Avizia Case Study

Avizia, a cutting-edge player in the telemedicine market based in Reston, Virginia, offers a comprehensive platform that manages the complexity of delivering healthcare with a seamless experience for both clinician and patient. The solution features connected FDA Class I medical devices and an enterprise software as a service platform that enables virtual waiting rooms, access to patient data, and virtual consultations with medical providers. The telehealth platform delivers efficiencies in medicine and brings high-quality healthcare to rural and underserved locations.

According to a Mordor Intelligence report, the global market for telemedicine was estimated to be worth about $23.2 million in 2015, and it is expected to reach $66.6 million by 2021. Telemedicine can be beneficial for patients in isolated communities and remote regions, who can receive care from doctors far away without having to visit them. There are many types of telemedicine, ranging from acute stroke care in rural hospitals to expanded access to urgent care providers in school-based health centers. The practice makes it possible to facilitate real-time interactions between patient and provider.

Enter Avizia. A technology solution provider, the company is working to transform healthcare for the twenty-first century with telemedicine solutions that make it easy to practice medicine remotely with medical devices. Avizia aims to streamline the delivery of virtual care with Its flagship product, Avizia ONE, a cloud-based software as a service (SaaS) telehealth platform that furnishes healthcare providers with clinical workflow and care-coordination tools. The solution can operate with existing network and video infrastructure and reduce or eliminate the need for on-premises video servers. The company hosts high-definition video conferencing on telemedicine carts—which are portable medical and telecommunication systems that can be wheeled into different rooms—and on other devices including computers and smartphones.

To support Avizia ONE services, the company required a centralized infrastructure that was secure, reliable, and highly available. It sought a competitive advantage in an industry that required cloud technology to realize its full potential. Avizia needed a cloud service that would be agile and scale easily to make it possible to maintain compliance in a highly regulated industry. It also wanted the cloud offering to feature highly responsive support services so the company could quickly and effectively innovate with confidence.

“At a high level, there are two broad strokes to telemedicine,” says Cory Costley, chief product officer at Avizia. “One is clinical care and the other is direct-to-patient delivery. The main driver of telemedicine is access to world-class healthcare from wherever you are in the world.”

In the first case, a patient comes to a location—a rural emergency department, for example—and telemedicine enables medical practitioners in a different location to provide services for typical use cases such as stroke, behavioral health issues, dermatology, pediatrics, cardiology, and telepharmacy. In the second case, the healthcare consumer uses the Avizia telemedicine app on a device—a smartphone, for example—to participate in a follow-up visit, meet with a specialist, or address an urgent care issue. Avizia hosts hundreds of telemedicine consultations weekly.

Cloud computing has changed the landscape for the telemedicine industry. “Between the need for cutting-edge security that healthcare data requires and other key needs such as load balancing, hosting an on-premises infrastructure would be too expensive,” says Costley. “It would be impossible to stay up to date.”

Even so, there’s hesitancy to use the cloud in healthcare systems in spite of a record of security breaches in on-premises implementations that indicates that cloud services offer superior security. Says Costley, “If you look at data leaks in the industry, it’s clear that on-premises solutions are increasingly under attack.”

Avizia has been employing Amazon Web Services (AWS) since its inception. The AWS Cloud is gaining popularity with life sciences customers because AWS has worked with regulatory industry experts to bolster security, data management, and auditability to help customers meet compliance goals.

For example, AWS provides Avizia with compliance reports as well as SOC 2 reports, which describe the cloud provider’s reporting controls as they relate to security, availability, and confidentiality. AWS and Avizia have signed a Business Associate Agreement (BAA), a contract with a HIPAA-covered entity that defines SLAs for data management. The Health Insurance Portability and Accountability Act of 1996 (HIPAA)—with which Avizia must comply—upholds standards for the electronic exchange, privacy, and security of health information, and establishes safeguards to protect patient privacy. Avizia has obtained and maintained ISO 13485, a standard for the design and manufacture of medical devices, by modernizing its solutions with AWS Cloud services.

“AWS Cloud security policies are cutting edge,” says Costley. “Most cloud providers won’t sign a BAA because they don’t know about it or can’t adhere to a strenuous agreement on data treatment. And the SOC 2 reports are a key part of how we demonstrate compliance to our customers.”

Avizia implemented Amazon Virtual Private Cloud (Amazon VPC), which makes it possible for its customers to use the company’s services in an independent, secure, and isolated cloud infrastructure. For scalable object storage of images, archive data, and security logs, the company uses Amazon Simple Storage Service (Amazon S3). Avizia deploys Amazon RDS for PostgreSQL as its relational database engine to build HIPAA-compliant applications, store healthcare-related information, and achieve the redundancy the company needs to serve customers around the world. With Elastic Load Balancing, Avizia is confident that during spikes or troughs in usage, its workloads will be spread appropriately across AWS Availability Zones.

“AWS services are the foundation for our compliance-centric solution,” says Costley. “On top of that strong foundation, we layer our application to make sure we’re using those services effectively and in a way that complies with the stringent regulations.”

Avizia attributes its progress in the telemedicine industry to building its solution on the AWS Cloud. “From a technology-stack standpoint, I’d say we are at least six to 12 months in front of our competitors who are not on AWS, because of how agile we can be,” says Costley. “We might be one to two years in front of the competition in our ability to adapt and try new things.”

The company was able to minimize its investment in development and operations. “Without AWS, we would need the DevOps team to be at least twice the size that it is,” Costley says.

In telemedicine, performance and availability can be life-and-death matters, so healthcare providers and patients need the application to be highly responsive. “Our customers require us to deliver 99.95 or better uptime,” says Costley. “By using AWS, we’re confident we achieve 99.99 percent uptime.”

Avizia has benefited from high-quality service from AWS. “AWS fits perfectly in terms of providing us with the knowledgeable, responsive, and engaging services we needed,” says Costley. “It’s reassuring to know that if we’re trying new technologies, we have the support we need.”

Most important of all, by running its solution in the AWS Cloud, Avizia can sustain compliance in a highly regulated industry. “When you’re in telehealth and you touch protected health information, security is paramount,” says Costley. “That is very big challenge for a fast-moving startup. AWS is absolutely critical to do what we do today. Security and compliance are table stakes. If you don’t have those, the rest doesn’t matter.”