In order to best serve their patients, medical professionals must collaborate and confer with colleagues around the world on how to best approach complex medical issues. With the advent of technology, methods of sharing information with peers in a digital format have led to an enhanced ability for collaboration — not within a small regional area but across the world. Doing so, however, requires the highest possible quality of medical images as well as the ability to store them in a location that is easily accessible to various medical professionals, no matter where they reside.

A top medical research firm approached ClearScale, an AWS Premier Consulting Partner, to assist them with this very task. The client had developed a medical scanning device with amazing resolution and depth, and in order for other researchers around the world to study the digital artifacts, they had to be stored and shared via a portal in DICOM format. DICOM is an ISO 12052 Digital Imaging and Communications-in-Medicine protocol that defines the quality and data necessary for accurate clinical diagnoses and is one of the most highly adopted digital medical formats around the world.

Given the robust amount of data required for our client’s imaging needs, as well as the quality of the images themselves, it was clear that implementing AWS services was the only feasible way to ensure the client could successfully store and share their images in DICOM format.

As with every client, we undertook an extensive evaluation period in order to understand the customer’s specific requirements. In determining a way to optimize our solution to meet their current and future needs, it was immediately evident that in order to store and distribute the high-quality imagery and vast amounts of data, ClearScale would need to leverage Amazon S3 buckets to store the loads of information. The S3 buckets then had to be configured to replicate the data across several Availability Zones using Elastic Block Store (EBS) and load-balanced by AWS Elastic Load Balancing (ELB).

Securing Patient Health Records

In order to ensure complete security for encrypted patient information, ClearScale enabled AWS Virtual Private Cloud (VPC) and Security Groups and placed them behind AWS Identity Access Management (IAM). To handle the high volume of computing that would be required by the portal, we set up Amazon Relational Database Service (RDS) and configured it with EC2 to provide resizable computing capacity in the cloud; this would allow the system to flex and scale in near real-time in order to adjust for higher volumes of use.

The last step was the development of the portal, which ClearScale accomplished with a PHP CMS configuration and integration into the client’s AWS instance. The portal itself was built to include pages and dashboards for managing projects and proposals. In order to make the portal a pivotal part of the client’s business need, ClearScale implemented a voting system that allows users to provide direct feedback on proposals that are submitted by other members.

However, the true strength of the proposed portal lay with the integration with DICOM viewer. By integrating these tools directly with the Amazon S3 buckets, ClearScale was able to leverage the power and scalability of AWS services with the robust model processing of DICOM data fed in via the S3 buckets. This provides an experience unlike any previously seen in similar medical imaging or portal systems.

To enhance the entire connectivity experience for users of the portal, ClearScale integrated a convenient chat service designed to provide real-time conversation and interaction capabilities between members all over the world. Supplemented with Amazon’s Simple Query Service (SQS) and Simple Email Service (SES), this made the portal a true medical research collaboration tool by connecting doctors and staff with specific skillsets to members that need expert advice on the images they provided.

Automated AWS Solutions

All of this was supported by several key Amazon tools designed to automate and manage the instance for our client. CloudFormation was critical in creating the initial set of AWS resources, after which it was used for regular, predictable updates for those resources. In concert with Elastic Beanstalk, which is used to deploy and manage the application itself, these two services allow the client to maintain critical application functionality without impacting end users. Providing visibility to resource management, CloudWatch constantly monitors the environment to verify that critical services are operating as they should while CloudTrail monitors user activity by tracking API calls made by the portal.

The complexity of our client’s goals and the need to leverage tools and applications that would maintain the integrity of DICOM-quality medical imagery and data meant that ClearScale had to design a solution and architecture that would integrate many key AWS services. This was the only way to deliver on our promise of a truly integrated and collaborative medical portal.

At ClearScale, the scope of projects presented to us is widely varied and complex, but we always strive to think outside the box, utilize all the resources at our disposal, and deliver a solution that fully leverages the best that AWS services have to offer.

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