NextGen Healthcare Increases Reliability for Customers and Reduces Costs Using AWS

NextGen provides innovative healthcare solutions such as clinical care, practice management, and engagement solutions to doctors’ offices and other healthcare providers. The company’s legacy, on-premises infrastructure was expensive to maintain and deploy and added a heavy operational burden. It also lacked the agility to respond quickly to customer demand.

Because NextGen deals with sensitive healthcare information, it is critical for it to comply with HIPAA and the Health Information Technology for Economic and Clinical Health Act. “The AWS services that we use are HIPAA eligible, the security they offer is fantastic, and the availability on AWS is exceptional,” says David Slazyk, chief information and security officer at NextGen.

NextGen turned to AWS to modernize its legacy infrastructure and create commonality for its technology stacks while improving the availability of its products for customers. NextGen first started using AWS in 2010 and went all in in 2018, starting its migration of NextGen Enterprise customers to AWS. By 2022, the company had closed 13 of its 16 data centers, with the remaining three slated to be shut down after all its products were migrated to the cloud.

NextGen’s modernization efforts have gone through three main phases. The company’s first large software-as-a-service migration was its Patient Portal in 2017. The solution, which was large and complex, had experienced reliability challenges in the data center. NextGen took the time to understand its application and performed a lift-and-shift migration with some modifications. The team also built in automation and a set of modular infrastructure-as-code components that it could reuse in future deployments. As a result of the migration, the company increased the reliability of its Patient Portal, achieving 100 percent uptime for the 12 months after migration. The increased stability was a success for customers and also meant that NextGen employees spent less time troubleshooting problems. “Our Patient Portal was the first major product that we migrated,” says Steve Ruiz, vice president of DevOps at NextGen. “As we’ve migrated more products over the years, we’ve iterated and become better at the process. Now, we’re migrating multiple products every year.”

The first migration improved the product for customers, but NextGen still needed to work out certain organizational aspects of the process. In subsequent migrations, NextGen prioritized training its personnel on AWS so that those engineers could immediately use the modernized solution on AWS without needing as much support from the NextGen DevOps team afterward. NextGen also implemented AWS Control Tower, which simplifies AWS experiences by orchestrating multiple AWS services while maintaining security and compliance needs. In its AWS Control Tower landing zone—which provides a multiaccount AWS environment with account structure, governance, network, and security configurations for the company’s more than 100 AWS accounts—NextGen established guardrails that could be applied simply across its accounts. “We focus on compliance as a default,” says Ruiz. “It’s a lot of work to set up everything to be compliant with the security requirements of the industry, so by making these modules, we make it simple for our builders to tick all the boxes.”

The second major phase of modernization happened in 2020 and involved the company’s Virtual Visits product, which supports telemedicine for doctors’ offices. When NextGen acquired the solution in 2019, some doctors had been testing it as a new option for seeing patients, but it hadn’t been widely implemented. In 2020, due to the COVID-19 pandemic, the demand for the solution grew exponentially. Virtual Visits was originally built in AWS but in a single account. NextGen replatformed the product into its landing zone and applied the guardrails set up there, implementing infrastructure as code and automating deployments. To boost reliability and scalability, the company set up automatic scaling groups and rearchitected the application to use managed services such as Amazon Simple Queue Service (Amazon SQS), which provides fully managed message queuing for microservices, distributed systems, and serverless applications. NextGen achieved a 140 times growth of this product in 2 months. “We’ve seen our client satisfaction scores go up. Performance is drastically improved, and high availability is commonplace for us now,” says Slazyk.

In the third phase of modernization in 2022, NextGen rebuilt its RxHub API on AWS. The company wanted to migrate the solution so it could close one of its on-premises data centers. It also wanted to reduce operational workloads for the solution, which didn’t require regular major upgrades. NextGen migrated RxHub to Amazon Aurora, designed for unparalleled high performance and availability at a global scale with full MySQL and PostgreSQL compatibility, which reduced costs by getting rid of licensing fees. NextGen also implemented AWS managed services for this product to reduce manual efforts and further contribute to cost savings. “We continue optimizing the cost of using AWS,” says Craig Randall, senior vice president of software development at NextGen. “We can then offer a better service to our clients, and we can return those cost savings to them over time.”