When the COVID-19 pandemic descended on the United States with full force, one telemedicine provider saw its video call volume increase by fifteenfold. As a result, an infrastructure that worked well for a fairly stable level of baseline traffic was suddenly plagued by reliability, performance and scalability problems, dropping nearly sixty percent of calls.
As a leading managed services and managed security services provider specializing in healthcare, Cloudticity worked with several telemedicine and other providers to address reliability, scalability, and performance. In the process we identified key best practices that can benefit any telemedicine enterprise--and many other healthcare organizations as well.
Here are the top three reliability best practices for telemedicine providers on AWS.
1. Enable Auto Scaling
AWS Auto Scaling monitors applications using Amazon CloudWatch and automatically adjusts capacity to maintain steady, predictable performance at the lowest possible cost. For telemedicine providers, Auto Scaling adds Amazon EC2 and other resources as needed to ensure that spikes in high-bandwidth video traffic will not overwhelm capacity. When properly configured, Auto Scaling also contributes to cost optimization, which is discussed below.
Using scaling policies, you can exercise more precise control over the dynamic scaling process, for example, set maximum scaling limits or base scaling decisions on multiple measurements of loading. In most cases, setting up dynamic scaling requires deep knowledge of Amazon CloudWatch and policy-based process control and is not recommended for DIYers.
2. Fortify Critical Databases
As demand soars, information queries can become a bottleneck and cause application slowdowns or outages. AWS Relational Database Service (RDS) allows you to scale your database's compute and storage resources with only a few mouse clicks or an API call.
However, scaling the database alone may not be enough, because the root problem is usually too many read operations for a single database. All Amazon RDS engine types allow you to launch read-only replicas of the database to spread the read load for consistent query response and allow for regional location of database information to reduce read latency.
For cloud applications, Cloudticity typically uses AWS Elasticache to create and manage the read replicas mentioned above. Amazon ElastiCache allows you to seamlessly set up, run, and scale in-memory data stores in the cloud. AWS Elasticache supports two open source code bases, Redis and Memcached.
3. Offload Legacy Bandwidth
Established telemedicine providers often rely on legacy applications that were not intended to scale rapidly enough to respond to an event such as COVID-19.
As a case in point, the provider discussed earlier had a fixed-capacity telemedicine calling infrastructure in several colocation facilities. In the short term, migrating that capability to AWS was out of the question. However, Cloudticity and the customer identified a significant subset of noncritical tasks (for example, downloading software updates) that could be safely moved to AWS using Amazon CloudFront content delivery network, reducing the load on the proprietary front end.
This best practice may require changes to your existing applications. Leveraging healthcare-specific cloud expertise, Cloudticity Professional Services can help you optimize your apps for the cloud and improve performance and availability while maintaining and improving HIPAA and HITRUST compliance.
When migrating customer-facing applications to AWS, telemedicine providers may need to maintain existing IP addresses for some of their customers. Bring Your Own IP (BYOIP), a little-known feature of Amazon EC2, enables you to use an existing IPv4 address for the AWS-hosted application.
Preparing For The Future
It’s easy to think that what happened to telemedicine companies in the wake of COVID-19 won’t happen again. But prior to COVID-19, no one would’ve thought it could happen at all. The lesson is that, if we want to be effective healthcare providers, we need to be agile, flexible, and ready to turn on a dime. The cloud enables this for healthcare IT.
To access the full list of recommendations for telemedicine providers on AWS, check out the full eBook.