAAS toolkit and what will help us move fast while meeting regulatory and reliability requirements. These are products we really use all the time, that we actually pay for and that aren’t trials or pilots.

  1. Amazon Web Services (AWS) — we are power users of AWS. Besides requiring a Business Associate Agreement for HIPAA compliance, we have to connect to on-premise devices and storage systems in hospitals. We set up VPCs on AWS and connect using VPNs to hospitals devices. We store large amounts of medical image data on S3. This infrastructure is not just for consumer grade companies, it can be used for so much more.
  2. Github — Getting FDA 510K approval requires a “Tracibility” exercise. That means that features, functionality and processes need to be categorized and linked. The linkage needs to be documented. We ran our whole 510K process on Github using issues and labels and it was approved by the FDA.
  3. Twilio — Bring your own device (BYOD) is sweeping healthcare. Physicians and staff need to receive notice of critical results quickly to, for example, treat strokes or stop bleeds. Through Twilio we support custom workflows that can call team members, send secure links to the mobile web on smartphones. We can allow critical communication without requiring the installation of apps and the issues (regulatory and otherwise) that come with that.
  4. TokBox — MedXT is used for telemedicine. Physician specialists like Radiologists and Cardiologists remotely diagnose and plan treatment for patients. TokBox helps connect physicians to facilities, but importantly it doesn’t require an install on the client. The majority of facilities will not allow the installation of arbitrary software on workstations in the hospital/clinic.
  5. HelloFax — I won’t mince words, much of healthcare still runs on fax. More than 50% of facilities that use MedXT request that interpretations and results be sent by fax. One problem that we saw immediately when we rolled out a fax integration was finger pointing. Facilities would claim that a fax was never sent, and remote physicians would have no record what happened. HelloFax’s simple feature of passing back via API the status of the fax (success, or failed due to X) has greatly reduced the disputes and confusion that happen in the chaos of the ED.
  6. Olark — On MedXT we have a live demo of our software available on the website without registration. Members of our staff walk potential customers through the live demo using Olark screen sharing. Sounds simple, but in healthcare enterprise software this is extremely rare. In most healthcare companies when you request a demo, a salesman and a steak dinner will come to you.
  7. — When onboarding a customer, connecting their MRI Scanner and setting up all the users we often use and screen record the training. Then we upload the video in a private share for the customers to walk through again if they need to. We have videos that have been watched over 100 times during a large deployment.
  8. + Xero — I really wanted to use NetSuite to run MedXT because I know the product is good, but the cheapest license was over 12K/year. We have found with a little bit of programming, Xero and have been able to replicate the functionality of NetSuite that we need at under $1K/year. They also support payroll.
  9. DNSimple — We have registered for many, many domains as part of our company journey. DNSimple is cost effective and has excellent SSL support.
  10. Google Apps — Email and calendar. I personally would prefer Outlook + Exchange, but for us this is not cost effective.
  11. Track1099 — Send out 1099's in 30 minutes. All you need to do is export your data from Xero.

At this moment, most of our new MedXT customers come through referral, so the next frontier is scaling sales and marketing. In that spirit I plan to try: Crowdbooster, Hootsuite, PressFriendly,, Trello, RelateIQ. I’ll report back what I find.



Reshma Khilnani

Visiting Partner at YC. Founder Droplet, MedXT. Facebook, Microsoft, Box Alum.