AWS enabled us to launch our application in a very short space of time. We could extend our current environment into the cloud and integrate information from different sources, plus we can scale without incurring huge upfront costs.
Kevin Aron CEO

South African firm Medscheme, a member of the AfroCentric Group of companies, has a mission to create a world of sustainable healthcare. For more than 40 years it has provided a range of healthcare risk management services and now reaches around three and half million people in its native country, as well as in Botswana, Mauritius, Namibia, Swaziland, and Zimbabwe. Its Health Intelligence Unit generates insight about providers and beneficiaries of care to support better management of the health risks of population by understanding their clinical needs. In 2014, it received the Johns Hopkins Adjusted Clinical Groups System (ACG) Starfield Award for its work on a comprehensive care management program focused on at-risk individuals.

In many developed countries, the cost of healthcare is growing at twice the rate of the cost of other consumer goods. Medscheme wanted to address this by changing both healthcare delivery and the way in which providers are reimbursed for services. As a result, it needed to come up with a new payment model.

Traditionally, healthcare providers are paid a fee by an insurer for delivering a certain service—a so-called volume-based model. This isn’t ideal because being paid for individual components of care doesn’t incentivize providers to deliver their services as part of a connected healthcare pathway for a given patient. This can lead to unnecessary or duplicated services and a lack of focus on patient outcomes.

Medscheme wanted to move to a model of value-based care, where providers work with their peers to offer a bundle of coordinated healthcare services, delivered proactively in many cases, with a focus on preventing rather than curing illness and with predefined outcome measures for a patient.

Medscheme ran a small-scale trial, where it identified individuals who were at risk of a significant deterioration in health within the next year. It called them to discuss their individual healthcare needs, and asked their doctors to get in touch with these particular patients. “With this approach, we saw reduced levels of hospitalization, shorter average length of hospital stays, and lower costs associated with treatment,” says Kevin Aron, CEO of Medscheme, “but it could only work on a small scale because we were doing it over the phone. We needed a system through which we could reach thousands, or millions, of people.”

Medscheme’s strategy of focusing patient care and improving outcomes is based on population health management principles shared with the Johns Hopkins ACG System.

To scale up its model, Medscheme wanted to develop a system capable of sharing information between providers and patients. It had to comply with industry standards and interface with as many existing healthcare systems as possible to ensure information could be shared among providers. “We got to the point of building an Electronic Health Record ecosystem to support our model,” says Aron, “and needed an underlying infrastructure that we could use to roll it out quickly. The infrastructure also had to be able to grow incrementally and use existing frameworks and standards. AWS was a natural choice due to the depth of its portfolio.”

Medscheme designed an application that healthcare providers can access via a web portal. It’s based on an Amazon Web Services (AWS) reference architecture. The three-tiered service has Amazon Elastic Compute Cloud (Amazon EC2) instances across a web and application layer, with Elastic Load Balancing automatically distributing incoming application traffic across multiple Amazon EC2 instances. In the application layer, it uses Redis with Amazon ElastiCache for in-memory caching. Amazon Virtual Private Cloud (Amazon VPC) lets Medscheme isolate parts of its infrastructure in a secure manner, while AWS Identity and Access Management (IAM) allows controlled access to AWS services and resources for its users. The database backend is provided by Amazon Relational Database Service (Amazon RDS). The whole environment is replicated across three different Availability Zones to protect against potential hardware failures and keep uptime high.

After a pilot phase in 2014 and 2015, Medscheme is looking to roll out its Electronic Health Record (EHR) system to the entire population of over three and a half million patients in 2016. By using AWS, it has a secure, scalable, and interoperable infrastructure with which to do this.

For Aron, the most impressive achievement is getting its EHR system up and running in just five months. “AWS enabled us to launch our application in a very short time,” he says. “We could extend our current environment into the cloud and integrate information from different sources, plus we could scale without incurring huge upfront costs.”

The environment is also secure and compliant—a vital factor in the world of healthcare IT. “We work with strict regulations regarding confidentiality and privacy,” says Aron. The fact that AWS has ISO27001, Payment Card Industry Data Security Standard (PCI DSS), and Health Insurance Portability and Accountability Act (HIPAA) certification is vital. “We’re confident that the environment is secure and if we follow best practices we can be sure our patients’ medical data is safe,” he says.

The goal is that providers can now use the EHR and follow healthcare pathways laid out by Medscheme to deliver better outcomes and more coordinated care.

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