XRHealth Rapidly Expands, Increases Availability Using Amazon RDS

Founded in 2016, XRHealth is a software-as-a-service (SaaS) medical company that provides virtual reality (VR) physical and cognitive therapy solutions. Patients can use these solutions to perform exercises from home while virtually collaborating with their clinicians. XRHealth saw an opportunity to expand to new regions as demand for these telehealth solutions increased. 

Yet XRHealth could not sustain additional growth in its self-managed MySQL cloud database, which failed to scale to handle the amplified volume, leading to frequent downtimes that degraded user experience. XRHealth needed a new database that would easily scale up and maintain compliance with regulations protecting sensitive patient data. 

As a young startup of 50 people, XRHealth realized the managed services of Amazon Web Services (AWS) would help the company best achieve its goals and save costs. In early 2020 it migrated to Amazon Relational Database Service (Amazon RDS) for MySQL and used it to deploy scalable MySQL instances in minutes with cost-efficient and resizable hardware capacity. On Amazon RDS, XRHealth achieved out-of-the-box compliance with regulations such as HIPAA and the European Union’s General Data Protection Regulation (GDPR); rapidly expanded to new regions; provided better performance to more users; optimized costs; and relieved its in-house staff of system maintenance tasks. Being on AWS also enabled XRHealth to quickly scale up and deploy new telehealth services during the COVID-19 pandemic.

XRHealth pairs patients with clinicians and provides patients with VR headsets that enable them to access more than 12 therapy programs—like pain management and stroke rehabilitation—from anywhere. Clinicians can check in real time whether patients are performing exercises consistently and correctly, and they can measure patients’ progress using the data that the VR technology generates on patients’ movements and breathing patterns. “When patients put on the VR headset, they step into our virtual clinic with endless virtual treatment rooms,” says Eran Orr, founder of XRHealth. “We monitor them and quantify their outcomes to provide them with better care. And we can do that in an efficient, sophisticated way by using AWS.” 

As XRHealth’s services grew in popularity, the startup raised $15 million to expand its business and roll out services to Australia. But its self-managed MySQL database couldn’t handle the increased load. Additionally, deploying to new regions was complicated because XRHealth’s DevOps team of two had to set up and configure its MySQL deployment and manage the replication and configuration of data—a big job for a small team. “Our vision is to have telehealth clinics around the world, starting in Australia, Israel, and the United States,” says Tal Arbel, vice president of data products at XRHealth. “We need to replicate our model fast while meeting regulations and our customers’ needs.” 

By moving to Amazon RDS for MySQL, XRHealth could improve the accessibility of its VR therapy solutions for more users and simplify its platform through managed services. “AWS has amazing abilities for small companies like us to start small, experiment, and iterate to find our path to success in terms of the right technical solution for the right business opportunity,” says Arbel.

XRHealth completed its migration to Amazon RDS for MySQL in January 2020. The startup was prepared for a rapid expansion, with the ability to set up a fully compliant database infrastructure in a new region in 10 days. Preparing the machines to expand would have taken twice as long with the previous provider. “Amazon RDS makes it possible to run a lot faster because we have five development environments and development teams working in parallel,” explains Orr. At the onset of the COVID-19 pandemic, XRHealth entered new regions sooner than it had planned and expedited the deployment of telehealth services like stress management and management for attention deficit hyperactivity disorder (ADHD). 

When XRHealth was preparing to launch in Australia in August 2020, its Australian customers required that their data remain in the same region for security. Using Amazon RDS Read Replicas, XRHealth simply replicated its database to that region, expanding faster than it could have otherwise. To encrypt its data at rest and in transit, XRHealth uses AWS Key Management Service (AWS KMS) to easily create and manage cryptographic keys and control their use across a wide range of AWS services and in its applications. AWS KMS enables XRHealth staff to analyze the data without ever seeing personally identifiable patient information. 

The ability to automatically generate read replicas also enables XRHealth to replicate instances to elastically scale and maintain read performance, and it did so even as demand increased during the pandemic. Whereas the startup experienced 5 percent downtime in its previous environment, Amazon RDS provides virtually full uptime. “On AWS, it’s a click of a button to create a new replica instance and start using it without managing it,” says Tomer Pinto, DevOps engineer at XRHealth. 

Amazon RDS’s automated backup capabilities, which enable point-in-time recovery for database instances, further promote high durability and availability. This feature enables XRHealth to back up its database and transaction logs and store both for 35 days, so it can restore its database instance to any second during the retention period, up to the previous 5 minutes. “Backups and disaster recovery are crucial for medical companies,” says Arbel. “We rely on AWS for core capabilities in terms of backups, and that makes a lot of noise go away for the development team and the informational security management team.” 

On AWS, XRHealth has been able to expand not only rapidly but also cost effectively. Using on-premises infrastructure to launch in new regions would have required buying expensive machines. But there is no upfront commitment on Amazon RDS: XRHealth only pays a monthly charge for each launched database instance. And the managed service of AWS means that XRHealth eliminates a lot of administrative work for its in-house teams, increasing their efficiency. “Using Amazon RDS, we don’t have any management overhead,” says Arbel. “And we don’t need to manage the Linux system or MySQL replication. We know Amazon RDS is always live and doing the job for us.”

XRHealth has noticed that running on AWS has instilled confidence in its customer base. Arbel says that information technology departments at large US medical centers were immediately satisfied with XRHealth’s infrastructure upon hearing that it was on AWS: “Being on AWS gives our customers confidence in our infrastructure.”

By using Amazon RDS for MySQL, XRHealth has been able to expand its secure telehealth services without overwhelming its small teams. This has enabled patients worldwide to continue their therapy even during the COVID-19 pandemic so that their recovery does not suffer. 

XRHealth plans to continue its expansion to new regions and markets: whereas previously it operated as a business-to-business startup, it now works with insurance companies and medical centers so that patients can access health services from the comfort of their homes. “The combination of our technology and AWS technology has the potential to change the outpatient industry as we know it,” says Orr. “We are very excited to be on this journey.”