Reshma Khilnani is the Co-founder and CEO of Medplum, an open-source healthcare developer platform that helps build, test, and deliver healthcare products and services. With a background in big tech and a passion for solving healthcare’s most complex challenges, Reshma is at the forefront of driving innovation in the industry. Her work with Medplum spans empowering developers, advancing interoperability, and supporting the next generation of healthcare delivery models. In our conversation, Reshma shares her insights on:
The Origin and Vision of Medplum: Reshma shares how her experiences in building healthcare applications inspired a platform to reduce redundancy, incorporate lessons learned, and enable scalable developer solutions.
Challenges with Traditional EMRs: She highlights the limitations of legacy EMRs, such as feature bloat, poor modularity, and rigid designs, and how Medplum reimagines these systems with modern workflows.
The Power of Headless and Open-Source Architecture: Reshma explains how headless systems drive modularity and adaptability while open-source fosters transparency, collaboration, and cost efficiency.
Engineering-Led Product Development: Medplum thrives without formal product managers, relying on customer feedback, developer collaboration, and iterative design to solve real-world problems.
Go-to-Market Strategies for Open-Source Platforms: Reshma describes how Medplum targets developers, drives grassroots adoption, and converts users to enterprise clients with compliance tools and premium features.
The Role of Messaging and Tasking: Reshma underscores how messaging and tasking enable real-time collaboration, proactive task management, and integration into healthcare workflows.
Lessons from Building Zero-to-One: She reflects on challenges like navigating healthcare regulations, improving interoperability with FHIR, and addressing the health tech talent gap.
Opportunities for Health Tech Innovation: Reshma identifies key opportunities like reducing administrative burdens, advancing interoperability, empowering developers, and enabling virtual and hybrid care models.
In this episode of Concept to Care, Reshma provides a compelling look into how Medplum is shaping the future of healthcare technology. Her insights into product development, architectural design, and health tech innovation offer valuable lessons for developers, healthcare leaders, and entrepreneurs looking to make an impact in the industry.
Some takeaways:
The Origin Story of Medplum: Reshma described Medplum as the product of repeated experiences building healthcare applications, each time realizing developers were recreating the same systems with minor variations. She and her team saw an opportunity to break this cycle by creating a platform that reduces redundancy, incorporates hard-earned lessons from previous iterations, and demonstrates the "right way" to build healthcare apps. Medplum’s vision is to empower developers with open-source tools that ensure flexibility, scalability, and composability from the start.
Why Traditional EMRs Fall Short: Reshma outlined several reasons why traditional EMRs often feel frustrating and inadequate:
Feature Overload: Over decades, EMRs have become “pin cushions full of functionality,” burdened with features added to address regulatory changes and increasingly complex workflows. This accumulation has made them unwieldy.
Lack of Modularity: In contrast to other industries where functionality is distributed across specialized applications, EMRs tend to bundle everything into one massive system, making them less efficient and harder to navigate.
Ergonomic Failures: Many EMRs are not user-friendly for clinicians, requiring excessive typing, dictation, or clicking. Reshma highlighted that software should reduce the burden on users, allowing them to focus on face-to-face patient interactions.
Rigid Design: EMRs are often designed with rigid assumptions, such as fee-for-service workflows or specific provider locations. This rigidity makes it challenging to adapt them to modern use cases, such as value-based care or multi-clinic practices.
Medplum seeks to address these challenges by rethinking healthcare software with a headless architecture that enables modular, fit-for-purpose solutions. Its composability allows organizations to tailor their applications to specific workflows without inheriting unnecessary complexity.
The Power of Headless and Open-Source Architectures: Medplum combines the strengths of headless and open-source architecture to deliver unparalleled flexibility and capability. Reshma highlighted key benefits for each approach:
Why Headless Architecture Matters
Enforces Abstraction: A headless system separates the backend logic from the user interface, ensuring clean, modular development. This prevents the intertwining of features and workflows, making changes easier and reducing complexity.
Composability: Developers can mix and match components, creating tailored workflows and applications that meet specific needs without building unnecessary features.
Adaptability: A headless system allows UI changes or backend upgrades without disrupting the other, empowering organizations to evolve at their own pace.
Change Management: By enabling modifications at all layers of the system (e.g., UI, identities, access controls), headless architecture supports seamless iteration and upgrades over time.
Developer Ergonomics: With APIs that handle nearly all functionalities, headless architecture simplifies integration and development, making it easier for teams to focus on core innovations.
Why Open-Source Matters
Transparency: Open-source platforms allow users to inspect and understand the inner workings, building trust and enabling deep customization.
No End of the Road: Developers aren’t limited by proprietary constraints—they can dig into the codebase to solve complex problems or create novel solutions.
Community Contributions: Open-source fosters a collaborative ecosystem where users share improvements and solutions, driving innovation and robustness. Medplum benefits from active contributions, signaling adoption in production environments.
Proven Paradigms: Inspired by successful open-source tools like Postgres and Kafka, Medplum applies the same principles to healthcare software, providing developers with familiar paradigms that work.
Cost Efficiency: Open-source reduces the barriers to entry for small teams and startups while offering the flexibility to scale up with enterprise-level capabilities.
Together, headless and open-source architectures make Medplum uniquely positioned to transform healthcare software. It empowers developers to build faster, organizations to scale more efficiently, and healthcare ecosystems to innovate beyond the limitations of traditional systems.
Challenges and Lessons in Zero-to-One Building: Reshma shared key challenges Medplum faced during its development journey and how her team overcame them:
Navigating Healthcare Regulations: Building an open-source platform in a highly regulated industry required strict compliance with standards like SOC 2. Medplum addressed this by prioritizing transparency, allowing users to inspect and trust its software while ensuring it met all regulatory requirements.
Bridging the Customization Gap: Organizations often struggle between building custom solutions or relying on rigid off-the-shelf products. Medplum resolved this by offering a headless, API-first platform, enabling developers to build modular applications tailored to their needs without starting from scratch.
Improving Data Quality and Interoperability: Healthcare data’s lack of standardization creates barriers to integration. Medplum adopted the FHIR standard and leveraged community contributions to ensure consistent data modeling, enhancing interoperability and data quality across systems.
Tackling Talent Scarcity: Finding engineers proficient in both software and healthcare is a persistent challenge. Medplum’s comprehensive documentation and intuitive platform lower the barrier for developers, empowering a broader range of contributors to build impactful applications.
The Role of Product in an Engineering-Led Culture: Medplum’s engineering-first approach is a deliberate choice, reflecting the company’s mission to serve developers and technical teams. Reshma shared insights into how Medplum thrives without a formal product manager and how this decision aligns with their customer-centric philosophy:
Engineering-Driven Product Development: At Medplum, product decisions emerge organically through close interactions between forward-deployed engineers and customers. These engineers gather requirements by embedding themselves with clients, listening to their needs, and reverse-engineering problems into actionable solutions.
Product’s Role in Modern Health Tech: Reshma emphasized that in healthcare, product management must extend beyond traditional responsibilities to include subject matter expertise. Strong product leaders need to navigate complex requirements, prioritize what to build (and what not to build), and ensure implementations remain focused and manageable.
Customer Engagement as a Substitute for Traditional Product Management: Instead of a dedicated product management team, Medplum leans heavily on customer feedback. This includes maintaining active Slack channels, Discord groups, and open-source issue trackers. These channels allow developers and users to share direct feedback, vote on priorities, and shape the roadmap collaboratively.
Why This Model Works for Medplum: The company’s focus on developers as primary users aligns with an engineering-led structure. Engineers at Medplum are empowered to act as product owners, translating real-world customer use cases into technical requirements.
Potential Evolution: While Medplum doesn’t currently have formal product managers, Reshma acknowledged the value of strong product leadership in scaling healthcare applications. As the company grows, there may be opportunities to integrate more traditional product management functions while preserving its engineering-driven DNA.
Go-to-Market Strategy for a Developer-Focused Platform: Reshma provided insights into how Medplum’s GTM strategy is uniquely tailored to its technical, developer-first product and contrasts with traditional off-the-shelf health software approaches:
Target Audience: Medplum primarily sells to developers, IT leaders, and forward-thinking healthcare organizations. By focusing on these technical users, Medplum positions itself as a tool to empower innovation rather than just a software solution.
Developer-Led Adoption: The company relies on an open-source model to lower barriers to entry. Developers can freely explore and build with Medplum, integrating it into their workflows without requiring upfront buy-in from non-technical stakeholders. This strategy enables grassroots adoption.
Building Credibility Through Use: By fostering a community of developers and providing extensive documentation, Medplum ensures its platform’s capabilities are showcased organically. Developers who experience its power often become internal advocates, influencing organizational decision-makers.
Simplifying the Sales Process: Rather than pursuing high-touch sales cycles, Medplum uses its open-source adoption to identify users already engaged with the platform. The focus then shifts to converting these users to paid customers by offering enterprise features like compliance tools, premium support, and advanced integrations.
Closing Deals: Medplum ensures enterprise clients recognize value by highlighting its scalability, flexibility, and ability to solve healthcare-specific challenges (e.g., interoperability). Success stories and developer endorsements help build trust and accelerate decision-making.
Driving the Next Generation of Healthcare Software: Reshma highlighted messaging and tasking as foundational features for the future of healthcare technology, explaining their critical role in advancing care delivery and operational efficiency:
Enabling Connected Workflows: The next generation of healthcare software must focus on creating seamless, connected workflows where communication and task management are embedded into clinical and operational processes. Messaging and tasking features serve as the glue that holds these workflows together, enabling timely collaboration and reducing delays in care delivery.
Messaging for Real-Time Coordination: Messaging functionality allows clinicians, staff, and even patients to communicate in real-time, fostering immediate responses and collaboration. This is particularly valuable in urgent or complex care scenarios, where timely communication can directly impact outcomes.
Tasking for Proactive Management: Tasking systems ensure that key actions are organized, prioritized, and tracked to completion. When tied to specific clinical events—such as lab results, referrals, or medication reviews—tasking creates accountability and prevents critical steps from being overlooked.
Integration as a Must-Have: To realize their full potential, messaging and tasking must be deeply integrated into EMR/CRM ecosystems. By linking messages and tasks directly to patient data and clinical events, healthcare software can provide context-rich, actionable insights that streamline decision-making and reduce cognitive load for users.
Medplum’s approach to embedding messaging and tasking into its platform exemplifies the evolution of healthcare software—shifting from siloed tools to cohesive systems that improve communication, task execution, and, ultimately, patient care.
Opportunities for Innovation in Health Tech: Reshma shared her vision for where health tech is headed over the next 1–3 years and how Medplum aims to play a pivotal role in driving innovation:
Streamlining Administrative Burdens: One of the biggest opportunities lies in reducing the administrative overhead for clinicians through automation and better system integration. By leveraging technologies like AI and structured data workflows, health tech can enable clinicians to focus more on patient care and less on operational tasks.
Advancing Interoperability: The next wave of innovation will prioritize seamless data exchange across healthcare systems. Medplum’s commitment to FHIR standards and its dual API approach (GraphQL and REST) positions it as a key enabler of interoperability, helping organizations break down data silos.
Empowering Developers: Reshma emphasized that developers are the driving force behind health tech innovation. By providing tools like Medplum, which simplify building modular, scalable applications, health tech can accelerate the creation of solutions tailored to diverse clinical and operational needs.
Evolving Care Models: With the rise of virtual care and hybrid care delivery models, there’s a growing demand for platforms that can adapt to non-traditional workflows. Medplum’s headless architecture and open-source nature give it the flexibility to power these emerging models, enabling organizations to innovate without being constrained by legacy systems.
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Where to find Reshma Khilnani
email: reshma@medplum.com
Medplum: https://www.medplum.com/
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Where to find Angela and Omar:
Angela Suthrave
Omar Mousa
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Referenced:
Medplum: https://www.medplum.com/
Medplum Documentation: https://www.medplum.com/docs
Medplum on Youtube: https://www.youtube.com/@medplum
Medplum Case Studies: https://www.medplum.com/case-studies
Medplum Github: https://github.com/medplum/medplum
Medplum Discord Community: https://discord.com/invite/medplum
How to contribute to Medplum: https://www.medplum.com/docs/contributing
What is Open Source: https://opensource.com/resources/what-open-source
What is Headless Architecture: https://alokai.com/blog/headless-architecture
Nikhil Krishnan giving Palantir credit: https://x.com/nikillinit/status/1859061406273765387
Other Opensource Companies that Medplum is taking cues from:
Databricks: https://www.databricks.com/
Atlassian: https://www.atlassian.com/
PostHog: https://posthog.com/
Supabase: https://supabase.com/
Some accredited certifications and organization bodies:
What is HIPAA: https://www.cdc.gov/phlp/php/resources/health-insurance-portability-and-accountability-act-of-1996-hipaa.html
What is SOCII: https://www.vanta.com/collection/soc-2/what-is-soc-2
What is the ONC Certification: https://www.healthit.gov/topic/certification-ehrs/about-onc-health-it-certification-program
Who is NCQA: https://www.ncqa.org/about-ncqa/
Healthcare Data Standards
What is HL7V2: https://v2.hl7.org/conformance/HL7v2_Conformance_Methodology_R1_O1_Ballot_Revised_D9_-_September_2019_Introduction.html
What is FHIR: https://www.healthit.gov/sites/default/files/2019-08/ONCFHIRFSWhatIsFHIR.pdf
What is DICOM: https://www.dicomstandard.org/about
What is LOINC: https://loinc.org/get-started/what-loinc-is/
What is SNOMED CT: https://www.snomed.org/what-is-snomed-ct
GraphQL vs Rest APIs: https://www.medplum.com/blog/graphql-vs-rest
What is composability: https://www.medplum.com/blog/composability-medplum
Sid Sijibrandij, Founder of GitLabs on why companies should have a handbook: https://mocharymethod.org/mochary-method-ep-12/
GitLabs Handbook: https://handbook.gitlab.com/
Reshma uses Claude to help code and use as a sounding board or thought buddy: https://claude.ai/
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