Healthcare on Rails: Why these 10 companies chose Ruby on Rails
Reading time: ~ 11 minutes
Open sourced in 2004, Ruby on Rails has made a big impact on the software industry. While Planet Argon embraced open source technology early on, it took a few years for some bigger industries to really warm up to the idea.
While they are rare these days, I still have faint memories of conversations (nearly debates) with CTO-level folks who were skeptical about relying on open source software, let alone a new framework to develop their web applications in.
“Who do we call if we need support?”
There was a time when "your developers" didn’t seem to resonate with them as a reassuring response.
Fast-forward 12+ years; we live in a far different world now. Microsoft and Apple are open sourcing their languages, frameworks, and databases. Open source won its way into every major industry. We don’t debate these topics anymore.
The question is no longer, “should we use open source?” … it’s, “which open source toolset should we leverage?”
At Planet Argon, we’ve worked in a wide range of industries and have decided to focus our attention on Healthcare. It’s an area that we feel proudest to apply our problem-solving skills.
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Recently, I had an opportunity to speak with several organizations in this space. Aside from a desire to learn more about their service and product offerings, I wanted to understand what their motives were for choosing Ruby on Rails. I’m familiar with our own reasons, but how are other companies navigating these big decisions?
To provide a range of perspectives, I sought out ten different Healthcare companies within North America to talk shop. They were kind enough to share some time with me and provided permission to publish some of their responses. Again, in the open source world—many of us want to help each other out.
1. MeYou Health
Headquarters: Boston, Massachusetts, USA
Q&A with: Antares Meketa, Head of Product (formerly Head of Engineering)
Q. What does MeYou Health specialize in?
Antares at MeYou Health:
MeYou Health has built out a platform that gets participants to assess and improve their well-being through small daily actions. The fancy description is that we build social behavioral health interventions, but the simpler one is that we get people to walk more, eat better, quit smoking, and adopt other healthy behaviors!
Q: Why did MeYou Health decide to use Rails?
Antares at MeYou Health:
MeYou Health was founded with a goal of being an excellent software company first, and a healthcare company second. Therefore, from the beginning, we wanted to choose a technology platform that would allow us to focus on the craft of software development.
Ruby on Rails is, of course, built to simplify web and API development, allowing developers to focus on more complex work. However, and arguably more importantly for us, it's also the place where people have really innovated in software testing tools.
The founding engineers at MeYou Health had all experienced the pain of working with large codebases that have inadequate (or non-existent) automated test coverage. We started with no code, and no products, and the first thing we did was establish what we wanted our software development process to be: BDD/TDD, full-stack automated testing without a QA team, continuous integration and deployment, etc.
From there, Ruby on Rails was a clear choice based on the sophistication of the testing and tooling ecosystem.
Q: What other frameworks did MeYou Health consider?
Antares at MeYou Health:
We did consider using a more Microsoft-heavy stack (ASP.NET, etc.) as some of our founding engineers had experience there. However, we quickly solidified on Ruby on Rails for all the reasons mentioned above.
Q: How has this decision helped MeYou Health’s business goals?
Antares at MeYou Health:
I would say that our ability to focus on the craft of software development has helped our company's business goals, and Ruby on Rails has helped us focus on the craft of software development.
Adopting good software development practices, being flexible as these practices change over time, and picking a technology stack that can help enable that level of process flexibility have all led to us spending much more time on feature development and solving complex problems.
It has also allowed us to hire and retain truly excellent engineers who care about the craft of software development as much as we do!
2. Watsi
Headquarters: San Francisco, California, USA
Q&A with: Thomas Bukowski, Lead Developer
Watsi allows anyone to directly fund life-changing healthcare around the world.
Disclaimer: Robby is a Watsi contributor.
Q: Why did Watsi select Ruby on Rails?
Thomas at Wastsi:
Mostly due to [our own] familiarity. Every tool and framework has its own pitfalls and strengths, but picking something we're familiar with let us get started and launch faster.
Q: What other frameworks did Watsi consider?
Thomas at Wastsi:
Node.JS, and related frameworks that would have allowed us to share logic between the client and server codebases.
Q: How has this decision helped Watsi’s business goals?
Thomas at Wastsi:
I think all the standard reasons apply here: selecting something we were already familiar with and with large library ecosystem helped us get started faster, and folks we've hired tend to already have at least some knowledge of Rails. A lot of what we built initially was relatively run-of-the-mill web functionality, and Rails really shines at this kind of early stage prototyping.
3. PatientsLikeMe, Inc.
Headquarters: Cambridge, Massachusetts, USA
https://www.patientslikeme.com/
Q&A with: Amy Newell, Director of Engineering
Q: What does PatientsLikeMe specialize in?
Amy at PatientsLikeMe:
PatientsLikeMe is a free website where patients living with any condition can track their health, connect with others for information and support, and share data for research. We share that data with healthcare partners so they can better understand patients, and develop more effective products, services, and care.
Q: Why did PatientsLikeMe select Ruby on Rails?
Amy at PatientsLikeMe:
We were looking for improved speed of development (over, for example, Java) and a framework that we could have fun using.
Q: What other frameworks did PatientsLikeMe consider?
Amy at PatientsLikeMe:
We also considered Django. The story is that PatientsLikeMe's technical cofounder emailed both teams about their frameworks and liked DHH's answer better.
Q: How has this decision helped PatientsLikeMe’s business goals?
Amy at PatientsLikeMe:
Rails enabled us to make lots of progress on PatientsLikeMe with very few engineers. As we grew, using what became a hot technology helped with hiring and retention.
4. Optum
Headquarters: Twin Cities, Minnesota, USA
Q&A with: Josh Cutler, (former) Director of Cloud Foundational Services
Q: What does Optum specialize in?
Josh from Optum:
Primarily claims and claims processing related software. That said, if there is a product in the healthcare space that involves software, Optum likely has a play in the space.
Q: Why did Optum select Ruby on Rails?
Josh from Optum:
Ruby on Rails provided a much faster time to market for the types of applications that we were building. Web apps that lend themselves to simple MVC (Model View Controller) construction were built much faster by taking advantage of the tooling and ecosystem behind Rails.
Furthermore, it allowed us to hire from a different talent pool and bring in more "native" web developers.
Q: What other frameworks did Optum consider?
Josh from Optum:
We literally use all of the major ones on different projects at Optum (Node, .Net, tons of Java flavors). The key driver is often the talent on that specific product team.
Q: How has this decision helped Optum’s business goals?
Josh from Optum:
Faster time to market because of developer productivity and the great open source ecosystem.
5. SpendWell Health
Headquarters: Portland, Oregon, USA
https://www.spendwellhealth.com
Q&A with: Chris Coogan, Director of Product and Technology
Q: What does SpendWell Health specialize in?
Chris at SpendWell Health:
We operate a marketplace where people can purchase medical services like X-rays, wellness visits, massage, chiropractic, and other routine types of medical care. We show real prices and integrate with a shopper's insurance plan to make the experience better than it has ever been before.
Q: Why did SpendWell Health select Ruby on Rails?
Chris at SpendWell Health:
Rapid development of web applications, community support.
Q: What other frameworks did SpendWell Health consider?
Chris at SpendWell Health:
We talked about Java (for about 30 seconds) and Django (a bit more seriously)
Q: How has this decision helped SpendWell Health’s business goals?
Chris at SpendWell Health:
SpendWell has been able to build features quickly and test them with customers gaining valuable product insight.
6. Doximity
Headquarters: San Francisco, California, USA
https://engineering.doximity.com
Q&A with: Dean Lucas, Minister of Culture & Product
Q: What does Doximity specialize in?
Dean at Doximity:
Doximity is a secure, HIPAA-compliant professional network for physicians.
Q: Why did Doximity select Ruby on Rails?
Dean at Doximity:
At our previous company, we had built a couple of Rails apps and the experience was liberating. We were able to deliver code at such a high velocity compared to the Java stack we had been developing on for years.
At that time, the Rails community was at a point where we were confident that we would be able to find the kind of support we'd need for an enterprise level app.
Q: What other frameworks did Doximity consider?
Dean at Doximity:
In addition to Ruby, the founding engineers at Doximity all had experience with Java, Python, and PHP. We considered the open source frameworks available for each language and only Rails fell into that sweet spot for rapid development that combines stability with flexibility.
It was an easy decision for us.
Q: How has this decision helped Doximity’s business goals?
Dean at Doximity:
Rails was just one very important piece of a larger vision for how we wanted Doximity to evolve technologically. From the beginning, we had continuous delivery squarely in our crosshairs. The Rails stack in itself doesn't enable continuous delivery, but for us, it most certainly was the foundation.
Rails plays very nicely with TDD and feature flag development. Last year, we did 22 code updates to production per day, on average. The platform allows us to be very innovative while delivering product with massively high efficiency.
7. One Medical Group
Headquarters: San Francisco, California, USA
http://www.onemedical.com/jobs/product/
Q&A with: Jérémie Meyer de Ville, Engineering Manager
Q: What does One Medical Group specialize in?
Jérémie at One Medical Group:
One Medical is reinventing the health care space from the tech side (as well as through patient experience). We build new tech in partnership with our doctors. Our software focuses on patient-facing applications and a proprietary, homegrown system used by our physicians.
Q: Why did One Medical Group select Ruby on Rails?
Jérémie at One Medical Group:
First, the Ruby language is awesome! It is expressive, easy to grasp and lets you actually write beautiful code (you know what I am talking about if you are coming from PHP or Java...). Equally important is that Ruby has a very vibrant and diverse community.
The Ruby on Rails framework besides using Ruby as the primary language was selected for a very long list of reasons including the Convention over Configuration paradigm, Don't Repeat Yourself, ORM, migrations, Test/Dev/Prod environments. All in all, it makes it a perfect tool for Agile development.
It was also reassuring to know that Rails was used "In Real Life" by its makers assuring us that the framework would kept being updated (including security fixes...)
And last but not least, having Rails making opinionated decisions lets us focus on building our product!
Q: What other frameworks did One Medical Group consider?
Jérémie at One Medical Group:
We moved away from ColdFusion…
Q: How has this decision helped One Medical Group’s business goals?
Jérémie at One Medical Group:
Ruby on Rails accompanied One Medical in its growth by attracting talented engineers, making short iterations to try out new product features easy and allowing a gradual migration to the API+Rich/Mobile client model.
8. Wellbe, Inc.
Headquarters: Madison, Wisconsin, USA
Q&A with: David Elderbrock, Chief Technology Officer
Q: What does Wellbe specialize in?
David at Wellbe:
Wellbe’s web-based platform helps patients know what to expect and enables them to participate as partners throughout the process of their care. Wellbe ensures that providers can effectively monitor and coordinate the care of a larger volume of patients, leading to better patient outcomes and higher levels of satisfaction.
Q: Why did Wellbe select Ruby on Rails?
David at Wellbe:
We wanted a programming language that would encourage high quality, consistent coding practices so that team members could work on the codebase without spending a lot of time understanding what the previous developer had been doing. We wanted a framework that would enable us to focus on delivering a high-quality user experience and still ensure that lower level functionality was rock-solid.
We wanted a programming language that had a strong community supporting it.
Q: What other frameworks did Wellbe consider?
David at Wellbe:
The first version of our product was written in PHP, which was largely the technology we vetted Rails against.
We briefly considered an all-Javascript solution but didn't really see that as a fit. Java, too heavy-weight. .NET, too many strings attached.
Q: How has this decision helped Wellbe’s business goals?
David at Wellbe:
Healthcare is undergoing seismic changes, and Wellbe is committed to remaining an innovation leader. Ruby on Rails enables us to move nimbly and with assurance as our platform capabilities evolve.
9. Omada Health
Headquarters: San Francisco, California, USA
Q&A with: Andrew DiMichele, Co-Founder and CTO
Q: What does Omada Health specialize in?
Andrew at Omada Health:
Omada Health is a digital behavioral medicine company that empowers those at the tipping point of chronic disease reduce their risk for conditions like type 2 diabetes and heart disease.
Q: Why did Omada Health select Ruby on Rails?
Andrew at Omada Health:
Rails was designed for rapid web application development, which makes it an ideal tool for a web-based startup.
Rails is supported by a large, active community that contributes open-source libraries and extensions to Rails, accelerating your engineering efforts further since you can re-use code to solve common engineering challenges (like user logins).
People in the Rails community also tend to care a lot about "how" they work in addition to "what" they work on and what tools they use. These folks are helpful to a young startup that needs to define its engineering process.
Q: What other frameworks did Omada Health consider?
Andrew at Omada Health:
ASP.Net, Python/Django, Node.js
Q: How has this decision helped Omada Health’s business goals?
Andrew at Omada Health:
It has helped us get our product and new features into the hands of users faster. Because of the "Rails magic" as it's called (the opaque, behind-the-scenes code that takes care of many of the tedious details of serving a web application) and the large collection of high-quality libraries, you focus your engineering time on a small number of tasks that are unique to your particular business problem.
10. Chiron Health
Headquarters: Austin, Texas, USA
http://chironhealth.com/about/
Q&A with: Justin Turner, Chief Technology Officer
Q: What does Chiron Health specialize in?
Justin at Chiron Health:
We are the premier provider of telemedicine software. Telemedicine is a video platform which enables doctors to talk to their patients online through a browser or mobile app. This allows patients to see their doctors without going to the office. It is also HIPAA compliant and conforms to health care regulations, which enables the doctors to be reimbursed.
Q: Why did Chiron Health select Ruby on Rails?
Justin at Chiron Health:
Rapid development, community support.
Q: What other frameworks did Chiron Health consider?
Justin at Chiron Health:
Java, Grails, AngularJS
Q: How has this decision helped Chiron Health’s business goals?
Justin at Chiron Health:
It enabled us to leverage the practicality and speed of Ruby on Rails. Because of the large ecosystem, both in code and infrastructure, it has allowed us to rapidly develop features and integrations with external health care systems using a very small yet efficient team.
Closing Thoughts
Firstly, a huge thank you to everyone involved who took the time to share their perspectives with me and the rest of the community.
Secondly, one thing that I got out of this is that the bigger healthcare companies are often working with a few pieces of technology. Ruby on Rails is part of their ecosystem and one of the big reasons for embracing it is that they believe it’s attracting top-notch developers that help them stay competitive in the marketplace. They have an interest in keeping their architecture lean and versatile as they expect to need to pivot along the way. It’s telling that some of these companies initially developed their products with another platform and ended up rewriting it with Ruby on Rails.
Lastly, several of these companies are hiring! If you’re a developer and want to help improve our healthcare industry from the inside, get in touch with them. Tell them that Planet Argon sent you. ;-)
If you work in the healthcare industry and are exploring your technology options for an upcoming project, get in touch with us.
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