Aventi is a 340B TPA (Third Party Administrator).
That’s a big pair of shoes to fill within the US healthcare ecosystem: 340B is a sophisticated program that allows hospitals (“covered entities”) in low-income areas to generate more revenue by acquiring certain drugs at discounted prices from manufacturers.
With Vitamin Software’s help, within a year, Aventi managed to create a running system that connected to the various sources of data (hospitals, pharmacies, wholesalers), computed complex reports and ensured that:
the right drugs reached the right destination at the right time, automatically
every stakeholder involved had a clear understanding of the financials, that needed to be accurate to the cent level
These requirements require full traceability and a degree of accuracy that would have never been possible without AWS. AWS enabled us to scale the system easily and provide strong compliance measures. We will describe the main challenges in the rest of this post.
Photography by chuttersnap
System Architecture
First off, Aventi’s system needs to securely connect to several partners (hospital systems, pharmacy systems, and wholesalers). In healthcare, this typically happens by leveraging SFTP services. To achieve this, we made good use of several AWS services. EC2 for creating a secure internal SFTP server for partners that didn't have one. VPCs and Security Groups to configure security rules. And ELBs (Elastic Load Balancers) to ensure that the endpoints accessible to partners are exposed over secure connections (TLS).
Next, we needed to ensure that all information processed was appropriately backed up and available in case of a disaster recovery scenario. Amazon EBS (used for the disk drives) and RDS (used for the relational database) have advanced backup policies that enable us to have snapshots available for all the relevant moments. Both are easy to restore from backup, and we had no problem doing so to maintain our customers’ continuity of service.
Amazon RDS sits at the core of everything: it’s a relational database that scaled up well for us, despite having an ambitious amount of data to process from the get-go. Amazon RDS enabled us to rapidly increase the number of clients (and hence, the quantity of the data) without any glitches in the process.
Aventi has both write-heavy and read-heavy workloads depending on the moment of the day or the month. We need to store detailed records of what was imported and when, and what operations were performed to the level of detail that the last cent is captured. This means that for any record of data incoming, there are tens of records being created to track the initial state and the changes caused by the new record.
Since 340B is all about reporting, we’re happy to report that we deployed a secure web app on top of Amazon RDS, to compute the appropriate 340B reports. The reports are computed using Python/Django, with plenty of logs being generated on Amazon EBS (and rotated) when that happens.
Most actions in the Aventi system are currently triggered via scheduled cron jobs, yet we can’t wait to migrate them to Amazon Lambda. The service is a much better choice in terms of resource utilization. We’ve used Lambda before at Vitamin with excellent results in terms of reliability and recurrent costs.
Worth noting that the communication with the wholesalers is the most sensible bit in the whole system. It’s fully automated, and it needs to be as precise as it gets. The communication happens over EDI (a set of standards for encoding data exchanged between companies). AWS made it very easy to implement EDI, helping us leverage open source technologies.
How AWS Made EDI Happen
EDI is a fantastic invention that has been with us for tens of years. It’s used in verticals such as healthcare, retail, and logistics. However, what’s a blessing in terms of EDI is also what makes it difficult: its versatility and ability to convey complex information such as, a catalog of drugs with different attributes, or an invoice for a wholesaler order.
Using EDI, specifically the X12 messages 832, 850, 855, 856, 810, or 997, Aventi manages to integrate with wholesalers and deliver the right drugs in the right place at the right time. EDI has some pretty specific requirements: everything needs to be traceable, and all messages should be thoroughly validated. Messages need to be saved both in their original format and in their translated format securely. On top of that, messages need to be stored in a queryable form to keep track of the status of every single unit of a drug that gets shipped.
These would have never been possible without AWS. Storing large amounts of information in queryable form was made possible by Amazon RDS. It scaled superbly despite the rising quantity of data.
Then, generating vast amounts of logs for full traceability is a must to ensure that every unit of each drug is tracked and accounted for. This is only made possible by the ease of use and excellent performance of Amazon EBS.
Last but not least, the open-source technologies that we’re leveraging to deploy EDI systems are hosted on EC2. We can tell you one thing: EC2 never disappoints! We are always impressed with the lower costs each year, and the increases in power that come. It’s nowadays much more affordable to run a cloud-based business if you’re using the right tools.
Conclusions
Aventi’s adoption of AWS helped it accelerate the business, enabling it to onboard clients faster. That’s not to dismiss our help in designing and building the system. And we had pretty good material, both from Aventi and AWS, to start with!
If you need a free consultation about how you can accelerate your own business using AWS, don’t hesitate to drop us a line at sales@vitaminsoftware.com.