Reshma
Khilnani

She's already two companies deep in healthcare before most founders have shipped their first feature. Reshma Khilnani is the Co-Founder and CEO of Medplum - the open-source, FHIR-native platform that lets developers build custom EHRs, patient portals, and clinical workflows without spending five years negotiating with Epic's sales team.

Medplum is not a nice-to-have. For the growing wave of digital health startups and health systems that need bespoke clinical infrastructure, it's the difference between building on bedrock and building on sand. HIPAA-compliant by default. SOC2-certified. ONC-certified. Apache 2.0 licensed, meaning any hospital can fork it, run it on-premise, and own every line. In 2024 alone, the open-source community doubled: 1,500+ GitHub stars, 150+ contributors, 5x growth in a year.

The team that shipped all of this was eight people. $1.2 million in revenue. Those two numbers together tell you something important about how Reshma builds.

Before Medplum, there was Droplet Health - an at-home diagnostics company she co-founded and co-led that was acquired by Ro (now Kit.com). Before that, there was Box, where as Engineering Manager she delivered 3D rendering, DICOM medical imaging, and content preview products at scale - and got a shoutout in Fortune magazine as one of "Box's big data triple threat." And before Box, there was MedXT: a YC W13 medical imaging platform for telemedicine, serving hospitals and imaging centers worldwide. Box acquired it.

Three companies. Two exits. One through-line: making healthcare infrastructure actually work for the people building on top of it.

Healthcare software has a dirty secret: most of it is built on legacy systems that were never designed to talk to each other. FHIR (Fast Healthcare Interoperability Resources) is the international standard trying to fix that. Medplum is a headless EHR and full FHIR server, built natively on that standard from day one.

What that means in practice: a startup building a remote patient monitoring tool can plug into Medplum and get a complete FHIR-compliant backend - RESTful APIs, GraphQL support, resource validation, versioning, event-driven architecture, HL7 integration, scheduling, lab networks, messaging, billing hooks, and a React UI component library - without building any of it themselves.

The open-source play is deliberate and philosophically grounded. In healthcare, developers need to audit their infrastructure. A proprietary black box asking you to just trust us is not viable when patient data is on the line. Medplum's entire codebase sits on GitHub under Apache 2.0. That's not a growth hack. It's a trust signal - the kind that takes years to earn and seconds to lose.

Medplum was accepted into Y Combinator's S22 batch - Reshma's second time through the program, this time as a founder rather than a partner. It's a rare arc: go through YC, get acquired, come back to mentor founders, then go back as a founder yourself. She had seen 100+ companies at that stage. She knew exactly what she was walking into.

The throughline in Reshma's career is infrastructure - systems that other systems depend on. At Facebook from 2010 to 2012, she was a Product Manager on the Developer Platform, helping build Facebook Credits, Facebook for Android, Facebook Gifts, promoted posts, and a global payments network spanning 80+ payment methods. That's not a soft product job. That's engineering-adjacent work at the scale where a bug costs millions and a decision about payment flow architecture affects a billion users.

She brought that discipline into healthcare. Medical imaging at MedXT, content preview and 3D rendering at Box, at-home diagnostics at Droplet, and now clinical infrastructure at Medplum. Each company built on what came before. None of them were accidental.

Most open-source companies treat open-source as a customer acquisition strategy. Get developers hooked, then charge the enterprise. Reshma flipped that framing when she went on Emily Omier's "The Business of Open Source" podcast: Medplum uses open source for trust, not growth.

In healthcare, that distinction matters enormously. A hospital considering an EHR platform isn't just evaluating features. They're evaluating whether they can audit the code that's touching patient records, whether they can run it in their own data center, whether they own the infrastructure or are at the mercy of a vendor's pricing decisions. Open source under Apache 2.0 answers all three questions before the sales conversation even starts.

It also creates a different kind of community. Medplum's 150+ contributors aren't just adding features for fun - they're often healthcare developers solving their own real clinical problems. The GitHub repository becomes a collective intelligence about what healthcare builders actually need, not what a product team imagined they might want.