Storage and compute functionality in the cloud enables agility via "infrastructure as code" products such as Terraform. Terraform enables virtual server spin up on demand within applications to provision and manage any cloud, infrastructure, or service. Each cloud provider has strengths. Customers like Google Cloud Platform because of BigQuery, which scales infinitely. Customers like Amazon because of the tools like Comprehend Medical and Sagemaker. Customers like Azure because of its integration with existing Microsoft components.
Similarly, database functionality such as MySQL or PostgreSQL can be rapidly deployed using a front end service such as Google's SQL Cloud that makes it easy to set up, maintain, manage, and administer relational databases on Google Cloud Platform.
Kubernetes is an open-source container-orchestration system for automating application deployment, scaling, and management. It was originally designed by Google, and is now maintained by the Cloud Native Computing Foundation.
For healthcare applications, it's clear that Fast Healthcare Interoperability Resources (FHIR) interfaces for inbound and outbound data exchange are the right approach to application/EHR integration. Highly scalable FHIR services are available via HAPI FHIR on Smile CDR . Google Health's FHIR endpoint is also a good choice.
FHIR is best for exchanging summary data, as well as making EHR data available to an application more broadly. For HL7 version 2, the Google Healthcare API supports a Minimal Lower Layer Protocol (MLLP) entry point and a message repository (along with cloud publication/subscription notifications).
And of course, modern network security requires data be stored in encrypted form as well as in transit in encrypted form. This simple idea will mitigate numerous security risks.
I recently met with well respected industry leaders and asked how Mayo Clinic can future proof its Platform efforts. I was told
"Ensure that infrastructure as code is used to deploy storage and compute. Ensure relational databases can be deployed and managed on the cloud hosting platform. Use Kubernetes to automate application deployment. Embrace hosted FHIR and API management services."
As we evaluate new partnerships and collaborations, we do a technical deep dive to avoid locally hosted, siloed, and proprietary approaches, instead favoring a cloud native architecture using Terraform, Kubernetes, and FHIR.
As Wayne Gretzky taught us, you need to skate where the puck will be. These cloud native architectures are clearly where the puck is going.