Healthcare in the Cloud: CareCloud's CTO and Cloud Technology manager will take you through their experiences and challenges in migrating from a physical infrastructure to a hybrid model. They will discuss their zero failure architecture for healthcare in the cloud and how they use auto-scaling to eliminate variability problems. Thomas Packert is Chief Technology Officer at CareCloud, where he is responsible for identifying technologies and managing implementations of CareCloud’s proprietary systems to maximize the scalability, flexibility, and productivity enjoyed by the company's clients. His mission is to deliver high-productivity, secure, compliant systems for all stakeholders. Mr. Packert comes to CareCloud with numerous years of experience developing healthcare billing systems, healthcare supply chains, and financial reporting systems for HMOs. Saul Waizer is Cloud Technology Manager at CareCloud. Mr. Waizer leads the infrastructure team and oversees the development of CareCloud's core technology and infrastructure. He specializes in High-Availability, cloud infrastructure, PaaS, and web scaling. Over the last 10 years Mr. Waizer has managed systems and network operations for domestic and international organizations in many industries, including online banking, healthcare, entertainment, and internet security. At CareCloud, Mr. Waizer uses his expertise to mentor others on cloud computing, lead research and development efforts, and help introduce new technologies to the company's ever-evolving platform.

1. Thomas Packert
CTO
Saul Waizer
Cloud Technology Manager

2. Who We Are
• An on-demand software and services company for healthcare
• Founded by experienced healthcare IT professionals
• Our products and services include:
– Revenue Cycle Management services
– Healthcare IT Platform
– On-demand, modern, easy to use, collaborative
electronic health record
– Software-as-a-service for administrative, financial and
clinical functions
– Revenue Cycle Management services
• Open philosophy and commitment to work with best of breed
vendors
• Agile development and rapid customization of customer
requirements
• Winner of IBM SmartCamp Silicon Valley
• Backed by Intel Capital and Norwest Venture Partners with
$20M of venture capital
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4. Our Technology
Fully Web-Based
• Accessible through multiple devices
• Platform agnostic
• Browser agnostic
Focus on Design and Usability
• Desktop-class experience
• Intuitive and easy user interface
• Reduced training requirements
Enterprise-Class Capabilities
• Multi-tenant / sophisticated client
configurations
• Handles small to very large practices
• Role-Based Security and Workflow
Open & Secure Systems Philosophy
• Rapid integration with virtually any system
including other EMR & HIE vendors
• Highly configurable and any protocol
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5. Original concerns of ‘going cloud’
• Sales Prevention – will
explaining cloud security slow
down or prevent sales
• New rules and financial
penalties stipulated in 2009
HITECH Act
• Introduction of the ‘willful
neglect’ concept with HITECH
act
• Security Models unproven,
theoretical Virtualization attacks
like Blue Pill, Red Pill
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6. Saul Waizer
Manager of Cloud Infrastructure @CareCloud
• High Availability
• Scalability
• Virtualization
• Cloud Infrastructure
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7. Goals: Zero Failure - Architected for Disaster
• Redundancy
• Eliminate single points of failure
• Security
• HIPAA compliance and regulations
• Scalability
• Automate provisioning of server capacity, enable
auto-scaling.
• Costs
• Implement a cost effective solution that allows
our infrastructure to scale based on needs
without incurring in long term costs or contracts.
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8. Goals: Zero Failure - Architected for Disaster
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9. Simplify – The RightScale Solution
•RightScale Professional Services
•Create work plan based on company goals
•Customized Server Templates
•RightScripts
•Auto-Scaling arrays
•Clustering
•Centralized management
•Automation is the key
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10. Goals: Zero Failure - Architected for Disaster
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11. Complex Simplicity
Dynamic Routing SSL Load
Processing Termination Balancing
S3
Auto-Scaling Elastic Arrays
Authentication Cluster
CloudFront Database/Caching Cluster
External Application Cluster
RightScale managing AWS
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12. How it works
Dynamic Routing SSL Termination Load Balancing
Processing
A sophisticated layer handles incoming traffic, routing, load balancing
and SSL termination.
Complex simplicity: This layer adds and removes instances without
human intervention
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13. How it works
Auto-Scaling Arrays
This layer controls our alert-based arrays, built from the ground up
to assemble a fully functional production ready CareCloud instance
Full Control: We are able to independently scale each component
of our application as needed, provision virtually infinite capacity
and computing power in an automated fashion. Elastic arrays
shrink automatically, reducing our costs and maintaining elasticity.
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14. Conclusion - Architecting for High Availability
• Can your current app scale? Find weak points
• Can you survive a large failure? Design with HA in mind
• Cloud or Hybrid?
• Avoid single points of failure. Multi-AZ, Multi-Cloud HA
• Automate and Optimize
• Document everything
• Test, test, test, drink coffee, test again.
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15. Thank You
Thomas Packert
CTO @CareCloud
tpackert@carecloud.com
Saul Waizer
Cloud Technology Manager @CareCloud
swaizer@carecloud.com
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