Thursday, October 1, 2026
When a patient arrived in the Wenatchee emergency room with a heart attack just weeks after Coltrain launched, cardiologist Dr. Gautam Nayak saw years of frustration and experimentation finally crystallize into something simple and powerful: faster communication that could save a life.
Using Coltrain, the ER physician and Nayak coordinated the patient’s care and moved them from the emergency department to the cath lab 15 minutes faster than usual.
“For every minute you save getting a blocked artery open in a heart attack, you reduce mortality by about one percent,” Nayak said. “Very early on, we had validation that Coltrain doesn’t just save time—it can save lives.”
That moment underscored a problem Nayak had been grappling with for years in Central Washington’s rural healthcare system: despite cutting-edge procedures and medications, the way clinicians communicate often lags far behind.
“We’re still using faxes and carrying pagers,” he said. “Patients move across large geographies and multiple clinics and systems, but none of us are connected. We’re all on different electronic health records that don’t talk to one another.”
After seeing patient outcomes suffer due to those gaps, Nayak decided he could no longer accept “that’s just how it is” as an answer.
“I tried to solve it within our system,” he said. “But it was so expensive to roll out something that could work across an entire region and multiple organizations. After struggling with that for a few years, I thought, maybe I can try to do this myself.”
The result is Coltrain, a web and mobile app designed to give clinicians a shared, secure space to coordinate care around individual patients—regardless of which clinic, hospital, or health system they belong to.
Unlike general-purpose messaging apps or siloed hospital communication tools, Coltrain is built around patient cases, creating a shared, real-time workspace for care teams.
“It’s all case-based,” Nayak said. “Any clinician—doctors, PAs, nurse practitioners, nurses, pharmacists, members of the care team—can download the app, register, and start communicating as a team around specific patient cases.”
That structure eliminates the need to repeat information or restart conversations when new specialists are involved.
“If you and I are discussing a case and we realize we need to add a kidney doctor, they can come into the case and immediately see everything we’ve been talking about,” he said. “There’s no redundancy. It’s really easy to get everyone on the same page at the same time.”
Coltrain also functions as an open clinical network rather than a closed system.
“You can see everyone who’s in the network and add whoever you need,” Nayak said. “You can search for the right person if you’re not sure who that is.”
That flexibility is particularly valuable in rural communities, where clinicians may not always know who to call—or may be stepping into unfamiliar environments as locum or temporary providers.
Nayak has practiced cardiology in Central Washington since 2009, following a decade of service in the Navy. His cofounder and best friend, Dr. Sanjay Khicha, is a cardiothoracic surgeon in Wichita, Kansas. Despite practicing in different regions, the two realized they were facing the same fundamental challenge.
“He had the exact same pain point,” Nayak said. “We were just chatting one day, years ago, and realized we both couldn’t get this kind of communication done in a way our systems would support.”
Rather than waiting for a system-wide solution, they decided to build one themselves, pulling together early funding from grants and personal networks.
Today, more than 1,700 clinicians use Coltrain across Washington and Kansas—two states where rural geography often means patients travel long distances and navigate multiple, disconnected systems of care.
If Coltrain’s early success showed it could save minutes, a case over Memorial Day weekend revealed just how critical those minutes can be.
A patient arrived at Wenatchee’s emergency room in cardiogenic shock—“as sick as it gets,” Nayak said. It quickly became clear the patient needed an advanced procedure available only at a major medical center.
While Nayak’s partner worked to stabilize the patient in the cath lab, he turned to Coltrain to coordinate the next step.
“He asked me to communicate with our colleagues at the University of Washington through Coltrain,” Nayak said. “At this point I’ve gotten most of the cardiology community around the state on Coltrain.”
Within five minutes of starting a case and sharing images, the response came back with a plan already in motion.
“I didn’t just get, ‘Yes, we can take care of this, send the patient,’” he said. “Because they happened to be sitting with the ICU charge nurse, they already had a bed ready in the ICU.”
The transfer—from Wenatchee to Seattle—took about 70 minutes.
“This was life saving,” Nayak said. “In a traditional process, that transfer could easily have taken at least five or six hours, maybe a day or two. In that amount of time, they might not have made it.”
Stories like that continue to fuel the work.
“All I need is one of those stories every so often,” he said. “It keeps me wanting to build this out. Knowing patients’ lives are better or longer because we communicated faster—that’s the most gratifying part.”
Beyond emergency situations, Nayak sees Coltrain as a way to address one of healthcare’s most pressing challenges: access to specialists.
By enabling faster, more efficient collaboration between providers, the platform allows primary care clinicians to connect with specialists quickly—often without the delays of traditional referrals. That speed helps patients get on the right treatment path sooner, while allowing specialists to focus their time where it’s most needed.
At its core, Nayak believes the platform strengthens something that has always been central to medicine: relationships between clinicians.
Coltrain’s growth has also been shaped by the entrepreneurial ecosystem in North Central Washington, particularly the Flywheel Investment Conference and the NCW Tech Alliance.
Although the company did not receive Flywheel funding, Nayak describes the experience as pivotal. Through mentorship, coaching, and a supportive network, the process helped refine Coltrain’s strategy and clarify its long-term vision.
Initially hesitant to apply, Nayak ultimately found the experience transformative, providing both confidence and a clearer roadmap for growth. Today, he credits both organizations as foundational partners whose guidance and advocacy played a key role in the company’s development.
That impact was further recognized when Nayak was named the 2024 Entrepreneur of the Year by the NCW Tech Alliance for his work on Coltrain.
In the near term, Nayak’s focus remains local and practical.
“Short term, I want our entire clinical community in Central Washington on the platform,” he said. “I want us fully coordinated here, and I want stronger partnerships with the big systems in Seattle and Spokane, where our referral pathways already run.”
If that vision becomes reality, it could mean faster access to advanced care when needed—and stronger support for keeping appropriate care closer to home.
For now, though, Nayak is driven less by scale and more by the everyday impact he hears from colleagues: a patient transferred in time, a rural provider who feels supported, a clinician learning through collaboration.
“When a colleague in a smaller town gets a patient in faster and feels truly supported, that’s huge,” he said. “When a PA or NP tells me they’re learning just by being part of these conversations, it reminds me why we started this.”
Those moments, he added, carry a certain pull.
“I don’t play golf,” he said. “But I hear when you get a really good shot, you just want to go back out there and keep playing. For me, every time I hear one of these stories, I think, we’ve got to keep building this. We can do better for our patients.”
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