How Healthie built an industry-changing EHR SaaS without ever touching infrastructure.

Paper medical records were never ideal: Difficult to share, limited by storage, and dishearteningly fire-prone, they were the best we had. Until electronic health records (EHR)—digital copies of a patient’s medical history, lab tests, immunizations, allergies, etc.—came along. 

EHRs are easier to share, more secure, and not bound by physical storage limitations. But until 2016, there were very few EHR SaaS providers to help healthcare businesses scale administrative duties and keep personal information secure. When Healthie came to market seven years ago, they initially served dietitians, but quickly expanded into other sectors of health and wellness providers. 

In the early stages of SaaS growth, it can be overwhelming, if not impossible, for teams to maintain pace of quality development and implement dedicated infrastructure support at the same time. John Bachir, Healthie’s Director of Engineering, faced these same challenges. To keep up with Healthie’s success, he needed a team of reliability experts and numerous developers to build and release features quickly. 

Enter Aptible in 2017, when Healthie was at its most critical stage of growth. By simplifying the regulatory compliance needs of Healthie’s backend, Aptible enabled Healthie to maintain a strong and secure platform without hiring Site Reliability Engineers (SREs), and instead invest in growing their engineering team to improve the application. 

Now, Healthie serves over 2,000 organizations, delivering modern, virtual-first experiences between providers and patients - impacting over 3 million patient lives.

“If you aren’t using Aptible, you’re wasting time reinventing the wheel. Even without the HIPAA compliance, which is a huge win, Aptible is simply a great offering with great features.”

The Challenge

“We had a scrappy team delivering an industry-changing EHR SaaS, in large part because we were able to focus on application development, rather than infrastructure.”

Bachir manages the Healthie development team of 30 engineers and is responsible for the web and mobile applications. 

Early-stage SaaS companies struggle to balance rapid growth with lean investment in infrastructure expertise. And when your application is serving customers in the healthcare space, compliance requirements are the top priority. Meanwhile, infrastructure needs become more critical and costly as you scale. 

“If you’re only hiring one person to set up Kubernetes and be responsible for the whole infrastructure—AWS, key management, and permissions,” says Bachir, “they’d better be perfect.” 

Because there’s so much demand for SREs to manage such important elements, it’s hard to find, afford, and retain these professionals. Realistically, organizations can’t hire only one full-time expert; they need at minimum another part-time SRE to fill in when needed. 

In the early days of Healthie, they were operating with a small but highly ambitious engineering team. For developers so early in their careers, adding the responsibilities of managing infrastructure would have been a huge obstacle, crippling the team’s pace. 

“We had team members only 1-2 years out of coding bootcamps but were able to make meaningful contributions to building an industry-changing EHR SaaS,” Bachir reminisces. “That’s really impressive.”

A big part of why the Healthie team succeeded in driving fast-paced healthcare innovation, was due to their focus on application development. Engineers could spend their time focusing on data structures and improving the UI without thinking about scaling servers or keeping security patches up to date. Bachir and his team have confidence Aptible is taking care of all of this for them.    

The Solution

“We’re thinking about our application most of the time, not our infrastructure.”

When Bachir started working at Healthie, he wasn’t familiar with Aptible, but had over 12 years of experience working with other platforms-as-a-service (PaaS), Heroku in particular. At previous jobs, he spent at least 20% of his time on infrastructure management. 

“I was immediately impressed with Aptible,” says Bachir. “Because I had experience working with other PaaS, I saw features Aptible had that I found lacking in other products. The immense value it was bringing to our processes was obvious.” 

Aptible offers numerous things that other PaaS providers don’t, which Bachir and the Healthie team have found particularly valuable: 

• More flexibility for deploying services 
• Multiple HTTP endpoints per app
• Logical replication of Postgres, making updates easier
• CPU & RAM Optimized Container Profiles to reduce cost 
• Extremely responsive Support Team with email and Slack support

“The support has been fantastic! It actually might be my favorite thing about working with Aptible,” exclaims Bachir. “Speaking with their support team has been extremely confidence-inspiring and makes me feel like we’re getting our money’s worth.”

Before Aptible, Bachir felt pressured to keep up with infrastructure and DevOps trends and blogs, but no more. Healthie doesn’t even have to build their own Docker images; they can just push a Docker file and Aptible builds the image for them. 

“I don’t need to have a comprehensive understanding about the layers of the Docker infrastructure. All I need to know is that if I push up a Docker file, Aptible takes care of everything. I don’t need to think about maintaining Docker images,” explains Bachir. 

Engineering teams with large tech stacks are subject to complex infrastructure needs. While critical issues don’t arise every day, they can be devastating when they do. To find a solution, engineers spend hours on research and testing. With Aptible, all of the thinking is done ahead of time.

Another aspect of Aptible that Bachir appreciates are the default HIPAA-compliant elements offered in the application. 

“Our team can have confidence that if you’re building inside of Aptible, all those HIPAA boxes are checked,” says Bachir. “You don't have to confirm anything when deploying inside of Aptible. That’s a huge win.” 

Because their compliance and infrastructure needs are largely taken care of, Healthie has been able to consistently prioritize hiring roles focused on delivering product value to the market. Bachir can hire steadily from a larger hiring pool because he doesn't need to add things like “AWS experience” to Healthie’s job descriptions. 

The Results 

“We were able to greatly delay hiring an infrastructure engineer because we’re on Aptible.”

Even now, as a Series-A funded company with good and growing revenue, Healthie can continue to prioritize hiring in software development over infrastructure. Bachir didn’t have to immediately worry about hiring expensive SREs or DevOps specialists because Aptible managed so much of their infrastructure.  

“There’s a certain level of infrastructure operations below which I never have to worry about,” says Bachir. “That’s a big benefit, and generally a relief for our entire engineering team.” 

Developers at Healthie never have to think about the nitty gritty of infrastructure needs. Customer Support Engineers can open shell sessions, access new databases and never have to think about the nuts and bolts of how the backend is implemented. They can just use it as a tool. 

Enabling developers to focus on the application early on instead of the backend paid off greatly for Healthie. Bachir has been able to retain quality engineers because he doesn’t task them with stressful infrastructure puzzles. The company is a leading EHR SaaS provider in the world and has no signs of slowing down.

“The amount of time Aptible allows us to spend on application development everyday really adds up, and has been critical to our success and user adoption.”