Category Archives: Cloud

Digital health exchange #healthxchange innovation session

This morning I am at the digital health exchange panel session in Arlington, VA.

Panel Moderator: Mark Naggar, Project Manager, HHS Buyers Club (HHS IDEA Lab) – Office of the Chief Technology Officer, Department of Health and Human Services (confirmed)

  1. Dr. Neil Evans is a board-certified, Co-Director of Connected Health, aligned under the Office of Informatics and Analytics, in the Veterans Health Administration within the U.S. Department of Veterans Affairs and practicing primary care internist at the Washington, D.C. Veterans Affairs Medical Center. Dr. Evans co-leads the effort to improve services to Veterans, their families and Caregivers by increasing access, fostering continuity and promoting patient empowerment through electronic health technologies wth a focus on mobile and digital health.  (confirmed)
  2. Kathryn Wetherby serves as a Public Health Advisor at the Substance Abuse and Mental Health Services Administration (SAMHSA)where she leads large health information technology projects and contracts. Ms. Wetherby has over 16 years of experience in both the public and private sectors; including implementation of large scale, enterprise-wide health information technology systems, mobile technologies, standards, strategic planning and organization and operational change. (confirmed)
  3. Justin Woodson is an Associate Professor, Uniformed Services University Health Services (USUHS), the institution charged with training, educating and preparing officers and leaders to directly support the Military Health System, the National Security and National Defense Strategies of the United States and the readiness of our Armed Forces. (confirmed)
  4. Joe Klosky, Senior Technical Advisor, Food and Drug Administration.   Having previously served as the Chief Technology Officer for the FDA in 2007, Mr. Klosky has supported a number of initiatives across HHS, including a detail to the to the NIH CIO and Chief Enterprise Architect. Mr. Klosky recently rejoined the FDA as a senior technical advisor in support of HHS wide work groups and projects. (confirmed)


The panelist roles and perspective:

Dr.Neil Evans – connected health covers all technology outside the face to face engagement for veterans.

Connected health runs the VA innovation competitions.

Kate Wetherby – leads health it projects including mobile apps and portals and solutions for outreach in rural areas.

Justin Woodson – innovating by “getting out of the box”. Justin is based in the military medical school. Role in innovation is to create unique experiences at the intersection of military and academia. Building interactive experiences.

Joe Klosky – FDA: troubleshooter – “into the breach”. Using Amazon cloud at FDA. Handling very sensitive data.

Mark Naggar – HHS is trying to develop a more collaborative and innovative ecosystem. HHS has its own internal accelerator.

Q: what organizations do the panelists admire for innovation?

Justin W: private organizations have more flexibility to acquire talent and apply it. Organizations like Google are willing to take risks.

Neil E: Procter & Gamble mixes employees across divisions. They expected people to take time out of their normal duties to mingle with colleagues from other divisions and to share ideas.

Justin W/Neil E: medicine tends to work in silos. More effort is needed to make inter-disciplinary interactions happen. This has to tap the people in the field that are doing the work.

Joe K:  use commercial tools to help collaboration happen. Also mingle commercial tools to create new solutions.

Kate W: combatting the “we have always done it this way”. You need to have people to drive the change.

Mark N: HHS has implemented the entrepreneur-in-Residence program. Unfortunately they are restricted from bringing people from for-profit companies. But people are trying to figure out how to do this.

Q: where have you gone from concept to execution successfully – or what have you learned from a failure to get to execution.

Neil E: VA has entrepreneur in residence. Last year they were able to partner with Walgreens to help veterans get their flu vaccine and have the data fly in to the Vista EHR.  After a pilot in 2013 this was rolled out across the country this year.

Choose a project with a hard deadline. Eg. There is a deadline for flu vaccines.

Even simple projects can require innovative approaches.

The va mail pharmacy implemented a system to allow veterans to track their medications through the mail system.

Justin W: innovation does not have to be new. It can be a mashup of existing solutions to solve a problem. Taking existing ideas in to a new realm.

Kate W: Consent to Share – working on interoperability. Dealing with privacy and security regulations. Working on data segmentation privacy and consent to share. Parse the medical record and segment it to allow the patient to share sub-sections of their health record. There are issues with sharing certain health data. Variations at the state level.

SAMSHA has built this in to a PHR. Cerner and nexgen have done similar work. HHS has shown the direction and is encouraging others to build on what they have done for data segmentation.

Joe K: FDA is at every custom station. It is a massive undertaking. Working on a risk based model. Applying technology eg. Forensic technology lab in Cleveland. Technology is being used to handle globalization despite budget constraints.

Q: what barrier would you remove to improve the path to innovation?:

Justin W: change the manning model.

Joe K: the procurement process around innovation while complying with FAR

Neil E: in IT rules applied for production but need simpler!more agile approaches for pilots.

Kate W: workforce development to prep people for technology use.

Justin W:  focus on leadership development that includes innovation as a leadership responsibility.

Neil E: VA annual innovation competition. It creates community. Ideas get voted on and commented on. The comment process creates communities of interest.

Q: How do small businesses with innovative ideas partner with the agencies.

HHS has s&i framework committed and other work groups. There are a lot of open forums and information on HHS web sites.

Big challenge is to educate and communicate to the workforce about new innovations.

Kate W: project Echo – using Telehealth for workforce training.


Mark Scrimshire
HHS Entrepreneur-in-Residence at CMS building BlueButton Plus for Medicare.
Mark is available for challenging assignments at the intersection of Health and Technology using Big Data, Mobile and Cloud Technologies. If you need help to move, or create, your health applications in the cloud let’s talk.
Stay up-to-date: Twitter @ekivemark
Disclosure: I began as a Patient Engagement Advisor and am now CTO to Personiform, Inc. and their platform. Medyear is a powerful free tool that helps you collect, organize and securely share health information, however you want.  Manage your own health records today. Medyear: Less hassle. Better care.

#MongoDBworld CharityMajors (@mipsytipsy) @Parse closing keynote

Charity Majors @PArse / Facebook

Parse hands the backend – Push notifications, Analytics and a ton of other server-side services and deliver at scale.

Parse has 270,000 mobile apps running on Parse – all hosted on MongoDB.

All Software is a pain!

MongoDB + Ops


Reliability – MongoDB is not immune to crashes. The key to resiliency is the Replica Set. You only have to be concerned about the service.

Horizontally scalable services means no Pets. You are dealing with a herd. Cattle not pets. No hand crafted server pets because pets will always die.

Charity – A Battlestar Geek – Your life is without meaning without BG!

Design for High Availability from the outset.

You can’t design in high availability AFTER the fact.

Ops people hate software because they have to plan for failure. It is going to happen.


When you change a schema EVERYTHING break! Why do you want a schema????

Data model Flexibility is critical

Workload flexibility is also critical to flexibility.

When you have hundreds of thousands of apps you have everything. You can’t optimize for a specific load.

Every App must be performant AND must be able to scale.

ONE re-usable solution is better than multiple platforms optimized for specific systems. Engineering workload is a limiting factor.

Choose ONE SINGLE Reusable solution.


Make repetitive annoying tasks made easy.

Scalability is about more than handling tasks really quickly.

The replica set allows you to take out nodes and work on them.

Parse is dealing with 100’s of Terabytes every month.

MongoDB works for Parse:
– Flexible
– Resilient
– Automation friendly

Automation needs operations best practices to be shared. Operations is still young.
Parse has published open source tools

Parse launched these tools today:
– Mongo Proxy

Allows the replay of workload profiles. Replay in line with original snapshots, or as fast as possible.

Both tools are written in GO.

@swiftstack workshop and #wd demonstrating a server running immersed in fluid

HGST, a subsidiary of Western Digital are demonstrating a server running while immersed in 3M Engineered Fluid.

HGST is headquartered in San Jose, CA.

Fasinating Ultrastar drive that is hermetically sealed. The air is removed and replaced with helium. It allows closer packing of drives because there is less jitter as a result of air resistance.

HGST Active Archiving is designed for sub-second response to rarely accessed and never modified data. They are creating 6TB drives that will push to 10TB by the end of 2014. This is ideal for petabyte object storage environments.

A public test cluster running Swift is built on Atom servers running with HGST Ultrastar drives with a Red Hat or Ubuntu OS for OpenStack.

benefits for the drives come from more storage per server, at lower cost per TB given fewer servers and less power consumption than traditional drive storage solutions.

Mark Scrimshire
Health and Cloud Technologist

#OpenStack Design Workshop – Working with Swift. Presented by @SwiftStack and @Racktop Systems

Today I am at a design workshop for Swift – NOT the Apple programming language announced this week but rather the Object storage solution that is a core part of the OpenStack cloud platform.

The Training is being given by SwiftStack – and Racktop Systems –

This is a One day workshop and I will be publishing real-time notes from the session. So here goes…

Swift and SwiftStack

Swift is the object storage platform for OpenStack.
SwiftStack is the leading contributor to Swift and provides a wrapper of services for Swift to make the service easier to implement.

SwiftStack is a Venture-backed company that was established in 2011.

SwiftStack provides the operational and management layer for Swift.

There are more than 2,000 contributors to the Swift platform.

Rackspace originated Swift but now IBM, AT&T, HP, Comcast and Time Warner Cable have all built on the Swift/SwiftStack platform.

Swift runs on commodity hardware, as does OpenStack.

 Storage in OpenStack includes:

  • Cinder (Block)
  • Swift (Object)
  • Manila (Shared File System)

Swift is the OpenStack equivalent of Amazon S3.

Design Goals:
Swift is an API.

– Reliable
– Highly Scalable
– Hardware Proof – it assumes unreliable hardware.

Swift runs on any Linux-based architecture.

Load Balancers are outside swift. SwiftStack includes load balancing.

Load Balancer (includes SSL and Authentication) talks to:
– Proxy talks to:

– Account / Container / Object
– A replication and consistency layer  talks to:
– Standard servers with disks.
Authentication can use OpenStack Keystone but you can integrate other standards such as LDAP or Active Directory.
Guidance is to not use Keystone since it is not designed for lighter loads and doesn’t scale well to support heavily used and large scale environments.
Keystone can also create a single point of failure for Swift. Better options would be to use robust Active Directory or LDAP that will probably already exist in the environment.
Swift also offers a simple hashed user/password Auth function for quick setup.


– Enforces the default 3x replication
– Enforces a quorum
– Enforces User set ACLs
– Uses fastest available copy for reads (single read only required)
Swift doesn’t want RAID. Data protection is done by RAID.
Failure points:
– Node
– Zone
– Region
Swift will store data to create the most unique positioning of data to avoid placing in an location shared with another copy.
An Account Container keeps track of containers and objects
Objects stored by Object Servers. Metadata is stored with the data using a standard filesystem (XFS).

Disk Storage:

– Use SATA or SAS drives
– You can use SSD for Read heavy Caching


– Ubuntu
– CentoOS
Now for the Hands on workshop…. The Swiftstack platform I am working with is being provided out of Rackspace (
We are working with two things:
– Web Browser access to
– SSH to the node(s) we are creating.
NTP is an important service.
If your nodes use Active Directory for authentication, you should specify your AD servers’ hostnames or IPs for the NTP server settings.
Partition Power – Err on the side of over sizing. This is harder to change once set. Replication happens on a partition basis (regardless of data content in a partition). Replication has a performance overhead.
A Partition Power of 16 gives a pool of up to nearly 2,000  (1966) drives in a cluster. Which with 3TB drives yields usable storage of 1.97PB with 3TB drives.
A node can only belong to one cluster.
If nodes have multiple interfaces you can assign one interface to the proxy and load balancer and the other interface for intra-node communications.
Note: Linux uses Partition for a section of a drive
Swift uses Partition as a folder or bucket.

Building Big Data HealthCare Solutions in the cloud

I have just finished giving a presentation with Datastax on building HealthCare Big Data Solutions in the cloud.

Here are the slides from the session:

Travis Price also rounded out the session with a high level tutorial on Cassandra and a really cool demonstration of the robustness of the Datastax platform using a stack of Raspberry Pi computers configured running a version of Debian Linux and Datastax Enterprise configured as two 5-Node datacenters in a cluster.

The Raspberry Pis were configured with 512MB RAM, an SD Card as a drive and a USB-connected WiFi.It is a great way to show how Datastax works around and recovers hardware failures.

What a great Company manifesto! @hubspot – Thanks for sharing!

I am sitting in Cambridge, MA getting ready for a series of Big Data meetings and this slideshare popped up in my stream from Hubspot. Ironically I am sitting in a coffee shop less than two miles from the Hubspot HQ.

This is a great company manifesto that strives to do the right thing for the customer and the team. Inspired by Netflix and other great companies this is a manifesto that more companies should strive to match if they truly value the team that makes up the company.

It also includes a great quote from Tim O’Reilly. Thanks for inspiring us Tim!


Caring and Sharing in HealthCare – Medyear’s Personal #Health Network platform

I have just completed a webinar with Sqrrl to present the Medyear Personal Health Network platform. We built Medyear using the highly secure Sqrrl big data platform. This enables us to give our members granular control offer their health data. BlueButton and Direct Project standards allow members to upload their clinical data and add their own chronicles in to their health timeline.

Medyear has been building this platform for some time. The industry is now starting to recognize the value of putting the patient at the center. How do we know this? Because they have now got a label for the platform that Medyear has built: The Consumer-Mediated Exchange. Basically a Health  Record Platform that puts the Patient in control.

Check out the deck from the webinar on my Slideshare account:

Goto Vimeo for a quick video tour of the Medyear platform: or goto to get your own account and try it out the beta platform for yourself.

Using Big Data to Wow the Customer

The Flexibility of Big Data platforms enable organizations to quickly consolidate information from multiple sources in order to WOW! the customer with excellent customer service. Think about it. Don’t you feel more positive when you are dealing with a Customer Service Agent that seems to have all the information at their fingertips. It is so much better than being bounced around between departments, or waiting for them to access multiple systems to get the information they need to help you.

Here is an example of how some organizations have used MongoDB to deliver the Wow!:


Patient Engagement and Health Standards and the start of @Medyears

Today I am heading to Northern Virginia for meetings. On the agenda will be topics such as Health Standards and the Transformation underway in Healthcare. Consequently I thought it would be a good day to wear one of my Walking Gallery Jackets.

AEIOU of Patient Engagement

AEIOU of Patient Engagement

This jacket is one of two jackets painted for me by Regina Holiday as part of the Walking Gallery of Healthcare. The theme of this jacket came from a day at HIMSS in 2012. I was speaking there on Patient Engagement and after following Dr. Regina Benjamin, then the Surgeon General, and Regina Holiday you have to make an impact since they are incredibly engaging speakers. One of the themes I used in my talk was The “AEIOU of Patient Engagement.” I wanted to leave the audience with some simple guidelines for embracing Patient Engagement in Healthcare. Hence, AEIOU

  • Actionable
  • Easy
  • Immediate
  • Open
  • Unobtrusive

When I found this jacket on a trip to New York I asked Regina to paint it with the AEIOU of Patient Engagement.

After my presentation I also met Panha Chheng the founder of Personiform and I am still advising Medyear as they build the first Personal Health Network. The technical Term Du Jour is “Consumer-Mediated Exchange.” What a mouthful. Basically Medyear is putting in to practice my recommendations. Medyear is built using the emerging BlueButton and Direct Project standards. It puts the member in charge of their Health information. Allowing them to consolidate information from multiple sources in to a timeline that they control. It then provides simple, but very powerful controls to allow them to share their health information at a very granular level with whomever they choose, for as long as they choose.

Medyear has come a long way since that first meeting with Panha. The Medyear platform has been built on Sqrrl to provide strong, atomic level security. This is essential for Medyear to give our members the granular security control to individual entries their timeline. I have been working with the Sqrrl team to put together a webinar about building Healthcare applications securely in the Cloud. I will post more details soon.