Title

AWS re:Invent 2022 - How NextGen Healthcare uses AWS to deliver better services (ENT216)

Summary

• Introduction: Anand Dair, a Principal Solutions Architect at AWS, and Steve Reiss, VP of DevOps at NextGen Healthcare, discuss NextGen Healthcare's journey in leveraging AWS for migrations and modernization.
• NextGen Healthcare's Mission: To improve healthcare outcomes through technology solutions, including clinical care, practice management, patient engagement, data exchange, interoperability, analytics, and care management.
• Challenges and Goals: NextGen faced challenges in agility, operational burden, product reliability, and scalability. Goals included demystifying infrastructure, removing single points of failure, standardizing technology, improving compliance and security, and managing costs.
• Migration Journey: NextGen's AWS adoption began with EC2, S3, and SimpleDB. In 2015, they started using AWS as a primary platform, closed 13 data centers, and focused on AWS managed services.
• Three Keys to Success: Anand discusses the importance of having a clear plan, selecting an operational model, and iterating, learning, and repeating. He introduces the six R's of migration: Retain, Retire, Rehost, Replatform, Refactor, and Re-architect.
• NextGen's Application Migrations: Steve shares examples of migrations, including a large Microsoft stack application, a telemedicine product, and an e-prescribing API, highlighting the importance of automation, managed services, and organizational involvement.
• Security and Compliance: NextGen assumes all data is sensitive, uses BA-only services, conducts reviews, and uses third-party assurance. They have implemented an account landing zone and guardrails for security.
• Future Plans: NextGen aims to enhance cost optimization, data usage, and self-service capabilities for builders.
• Key Takeaways: Separate workloads, prioritize preventative guardrails, focus on reusable tooling, adopt pipelines and automation, move to managed services, and invest in training.
• Benefits Realized: Improved reliability, product team empowerment, adherence to security requirements, reduced operational duties, and more time to focus on core problems.

Insights

• Cultural Change: NextGen's journey emphasizes the importance of cultural change within the organization, particularly in involving product development teams from the start and making them accountable for the migration and operation of applications in AWS.
• Automation and Managed Services: The success of NextGen's migration heavily relied on automation and the use of AWS managed services, which helped reduce operational burden and allowed for scalability and reliability.
• Security as a Default: By assuming all data is sensitive and implementing strict guardrails, NextGen was able to meet complex security requirements by default, which is crucial in the healthcare industry.
• Cost Management: The transition to AWS managed services and the move from proprietary software to open-source alternatives (e.g., from SQL Server to Aurora Postgres) resulted in significant cost savings, including the reduction of licensing fees.
• Training and Upskilling: NextGen's approach to training and upskilling existing staff to handle AWS technologies highlights the importance of investing in human capital as a strategy for successful cloud adoption and overcoming the challenge of recruiting experienced AWS talent.
• Iterative Learning: The iterative approach to migration, where each migration builds upon the learnings of the previous one, showcases the continuous improvement mindset necessary for successful cloud adoption.
• Operational Model Selection: The choice of a self-managed operational model reflects NextGen's commitment to building internal AWS expertise and capabilities, which is a strategic decision that may not be suitable for all organizations depending on their resources and goals.