Applying technology to healthcare data has the potential to produce many exciting and important outcomes. The analysis produced from healthcare data can empower clinicians to improve the health of individuals and populations by enabling them to make better decisions that enhance the care they provide.
The Observational Health Data Sciences and Informatics (OHDSI, pronounced “Odyssey”) program and community is working toward this goal by producing data standards and open-source solutions to store and analyze observational health data. Using the OHDSI tools, you can visualize the health of your entire population. You can build cohorts of patients, analyze incidence rates for various conditions, and estimate the effect of treatments on patients with certain conditions. You can also model health outcome predictions using machine learning algorithms.
One of the challenges often faced when working with big data tools is the expense of the infrastructure required to run them. Another challenge is the learning curve to implement and begin using these tools. Amazon Web Services has enabled us to address many of the classic IT challenges by making enterprise class infrastructure and technology available in an affordable, elastic, and automated way. This blog post demonstrates how to combine some of the OHDSI projects (Atlas, Achilles, WebAPI, and the OMOP Common Data Model) with AWS technologies. By doing so, you can quickly and inexpensively implement a health data science and informatics environment.
Shown following is just one example of the population health analysis that is possible with the OHDSI tools. This visualization shows the prevalence of various drugs within the given population of people. This information helps researchers and clinicians discover trends and make better informed decisions about patient health.
OHDSI application architecture on AWS
Before deploying an application on AWS that transmits, processes, or stores protected health information (PHI) or personally identifiable information (PII), address your organization’s compliance concerns. Make sure that you have worked with your internal compliance and legal team to ensure compliance with the laws and regulations that govern your organization. To understand how you can use AWS services as a part of your overall compliance program, see the AWS HIPAA Compliance whitepaper. With that said, we paid careful attention to the HIPAA control set during the design of this solution.
This blog post presents a complete OHDSI application environment, including a data warehouse with sample data. It has the following features:
- It’s deployed in an isolated, three-tier Amazon Virtual Private Cloud (Amazon VPC) with high availability
- It uses data-at-rest and in-flight encryption (certificates must be added for the web application servers and load balancer)
- It uses managed services from AWS; OS, middleware, and database patching and maintenance is largely automatic
- It creates automated backups for operational and disaster recovery
- It’s built automatically in about an hour
- It produces a reasonable monthly cost with Business Level support based on the AWS Solution Calculator
Following, you can see a block diagram of how the OHDSI tools map to the services provided by AWS.
Atlas is the web application that researchers interact with to perform analysis. Atlas interacts with the underlying databases through a web services application named WebAPI. In this example, both Atlas and WebAPI are deployed and managed by AWS Elastic Beanstalk. Elastic Beanstalk is an easy-to-use service for deploying and scaling web applications. Simply upload the Atlas and WebAPI code and Elastic Beanstalk automatically handles the deployment. It covers everything from capacity provisioning, load balancing, autoscaling, and high availability, to application health monitoring. Using a feature of Elastic Beanstalk called ebextensions, the Atlas and WebAPI servers are customized to use an encrypted storage volume for the middleware application logs.
Atlas stores the state of the various patient cohorts that are analyzed in a dedicated database separate from your observational health data. This database is provided by Amazon Aurora with PostgreSQL compatibility.
Amazon Aurora is a relational database built for the cloud that combines the performance and availability of high-end commercial databases with the simplicity and cost-effectiveness of open-source databases. It provides cost-efficient and resizable capacity while automating time-consuming administration tasks such as hardware provisioning, database setup, patching, and backups. It is configured for high availability and uses encryption at rest for the database and backups, and encryption in flight for the JDBC connections.
We accomplish this through the AWS CloudFormation code shown following:
All of your observational health data is stored inside the OHDSI Observational Medical Outcomes Partnership Common Data Model (OMOP CDM). This model also stores useful vocabulary tables that help to translate values from various data sources (like EHR systems and claims data).
The OMOP CDM schema is deployed onto Amazon Redshift. Amazon Redshift is a fast, fully managed data warehouse that allows you to run complex analytic queries against petabytes of structured data. It uses using sophisticated query optimization, columnar storage on high-performance local disks, and massively parallel query execution. You can also resize an Amazon Redshift cluster as your requirements for it change.
The solution in this blog post automatically loads de-identified sample data of 1,000 people from the CMS 2008–2010 Data Entrepreneurs’ Synthetic Public Use File (DE-SynPUF). The data has helpful formatting from LTS Computing LLC. Vocabulary data from the OHDSI Athena project is also loaded into the OMOP CDM, and a results set is computed by OHDSI Achilles.
|Application Component||AWS Service||Source Link|
|Atlas Application||AWS Elastic Beanstalk||https://github.com/OHDSI/Atlas|
|WebAPI Web Services||AWS Elastic Beanstalk||https://github.com/OHDSI/WebAPI|
|WebAPI Database Schema||Amazon Relational Database Service (Amazon RDS) Aurora PostgreSQL||http://www.ohdsi.org/web/wiki/doku.php?id=documentation:software:webapi:postgresql_installation_guide|
|OMOP CDM v5.2 Database Schema||Amazon Redshift||https://github.com/OHDSI/CommonDataModel/tree/master/Redshift|
|CMS DE-SynPUF Sample Data||Amazon Redshift||https://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/SynPUFs/DE_Syn_PUF.html|
|Athena Vocabulary Data||Amazon Redshift||http://athena.ohdsi.org/|
|Achilles Results Computation||Amazon Redshift||https://github.com/OHDSI/Achilles|
Following is a detailed technical diagram showing the configuration of the architecture to be deployed.
Deploying OHDSI on AWS
Everything just described is automatically deployed by using an AWS CloudFormation template. Using this template, you can quickly get started with the OHDSI project. The CloudFormation templates for this deployment as well as all of the supporting scripts and source code can be found in the AWS Labs GitHub repo.
From your AWS account, open the CloudFormation Management Console and choose Create Stack. From there, copy and paste the following URL in the Specify an Amazon S3 template URL box, and choose Next.
On the next screen, you provide a Stack Name (this can be anything you like) and a few other parameters for your OHDSI environment.
You use the DatabasePassword parameter to set the password for the master user account of the Amazon Redshift and Aurora databases.
You use the EBEndpoint name to generate a unique URL for Atlas to access the OHDSI environment. It is http://EBEndpoint.AWS-Region.elasticbeanstalk.com, where EBEndpoint.AWS-Region indicates the Elastic Beanstalk endpoint and AWS Region. You can configure this URL through Elastic Beanstalk if you want to change it in the future.
You use the KPair option to choose one of your existing Amazon EC2 key pairs to use with the instances that Elastic Beanstalk deploys. By doing this, you can gain administrative access to these instances in the future if you need to. If you don’t already have an Amazon EC2 key pair, you can generate one for free. You do this by going to the Key Pairs section of the EC2 console and choosing Generate Key Pair.
Finally, you use the UserIPRange parameter to specify a CIDR IP address range from which to access your OHDSI environment. By default, your OHDSI environment is accessible over the public internet. Use UserIPRange to limit access over the Internet to a single IP address or a range of IP addresses that represent users you want to have access. Through additional configuration, you can also make your OHDSI environment completely private and accessible only through a VPN or AWS Direct Connect private circuit.
When you’ve provided all Parameters, choose Next.
On the next screen, you can provide some other optional information like tags at your discretion, or just choose Next.
On the next screen, you can review what will be deployed. At the bottom of the screen, there is a check box for you to acknowledge that AWS CloudFormation might create IAM resources with custom names. This is correct; the template being deployed creates four custom roles that give permission for the AWS services involved to communicate with each other. Details of these permissions are inside the CloudFormation template referenced in the URL given in the first step. Check the box acknowledging this and choose Next.
You can watch as CloudFormation builds out your OHDSI architecture. A CloudFormation deployment is called a stack. The parent stack creates two child stacks, one containing the VPC and IAM roles and another created by Elastic Beanstalk with the Atlas and WebAPI servers. When all three stacks have reached the green CREATE_COMPLETE status, as shown in the screenshot following, then the OHDSI architecture has been deployed.
There is still some work going on behind the scenes, though. To watch the progress, browse to the Amazon Redshift section of your AWS Management Console and choose the Amazon Redshift cluster that was created for your OHDSI architecture. After you do so, you can observe the Loads and Queries tabs.
First, on the Loads tab, you can see the CMS De-SynPUF sample data and Athena vocabulary data being loaded into the OMOP Common Data Model. After you see the VOCABULARY table reach the COMPLETED status (as shown following), all of the sample and vocabulary data has been loaded.
After the data loads, the Achilles computation starts. On the Queries tab, you can watch Achilles running queries against your database to build out the Results schema. Achilles runs a large number of queries, and the entire process can take quite some time (about 20 minutes for the sample data we’ve loaded). Eventually, no new queries show up in the Queries tab, which shows that the Achilles computation is completed. The entire process from the time you executed the CloudFormation template until the Achilles computation is completed usually takes about an hour and 15 minutes.
At this point, you can browse to the Elastic Beanstalk section of the AWS Management Console. There, you can choose the OHDSI Application and Environment (green box) that was deployed by the CloudFormation template. At the top of the dashboard, as shown following, you see a link to a URL. This URL matches the name you provided in the EBEndpoint parameter of the CloudFormation template. Choose this URL, and you can start using Atlas to explore the CMS DE-SynPUF sample data!
Cost of deploying this environment
It used to be common to see healthcare data analytics environments deployed in an on-premises data center with expensive data warehouse appliances and virtualized environments. The cloud era has democratized the availability of the infrastructure required to do this type of data analysis, so that now it is within reach of even small organizations. This environment can expand to analyze petabyte-scale health data, and you only pay for what you need. See an estimated breakdown of the monthly cost components for this environment as deployed on the AWS Solution Calculator.
It’s also worth noting that this environment does not have to be run all of the time. If you are only performing analyses periodically, you can terminate the environment when you are finished and restore it from the database backups when you want to continue working. This would reduce the cost of operation even further.
Now that you have a fully functional OHDSI environment with sample data, you can use this to explore and learn the toolset and its capabilities. After learning with the sample data, you can begin gaining insights by analyzing your own organization’s health data. You can do this using an extract, transform, load (ETL) process from one or more of your health data sources.
If you found this post useful, be sure to check out Build a Healthcare Data Warehouse Using Amazon EMR, Amazon Redshift, AWS Lambda, and OMOP for info on how to automate data ETL to the OMOP CDM.
About the Author
James Wiggins is a senior healthcare solutions architect at AWS. He is passionate about using technology to help organizations positively impact world health. He also loves spending time with his wife and three children.