Learn how Modernizing Medicine, an electronic medical records company, serves thousands of customers and leverages Continuent Tungsten to manage databases on Amazon AWS. Modernizing Medicine is a fast-growing SaaS company, offering electronic medical records management solution for thousands of small and medium-sizes dermatology, ophthalmology, optometry, plastic surgery, cosmetic and orthopedics practices. Continuent Tungsten is a leading database-as-a-service solution for MySQL and Oracle. Continuent Tungsten allows enterprises running business-critical MySQL applications to affordably achieve business and revenue continuity through Tungsten's commercial-grade high availability (HA) and globally redundant disaster recovery (DR) capabilities. Continuent Tungsten makes it simple to create new data services (database-as-a-service) in the cloud or in your private datacenter, and to manage them all from a single point.

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Modernizing Medicine
a SaaS Solution running on
Amazon Web Services
Matt Lang, Senior Site Reliability Engineer,
Modernizing Medicine
Edward Archibald, CTO, Continuent

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With AWS, a complete,
affordable LAMP stack, on
demand, in minutes - but
some assembly is
required...
apache/php
haproxy
MyApp
Your mobile
destination...
MySQL
AWS is a catalyst
for Innovation
What happens when your
app becomes business
critical for your customers?

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Taking a Closer look at Amazon RDS,
Amazon’s DBaaS Offering

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What does ‘managed’ mean?
• DBMS instance is up and running in minutes,
fully integrated with service policies, and
bound to a public IP address
• Automated backups plus point-in-time
recovery
• Provision read slaves with a few clicks of a
mouse
• High-availability options are available
• Instances can be easily resized
• Software updates can be automated

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How do I use it?
• Add hosts to security group
• Configure your application to use the
‘endpoint’ provided
• Applications that already make a distinction
between database connections used for writes
versus those used for reads can make easy
use of read slaves
• Automation of backups, failover, slave
provisioning etc. happen behind the scenes

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apache/php
haproxy
MyApp
Your mobile
destination...Service encapsulation,
RDS Style
MySQL

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apache/php
haproxy
MyApp
Your mobile
destination...
Multi-AZ
Instance
Active
Multi-AZ
Instance
Standby
Synchronous
Block-level
Replication
Read Slave
Service encapsulation
RDS Style
• Applications reference
‘service’ via
‘endpoint’
• Single endpoint for
writes
• Zero or more
endpoints for reads

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How well does it work? RDS Multi-AZ
failover
• Failure is detected - can test via reboot
• Actual failover appears to be completed within
about 20 seconds - depends on size of
databases etc.
• Some applications may not ‘see’DNS
interruption and may not re-connect
• DNS Changes need to propagate - can take
minutes. In my example, it took about 7
minutes and I needed to restart the app for it
to ‘see’ the DNS change

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How well does it work? RDS Multi-AZ
failover

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How well does it work? RDS Multi-AZ
failover

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App is able to
connect at 22:11:45
- about 7 minutes
later
How well does it work? RDS Multi-AZ
failover

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Other RDS Limitations
• No cross-region replication
• Only runs in AWS
• No cross-cloud/multi-data-center operation
• Black-box - difficult or impossible to
diagnose and correct problems with
replication

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Introducing Continuent Tungsten
Cloud-scale DBaaS
• Runs wherever you need your data to be
• Fast failover - typically 5-15 seconds - does
not rely on DNS
• Built-in load balancing - applications connect
to a single IP address to access all data
resources
• Compute/DB resources are ‘open’ - no black
boxes here
• Full resource utilization - no ‘standby’

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apache/php
haproxy
MyApp
Your mobile
destination...
MySQL
Service encapsulation,
Tungsten Style

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Tungsten
Data Service
apache/php
haproxy
MyApp
Your mobile
destination...
Service encapsulation,
Tungsten Style
• Single endpoint for both writes and
reads
• Read-only resources visible and
load balanced as they appear
• Service-oriented connectivity can
span sites

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west east
usa
Service encapsulation,
Tungsten Style

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apache/php
haproxy
MySocialSite
apache/php
haproxy
MySocialSite
usa
Service encapsulation,
Tungsten Style

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Continuent’s SaaS Customers

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Introducing Matt Lang
and Modernizing Medicine

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Modernizing Medicine Mission
Modernizing Medicine® is transforming how healthcare information is
created, consumed and utilized in order to increase efficiency and
improve outcomes. Its product, Electronic Medical Assistant®
(EMA™), is a cloud-based, specialty-specific electronic medical
record (EMR) system with a massive library of built-in medical
content, designed to save physicians time.
Available as a native iPad application or from any web-enabled Mac
or PC, EMA adapts to each provider’s unique style of practice and is
designed to interface with hundreds of different practice management
systems.
Today, Modernizing Medicine provides specialty-specific offerings for
the dermatology, ophthalmology, optometry, orthopedics and plastic
and cosmetic surgery markets, and to more than 1,100 physician
practices across the country.
In 2013 Modernizing Medicine was listed on Forbes’ annual ranking
of America’s Most Promising Companies.

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Electronic Medical Assistant (EMA™)
• Saves doctors' time by eliminating the need to
transcribe notes, allowing the Doctor to focus
on the patient.
• EMA learns preferences and adapts to the
doctor which reduces time spent on coding, all
with a touchscreen interface on the iPad
• EMA grand rounds provides statistical results
of treatments across millions of patient
encounters

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Database technology pain points
• setting up/maintaining replication
• need for high-availability
• protecting patient data (encryption, data at
rest, data in transit)
• massive and unpredictable growth
• Big data -- we have the data to revolutionize
medicine, but how do we do it?

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How we are addressing the issues
• Tungsten takes care of replication and high-
availability
• leveraging AWS, pod design, automatons to
deploy new pods
• file system encryption, S3 encryption, SSL,
Continuent Tungsten for all db traffic
• taking small steps. maybe we will replicate
data from all pods into central DB, using
Tungsten. Then transform data, create
datamarts.

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VPC (subnet 10.0.0.0/16)
Deployment Topology

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Quick Demo:
Creating and administering a
Continuent Tungsten Data Service

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Continuent Tungsten failover

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Continuent Tungsten failover

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Continuent Tungsten failover
Failure detected
and failover
completed within 15
seconds

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Continuent Tungsten failover
Failed db instance
is isolated from the
service

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What else can Tungsten do?
• Cross-region fail over with a single command
• Multi-site, multi-master architectures
supported
• Run services cross-cloud i.e. AWS to
Rackspace Cloud etc.
• Applications can specify ‘read affinity’ in
order to read from local resources

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Questions?

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San Jose, CA 95128
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