The Finnish psychotherapy clinic Vastaamo was the victim of a data breach and theft. The criminals tried extorting money from the clinic. When that failed, they started extorting money from the patients:
Neither the company nor Finnish investigators have released many details about the nature of the breach, but reports say the attackers initially sought a payment of about 450,000 euros to protect about 40,000 patient records. The company reportedly did not pay up. Given the scale of the attack and the sensitive nature of the stolen data, the case has become a national story in Finland. Globally, attacks on health care organizations have escalated as cybercriminals look for higher-value targets.
[…]
Vastaamo said customers and employees had “personally been victims of extortion” in the case. Reports say that on Oct. 21 and Oct. 22, the cybercriminals began posting batches of about 100 patient records on the dark web and allowing people to pay about 500 euros to have their information taken down.
Healthcare organizations collect vast amounts of patient information every day, from family history and clinical observations to diagnoses and medications. They use all this data to try to compile a complete picture of a patient’s health information in order to provide better healthcare services. Currently, this data is distributed across various systems (electronic medical records, laboratory systems, medical image repositories, etc.) and exists in dozens of incompatible formats.
Emerging standards, such as Fast Healthcare Interoperability Resources (FHIR), aim to address this challenge by providing a consistent format for describing and exchanging structured data across these systems. However, much of this data is unstructured information contained in medical records (e.g., clinical records), documents (e.g., PDF lab reports), forms (e.g., insurance claims), images (e.g., X-rays, MRIs), audio (e.g., recorded conversations), and time series data (e.g., heart electrocardiogram) and it is challenging to extract this information.
It can take weeks or months for a healthcare organization to collect all this data and prepare it for transformation (tagging and indexing), structuring, and analysis. Furthermore, the cost and operational complexity of doing all this work is prohibitive for most healthcare organizations.
Today, we are happy to announce Amazon HealthLake, a fully managed, HIPAA-eligible service, now in preview, that allows healthcare and life sciences customers to aggregate their health information from different silos and formats into a centralized AWS data lake. HealthLake uses machine learning (ML) models to normalize health data and automatically understand and extract meaningful medical information from the data so all this information can be easily searched. Then, customers can query and analyze the data to understand relationships, identify trends, and make predictions.
How It Works Amazon HealthLake supports copying your data from on premises to the AWS Cloud, where you can store your structured data (like lab results) as well as unstructured data (like clinical notes), which HealthLake will tag and structure in FHIR. All the data is fully indexed using standard medical terms so you can quickly and easily query, search, analyze, and update all of your customers’ health information.
With HealthLake, healthcare organizations can collect and transform patient health information in minutes and have a complete view of a patients medical history, structured in the FHIR industry standard format with powerful search and query capabilities.
From the AWS Management Console, healthcare organizations can use the HealthLake API to copy their on-premises healthcare data to a secure data lake in AWS with just a few clicks. If your source system is not configured to send data in FHIR format, you can use a list of AWS partners to easily connect and convert your legacy healthcare data format to FHIR.
HealthLake is Powered by Machine Learning HealthLake uses specialized ML models such as natural language processing (NLP) to automatically transform raw data. These models are trained to understand and extract meaningful information from unstructured health data.
For example, HealthLake can accurately identify patient information from medical histories, physician notes, and medical imaging reports. It then provides the ability to tag, index, and structure the transformed data to make it searchable by standard terms such as medical condition, diagnosis, medication, and treatment.
Queries on tens of thousands of patient records are very simple. For example, a healthcare organization can create a list of diabetic patients based on similarity of medications by selecting “diabetes” from the standard list of medical conditions, selecting “oral medications” from the treatment menu, and refining the gender and search.
Healthcare organizations can use Juypter Notebook templates in Amazon SageMaker to quickly and easily run analysis on the normalized data for common tasks like diagnosis predictions, hospital re-admittance probability, and operating room utilization forecasts. These models can, for example, help healthcare organizations predict the onset of disease. With just a few clicks in a pre-built notebook, healthcare organizations can apply ML to their historical data and predict when a diabetic patient will develop hypertension in the next five years. Operators can also build, train, and deploy their own ML models on data using Amazon SageMaker directly from the AWS management console.
Let’s Create Your Own Data Store and Start to Test Starting to use HealthLake is simple. You access AWS Management Console, and click select Create a datastore.
If you click Preload data, HealthLake will load test data and you can start to test its features. You can also upload your own data if you already have FHIR 4 compliant data. You upload it to S3 buckets, and import it to set its bucket name.
Once your Data Store is created, you can perform a Search, Create, Read, Update or Delete FHIR Query Operation. For example, if you need a list of every patient located in New York, your query setting looks like the screenshots below. As per the FHIR specification, deleted data is only hidden from analysis and results; it is not deleted from the service, only versioned.
You can choose Add search parameter for more nested conditions of the query as shown below.
Amazon HealthLake is Now in Preview Amazon HealthLake is in preview starting today in US East (N. Virginia). Please check our web site and technical documentation for more information.
Micro Focus – AWS Advanced Technology Parnter, they are a global infrastructure software company with 40 years of experience in delivering and supporting enterprise software.
We have seen mainframe customers often encounter scalability constraints, and they can’t support their development and test workforce to the scale required to support business requirements. These constraints can lead to delays, reduce product or feature releases, and make them unable to respond to market requirements. Furthermore, limits in capacity and scale often affect the quality of changes deployed, and are linked to unplanned or unexpected downtime in products or services.
The conventional approach to address these constraints is to scale up, meaning to increase MIPS/MSU capacity of the mainframe hardware available for development and testing. The cost of this approach, however, is excessively high, and to ensure time to market, you may reject this approach at the expense of quality and functionality. If you’re wrestling with these challenges, this post is written specifically for you.
In the APG, we introduce DevOps automation and AWS CI/CD architecture to support mainframe application development. Our solution enables you to embrace both Test Driven Development (TDD) and Behavior Driven Development (BDD). Mainframe developers and testers can automate the tests in CI/CD pipelines so they’re repeatable and scalable. To speed up automated mainframe application tests, the solution uses team pipelines to run functional and integration tests frequently, and uses systems test pipelines to run comprehensive regression tests on demand. For more information about the pipelines, see Mainframe Modernization: DevOps on AWS with Micro Focus.
In this post, we focus on how to automate and scale mainframe application tests in AWS. We show you how to use AWS services and Micro Focus products to automate mainframe application tests with best practices. The solution can scale your mainframe application CI/CD pipeline to run thousands of tests in AWS within minutes, and you only pay a fraction of your current on-premises cost.
The following diagram illustrates the solution architecture.
Figure: Mainframe DevOps On AWS Architecture Overview
Best practices
Before we get into the details of the solution, let’s recap the following mainframe application testing best practices:
Create a “test first” culture by writing tests for mainframe application code changes
Automate preparing and running tests in the CI/CD pipelines
Provide fast and quality feedback to project management throughout the SDLC
Assess and increase test coverage
Scale your test’s capacity and speed in line with your project schedule and requirements
Automated smoke test
In this architecture, mainframe developers can automate running functional smoke tests for new changes. This testing phase typically “smokes out” regression of core and critical business functions. You can achieve these tests using tools such as py3270 with x3270 or Robot Framework Mainframe 3270 Library.
The following code shows a feature test written in Behave and test step using py3270:
# home_loan_calculator.feature
Feature: calculate home loan monthly repayment
the bankdemo application provides a monthly home loan repayment caculator
User need to input into transaction of home loan amount, interest rate and how many years of the loan maturity.
User will be provided an output of home loan monthly repayment amount
Scenario Outline: As a customer I want to calculate my monthly home loan repayment via a transaction
Given home loan amount is <amount>, interest rate is <interest rate> and maturity date is <maturity date in months> months
When the transaction is submitted to the home loan calculator
Then it shall show the monthly repayment of <monthly repayment>
Examples: Homeloan
| amount | interest rate | maturity date in months | monthly repayment |
| 1000000 | 3.29 | 300 | $4894.31 |
# home_loan_calculator_steps.py
import sys, os
from py3270 import Emulator
from behave import *
@given("home loan amount is {amount}, interest rate is {rate} and maturity date is {maturity_date} months")
def step_impl(context, amount, rate, maturity_date):
context.home_loan_amount = amount
context.interest_rate = rate
context.maturity_date_in_months = maturity_date
@when("the transaction is submitted to the home loan calculator")
def step_impl(context):
# Setup connection parameters
tn3270_host = os.getenv('TN3270_HOST')
tn3270_port = os.getenv('TN3270_PORT')
# Setup TN3270 connection
em = Emulator(visible=False, timeout=120)
em.connect(tn3270_host + ':' + tn3270_port)
em.wait_for_field()
# Screen login
em.fill_field(10, 44, 'b0001', 5)
em.send_enter()
# Input screen fields for home loan calculator
em.wait_for_field()
em.fill_field(8, 46, context.home_loan_amount, 7)
em.fill_field(10, 46, context.interest_rate, 7)
em.fill_field(12, 46, context.maturity_date_in_months, 7)
em.send_enter()
em.wait_for_field()
# collect monthly replayment output from screen
context.monthly_repayment = em.string_get(14, 46, 9)
em.terminate()
@then("it shall show the monthly repayment of {amount}")
def step_impl(context, amount):
print("expected amount is " + amount.strip() + ", and the result from screen is " + context.monthly_repayment.strip())
assert amount.strip() == context.monthly_repayment.strip()
To run this functional test in Micro Focus Enterprise Test Server (ETS), we use AWS CodeBuild.
In the CodeBuild project, we need to create a buildspec to orchestrate the commands for preparing the Micro Focus Enterprise Test Server CICS environment and issue the test command. In the buildspec, we define the location for CodeBuild to look for test reports and upload them into the CodeBuild report group. The following buildspec code uses custom scripts DeployES.ps1 and StartAndWait.ps1 to start your CICS region, and runs Python Behave BDD tests:
version: 0.2
phases:
build:
commands:
- |
# Run Command to start Enterprise Test Server
CD C:\
.\DeployES.ps1
.\StartAndWait.ps1
py -m pip install behave
Write-Host "waiting for server to be ready ..."
do {
Write-Host "..."
sleep 3
} until(Test-NetConnection 127.0.0.1 -Port 9270 | ? { $_.TcpTestSucceeded } )
CD C:\tests\features
MD C:\tests\reports
$Env:Path += ";c:\wc3270"
$address=(Get-NetIPAddress -AddressFamily Ipv4 | where { $_.IPAddress -Match "172\.*" })
$Env:TN3270_HOST = $address.IPAddress
$Env:TN3270_PORT = "9270"
behave.exe --color --junit --junit-directory C:\tests\reports
reports:
bankdemo-bdd-test-report:
files:
- '**/*'
base-directory: "C:\\tests\\reports"
In the smoke test, the team may run both unit tests and functional tests. Ideally, these tests are better to run in parallel to speed up the pipeline. In AWS CodePipeline, we can set up a stage to run multiple steps in parallel. In our example, the pipeline runs both BDD tests and Robot Framework (RPA) tests.
The following CloudFormation code snippet runs two different tests. You use the same RunOrder value to indicate the actions run in parallel.
The following screenshot shows the example actions on the CodePipeline console that use the preceding code.
Figure – Screenshot of CodePipeine parallel execution tests
Both DBB and RPA tests produce jUnit format reports, which CodeBuild can ingest and show on the CodeBuild console. This is a great way for project management and business users to track the quality trend of an application. The following screenshot shows the CodeBuild report generated from the BDD tests.
Figure – CodeBuild report generated from the BDD tests
Automated regression tests
After you test the changes in the project team pipeline, you can automatically promote them to another stream with other team members’ changes for further testing. The scope of this testing stream is significantly more comprehensive, with a greater number and wider range of tests and higher volume of test data. The changes promoted to this stream by each team member are tested in this environment at the end of each day throughout the life of the project. This provides a high-quality delivery to production, with new code and changes to existing code tested together with hundreds or thousands of tests.
In enterprise architecture, it’s commonplace to see an application client consuming web services APIs exposed from a mainframe CICS application. One approach to do regression tests for mainframe applications is to use Micro Focus Verastream Host Integrator (VHI) to record and capture 3270 data stream processing and encapsulate these 3270 data streams as business functions, which in turn are packaged as web services. When these web services are available, they can be consumed by a test automation product, which in our environment is Micro Focus UFT One. This uses the Verastream server as the orchestration engine that translates the web service requests into 3270 data streams that integrate with the mainframe CICS application. The application is deployed in Micro Focus Enterprise Test Server.
The following diagram shows the end-to-end testing components.
Figure – Regression Test Infrastructure end-to-end Setup
To ensure we have the coverage required for large mainframe applications, we sometimes need to run thousands of tests against very large production volumes of test data. We want the tests to run faster and complete as soon as possible so we reduce AWS costs—we only pay for the infrastructure when consuming resources for the life of the test environment when provisioning and running tests.
Therefore, the design of the test environment needs to scale out. The batch feature in CodeBuild allows you to run tests in batches and in parallel rather than serially. Furthermore, our solution needs to minimize interference between batches, a failure in one batch doesn’t affect another running in parallel. The following diagram depicts the high-level design, with each batch build running in its own independent infrastructure. Each infrastructure is launched as part of test preparation, and then torn down in the post-test phase.
Figure – Regression Tests in CodeBuoild Project setup to use batch mode
Building and deploying regression test components
Following the design of the parallel regression test environment, let’s look at how we build each component and how they are deployed. The followings steps to build our regression tests use a working backward approach, starting from deployment in the Enterprise Test Server:
Create a batch build in CodeBuild.
Deploy to Enterprise Test Server.
Deploy the VHI model.
Deploy UFT One Tests.
Integrate UFT One into CodeBuild and CodePipeline and test the application.
Creating a batch build in CodeBuild
We update two components to enable a batch build. First, in the CodePipeline CloudFormation resource, we set BatchEnabled to be true for the test stage. The UFT One test preparation stage uses the CloudFormation template to create the test infrastructure. The following code is an example of the AWS CloudFormation snippet with batch build enabled:
Second, in the buildspec configuration of the test stage, we provide a build matrix setting. We use the custom environment variable TEST_BATCH_NUMBER to indicate which set of tests runs in each batch. See the following code:
After setting up the batch build, CodeBuild creates multiple batches when the build starts. The following screenshot shows the batches on the CodeBuild console.
Figure – Regression tests Codebuild project ran in batch mode
Deploying to Enterprise Test Server
ETS is the transaction engine that processes all the online (and batch) requests that are initiated through external clients, such as 3270 terminals, web services, and websphere MQ. This engine provides support for various mainframe subsystems, such as CICS, IMS TM and JES, as well as code-level support for COBOL and PL/I. The following screenshot shows the Enterprise Test Server administration page.
Figure – Enterprise Server Administrator window
In this mainframe application testing use case, the regression tests are CICS transactions, initiated from 3270 requests (encapsulated in a web service). For more information about Enterprise Test Server, see the Enterprise Test Server and Micro Focus websites.
In the regression pipeline, after the stage of mainframe artifact compiling, we bake in the artifact into an ETS Docker container and upload the image to an Amazon ECR repository. This way, we have an immutable artifact for all the tests.
During each batch’s test preparation stage, a CloudFormation stack is deployed to create an Amazon ECS service on Windows EC2. The stack uses a Network Load Balancer as an integration point for the VHI’s integration.
The following code is an example of the CloudFormation snippet to create an Amazon ECS service using an Enterprise Test Server Docker image:
In this architecture, the VHI is a bridge between mainframe and clients.
We use the VHI designer to capture the 3270 data streams and encapsulate the relevant data streams into a business function. We can then deliver this function as a web service that can be consumed by a test management solution, such as Micro Focus UFT One.
The following screenshot shows the setup for getCheckingDetails in VHI. Along with this procedure we can also see other procedures (eg calcCostLoan) defined that get generated as a web service. The properties associated with this procedure are available on this screen to allow for the defining of the mapping of the fields between the associated 3270 screens and exposed web service.
Figure – Setup for getCheckingDetails in VHI
The following screenshot shows the editor for this procedure and is initiated by the selection of the Procedure Editor. This screen presents the 3270 screens that are involved in the business function that will be generated as a web service.
Figure – VHI designer Procedure Editor shows the procedure
After you define the required functional web services in VHI designer, the resultant model is saved and deployed into a VHI Docker image. We use this image and the associated model (from VHI designer) in the pipeline outlined in this post.
For more information about VHI, see the VHI website.
The pipeline contains two steps to deploy a VHI service. First, it installs and sets up the VHI models into a VHI Docker image, and it’s pushed into Amazon ECR. Second, a CloudFormation stack is deployed to create an Amazon ECS Fargate service, which uses the latest built Docker image. In AWS CloudFormation, the VHI ECS task definition defines an environment variable for the ETS Network Load Balancer’s DNS name. Therefore, the VHI can bootstrap and point to an ETS service. In the VHI stack, it uses a Network Load Balancer as an integration point for UFT One test integration.
The following code is an example of a ECS Task Definition CloudFormation snippet that creates a VHI service in Amazon ECS Fargate and integrates it with an ETS server:
UFT One is a test client that uses each of the web services created by the VHI designer to orchestrate running each of the associated business functions. Parameter data is supplied to each function, and validations are configured against the data returned. Multiple test suites are configured with different business functions with the associated data.
The following screenshot shows the test suite API_Bankdemo3, which is used in this regression test process.
Figure – API_Bankdemo3 in UFT One Test Editor Console
The last step is to integrate UFT One into CodeBuild and CodePipeline to test our mainframe application. First, we set up CodeBuild to use a UFT One container. The Docker image is available in Docker Hub. Then we author our buildspec. The buildspec has the following three phrases:
Setting up a UFT One license and deploying the test infrastructure
Starting the UFT One test suite to run regression tests
Tearing down the test infrastructure after tests are complete
The following code is an example of a buildspec snippet in the pre_build stage. The snippet shows the command to activate the UFT One license:
Because ETS and VHI are both deployed with a load balancer, the build detects when the load balancers become healthy before starting the tests. The following AWS CLI commands detect the load balancer’s target group health:
The next release of Micro Focus UFT One (November or December 2020) will provide an exit status to indicate a test’s success or failure.
When the tests are complete, the post_build stage tears down the test infrastructure. The following AWS CLI command tears down the CloudFormation stack:
At the end of the build, the buildspec is set up to upload UFT One test reports as an artifact into Amazon Simple Storage Service (Amazon S3). The following screenshot is the example of a test report in HTML format generated by UFT One in CodeBuild and CodePipeline.
Figure – UFT One HTML report
A new release of Micro Focus UFT One will provide test report formats supported by CodeBuild test report groups.
Conclusion
In this post, we introduced the solution to use Micro Focus Enterprise Suite, Micro Focus UFT One, Micro Focus VHI, AWS developer tools, and Amazon ECS containers to automate provisioning and running mainframe application tests in AWS at scale.
The on-demand model allows you to create the same test capacity infrastructure in minutes at a fraction of your current on-premises mainframe cost. It also significantly increases your testing and delivery capacity to increase quality and reduce production downtime.
A demo of the solution is available in AWS Partner Micro Focus website AWS Mainframe CI/CD Enterprise Solution. If you’re interested in modernizing your mainframe applications, please visit Micro Focus and contact AWS mainframe business development at [email protected].
Peter has been with Micro Focus for almost 30 years, in a variety of roles and geographies including Technical Support, Channel Sales, Product Management, Strategic Alliances Management and Pre-Sales, primarily based in Europe but for the last four years in Australia and New Zealand. In his current role as Pre-Sales Manager, Peter is charged with driving and supporting sales activity within the Application Modernization and Connectivity team, based in Melbourne.
Leo Ervin
Leo Ervin is a Senior Solutions Architect working with Micro Focus Enterprise Solutions working with the ANZ team. After completing a Mathematics degree Leo started as a PL/1 programming with a local insurance company. The next step in Leo’s career involved consulting work in PL/1 and COBOL before he joined a start-up company as a technical director and partner. This company became the first distributor of Micro Focus software in the ANZ region in 1986. Leo’s involvement with Micro Focus technology has continued from this distributorship through to today with his current focus on cloud strategies for both DevOps and re-platform implementations.
Kevin Yung
Kevin is a Senior Modernization Architect in AWS Professional Services Global Mainframe and Midrange Modernization (GM3) team. Kevin currently is focusing on leading and delivering mainframe and midrange applications modernization for large enterprise customers.
This guide demonstrates an example solution for collecting, tracking, and sharing pulse oximetry data for multiple users. It’s built using AWS serverless technologies, enabling reliable scalability and security. The frontend application is written in VueJS and uses the Amplify Framework. It takes oxygen saturation measurements as manual input or a BerryMed pulse oximeter connected to a browser using Web Bluetooth.
The serverless backend that handles user data and shared access management is deployed using the AWS Serverless Application Model (AWS SAM). The backend application consists of an Amazon API Gateway REST API, which invokes AWS Lambda functions. The code is written in Python to handle the business logic of interacting with an Amazon DynamoDB database. Authentication is managed by Amazon Cognito.
A screenshot of the frontend application running in a desktop browser.
An AWS account. This project can be completed using the AWS Free Tier.
Deploy the application
A high-level diagram of the full oxygen monitor application.
The solution consists of two parts, the frontend application and the serverless backend. The Amplify CLI deploys all the Amazon Cognito authentication and hosting resources for the frontend. The backend requires the Amazon Cognito user pool identifier to configure an authorizer on the API. This enables an authorization workflow, as shown in the following image.
A diagram showing how an Amazon Cognito authorization workflow works
First, configure the frontend. Complete the following steps using a terminal running on a computer or by using the AWS Cloud9 IDE. If using AWS Cloud9, create an instance using the default options.
Navigate to the amplify-frontend directory and initialize the project using the Amplify CLI command. Follow the guided process to completion.
cd aws-serverless-oxygen-monitor-web-bluetooth/amplify-frontend
amplify init
Deploy all the frontend resources to the AWS Cloud using the Amplify CLI command.
amplify push
After the resources have finishing deploying, make note of the aws_user_pools_id property in the src/aws-exports.js file. This is required when deploying the serverless backend.
Next, deploy the serverless backend. While it can be deployed using the AWS SAM CLI, you can also deploy from the AWS Management Console:
In Application settings, name the application and provide the aws_user_pools_id from the frontend application for the UserPoolID parameter.
Choose Deploy.
Once complete, copy the API endpoint so that it can be configured on the frontend application in the next step.
Configure and run the frontend application
Create a file, amplify-frontend/src/api-config.js, in the frontend application with the following content. Include the API endpoint from the previous step.
In a terminal, navigate to the root directory of the frontend application and run it locally for testing.
cd aws-serverless-oxygen-monitor-web-bluetooth/amplify-frontend
npm install
npm run serve
You should see an output like this:
To publish the frontend application to cloud hosting, run the following command.
amplify publish
Once complete, a URL to the hosted application is provided.
Using the frontend application
Once the application is running locally or hosted in the cloud, navigating to it presents a user login interface with an option to register.
The registration flow requires a code sent to the provided email for verification. Once verified you’re presented with the main application interface. A sample value is displayed when the account has no oxygen saturation or pulse rate history.
To connect a BerryMed pulse oximeter to begin reading measurements, turn on the device. Choose the Connect Pulse Oximeter button and then select it from the list. A Chrome browser on a desktop or Android mobile device is required to use the Web Bluetooth feature.
If you do not have a compatible Bluetooth pulse oximeter or access to Web Bluetooth, checking the Enter Manually check box presents direct input boxes.
Once oxygen saturation and pulse rate values are available, choose the cloud upload icon. This publishes the values to the serverless backend, where they are stored in a DynamoDB table. The trend chart then updates to reflect the new data.
Access to your historical data can be shared to another user, for example a healthcare professional. Choose the share icon on the right to open sharing options. From here, you can add or remove access to others by user name.
To view data shared with you, select the user name from the drop-down and choose the refresh icon.
Understanding the serverless backend
In the GitHub project, the folder serverless-backend/ contains the AWS SAM template file and the Lambda functions. It creates an API Gateway endpoint, six Lambda functions, and two DynamoDB tables. The template also defines an Amazon Cognito authorizer for the API using the UserPoolID passed in as a parameter:
This only allows authenticated users of the frontend application to make requests with a JWT token containing their user name and email. The backend uses that information to fetch and store data in DynamoDB that corresponds to the user making the request.
The first three endpoints handle updating and retrieving oxygen and pulse rate levels. When a user publishes a new measurement, the AddLevels function is invoked which creates a new item in the DynamoDB “Levels” table.
The FetchLevels function retrieves the user’s personal history. The FetchSharedUserLevels function checks the Access Table to see if the requesting user has shared access rights.
The remaining endpoints handle access management. When you add a shared user, this invokes the ManageAccess function with a user name and an action, such as share or revoke. If sharing, the item is added to the Access Table that enables the relationship. If revoking, the item is removed from the table.
The GetSharedUsers function fetches the list of shared with the user making the request. This populates the drop-down of accessible users. FetchUsersWithAccess fetches all users that have access to the user making the request, this populates the list of users in the sharing options.
The DynamoDB tables are created by the AWS SAM template with the partition key and range key defined for each table. These are used by the Lambda functions to query and sort items. See the documentation to learn more about DynamoDB table key schema.
In the GitHub project, the folder amplify-frontend/src/ contains all the code for the frontend application. In main.js, the Amplify VueJS modules are configured to use the resources defined in aws-exports.js. It also configures the endpoint of the serverless backend, defined in api-config.js.
In the file, components/OxygenMonitor.vue, the API module is imported and the desired API is defined.
API calls are defined as Vue methods that can be called by various other components and elements of the application.
In components/ConnectDevice.vue, the connect method initializes a Web Bluetooth connection to the pulse oximeter. It searches for a Bluetooth service UUID and device name specific to BerryMed pulse oximeters. On a successful connection it creates an event listener on the Bluetooth characteristic that notifies changes on measurements.
The handleData method parses notification events. It emits on any changes to oxygen saturation or pulse rate.
The OxygenMonitor component defines the ConnectDevice component in its template. It binds handlers on emitted events.
The handlers assign the values to the Vue data object for use throughout the application.
Further explore the project code to see how the Amplify Framework and the serverless backend are used to make a practical application.
Conclusion
Tracking patient vitals remotely has become more relevant than ever. This guide demonstrates a solution for a personal health and telemedicine application. The full solution includes multiuser functionality and a secure and scalable serverless backend. The application uses a browser to interact with a physical device to measure oxygen saturation and pulse rate. It publishes measurements to a database using a serverless API. The historical data can be displayed as a trend chart and can also be shared with other users.
Once more familiarized with the sample project you may want to begin developing an application with your team. The Amplify Framework has support for team environments, allowing all your developers to work together seamlessly.
To learn more about AWS serverless and keep up to date on the latest features, subscribe to the YouTube channel.
Halodoc, a Jakarta-based healthtech platform, uses tele-health and artificial intelligence to connect patients, doctors, and pharmacies. Join builder Adrian De Luca for this special edition of This is My Architecture as he dives deep into the solutions architecture of this Indonesian healthtech platform that provides healthcare services in one of the most challenging traffic environments in the world.
Biomedical researchers require access to accurate, detailed data. The MIT MIMIC-III dataset is a popular resource. Using Amazon Athena, you can execute standard SQL queries against MIMIC-III without first loading the data into a database. Your analyses always reference the most recent version of the MIMIC-III dataset.
This post describes how to make the MIMIC-III dataset available in Athena and provide automated access to an analysis environment for MIMIC-III on AWS. We also compare a MIMIC-III reference bioinformatics study using a traditional database to that same study using Athena.
Overview
A dataset capturing a variety of measures longitudinally over time, across many patients, can drive analytics and machine learning toward research discovery and improved clinical decision-making. These features describe the MIT Laboratory of Computational Physiology (LCP)MIMIC-III dataset. In the words of LCP researchers:
“MIMIC-III is a large, publicly available database comprising de-identified health-related data associated with approximately 60K admissions of patients who stayed in critical care units of the Beth Israel Deaconess Medical Center between 2001 and 2012. …MIMIC supports a diverse range of analytic studies spanning epidemiology, clinical decision-rule improvement, and electronic tool development. It is notable for three factors: it is publicly and freely available, it encompasses a diverse and large population of ICU patients, and it contains high temporal resolution data including lab results, electronic documentation, and bedside monitor trends and waveforms.”
Recently, the Registry of Open Data on AWS (RODA) program made the MIMIC-III dataset available through the AWS Cloud. You can now use the MIMIC-III dataset without having to download, copy, or pay to store it. Instead, you can analyze the MIMIC-III dataset in the AWS Cloud using AWS services like Amazon EC2, Athena, AWS Lambda, or Amazon EMR. AWS Cloud availability enables quicker and cheaper research into the dataset.
Services like Athena also offer you new analytical approaches to the MIMIC-III dataset. Using Athena, you can execute standard SQL queries against MIMIC-III without first loading the data into a database. Because you can reference the MIMIC-III dataset hosted in the RODA program, your analyses always reference the most recent version of the MIMIC-III dataset. Live hosting reduces upfront time and effort, eliminates data synchronization issues, improves data analysis, and reduces overall study costs.
Transforming MIMIC-III data
Historically, the MIMIC team distributed the MIMIC-III dataset in compressed (gzipped) CSV format. The choice of CSV format reflects the loading of MIMIC-III data into a traditional relational database for analysis.
In contrast, the MIMIC team provides the MIMIC-III dataset to the RODA program in the following formats:
The traditional CSV format
An Apache Parquet format optimized for modern data processing technologies such as Athena
Apache Parquet stores data by column, so queries that fetch specific columns can run without reading the whole table. This optimization helps improve the performance and lower the cost of many query types common to biomedical informatics.
To convert the original MIMIC-III CSV dataset to Apache Parquet, we created a data transformation job using AWS Glue. The MIMIC team schedules the AWS Glue job to run as needed, updating the Parquet files in the RODA program with any changes to the CSV dataset. These scheduled updates keep the Parquet files current without interfering with the MIMIC team’s CSV dataset creation procedures. Find the code for this AWS Glue job in the mimic-code GitHub repo. Use the same code as a basis to develop other CSV-to-Parquet conversions.
The code that converts the MIMIC-III NOTEEVENTS table offers a valuable resource. This table stores long medical notes made up of multiple lines, with commas, double-quotes, and other characters that can be challenging to transform. For example, you can use the following Spark read statement to interpret that CSV file:
The aline study code comprises about 1400 lines of SQL. It was developed for a PostgreSQL database, and is executed and further analyzed by Python and R code. We ran the aline study against the Parquet MIMIC-III dataset using Athena instead of PostgreSQL to answer the following questions:
What modifications would be required, if any, to run the study using Athena, instead of PostgreSQL?
How would performance differ?
How would cost differ?
Some SQL features used in the study work differently in Athena than they do in PostgreSQL. As a result, about 5% of the SQL statements needed modification. Specifically, the SQL statements require the following types of modification for use with Athena:
Instead of using materialized views, in Athena, create a new table. For instance, the CREATE MATERIALIZED VIEW statement can be written as CREATE TABLE.
Instead of using schema context statements like SET SEARCH_PATH, in Athena, explicitly declare the schema of referenced tables. For instance, instead of having a SET SEARCH_PATH statement before your query and referencing tables without a schema as follows:
SET SEARCH_PATH TO mimiciii;
left join chartevents ce
You declare the schema as a part of every table reference:
left join mimiciii.chartevents ce
Epoch time, as well as timestamp arithmetic, works differently in Athena than PostgreSQL. So, instead of arithmetic, use the date_diff() and specify seconds as the return value.
extract(epoch from endtime-starttime)/24.0/60.0/60.0
Athena uses the “double” data type instead of the “numeric” data type.
ROUND( cast(f.height_first as numeric), 2) AS height_first,
The preceding statement can be written as:
ROUND( cast(f.height_first as double), 2) AS height_first,
If VARCHAR fields are empty, they are not detected as NULL. Instead, compare a VARCHAR to an empty string. For instance, consider the following field:
where ce.value IS NOT NULL
If ce.value is a VARCHAR, it can be written as the following:
where ce.value <> ''
After making these minor edits to the aline study SQL statements, the study executes successfully using Athena instead of PostgreSQL. The output produced from both methods is identical.
Next, consider the speed of Athena compared to PostgreSQL in analyzing the aline study. As shown in the following graph, the aline study using Athena queries of the Parquet-formatted MIMIC-III dataset run 10 times faster than queries of the same data in an Amazon RDS PostgreSQL database.
Compare the costs of running the aline study in Athena to running it in PostgreSQL. RDS PostgreSQL databases bill in one-second increments for the time the database runs, while Athena queries bill per gigabyte of data each query scans. Because of this fundamental pricing difference, you must make some assumptions to compare costs.
You could assume that running the aline study in RDS PostgreSQL involves the following steps, taking up an eight-hour working day:
You’d then compare the cost of running an RDS PostgreSQL database for eight hours (at $0.37 per hour, db.m5.xlarge with 100-GB EBS storage) to the cost of running the aline study against a dataset using Athena (9.93 GB of data scanned at $0.005/GB). As the following graph shows, this results in an almost 60x cost savings.
Working with MIMIC-III in AWS
MIMIC-III is a publicly available dataset containing detailed information about the clinical care of patients. For this reason, the MIMIC team requires that you complete a training course and submit a formal request before gaining access. For more information, see Requesting access.
After you obtain access to the MIMIC-III dataset, log in to the PhysioNet website and, under your profile settings, provide your AWS account ID. Then click the request access link, under Files, on the MIMIC-III Clinical Database page. You then have access to the MIMIC-III dataset in AWS.
Choose Launch Stack below to begin working with the MIMIC-III dataset in your AWS account. This launches an AWS CloudFormation template, which deploys an index of the MIMIC-III Parquet-formatted dataset into your AWS Glue Data Catalog. It also deploys an Amazon SageMaker notebook instance pre-loaded with the aline study code and many other MIMIC-provided analytic examples.
After the AWS CloudFormation template deploys, choose Outputs, and follow the link to access Jupyter Notebooks. From there, you can open and execute the aline study code by browsing the filesystem to the path ./mimic-code/notebooks/aline-aws/aline-awsathena.ipynb.
After you’ve completed your analysis, you can stop your Jupyter Notebook instance to suspend charges for compute. Any time that you want to continue working, just start the instance and continue where you left off.
Conclusion
The RODA program provides quick and inexpensive access to the global biomedical research resources of the MIMIC-III dataset. Cloud-native analytic tools like AWS Glue and Athena accelerate research, and groups like the MIT Laboratory of Computational Physiology are pioneering data availability in modern data formats like Apache Parquet.
The analytic approaches and code demonstrated in this post can be applied generally to help increase agility and decrease cost. Consider using them as you enhance existing or perform new biomedical informatics research.
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.
Alistair Johnson is a research scientist and the Massachusetts Institute of Technology. Alistair has extensive experience and expertise in working with ICU data, having published the MIMIC-III and eICU-CRD datasets. His current research focuses on clinical epidemiology and machine learning for decision support.
This post is courtesy of Ryan Ulaszek, AWS Genomics Partner Solutions Architect and Aaron Friedman, AWS Healthcare and Life Sciences Partner Solutions Architect
In 2017, we published a four part blog series on how to build a genomics workflow on AWS. In part 1, we introduced a general architecture highlighting three common layers: job, batch and workflow. In part 2, we described building the job layer with Docker and Amazon Elastic Container Registry (Amazon ECR). In part 3, we tackled the batch layer and built a batch engine using AWS Batch. In part 4, we built out the workflow layer using AWS Step Functions and AWS Lambda.
Since then, we’ve worked with many AWS customers and APN partners to implement this solution in genomics as well as in other workloads-of-interest. Today, we wanted to highlight a new feature in Step Functions that simplifies how customers and partners can build high-throughput genomics workflows on AWS.
Step Functions now supports native integration with AWS Batch, which simplifies how you can create an AWS Batch state that submits an asynchronous job and waits for that job to finish.
Before, you needed to build a state machine building block that submitted a job to AWS Batch, and then polled and checked its execution. Now, you can just submit the job to AWS Batch using the new AWS Batch task type. Step Functions waits to proceed until the job is completed. This reduces the complexity of your state machine and makes it easier to build a genomics workflow with asynchronous AWS Batch steps.
The new integrations include support for the following API actions:
AWS Batch SubmitJob
Amazon SNS Publish
Amazon SQS SendMessage
Amazon ECS RunTask
AWS Fargate RunTask
Amazon DynamoDB
PutItem
GetItem
UpdateItem
DeleteItem
Amazon SageMaker
CreateTrainingJob
CreateTransformJob
AWS Glue
StartJobRun
You can also pass parameters to the service API. To use the new integrations, the role that you assume when running a state machine needs to have the appropriate permissions. For more information, see the AWS Step Functions Developer Guide.
Using a job status poller
In our 2017 post series, we created a job poller “pattern” with two separate Lambda functions. When the job finishes, the state machine proceeds to the next step and operates according to the necessary business logic. This is a useful pattern to manage asynchronous jobs when a direct integration is unavailable.
The steps in this building block state machine are as follows:
A job is submitted through a Lambda function.
The state machine queries the AWS Batch API for the job status in another Lambda function.
The job status is checked to see if the job has completed. If the job status equals SUCCESS, the final job status is logged. If the job status equals FAILED, the execution of the state machine ends. In all other cases, wait 30 seconds and go back to Step 2.
Both of the Submit Job and Get Job Lambda functions are available as example Lambda functions in the console. The job status poller is available in the Step Functions console as a sample project.
With Step Functions service integrations, it is now simpler to submit and wait for an AWS Batch job, or any other supported service.
The following code block is the JSON representing the new state machine for an asynchronous batch job. If you are familiar with the AWS Batch SubmitJob API action, you may notice that the parameters are consistent with what you would see in that API call. You can also use the optional AWS Batch parameters in addition to JobDefinition, JobName, and JobQueue.
When you deploy the job definition, add the command attribute that was previously being constructed in the Lambda function launching the AWS Batch job.
The key-value parameters passed into the workflow are mapped using Parameters.$ to the values in the job definition using the keys. Value substitutions do take place. The Docker run looks like the following:
Overall, connectors dramatically simplify your genomics workflow. The following workflow is a simple genomics secondary analysis pipeline, which we highlighted in our original post series.
The first step aligns the sample against a reference genome. When alignment is complete, variant calling and QA metrics are calculated in two parallel steps. When variant calling is complete, variant annotation is performed. Before, our genomics workflow looked like this:
AWS Step Functions service integrations are a great way to simplify creating complex workflows with asynchronous steps. While we highlighted the use case with AWS Batch today, there are many other ways that healthcare and life sciences customers can use this new feature, such as with message processing.
For more information about how AWS can enable your genomics workloads, be sure to check out the AWS Genomics page.
We’ve updated the open-source project to take advantage of the new AWS Batch integration in Step Functions. You can find the changes aws-batch-genomics/tree/v2.0.0 folder.
If you’re not already familiar with building visualizations for quick access to business insights using Amazon QuickSight, consider this your introduction. In this post, we’ll walk through some common scenarios with sample datasets to provide an overview of how you can connect yuor data, perform advanced analysis and access the results from any web browser or mobile device.
The following visualizations are built from the public datasets available in the links below. Before we jump into that, let’s take a look at the supported data sources, file formats and a typical QuickSight workflow to build any visualization.
Which data sources does Amazon QuickSight support?
At the time of publication, you can use the following data methods:
Connect to AWS data sources, including:
Amazon RDS
Amazon Aurora
Amazon Redshift
Amazon Athena
Amazon S3
Upload Excel spreadsheets or flat files (CSV, TSV, CLF, and ELF)
Connect to on-premises databases like Teradata, SQL Server, MySQL, and PostgreSQL
Import data from SaaS applications like Salesforce and Snowflake
Use big data processing engines like Spark and Presto
SPICE is the Amazon QuickSight super-fast, parallel, in-memory calculation engine, designed specifically for ad hoc data visualization. SPICE stores your data in a system architected for high availability, where it is saved until you choose to delete it. Improve the performance of database datasets by importing the data into SPICE instead of using a direct database query. To calculate how much SPICE capacity your dataset needs, see Managing SPICE Capacity.
Typical Amazon QuickSight workflow
When you create an analysis, the typical workflow is as follows:
Connect to a data source, and then create a new dataset or choose an existing dataset.
(Optional) If you created a new dataset, prepare the data (for example, by changing field names or data types).
Create a new analysis.
Add a visual to the analysis by choosing the fields to visualize. Choose a specific visual type, or use AutoGraph and let Amazon QuickSight choose the most appropriate visual type, based on the number and data types of the fields that you select.
(Optional) Modify the visual to meet your requirements (for example, by adding a filter or changing the visual type).
(Optional) Add more visuals to the analysis.
(Optional) Add scenes to the default story to provide a narrative about some aspect of the analysis data.
(Optional) Publish the analysis as a dashboard to share insights with other users.
The following graphic illustrates a typical Amazon QuickSight workflow.
Visualizations created in Amazon QuickSight with sample datasets
Data catalog: The World Bank invests into multiple development projects at the national, regional, and global levels. It’s a great source of information for data analysts.
The following graph shows the percentage of the population that has access to electricity (rural and urban) during 2000 in Asia, Africa, the Middle East, and Latin America.
The following graph shows the share of healthcare costs that are paid out-of-pocket (private vs. public). Also, you can maneuver over the graph to get detailed statistics at a glance.
Data catalog: The DBG PDS project makes real-time data derived from Deutsche Börse’s trading market systems available to the public for free. This is the first time that such detailed financial market data has been shared freely and continually from the source provider.
The following graph shows the market trend of max trade volume for different EU banks. It builds on the data available on XETRA engines, which is made up of a variety of equities, funds, and derivative securities. This graph can be scrolled to visualize trade for a period of an hour or more.
The following graph shows the common stock beating the rest of the maximum trade volume over a period of time, grouped by security type.
Data catalog: Data derived from different sensor stations placed on the city bridges and surface streets are a core information source. The road weather information station has a temperature sensor that measures the temperature of the street surface. It also has a sensor that measures the ambient air temperature at the station each second.
The following graph shows the present max air temperature in Seattle from different RWI station sensors.
The following graph shows the minimum temperature of the road surface at different times, which helps predicts road conditions at a particular time of the year.
Data catalog: Kaggle has come up with a platform where people can donate open datasets. Data engineers and other community members can have open access to these datasets and can contribute to the open data movement. They have more than 350 datasets in total, with more than 200 as featured datasets. It has a few interesting datasets on the platform that are not present at other places, and it’s a platform to connect with other data enthusiasts.
The following graph shows the trending YouTube videos and presents the max likes for the top 20 channels. This is one of the most popular datasets for data engineers.
The following graph shows the YouTube daily statistics for the max views of video titles published during a specific time period.
Data catalog: NYC Open data hosts some very popular open data sets for all New Yorkers. This platform allows you to get involved in dive deep into the data set to pull some useful visualizations. 2016 Green taxi trip dataset includes trip records from all trips completed in green taxis in NYC in 2016. Records include fields capturing pick-up and drop-off dates/times, pick-up and drop-off locations, trip distances, itemized fares, rate types, payment types, and driver-reported passenger counts.
The following graph presents maximum fare amount grouped by the passenger count during a period of time during a day. This can be further expanded to follow through different day of the month based on the business need.
The following graph shows the NewYork taxi data from January 2016, showing the dip in the number of taxis ridden on January 23, 2016 across all types of taxis.
A quick search for that date and location shows you the following news report:
Summary
Using Amazon QuickSight, you can see patterns across a time-series data by building visualizations, performing ad hoc analysis, and quickly generating insights. We hope you’ll give it a try today!
Karthik Odapally is a Sr. Solutions Architect in AWS. His passion is to build cost effective and highly scalable solutions on the cloud. In his spare time, he bakes cookies and cupcakes for family and friends here in the PNW. He loves vintage racing cars.
Pranabesh Mandal is a Solutions Architect in AWS. He has over a decade of IT experience. He is passionate about cloud technology and focuses on Analytics. In his spare time, he likes to hike and explore the beautiful nature and wild life of most divine national parks around the United States alongside his wife.
This blog post was co-authored by Ujjwal Ratan, a senior AI/ML solutions architect on the global life sciences team.
Healthcare data is generated at an ever-increasing rate and is predicted to reach 35 zettabytes by 2020. Being able to cost-effectively and securely manage this data whether for patient care, research or legal reasons is increasingly important for healthcare providers.
Healthcare providers must have the ability to ingest, store and protect large volumes of data including clinical, genomic, device, financial, supply chain, and claims. AWS is well-suited to this data deluge with a wide variety of ingestion, storage and security services (e.g. AWS Direct Connect, Amazon Kinesis Streams, Amazon S3, Amazon Macie) for customers to handle their healthcare data. In a recent Healthcare IT News article, healthcare thought-leader, John Halamka, noted, “I predict that five years from now none of us will have datacenters. We’re going to go out to the cloud to find EHRs, clinical decision support, analytics.”
I realize simply storing this data is challenging enough. Magnifying the problem is the fact that healthcare data is increasingly attractive to cyber attackers, making security a top priority. According to Mariya Yao in her Forbes column, it is estimated that individual medical records can be worth hundreds or even thousands of dollars on the black market.
In this first of a 2-part post, I will address the value that AWS can bring to customers for ingesting, storing and protecting provider’s healthcare data. I will describe key components of any cloud-based healthcare workload and the services AWS provides to meet these requirements. In part 2 of this post we will dive deep into the AWS services used for advanced analytics, artificial intelligence and machine learning.
The data tsunami is upon us
So where is this data coming from? In addition to the ubiquitous electronic health record (EHR), the sources of this data include:
genomic sequencers
devices such as MRIs, x-rays and ultrasounds
sensors and wearables for patients
medical equipment telemetry
mobile applications
Additional sources of data come from non-clinical, operational systems such as:
human resources
finance
supply chain
claims and billing
Data from these sources can be structured (e.g., claims data) as well as unstructured (e.g., clinician notes). Some data comes across in streams such as that taken from patient monitors, while some comes in batch form. Still other data comes in near-real time such as HL7 messages. All of this data has retention policies dictating how long it must be stored. Much of this data is stored in perpetuity as many systems in use today have no purge mechanism. AWS has services to manage all these data types as well as their retention, security and access policies.
Imaging is a significant contributor to this data tsunami. Increasing demand for early-stage diagnoses along with aging populations drive increasing demand for images from CT, PET, MRI, ultrasound, digital pathology, X-ray and fluoroscopy. For example, a thin-slice CT image can be hundreds of megabytes. Increasing demand and strict retention policies make storage costly.
Due to the plummeting cost of gene sequencing, molecular diagnostics (including liquid biopsy) is a large contributor to this data deluge. Many predict that as the value of molecular testing becomes more identifiable, the reimbursement models will change and it will increasingly become the standard of care. According to the Washington Post article “Sequencing the Genome Creates so Much Data We Don’t Know What to do with It,”
“Some researchers predict that up to one billion people will have their genome sequenced by 2025 generating up to 40 exabytes of data per year.”
Although genomics is primarily used for oncology diagnostics today, it’s also used for other purposes, pharmacogenomics — used to understand how an individual will metabolize a medication.
Reference Architecture
It is increasingly challenging for the typical hospital, clinic or physician practice to securely store, process and manage this data without cloud adoption.
Amazon has a variety of ingestion techniques depending on the nature of the data including size, frequency and structure. AWS Snowball and AWS Snowmachine are appropriate for extremely-large, secure data transfers whether one time or episodic. AWS Glue is a fully-managed ETL service for securely moving data from on-premise to AWS and Amazon Kinesis can be used for ingesting streaming data.
Amazon S3, Amazon S3 IA, and Amazon Glacier are economical, data-storage services with a pay-as-you-go pricing model that expand (or shrink) with the customer’s requirements.
The above architecture has four distinct components – ingestion, storage, security, and analytics. In this post I will dive deeper into the first three components, namely ingestion, storage and security. In part 2, I will look at how to use AWS’ analytics services to draw value on, and optimize, your healthcare data.
Ingestion
A typical provider data center will consist of many systems with varied datasets. AWS provides multiple tools and services to effectively and securely connect to these data sources and ingest data in various formats. The customers can choose from a range of services and use them in accordance with the use case.
For use cases involving one-time (or periodic), very large data migrations into AWS, customers can take advantage of AWS Snowball devices. These devices come in two sizes, 50 TB and 80 TB and can be combined together to create a petabyte scale data transfer solution.
The devices are easy to connect and load and they are shipped to AWS avoiding the network bottlenecks associated with such large-scale data migrations. The devices are extremely secure supporting 256-bit encryption and come in a tamper-resistant enclosure. AWS Snowball imports data in Amazon S3 which can then interface with other AWS compute services to process that data in a scalable manner.
For use cases involving a need to store a portion of datasets on premises for active use and offload the rest on AWS, the Amazon storage gateway service can be used. The service allows you to seamlessly integrate on premises applications via standard storage protocols like iSCSI or NFS mounted on a gateway appliance. It supports a file interface, a volume interface and a tape interface which can be utilized for a range of use cases like disaster recovery, backup and archiving, cloud bursting, storage tiering and migration.
The AWS Storage Gateway appliance can use the AWS Direct Connect service to establish a dedicated network connection from the on premises data center to AWS.
Specific Industry Use Cases
By using the AWS proposed reference architecture for disaster recovery, healthcare providers can ensure their data assets are securely stored on the cloud and are easily accessible in the event of a disaster. The “AWS Disaster Recovery” whitepaper includes details on options available to customers based on their desired recovery time objective (RTO) and recovery point objective (RPO).
AWS is an ideal destination for offloading large volumes of less-frequently-accessed data. These datasets are rarely used in active compute operations but are exceedingly important to retain for reasons like compliance. By storing these datasets on AWS, customers can take advantage of the highly-durable platform to securely store their data and also retrieve them easily when they need to. For more details on how AWS enables customers to run back and archival use cases on AWS, please refer to the following set of whitepapers.
A healthcare provider may have a variety of databases spread throughout the hospital system supporting critical applications such as EHR, PACS, finance and many more. These datasets often need to be aggregated to derive information and calculate metrics to optimize business processes. AWS Glue is a fully-managed Extract, Transform and Load (ETL) service that can read data from a JDBC-enabled, on-premise database and transfer the datasets into AWS services like Amazon S3, Amazon Redshift and Amazon RDS. This allows customers to create transformation workflows that integrate smaller datasets from multiple sources and aggregates them on AWS.
Healthcare providers deal with a variety of streaming datasets which often have to be analyzed in near real time. These datasets come from a variety of sources such as sensors, messaging buses and social media, and often do not adhere to an industry standard. The Amazon Kinesis suite of services, that includes Amazon Kinesis Streams, Amazon Kinesis Firehose, and Amazon Kinesis Analytics, are the ideal set of services to accomplish the task of deriving value from streaming data.
Example: Using AWS Glue to de-identify and ingest healthcare data into S3 Let’s consider a scenario in which a provider maintains patient records in a database they want to ingest into S3. The provider also wants to de-identify the data by stripping personally- identifiable attributes and store the non-identifiable information in an S3 bucket. This bucket is different from the one that contains identifiable information. Doing this allows the healthcare provider to separate sensitive information with more restrictions set up via S3 bucket policies.
To ingest records into S3, we create a Glue job that reads from the source database using a Glue connection. The connection is also used by a Glue crawler to populate the Glue data catalog with the schema of the source database. We will use the Glue development endpoint and a zeppelin notebook server on EC2 to develop and execute the job.
Step 1: Import the necessary libraries and also set a glue context which is a wrapper on the spark context:
Step 2: Create a dataframe from the source data. I call the dataframe “readmissionsdata”. Here is what the schema would look like:
Step 3: Now select the columns that contains indentifiable information and store it in a new dataframe. Call the new dataframe “phi”.
Step 4: Non-PHI columns are stored in a separate dataframe. Call this dataframe “nonphi”.
Step 5: Write the two dataframes into two separate S3 buckets
Once successfully executed, the PHI and non-PHI attributes are stored in two separate files in two separate buckets that can be individually maintained.
Storage
In 2016, 327 healthcare providers reported a protected health information (PHI) breach, affecting 16.4m patient records[1]. There have been 342 data breaches reported in 2017 — involving 3.2 million patient records.[2]
To date, AWS has released 51 HIPAA-eligible services to help customers address security challenges and is in the process of making many more services HIPAA-eligible. These HIPAA-eligible services (along with all other AWS services) help customers build solutions that comply with HIPAA security and auditing requirements. A catalogue of HIPAA-enabled services can be found at AWS HIPAA-eligible services. It is important to note that AWS manages physical and logical access controls for the AWS boundary. However, the overall security of your workloads is a shared responsibility, where you are responsible for controlling user access to content on your AWS accounts.
AWS storage services allow you to store data efficiently while maintaining high durability and scalability. By using Amazon S3 as the central storage layer, you can take advantage of the Amazon S3 storage management features to get operational metrics on your data sets and transition them between various storage classes to save costs. By tagging objects on Amazon S3, you can build a governance layer on Amazon S3 to grant role based access to objects using Amazon IAM and Amazon S3 bucket policies.
To learn more about the Amazon S3 storage management features, see the following link.
Security
In the example above, we are storing the PHI information in a bucket named “phi.” Now, we want to protect this information to make sure its encrypted, does not have unauthorized access, and all access requests to the data are logged.
Encryption: S3 provides settings to enable default encryption on a bucket. This ensures any object in the bucket is encrypted by default.
Logging: S3 provides object level logging that can be used to capture all API calls to the object. The API calls are logged in cloudtrail for easy access and consolidation. Moreover, it also supports events to proactively alert customers of read and write operations.
Access control: Customers can use S3 bucket policies and IAM policies to restrict access to the phi bucket. It can also put a restriction to enforce multi-factor authentication on the bucket. For example, the following policy enforces multi-factor authentication on the phi bucket:
In Part 1 of this blog, we detailed the ingestion, storage, security and management of healthcare data on AWS. Stay tuned for part two where we are going to dive deep into optimizing the data for analytics and machine learning.
As ransomware attacks have grown in number in recent months, the tactics and attack vectors also have evolved. While the primary method of attack used to be to target individual computer users within organizations with phishing emails and infected attachments, we’re increasingly seeing attacks that target weaknesses in businesses’ IT infrastructure.
How Ransomware Attacks Typically Work
In our previous posts on ransomware, we described the common vehicles used by hackers to infect organizations with ransomware viruses. Most often, downloaders distribute trojan horses through malicious downloads and spam emails. The emails contain a variety of file attachments, which if opened, will download and run one of the many ransomware variants. Once a user’s computer is infected with a malicious downloader, it will retrieve additional malware, which frequently includes crypto-ransomware. After the files have been encrypted, a ransom payment is demanded of the victim in order to decrypt the files.
What’s Changed With the Latest Ransomware Attacks?
In 2016, a customized ransomware strain called SamSam began attacking the servers in primarily health care institutions. SamSam, unlike more conventional ransomware, is not delivered through downloads or phishing emails. Instead, the attackers behind SamSam use tools to identify unpatched servers running Red Hat’s JBoss enterprise products. Once the attackers have successfully gained entry into one of these servers by exploiting vulnerabilities in JBoss, they use other freely available tools and scripts to collect credentials and gather information on networked computers. Then they deploy their ransomware to encrypt files on these systems before demanding a ransom. Gaining entry to an organization through its IT center rather than its endpoints makes this approach scalable and especially unsettling.
SamSam’s methodology is to scour the Internet searching for accessible and vulnerable JBoss application servers, especially ones used by hospitals. It’s not unlike a burglar rattling doorknobs in a neighborhood to find unlocked homes. When SamSam finds an unlocked home (unpatched server), the software infiltrates the system. It is then free to spread across the company’s network by stealing passwords. As it transverses the network and systems, it encrypts files, preventing access until the victims pay the hackers a ransom, typically between $10,000 and $15,000. The low ransom amount has encouraged some victimized organizations to pay the ransom rather than incur the downtime required to wipe and reinitialize their IT systems.
The success of SamSam is due to its effectiveness rather than its sophistication. SamSam can enter and transverse a network without human intervention. Some organizations are learning too late that securing internet-facing services in their data center from attack is just as important as securing endpoints.
The typical steps in a SamSam ransomware attack are:
1 Attackers gain access to vulnerable server
Attackers exploit vulnerable software or weak/stolen credentials.
2 Attack spreads via remote access tools
Attackers harvest credentials, create SOCKS proxies to tunnel traffic, and abuse RDP to install SamSam on more computers in the network.
3 Ransomware payload deployed
Attackers run batch scripts to execute ransomware on compromised machines.
4 Ransomware demand delivered requiring payment to decrypt files
Demand amounts vary from victim to victim. Relatively low ransom amounts appear to be designed to encourage quick payment decisions.
What all the organizations successfully exploited by SamSam have in common is that they were running unpatched servers that made them vulnerable to SamSam. Some organizations had their endpoints and servers backed up, while others did not. Some of those without backups they could use to recover their systems chose to pay the ransom money.
Timeline of SamSam History and Exploits
Since its appearance in 2016, SamSam has been in the news with many successful incursions into healthcare, business, and government institutions.
March 2016 SamSam appears
SamSam campaign targets vulnerable JBoss servers Attackers hone in on healthcare organizations specifically, as they’re more likely to have unpatched JBoss machines.
April 2016 SamSam finds new targets
SamSam begins targeting schools and government. After initial success targeting healthcare, attackers branch out to other sectors.
April 2017 New tactics include RDP
Attackers shift to targeting organizations with exposed RDP connections, and maintain focus on healthcare. An attack on Erie County Medical Center costs the hospital $10 million over three months of recovery.
January 2018 Municipalities attacked
• Attack on Municipality of Farmington, NM. • Attack on Hancock Health. • Attack on Adams Memorial Hospital • Attack on Allscripts (Electronic Health Records), which includes 180,000 physicians, 2,500 hospitals, and 7.2 million patients’ health records.
February 2018 Attack volume increases
• Attack on Davidson County, NC. • Attack on Colorado Department of Transportation.
March 2018 SamSam shuts down Atlanta
• Second attack on Colorado Department of Transportation. • City of Atlanta suffers a devastating attack by SamSam. The attack has far-reaching impacts — crippling the court system, keeping residents from paying their water bills, limiting vital communications like sewer infrastructure requests, and pushing the Atlanta Police Department to file paper reports. • SamSam campaign nets $325,000 in 4 weeks. Infections spike as attackers launch new campaigns. Healthcare and government organizations are once again the primary targets.
How to Defend Against SamSam and Other Ransomware Attacks
The best way to respond to a ransomware attack is to avoid having one in the first place. If you are attacked, making sure your valuable data is backed up and unreachable by ransomware infection will ensure that your downtime and data loss will be minimal or none if you ever suffer an attack.
In our previous post, How to Recover From Ransomware, we listed the ten ways to protect your organization from ransomware.
Use anti-virus and anti-malware software or other security policies to block known payloads from launching.
Make frequent, comprehensive backups of all important files and isolate them from local and open networks. Cybersecurity professionals view data backup and recovery (74% in a recent survey) by far as the most effective solution to respond to a successful ransomware attack.
Keep offline backups of data stored in locations inaccessible from any potentially infected computer, such as disconnected external storage drives or the cloud, which prevents them from being accessed by the ransomware.
Install the latest security updates issued by software vendors of your OS and applications. Remember to patch early and patch often to close known vulnerabilities in operating systems, server software, browsers, and web plugins.
Consider deploying security software to protect endpoints, email servers, and network systems from infection.
Exercise cyber hygiene, such as using caution when opening email attachments and links.
Segment your networks to keep critical computers isolated and to prevent the spread of malware in case of attack. Turn off unneeded network shares.
Turn off admin rights for users who don’t require them. Give users the lowest system permissions they need to do their work.
Restrict write permissions on file servers as much as possible.
Educate yourself, your employees, and your family in best practices to keep malware out of your systems. Update everyone on the latest email phishing scams and human engineering aimed at turning victims into abettors.
Please Tell Us About Your Experiences with Ransomware
Have you endured a ransomware attack or have a strategy to avoid becoming a victim? Please tell us of your experiences in the comments.
Good article about how difficult it is to insure an organization against Internet attacks, and how expensive the insurance is.
Companies like retailers, banks, and healthcare providers began seeking out cyberinsurance in the early 2000s, when states first passed data breach notification laws. But even with 20 years’ worth of experience and claims data in cyberinsurance, underwriters still struggle with how to model and quantify a unique type of risk.
“Typically in insurance we use the past as prediction for the future, and in cyber that’s very difficult to do because no two incidents are alike,” said Lori Bailey, global head of cyberrisk for the Zurich Insurance Group. Twenty years ago, policies dealt primarily with data breaches and third-party liability coverage, like the costs associated with breach class-action lawsuits or settlements. But more recent policies tend to accommodate first-party liability coverage, including costs like online extortion payments, renting temporary facilities during an attack, and lost business due to systems failures, cloud or web hosting provider outages, or even IT configuration errors.
There are challenges to creating these new insurance products. There are two basic models for insurance. There’s the fire model, where individual houses catch on fire at a fairly steady rate, and the insurance industry can calculate premiums based on that rate. And there’s the flood model, where an infrequent large-scale event affects large numbers of people — but again at a fairly steady rate. Internet+ insurance is complicated because it follows neither of those models but instead has aspects of both: individuals are hacked at a steady (albeit increasing) rate, while class breaks and massive data breaches affect lots of people at once. Also, the constantly changing technology landscape makes it difficult to gather and analyze the historical data necessary to calculate premiums.
Amazon Simple Notification Service (SNS) now supports VPC Endpoints (VPCE) via AWS PrivateLink. You can use VPC Endpoints to privately publish messages to SNS topics, from an Amazon Virtual Private Cloud (VPC), without traversing the public internet. When you use AWS PrivateLink, you don’t need to set up an Internet Gateway (IGW), Network Address Translation (NAT) device, or Virtual Private Network (VPN) connection. You don’t need to use public IP addresses, either.
VPC Endpoints doesn’t require code changes and can bring additional security to Pub/Sub Messaging use cases that rely on SNS. VPC Endpoints helps promote data privacy and is aligned with assurance programs, including the Health Insurance Portability and Accountability Act (HIPAA), FedRAMP, and others discussed below.
VPC Endpoints for SNS in action
Here’s how VPC Endpoints for SNS works. The following example is based on a banking system that processes mortgage applications. This banking system, which has been deployed to a VPC, publishes each mortgage application to an SNS topic. The SNS topic then fans out the mortgage application message to two subscribing AWS Lambda functions:
Save-Mortgage-Application stores the application in an Amazon DynamoDB table. As the mortgage application contains personally identifiable information (PII), the message must not traverse the public internet.
Save-Credit-Report checks the applicant’s credit history against an external Credit Reporting Agency (CRA), then stores the final credit report in an Amazon S3 bucket.
The following diagram depicts the underlying architecture for this banking system:
To protect applicants’ data, the financial institution responsible for developing this banking system needed a mechanism to prevent PII data from traversing the internet when publishing mortgage applications from their VPC to the SNS topic. Therefore, they created a VPC endpoint to enable their publisher Amazon EC2 instance to privately connect to the SNS API. As shown in the diagram, when the VPC endpoint is created, an Elastic Network Interface (ENI) is automatically placed in the same VPC subnet as the publisher EC2 instance. This ENI exposes a private IP address that is used as the entry point for traffic destined to SNS. This ensures that traffic between the VPC and SNS doesn’t leave the Amazon network.
Set up VPC Endpoints for SNS
The process for creating a VPC endpoint to privately connect to SNS doesn’t require code changes: access the VPC Management Console, navigate to the Endpoints section, and create a new Endpoint. Three attributes are required:
The SNS service name.
The VPC and Availability Zones (AZs) from which you’ll publish your messages.
The Security Group (SG) to be associated with the endpoint network interface. The Security Group controls the traffic to the endpoint network interface from resources in your VPC. If you don’t specify a Security Group, the default Security Group for your VPC will be associated.
The SNS API is served through HTTP Secure (HTTPS), and encrypts all messages in transit with Transport Layer Security (TLS) certificates issued by Amazon Trust Services (ATS). The certificates verify the identity of the SNS API server when encrypted connections are established. The certificates help establish proof that your SNS API client (SDK, CLI) is communicating securely with the SNS API server. A Certificate Authority (CA) issues the certificate to a specific domain. Hence, when a domain presents a certificate that’s issued by a trusted CA, the SNS API client knows it’s safe to make the connection.
Summary
VPC Endpoints can increase the security of your pub/sub messaging use cases by allowing you to publish messages to SNS topics, from instances in your VPC, without traversing the internet. Setting up VPC Endpoints for SNS doesn’t require any code changes because the SNS API address remains the same.
VPC Endpoints for SNS is now available in all AWS Regions where AWS PrivateLink is available. For information on pricing and regional availability, visit the VPC pricing page. For more information and on-boarding, see Publishing to Amazon SNS Topics from Amazon Virtual Private Cloud in the SNS documentation.
If you have comments about this post, submit them in the Comments section below. If you have questions about anything in this post, start a new thread on the Amazon SNS forum or contact AWS Support.
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With AWS Organizations, you can centrally manage policies across multiple AWS accounts without having to use custom scripts and manual processes. For example, you can apply service control policies (SCPs) across multiple AWS accounts that are members of an organization. SCPs allow you to define which AWS service APIs can and cannot be executed by AWS Identity and Access Management (IAM) entities (such as IAM users and roles) in your organization’s member AWS accounts. SCPs are created and applied from the master account, which is the AWS account that you used when you created your organization.
In a previous post, How to Use Service Control Policies in AWS Organizations to Enforce Healthcare Compliance in Your AWS Account, we reviewed how to create and manage SCPs and Organizational Units (OU) within an organization. In this post, I show how to use SCPs for access control in Organizations, with a specific focus on evaluating SCPs when an IAM entity calls an API in a member AWS account. I first cover some key Organizations concepts, and then I show how an SCP attached to an organization impacts which AWS service APIs are available to member accounts. Finally, I demonstrate these concepts with an example.
Organizational structure in Organizations
OUs give you a way to logically group and structure member AWS accounts in your organization. The screenshot shows the tree view of an example organizational structure in my organization with several OUs. Currently, I have selected OrgUnit01, and this is the current view I see in my main window. You can see here that within the OrgUnit01 OU, I have nested two additional OUs (OrgUnit01ChildA and OrgUnit01ChildB) and an AWS account is also contained within OrgUnit01, named “Developer Sandbox Account”.
The parts of the example organizational structure in the screenshot are:
Tree view — The hierarchy of your organization’s root and any OUs you have created
Tree view toggle — Enable and disable tree view
Organizational Units — Any child OUs of the selected root or OU in tree view
Accounts — Any AWS accounts (members or master) in the current OU
In the next section, I explain why at least one SCP must be attached to your root and OUs and introduce SCP evaluation.
How Service Control Policy evaluation logic works
To allow an AWS service API at the member account level, you must allow the API at every level between the member account and the root of your organization. This means you must attach an SCP at every level between your organization’s root and the member account that allows the given AWS service API (such as ec2:RunInstances). For more information, see About Service Control Policies.
Let’s say you want to allow the ec2:RunInstances API in the Developer Sandbox Account in the example structure in the preceding screenshot. To allow this AWS service API, you must allow the API in at least one SCP attached at each of these levels:
The organization’s root
The OU named OrgUnit01
If you don’t allow the AWS service in an SCP attached at each of these two levels, neither IAM entities nor the root user in the Developer Sandbox Account will be able to call ec2:RunInstances, even if an administrator has given them permission to do so (for IAM entities). In terms of policy evaluation, SCPs follow exactly the same policy evaluation logic as IAM does: by default, all requests are denied, an explicit allow overrides this default, and an explicit deny overrides any explicit allows.
What does this look like in practice? In the next section, I share a practical example to demonstrate how this works in Organizations.
An example structure with nested OUs and SCPs
In the previous section, I introduced design aspects of AWS Organizations that help prevent administrators from breaking structures in their Organizations. But because AWS Organizations is flexible enough to address multiple use cases, administrators can make changes that have unintended consequences, such as breaking organizational structures when moving an AWS account from one OU to another. In this section, I show an example with broken OU and SCP structures and explain how you can fix them.
I’ll take a blacklisting approach. That is, I’ll use the FullAWSAccess SCP, which doesn’t filter out any AWS service APIs. Then, I will filter out specific APIs by blacklisting them in subsequent SCPs attached to OUs at various points in my organization’s structure. For further reading on blacklisting and whitelisting with AWS Organizations, review AWS Organizations Terminology and Concepts.
Let’s say I have developed the OU and SCP structure shown in the diagram below. Before taking a close look at that diagram, I’ll briefly outline the goals I’m trying to achieve. Broadly speaking, there’s a small subset of APIs that I want to filter out using SCPs. This means that IAM entities in some AWS accounts in my organization will not have access to particular AWS service APIs, such as those related to Amazon EC2, while other accounts will not have access to APIs associated with Amazon CloudWatch, Amazon S3, and so on. Apart from these special cases, I do want the accounts in my organization to have access to all other APIs. More specifically, my goals are as follows:
Any AWS accounts in the Root should not have any API filtered out.
Any AWS accounts in OU 001 should have APIs for CloudWatch filtered out, but all other APIs will be accessible.
Any AWS accounts in OU 002 should have APIs for both CloudWatch and EC2 filtered out, but all other APIs will be accessible.
Any AWS accounts in OU 003 should have APIs for S3 filtered out, but all other APIs will be accessible.
To that end, let’s now look at my initial SCP and OU configuration in the image below that shows the example OU and SCP structure. The arrow shows the direction of inheritance: the root and the OUs below it (children) inherit SCPs from the OUs above them (parents). This example structure contains the following SCPs:
FullAWSAccess — Allows all AWS service APIs
Deny_CW — Denies all CloudWatch APIs
Deny_EC2 — Denies all Amazon EC2 APIs
Deny_S3 — Denies all Amazon S3 APIs
Now that I’ve outlined my intent, and shown you the OU / SCP structure that I’ve created to meet that set of goals, you can probably already see that the structure provided in the image above will not work correctly for my stated goals. In fact, AWS accounts in the Root container and OU 001 will have the intended access, as per my goals (1) and (2). I will not, however, meet my goals (3) and (4) with the above structure: entities in member accounts directly under OU 002 cannot perform any actions, even if they’re granted permissions by IAM access policies. This is because the FullAWSAccess SCP isn’t attached directly to this OU (it’s only inherited).
Why is this important? For an AWS service API to be available to IAM entities in a member account, the API must be specified in an SCP attached at every level all the way down the hierarchy to the relevant member account. Similarly, even though OU 003 does have the FullAWSAccess SCP attached directly to it, the fact that it’s not attached to the parent OU (OU 002) means that IAM entities in member accounts under OU 003 also aren’t able to access any service APIs. This doesn’t happen by default—I have deliberately taken this action to organize my structure in this way, to show both the flexibility and the kind of problems you can encounter when working with OUs and SCPs.
So I now need to fix the problems that I’ve inadvertently created. To start with, I’m going to make one change to OU 002 by attaching the FullAWSAccess SCP directly to that OU. After I do that, OU 002 has the attached and inherited policies that are shown in the following image.
With the FullAWSAccess policy attached to OU 002, member accounts in both OU 002 and OU 003 can access the other non-restricted AWS service APIs (keeping in mind that the FullAWSAccess policy was already applied to OU 003).
I have one final issue to address in this example: OU 003 has an SCP attached that blocks access to the Amazon S3 APIs. However, in this OU, the intent is to allow IAM entities in member accounts to access the EC2 APIs. EC2 API access is blocked because in the parent OU (OU 002), an SCP is attached that denies access to that API (the Deny_EC2 SCP), which means that any actions listed in Deny_EC2 have already been filtered out. An explicit deny always trumps an allow, so to meet goal (4) and have an OU in which EC2 APIs are allowed but access to CloudWatch APIs and S3 APIs is filtered out, I will move OU 003 up one level, placing it directly under OU 001. This change gives me a working OU and policy structure, as shown in the following image.
I recommend that at each level of your organization’s hierarchy, you directly apply the relevant SCPs. By doing this, you’re less likely to forget to apply an SCP to a particular OU, which can break your permission structure. By directly applying SCPs, you also make your policy structure easier to read.
If you have a group of accounts in your organization that are for testing purposes, I recommend that you experiment with OUs and SCPs. Applying SCPs to OUs and then moving an AWS account around within that structure can show you how SCPs affect IAM entities. For example, if you have an IAM user with the AdministratorAccess policy attached, you should see how SCPs can filter out certain AWS service APIs from specified member accounts.
Conclusion
I showed you how you can effectively apply SCPs to OUs in your organization and avoid some of the common issues that you might experience. I demonstrated an approach to designing a working organizational structure that I hope will help smooth your deployment of your organization and enables you to better centrally secure and manage your AWS accounts.
If you have comments about this post, submit them in the Comments section below. If you have questions about anything in this post, start a new thread on the Organizations forum.
Today, our customers use AWS CloudHSM to meet corporate, contractual and regulatory compliance requirements for data security by using dedicated Hardware Security Module (HSM) instances within the AWS cloud. CloudHSM delivers all the benefits of traditional HSMs including secure generation, storage, and management of cryptographic keys used for data encryption that are controlled and accessible only by you.
As a managed service, it automates time-consuming administrative tasks such as hardware provisioning, software patching, high availability, backups and scaling for your sensitive and regulated workloads in a cost-effective manner. Backup and restore functionality is the core building block enabling scalability, reliability and high availability in CloudHSM.
You should consider using AWS CloudHSM if you require:
Keys stored in dedicated, third-party validated hardware security modules under your exclusive control
FIPS 140-2 compliance
Integration with applications using PKCS#11, Java JCE, or Microsoft CNG interfaces
Healthcare applications subject to HIPAA regulations
Streaming video solutions subject to contractual DRM requirements
We recently released a whitepaper, “Security of CloudHSM Backups” that provides in-depth information on how backups are protected in all three phases of the CloudHSM backup lifecycle process: Creation, Archive, and Restore.
About the Author
Balaji Iyer is a senior consultant in the Professional Services team at Amazon Web Services. In this role, he has helped several customers successfully navigate their journey to AWS. His specialties include architecting and implementing highly-scalable distributed systems, operational security, large scale migrations, and leading strategic AWS initiatives.
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:
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.
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.
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.
Summary
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.
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.
At inception, Backblaze was a consumer company. Thousands upon thousands of individuals came to our website and gave us $5/mo to keep their data safe. But, we didn’t sell business solutions. It took us years before we had a sales team. In the last couple of years, we’ve released products that businesses of all sizes love: Backblaze B2 Cloud Storage and Backblaze for Business Computer Backup. Those businesses want to integrate Backblaze into their infrastructure, so it’s time to expand our teams!
Company Description: Founded in 2007, Backblaze started with a mission to make backup software elegant and provide complete peace of mind. Over the course of almost a decade, we have become a pioneer in robust, scalable low cost cloud backup. Recently, we launched B2 – robust and reliable object storage at just $0.005/gb/mo. Part of our differentiation is being able to offer the lowest price of any of the big players while still being profitable.
We’ve managed to nurture a team oriented culture with amazingly low turnover. We value our people and their families. Don’t forget to check out our “About Us” page to learn more about the people and some of our perks.
We have built a profitable, high growth business. While we love our investors, we have maintained control over the business. That means our corporate goals are simple – grow sustainably and profitably.
Some Backblaze Perks:
Competitive healthcare plans
Competitive compensation and 401k
All employees receive Option grants
Unlimited vacation days
Strong coffee
Fully stocked Micro kitchen
Catered breakfast and lunches
Awesome people who work on awesome projects
New Parent Childcare bonus
Normal work hours
Get to bring your pets into the office
San Mateo Office – located near Caltrain and Highways 101 & 280.
Want to know what you’ll be doing?
You will play a pivotal role at Backblaze! You will be the glue that binds people together in the office and one of the main engines that keeps our company running. This is an exciting opportunity to help shape the company culture of Backblaze by making the office a fun and welcoming place to work. As an Office Administrator, your priority is to help employees have what they need to feel happy, comfortable, and productive at work; whether it’s refilling snacks, collecting shipments, responding to maintenance requests, ordering office supplies, or assisting with fun social events, your contributions will be critical to our culture.
Office Administrator Responsibilities:
Maintain a clean, well-stocked and organized office
Greet visitors and callers, route and resolve information requests
Ensure conference rooms and kitchen areas are clean and stocked
Sign for all packages delivered to the office as well as forward relevant departments
Administrative duties as assigned
Facilities Coordinator Responsibilities:
Act as point of contact for building facilities and other office vendors and deliveries
Work with HR to ensure new hires are welcomed successfully at Backblaze – to include desk/equipment orders, seat planning, and general facilities preparation
Work with the “Fun Committee” to support office events and activities
Be available after hours as required for ongoing business success (events, building issues)
Jr. Buyer Responsibilities:
Assist with creating purchase orders and buying equipment
Compare costs and maintain vendor cards in Quickbooks
Assist with booking travel, hotel accommodations, and conference rooms
Maintain accurate records of purchases and tracking orders
Maintain office equipment, physical space, and maintenance schedules
Manage company calendar, snack, and meal orders
Qualifications:
1 year experience in an Inventory/Shipping/Receiving/Admin role preferred
Proficiency with Microsoft Office applications, Google Apps, Quickbooks, Excel
Experience and skill at adhering to a budget
High attention to detail
Proven ability to prioritize within a multi-tasking environment; highly organized
Collaborative and communicative
Hands-on, “can do” attitude
Personable and approachable
Able to lift up to 50 lbs
Strong data entry
This position is located in San Mateo, California. Backblaze is an Equal Opportunity Employer.
If this all sounds like you:
Send an email to [email protected] with the position in the subject line.
Want to work at a company that helps customers in 156 countries around the world protect the memories they hold dear? A company that stores over 500 petabytes of customers’ photos, music, documents and work files in a purpose-built cloud storage system?
Well here’s your chance. Backblaze is looking for a Vault Storage Engineer!
Company Description:
Founded in 2007, Backblaze started with a mission to make backup software elegant and provide complete peace of mind. Over the course of almost a decade, we have become a pioneer in robust, scalable low cost cloud backup. Recently, we launched B2 — robust and reliable object storage at just $0.005/gb/mo. Part of our differentiation is being able to offer the lowest price of any of the big players while still being profitable.
We’ve managed to nurture a team oriented culture with amazingly low turnover. We value our people and their families. Don’t forget to check out our “About Us” page to learn more about the people and some of our perks.
We have built a profitable, high growth business. While we love our investors, we have maintained control over the business. That means our corporate goals are simple – grow sustainably and profitably.
Some Backblaze Perks:
Competitive healthcare plans
Competitive compensation and 401k
All employees receive Option grants
Unlimited vacation days
Strong coffee
Fully stocked Micro kitchen
Catered breakfast and lunches
Awesome people who work on awesome projects
New Parent Childcare bonus
Normal work hours
Get to bring your pets into the office
San Mateo Office – located near Caltrain and Highways 101 & 280.
Want to know what you’ll be doing?
You will work on the core of the Backblaze: the vault cloud storage system (https://www.backblaze.com/blog/vault-cloud-storage-architecture/). The system accepts files uploaded from customers, stores them durably by distributing them across the data center, automatically handles drive failures, rebuilds data when drives are replaced, and maintains high availability for customers to download their files. There are significant enhancements in the works, and you’ll be a part of making them happen.
Must have a strong background in:
Computer Science
Multi-threaded programming
Distributed Systems
Java
Math (such as matrix algebra and statistics)
Building reliable, testable systems
Bonus points for:
Java
JavaScript
Python
Cassandra
SQL
Looking for an attitude of:
Passionate about building reliable clean interfaces and systems.
Likes to work closely with other engineers, support, and sales to help customers.
Customer Focused (!!) — always focus on the customer’s point of view and how to solve their problem!
Required for all Backblaze Employees:
Good attitude and willingness to do whatever it takes to get the job done
Strong desire to work for a small fast-paced company
Desire to learn and adapt to rapidly changing technologies and work environment
Rigorous adherence to best practices
Relentless attention to detail
Excellent interpersonal skills and good oral/written communication
Excellent troubleshooting and problem solving skills
This position is located in San Mateo, California but will also consider remote work as long as you’re no more than three time zones away and can come to San Mateo now and then.
Backblaze is an Equal Opportunity Employer.
Contact Us: If this sounds like you, follow these steps:
Founded in 2007, Backblaze started with a mission to make backup software elegant and provide complete peace of mind. Over the course of almost a decade, we have become a pioneer in robust, scalable low cost cloud backup. Recently, we launched B2, robust and reliable object storage at just $0.005/gb/mo. We offer the lowest price of any of the big players and are still profitable.
Backblaze has a culture of openness. The hardware designs for our storage pods are open source. Key parts of the software, including the Reed-Solomon erasure coding are open-source. Backblaze is the only company that publishes hard drive reliability statistics.
We’ve managed to nurture a team-oriented culture with amazingly low turnover. We value our people and their families. The team is distributed across the U.S., but we work in Pacific Time, so work is limited to work time, leaving evenings and weekends open for personal and family time. Check out our “About Us” page to learn more about the people and some of our perks.
We have built a profitable, high growth business. While we love our investors, we have maintained control over the business. That means our corporate goals are simple – grow sustainably and profitably.
Our engineering team is 10 software engineers, and 2 quality assurance engineers. Most engineers are experienced, and a couple are more junior. The team will be growing as the company grows to meet the demand for our products; we plan to add at least 6 more engineers in 2018. The software includes the storage systems that run in the data center, the web APIs that clients access, the web site, and client programs that run on phones, tablets, and computers.
The Job:
As the Director of Engineering, you will be:
managing the software engineering team
ensuring consistent delivery of top-quality services to our customers
collaborating closely with the operations team
directing engineering execution to scale the business and build new services
transforming a self-directed, scrappy startup team into a mid-size engineering organization
A successful director will have the opportunity to grow into the role of VP of Engineering. Backblaze expects to continue our exponential growth of our storage services in the upcoming years, with matching growth in the engineering team..
This position is located in San Mateo, California.
Qualifications:
We are a looking for a director who:
has a good understanding of software engineering best practices
has experience scaling a large, distributed system
gets energized by creating an environment where engineers thrive
understands the trade-offs between building a solid foundation and shipping new features
has a track record of building effective teams
Required for all Backblaze Employees:
Good attitude and willingness to do whatever it takes to get the job done
Strong desire to work for a small fast-paced company
Desire to learn and adapt to rapidly changing technologies and work environment
Rigorous adherence to best practices
Relentless attention to detail
Excellent interpersonal skills and good oral/written communication
Excellent troubleshooting and problem solving skills
Some Backblaze Perks:
Competitive healthcare plans
Competitive compensation and 401k
All employees receive Option grants
Unlimited vacation days
Strong coffee
Fully stocked Micro kitchen
Catered breakfast and lunches
Awesome people who work on awesome projects
New Parent Childcare bonus
Normal work hours
Get to bring your pets into the office
San Mateo Office — located near Caltrain and Highways 101 & 280.
Want to work at a company that helps customers in 156 countries around the world protect the memories they hold dear? A company that stores over 500 petabytes of customers’ photos, music, documents and work files in a purpose-built cloud storage system?
Well, here’s your chance. Backblaze is looking for a Sr. Software Engineer!
Company Description:
Founded in 2007, Backblaze started with a mission to make backup software elegant and provide complete peace of mind. Over the course of almost a decade, we have become a pioneer in robust, scalable low cost cloud backup. Recently, we launched B2 – robust and reliable object storage at just $0.005/gb/mo. Part of our differentiation is being able to offer the lowest price of any of the big players while still being profitable.
We’ve managed to nurture a team oriented culture with amazingly low turnover. We value our people and their families. Don’t forget to check out our “About Us” page to learn more about the people and some of our perks.
We have built a profitable, high growth business. While we love our investors, we have maintained control over the business. That means our corporate goals are simple – grow sustainably and profitably.
Some Backblaze Perks:
Competitive healthcare plans
Competitive compensation and 401k
All employees receive Option grants
Unlimited vacation days
Strong coffee
Fully stocked Micro kitchen
Catered breakfast and lunches
Awesome people who work on awesome projects
New Parent Childcare bonus
Normal work hours
Get to bring your pets into the office
San Mateo Office – located near Caltrain and Highways 101 & 280
Want to know what you’ll be doing?
You will work on the server side APIs that authenticate users when they log in, accept the backups, manage the data, and prepare restored data for customers. And you will help build new features as well as support tools to help chase down and diagnose customer issues.
Must be proficient in:
Java
Apache Tomcat
Large scale systems supporting thousands of servers and millions of customers
Cross platform (Linux/Macintosh/Windows) — don’t need to be an expert on all three, but cannot be afraid of any
Bonus points for:
Cassandra experience
JavaScript
ReactJS
Python
Struts
JSP’s
Looking for an attitude of:
Passionate about building friendly, easy to use Interfaces and APIs.
Likes to work closely with other engineers, support, and sales to help customers.
Believes the whole world needs backup, not just English speakers in the USA.
Customer Focused (!!) — always focus on the customer’s point of view and how to solve their problem!
Required for all Backblaze Employees:
Good attitude and willingness to do whatever it takes to get the job done
Strong desire to work for a small, fast-paced company
Desire to learn and adapt to rapidly changing technologies and work environment
Rigorous adherence to best practices
Relentless attention to detail
Excellent interpersonal skills and good oral/written communication
Excellent troubleshooting and problem solving skills
This position is located in San Mateo, California but will also consider remote work as long as you’re no more than three time zones away and can come to San Mateo now and then.
Backblaze is an Equal Opportunity Employer.
If this sounds like you —follow these steps:
Send an email to [email protected] with the position in the subject line.
At inception, Backblaze was a consumer company. Thousands upon thousands of individuals came to our website and gave us $5/mo to keep their data safe. But, we didn’t sell business solutions. It took us years before we had a sales team. In the last couple of years, we’ve released products that businesses of all sizes love: Backblaze B2 Cloud Storage and Backblaze for Business Computer Backup. Those businesses want to integrate Backblaze into their infrastructure, so it’s time to expand our sales team and hire our first dedicated outbound Sales Development Representative!
Company Description: Founded in 2007, Backblaze started with a mission to make backup software elegant and provide complete peace of mind. Over the course of almost a decade, we have become a pioneer in robust, scalable low cost cloud backup. Recently, we launched B2 — robust and reliable object storage at just $0.005/gb/mo. Part of our differentiation is being able to offer the lowest price of any of the big players while still being profitable.
We’ve managed to nurture a team oriented culture with amazingly low turnover. We value our people and their families. Don’t forget to check out our “About Us” page to learn more about the people and some of our perks.
We have built a profitable, high growth business. While we love our investors, we have maintained control over the business. That means our corporate goals are simple — grow sustainably and profitably.
Some Backblaze Perks:
Competitive healthcare plans
Competitive compensation and 401k
All employees receive option grants
Unlimited vacation days
Strong coffee
Fully stocked Micro kitchen
Catered breakfast and lunches
Awesome people who work on awesome projects
New Parent Childcare bonus
Normal work hours
Get to bring your pets into the office
San Mateo Office — located near Caltrain and Highways 101 & 280
As our first Sales Development Representative (SDR), we are looking for someone who is organized, has high-energy and strong interpersonal communication skills. The ideal person will have a passion for sales, love to cold call and figure out new ways to get potential customers. Ideally the SDR will have 1-2 years experience working in a fast paced sales environment. We are looking for someone who knows how to manage their time and has top class communication skills. It’s critical that our SDR is able to learn quickly when using new tools.
Additional Responsibilities Include:
Generate qualified leads, set up demos and outbound opportunities by phone and email.
Work with our account managers to pass qualified leads and track in salesforce.com.
Report internally on prospecting performance and identify potential optimizations.
Continuously fine tune outbound messaging – both email and cold calls to drive results.
Update and leverage salesforce.com and other sales tools to better track business and drive efficiencies.
Qualifications:
Bachelor’s degree (B.A.)
Minimum of 1-2 years of sales experience.
Excellent written and verbal communication skills.
Proven ability to work in a fast-paced, dynamic and goal-oriented environment.
Maintain a high sense of urgency and entrepreneurial work ethic that is required to drive business outcomes, with exceptional attention to detail.
Positive“can do” attitude, passionate and able to show commitment.
Fearless yet cordial personality- not afraid to make cold calls and introductions yet personable enough to connect with potential Backblaze customers.
Articulate and good listening skills.
Ability to set and manage multiple priorities.
What’s it like working with the Sales team?
The Backblaze sales team collaborates. We help each other out by sharing ideas, templates, and our customer’s experiences. When we talk about our accomplishments, there is no “I did this,” only “we.” We are truly a team.
We are honest to each other and our customers and communicate openly. We aim to have fun by embracing crazy ideas and creative solutions. We try to think not outside the box, but with no boxes at all. Customers are the driving force behind the success of the company and we care deeply about their success.
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