Wellsheet Sees Efficiency Grow With Amazon ECS Powering EHR Application 

Cloud303 Helps Scale EHR Application While Staying HIPAA-compliant 

 Migration  Modernization  HIPAA



Summary

Wellsheet is an intra-electronic health record (EHR) platform that prioritizes clinical content within physician workflow with machine learning.

Its AI-powered workflow is intuitive and integrated with Epic and Cerner to reduce a clinician’s time in the EHR, lessening clinician burnout and improving the quality of patient care.

Wellsheet is being used by clinicians on the frontline battling COVID-19 to provide real-time diagnostic result alerts; visibility of all patients being tested or confirmed with COVID-19 by location, by attending physician, and by associated isolation status; and reduced exposure through shared workspaces.

The application was hosted in Heroku, which is a container-based cloud platform that offers Platform as a Service (Paas). However, as the application grew in usage and popularity, Wellsheet began to realize Heroku was not the right fit anymore due to certain significant limitations.

Among the biggest drawbacks Wellsheet faced with Heroku were the high costs and the inability to access the underlying code and infrastructure.


Industries:
Local Government
Regions: 
NALADEMEAAPAC
AWS Segment: 
EnterpriseSMB


Our Customer

Wellsheet is an intra-electronic health record (EHR), speciality-agnostic cloud platform that prioritizes clinical content within physician workflow with machine learning. Wellsheet provides a predictive clinical workflow platform that uses the Fast Healthcare Interoperability Resources (FHIR) API standards to work within an existing EHR to surface the most relevant content for clinicians in a view that is contextualized and prioritized for their needs.

The Challenge


Cost

Wellsheet is a demanding EHR application. It requires changes to its backend infrastructure to be made in tandem with the growth of the platform. While Heroku fit the bill in the beginning, costs began to rise as time went on. This was mainly due to the way Heroku customers are charged based on the number and size of “Dynos” used. Dynos is a Heroku-proprietary Linux container where application processes are run. These Dynos can add up and cost a fortune in the long run, especially for an app as big as Wellsheet's.

Rigidity

As the Wellsheet platform grew with added intricacies to its infrastructure, Heroku’s fully-managed nature was holding them back. While it was convenient in the beginning, Wellsheet engineers eventually found it cumbersome because they could not tailor their back-end infrastructure according to the application’s needs due to Heroku automatically provisioning resources such as storage and database for the application. This proved to be a stumbling block in Wellsheet’s freedom to scale the application.

Scalability

Wellsheet was also desperate to hasten their exit from the Heroku ecosystem because of how tightly coupled the entire architecture was set up in Heroku. This proved to be a major disadvantage of being hosted in Heroku – it is not primed to support the complexities that microservices entail. The technological possibilities in the healthcare industry are endless, and Wellsheet sought a system that could cater to these possibilities. This meant that they needed to break out of their existing monolith on Heroku and dive into microservices, which would allow them to scale to their needs .

Why Wellsheet Chose AWS?

AWS was a great solution for Wellsheet for a few reasons. First, as their data needs were initially relatively modest but set to scale quickly, moving to an RDS Aurora database would be an ideal solution due to its unparalleled ability to scale in a number of ways and the fact that it would allow them to only pay for the capacity they need. Aurora’s flexibility and robust feature set would allow Wellsheet to easily adapt as their business grows. This can also be a huge money saver, as clients only pay for the capacity they need. Also, since they required flexibility, ECS was an ideal service choice. Containers could be deployed on a single EC2 instance and both the containers and instances could be scaled when the need arose.

Why Wellsheet Chose Cloud303?

Cloud303's reputation as the number one AWS Well-Architected Review partner boded well for Wellsheet's aspiration to roll out the EHR application, which had to be HIPAA-compliant, on AWS.

Cloud303 also turned out to be a great fit for Wellsheet because of their extensive experience with Health and Life Science companies. Cloud303’s experience also means that their engineers are extremely knowledgeable on what it takes to ensure HIPAA compliance in the cloud, including how to effectively keep track of the data needed for HIPAA compliance on the AWS account level as well as data and logs from within the application itself - all of which were defined and discusses extensively during the Well-Architect Review during the Assess Phase of the migration.

 
 
      Phil Supinski     Sujaiy Shivakumar
CEO/Solutions Architect      CTO/Solutions Architect

AWS Services Employed:
 EC2 ECS VPC

Cloud303's Solution

To keep up with the rapid development of Wellsheet, the company sought a system more scalable and robust than what Heroku had to offer. Their search ended when they realized that Amazon Web Services (AWS) had all the answers to their problems in terms of costs and scalability.

Following a glowing recommendation by AWS, Wellsheet acquired the services of Cloud303 – an AWS Advanced Consulting Partner – to help migrate and modernize Wellsheet’s cloud architecture while attempting to reduce the company’s cloud expenditure.

Breaking it down

After migrating the workload from Heroku, the application was decoupled into microservices. Wellsheet, which used to be hosted in a single container in Heroku, could now have its backend functions deployed into multiple containers in Amazon Elastic Container Services (ECS).

DevOps 

Cloud303 scoped out the project and optimized the EHR platform by configuring compute-optimized c5.2xlarge Amazon Elastic Compute Cloud (EC2) instances to power the Docker containers running in Amazon ECS. The workload was spread in private subnets over multiple availability zones in an Auto Scaling Group behind an Application Load Balancer in the North Virginia region for high availability.

HIPPA-Compliance

As part of HIPAA compliance, the entire infrastructure was encrypted both at rest and in transit. Encryption was managed with KMS-CMK, including automatic annual key rotation, which is a HIPAA requirement. Wellsheet also needed to access data from their partner hospitals in a secure fashion, so Cloud303 deployed Transit Gateway into a separate VPC, along with a Network Load Balancer to ensure data remain in a private network and remain HIPAA-compliant.

Results/Benefits

The benefits to Wellsheet’s business have been tremendous. They are configured to retain their logs, both at the application level and the account level, for the six years as required by HIPAA. They also have end-to-end encryption, both in transit and at rest. They have much more control over the resources they’re utilizing, which was not possible on a fully managed service like Heroku. Now, they can easily manage their own infrastructure and security levels as needed.


AWS Programs/Funding Used:
Partner Opportunity Acceleration Funding"MAP" Migration Acceleration Program