XRHealth rapidly scales, increases availability with Amazon RDS

As a startup with only 50 employees, XRHealth realized that managed services of AWS would help the company achieve its goals, optimizing staffing and costs in the best way. In early 2020, the company switched to using Amazon RDS for MySQL to deploy scalable MySQL instances in minutes with resizable and cost-effective hardware capacity. 

About XRHealth

Established in 2016, XRHealth is a medical company under the software-as-a-service (SaaS) model that specializes in providing real physical and cognitive therapy solutions. virtual reality (VR). Patients can use these solutions to perform exercises at home and interact with their physicians at the same time. XRHealth plans to expand into new regions as the demand for these telehealth solutions grows.
However, XRHealth was unable to sustain this rapid growth in its self-managed MySQL cloud database, unable to scale to handle amplified volumes, resulting in frequent downtime, which affected oriented towards user experience. As a result, XRHealth needed a new database that could easily scale and maintain compliance with regulations protecting sensitive patient data.
As a young startup with only 50 employees, XRHealth realized that Amazon Web Services (AWS) managed services would help the company achieve its goals of optimizing staffing and costs in the best way. In early 2020, the company switched to Amazon Relational Database Service (Amazon RDS) for MySQL to deploy scalable MySQL instances in minutes with resizable hardware capacity and cost-effectiveness. With Amazon RDS, XRHealth ensures compliance with regulations such as HIPAA and the European Union’s General Data Protection Regulation (GDPR); rapidly expanding into new areas; provide better performance for a larger number of users; optimization cost; At the same time reduce the number of personnel for system maintenance. Using AWS infrastructure also provides an opportunity for XRHealth to rapidly scale and deploy new telehealth services during the COVID-19 pandemic.

Managed MySQL Database on AWS

XRHealth pairs patients with clinicians and provides patients with a VR headset that gives them access to more than 12 therapeutic programs, such as 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 wear a VR headset, they walk into our virtual clinic with lots of different virtual treatment rooms,” said Eran Orr, founder of XRHealth. We monitor and evaluate results to provide them with better care. And we can do that efficiently and accurately with AWS services.”
As XRHealth’s services grew in popularity, the company raised $15 million to expand its business and roll out services to Australia. But the MySQL self-managed database cannot handle the increased load. In addition, deploying to new regions is also difficult because the DevOps team is only two people. The workforce is small, but they have to take on a lot of work such as setting up and configuring the MySQL deployment, managing replication and configuring data. “Our goal is to roll out telehealth clinics around the world, starting in Australia, Israel and the United States,” said Tal Arbel, vice president of data products at XRHealth. We need to scale this model quickly while also ensuring that we meet regulations and customer needs.”
By migrating to Amazon RDS for MySQL, XRHealth can improve the accessibility of VR therapy solutions to more users and simplify the platform through managed services. “AWS is a great choice for small companies like us to start small, experiment and iteratively to find the correct technical solution for business opportunities,” says Arbel. 

Drive global expansion with high performance and availability on AWS

XRHealth completed its migration to Amazon RDS for MySQL in January 2020. The startup is well prepared for its market expansion, with the ability to set up a fully responsive database infrastructure enough compliance in the new area in just 10 days. Orr explains: “Amazon RDS makes scaling a lot faster because we have five development environments and the development team works in tandem. With the outbreak of the COVID-19 pandemic, we expanded into new regions earlier than expected and accelerated the rollout of telehealth services such as stress management and attention deficit hyperactivity disorder (ADHD).”
As XRHealth prepares to launch in Australia in August 2020, Australian customers require XRHealth data to be in the same region for security reasons. Using Amazon RDS Read Replicas, XRHealth simply replicates the database to that region, everything is done quickly. To encrypt data at rest and in transit, XRHealth uses AWS Key Management Service (AWS KMS) to easily create and manage cryptographic keys and control usage. use data across many other AWS services as well as incorporate applications. AWS KMS allows XRHealth staff to analyze data without seeing the patient’s personally identifiable information.
The ability to automatically create read replicas also enables XRHealth to replicate instances to scale quickly and maintain read performance. With the previous environment, this startup experienced 5% downtime, however with Amazon RDS, they get 100% uptime. “On AWS, it’s just one click away to create a new replica and start using it with no management,” said Tomer Pinto, DevOps engineer at XRHealth.

Amazon RDS‘s automated backup capabilities enable point-in-time recovery for database instances, promoting greater availability and durability. This feature helps XRHealth back up the database and transaction logs, and maintain the storage time up to 35 days. As a result, the company can restore database versions at any second during the retention period. “Backup and troubleshooting are incredibly important for healthcare companies,” says Arbel. And we trusted AWS for this critical backup mission.”
On AWS, XRHealth can not only scale quickly but also be cost-effective. Using on-premises infrastructure to deploy in new regions will require the purchase of expensive machinery. But with Amazon RDS there are no upfront commitments: XRHealth only pays a monthly fee for each database instance launched. Using AWS managed services, XRHealth eliminates a lot of administrative work for employees and increases their efficiency. “Using Amazon RDS, we don’t have any administration costs,” says Arbel. And we don’t need to manage Linux systems or MySQL clones. We know Amazon RDS is up and running and does a good job of it for us.”

Deliver better service to patients with infrastructure on AWS


XRHealth has found that running on AWS builds trust in their customers. “The technology departments at major U.S. medical centers were extremely pleased with the XRHealth infrastructure when they learned we were deploying the infrastructure on AWS,” says Arbel. Using Amazon RDS for MySQL, XRHealth can scale up telehealth services securely even if the team is small. Furthermore, with infrastructure on AWS, patients around the world can continue their treatment even during the COVID-19 pandemic so their recovery is not affected. Previously, XRHealth operated as a startup specializing in B2B, but now they have partnered with insurance companies and medical centers so that patients can access medical services right in their homes. “The combination of our technology and AWS technology has the potential to change the entire outpatient industry as we do,” Orr said. “We are excited to contribute and join this journey.”

Benefits of AWS

  • Can set up a fully compliant infrastructure in a new region in 10 days
  • Expanded twice as fast as it would have with its previous cloud provider
  • Reduced downtime
  • Increased performance 
  • Enabled fast global expansion 
  • Optimized costs
  • Automates backups
  • Achieves out-of-the-box compliance with HIPAA, the GDPR, and other regulations

Services used

Amazon Relational Database Service (Amazon RDS) makes it easy to set up, operate, and scale relational databases in the cloud. This service provides cost-effective resizable capacity while automating time-consuming administrative tasks, such as hardware provisioning, database setup, patching, and patching. errors and backups. This service allows you to focus on your applications to get the performance, availability, security, and compatibility you expect.

AWS Key Management Service (KMS) makes it easy to create, manage cryptographic keys, and control cryptographic key usage across multiple AWS services and in your applications. AWS KMS is a secure and durable service that uses FIPS 140-2 validated or validated hardware security modules to protect your keys. AWS KMS is integrated with AWS CloudTrail to provide you with logs of all key usage to help meet your legal and compliance needs.


Amazon RDS manages the work involved in setting up a relational database, providing the infrastructure capacity required by the customer to install the database software. Customers will not have to spend money on management while increasing performance, optimizing costs and resources.
If your business is looking for a database solution, Amazon RDS is definitely a promising choice.

About VTI Cloud

VTI Cloud is an Advanced Consulting Partner of AWS Vietnam with a team of over 50+ AWS certified solution engineers. With the desire to support customers in the journey of digital transformation and migration to the AWS cloud, VTI Cloud is proud to be a pioneer in consulting solutions, developing software, and deploying AWS infrastructure to customers in Vietnam and Japan.

Building safe, high-performance, flexible, and cost-effective architectures for customers is VTI Cloud’s leading mission in enterprise technology mission.

In addition, VTI Cloud supports building VIET-AWS community. This group is one of the fast-growing AWS User Groups and officially recognized by Amazon in the Asia Pacific (Vietnam) region.

VIET-AWS is a place to connect and exchange support between Solutions Architect, DevOps, SysOps, and budding students with cloud computing services of Amazon Web Services (AWS). Join VTI Cloud to join VIET-AWS: https://www.facebook.com/groups/vietawscommunity

Reference: https://aws.amazon.com/vi/solutions/case-studies/xrhealth-case-study/