Thursday, April 2, 2015

Migrating Healthcare Applications to the Cloud through Containerization and Service Brokering

Organizations that are building their own cloud infrastructure from scratch or rely uniquely only on an infrastructure as a service (IaaS) from a provider, risk spending valuable resources and time building a specialized platform instead of focusing on their core business. On the other hand, organizations who adopt a turnkey proprietary cloud stack will lack flexibility and may end up locked into a specific technology or vendor.

Instead of designing the cloud architecture from the bottom up or the top down, a better strategy is to design from the inside out. By starting with the platform as a service (PaaS) as the central critical layer and creating ways to use various IaaS models and offerings in generic ways, it is possible to create a flexible and efficient lifecycle for the services and applications running on the platform.

In Healthcare, PaaS technology such as the one offered by Pivotal Cloud Foundry facilitates the rapid creation and migration of existing applications towards better user engagement, increasing collaboration between care givers and improving the lives of patients, while reducing the total cost of ownership (TCO).

The main characteristics of this platform are:
  • Application containerization
  • Optimized application scaling
  • Application to service brokering
  • Abstraction of IaaS
  • Excellent application lifecycle management
  • Automatic middleware stack and operating system configuration
  • Advanced application monitoring

In this architecture, backing services (e.g., databases, caching systems, other data services (e.g., Amazon S3), messaging/queueing systems, SMTP services, various external APIs (Google Maps, terminology services, healthcare registry services) are just attached resources. For example, there is a distinction between a local digital imaging and communications in medicine (DICOM) local image store and a remote, 3rd party DICOM picture archiving and communication system (PACS) service hosted in the cloud.

The type of platform is especially suitable managing micro services, which allows better componentization, development and testing processes, decentralized governance, resilience and maintainability. These services, especially when they are based on a RESTful architecture, are extremely easy to build, integrate, test, extend, and maintain, and are extremely adapted for mobile applications integration.

Good and efficient lifecycle management is important to produce and maintain high quality software. This is particularly important in healthcare where the patient life is at risk or a breach of privacy could occur as a result of poor quality software.

The advantage of abstracting the IaaS layer access through a common API is that there no need to have multiple versions of application code for each deployment model. The same code will work and be monitored the same way for all cloud deployment models, including on premise and hybrid.

On top of the generic open PaaS infrastructure, we are adding generic and cross-cutting capabilities not part of the original platform including:
  • Identity management to allow customers, patients and consumers to be accurately and uniquely recognized by using an enterprise master patient index (eMPI) for patients and a lightweight directory access protocol (LDAP) based directory for healthcare providers and consumers.
  • Security/Identity Access Management: authentication, authorization, and single sign-on, all critical to secure provider, patient, and consumer applications and in certain cases, can be addressed by declarative proxification of these services.
  • Cloud-based, connected device management: device registration, discovery, routing, diagnostics, remote control, firmware provisioning, data collection, device-app-user pairing (we are currently supporting 6 million active consumer devices).
  • Open cloud based clinical workflow collaboration capabilities.
  • Secure cloud-based big data store and analytics capability (e.g., to store patient’s observations and genomic data.


We are also creating and exposing healthcare and wellness related services that applications can consume:

Our HealthSuite Digital platform also offers high availability, scalability, privacy and security compliance with regulations (e.g., HIPAA, HITECH) and standards (e.g., NIST SP800-53, ISO 27001) using multitenancy, redundancy, 24/7 monitoring and operations, and disaster recovery.

   More on:  F. Andry, R. Ridolfo, J. Huffman, Migrating Healthcare Applications to the Cloud through Containerization and Service Brokering, 8th International Conference on Health Informatics (HealthINF 2015), pp. 164-171, Lisbon, Portugal, January 2015.

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