Siemens Healthineers moves more computing to the cloud to support value-based care development

Any time you interact with technology in a healthcare setting, there’s a good chance you will encounter a solution from Siemens Healthineers. The Erlangen, Germany–based company provides a broad portfolio of leading-edge, high-quality medical technology that touches the lives of approximately five million patients every day. Siemens Healthineers uses the data gathered from its 600,000 systems running worldwide to generate insights that help healthcare providers realize new opportunities to increase value and improve clinical, operational, and financial outcomes.

Digitalization is critical to technological progress in many industries, and healthcare is no exception. The healthcare industry needs ways to pull its data together, structure and analyze it, and draw conclusions that lead to improved ways of diagnosing patients and managing therapy. Siemens Healthineers is facilitating this transition with the Siemens Healthineers Digital Ecosystem.

“The Siemens Healthineers Digital Ecosystem is a platform where healthcare providers, payers, and software and services developers in the healthcare domain can come together to collaborate, gain insights from their data, and improve their core business areas,” says Carsten Spies, Head of Research and Development, Digital Ecosystem Platform, at Siemens Healthineers. “In my opinion, the healthcare industry is a little bit behind other industries in terms of digital transformation, so I think our Digital Ecosystem, and the technological advances we are making through our relationship with Microsoft, can prompt a big step forward in digitalization for the whole industry.”

Moving to the cloud for better applications while protecting patient health data

Providing solutions to a worldwide customer base can be complicated and of less value in regard to data-aggregation and analytics capabilities if systems need to be installed on-premises, so Siemens Healthineers relies on the cloud. “As a software development company, we see great value in cloud technology. With it, we can develop products for our customers that are accessible from anywhere, update products at any time in a seamless way for users, and provide a consistent user experience over a broad range of services,” says Spies.

But when it comes to healthcare information, deploying software in the cloud can be a tricky business because of specific security obligations. So, Siemens Healthineers thoroughly researched the options to ensure that its customers would be comfortable with its cloud platform. Ultimately, Siemens Healthineers selected Microsoft Azure. “Countries around the world consider patient health data sensitive personal information,” explains Thomas Gossler, Lead Architect, Digital Ecosystem Platform, at Siemens Healthineers. “There are differences in legislation and regulations, but everyone agrees that the data needs to be handled with care and a high level of technical security and privacy assurances. Microsoft has earned a large number of certifications for certain Azure regions, and this helps reassure our customers that a public cloud environment can be as secure as any other on-premises datacenter.”

Using Azure services to streamline development processes

With a solid, dependable cloud platform in place, Siemens Healthineers is focusing on speeding development and implementing a continuous delivery approach. The company not only provides its own software products, but it has also decided to encourage other developers to use its infrastructure to deliver solutions and services and bring even more value to customers. This requires rethinking the development processes.

“Stepping from the development of our own added-value services into becoming more of a platform provider makes it important for us to deconstruct into microservices,” says Thomas Friese, Vice President, Digital Ecosystem Platform, at Siemens Healthineers. “With a microservice-based architecture, internal and external developers can independently release microservices at any point in time, which makes development faster and enables a continuous delivery approach completely based on Azure. We have set an astonishing speed for product development.”

Siemens Healthineers has taken a containerized approach to application development, which means it uses virtualization at the application operating system level as opposed to launching virtual machines. The company deploys its distributed applications in Docker containers, orchestrates those containers using Kubernetes, and monitors and manages the environment with Azure Kubernetes Service (AKS). Siemens Healthineers chose AKS because developers can quickly and easily work with their applications with minimal operations and maintenance overhead—provisioning, upgrading, and scaling resources without taking applications offline. With AKS, Siemens Healthineers can comfortably scale out its Kubernetes environment and scale back again if it doesn’t need the compute power, creating very high-density deployments on a microservices level.

“Using Azure Kubernetes Service puts us into a position to not only deploy our business logic in Docker containers, including the orchestration,” says Gossler, “but also, through application gateway and API management, to easily manage the exposure and control and meter the access continuously.”

Managing a stable runtime environment with AKS helps Siemens Healthineers realize shorter release cycles and achieve its desired continuous delivery approach. Highly regulated environments like healthcare typically require many steps to go from development to public release, but implementing a continuous delivery pipeline has simplified the process and helped Siemens Healthineers achieve the speed it wants. And when rolling out new software, the company appreciates that it doesn’t have to worry about breaking its production environment, due to AKS upgrade and failure domains—new releases get deployed smoothly to customers with zero downtime. “With numerous competitors, big and small, entering the healthcare market, we need to accelerate delivery of improved functionality and new features to our customers to stay ahead of the competition,” says Gossler.

Siemens Healthineers relies on a serverless application model to expedite development, and as a result, developers have a very short path from coding to actual operation of their code. The Siemens Healthineers development team also adopted Azure Functions to make application management more efficient. “We see many workloads coming that run occasionally or need to be updated more often,” says Gossler. “We consider Azure Functions a very good mechanism to speed up those workloads and manage the functionality during our daily operations. We definitely plan to make a lot more use of Azure Functions over time.”

Making the best use of data and devices

Siemens Healthineers has brought in additional Azure capabilities that help deliver insights from data and offer the best possible tools for the healthcare industry. For example, the company has made great use of Azure Cosmos DB. “Azure Cosmos DB is an amazing technology,” says Gossler. “The biggest benefit for us is that we can have one database for anonymous data that is replicated worldwide into all regions that are relevant for us, in a consistency model that perfectly fits our needs. It’s key that Azure Cosmos DB is naturally built into the Azure core infrastructure, and we can build on its high availability and replication, offering software to all our customers at the same time.”

Siemens Healthineers is also investigating the use of Azure capabilities to manage on-premises devices whose functionality cannot be moved to the cloud. Software installations on these devices still need to be monitored and maintained by Siemens Healthineers. The company is looking at Azure IoT as a way to connect to on-premises devices and software with a cloud-based monitoring environment to stay ahead of any issues in the field and act quickly to resolve them when they occur.

“Prior mechanisms for connecting to devices in the field through remote desktop were slow and complex,” says Gossler. “But we’re hoping that with Azure IoT solution accelerators and serverless capabilities like edge computing, we can run functionality on edge devices in the field to simplify our data gathering and analysis—anonymizing data when necessary—and our operation of remote assistance workflows. This is an enabler for important analytic scenarios in the healthcare space.”

The new solutions the company is deploying are driving changes in the way that Siemens Healthineers deals with data. “Big data is a popular industry buzzword, but it’s not enough for data to just be big. It needs to become smart data,” says Spies. “With the Siemens Healthineers Digital Ecosystem, we are giving our customers much deeper insights into their data than were previously possible by helping healthcare providers, insurance companies, and software developers collaborate around healthcare data. I’m proud of working for this project—it really can change the healthcare industry.”

Delivering applications that optimize the business

The company’s use of Azure services has a direct impact on the development life cycle, but those improvements benefit the business side as well. Siemens Healthineers is reducing the total cost of ownership of its production workloads, creating more flexibility in the business models and pricing structure it can offer its customers.

“This is about economies of scale,” explains Gossler. “By operating the infrastructure at low cost and high availability, which we’re able to do with Azure, our customers benefit directly. And by incorporating technologies like Kubernetes, a well-known open-source environment, we are enabling partners to bring their own applications and software into our system so that together we can offer more and better solutions to our customers worldwide. We’ve been working with Azure for three-and-a-half years, and I’m reassured time and time again that Microsoft is able to provide us with the technology we need to keep moving forward. I‘m looking forward to continuing this relationship.”

Technical addendum:

Additional technologies driving the Siemens Healthineers Digital Ecosystem

While Siemens Healthineers relies heavily on Azure-related features, it also depends on other technologies—including open source—to make its digital ecosystem shine as both a development environment and a delivery platform for innovative functionality. Here are a few of the other key tools, with Gossler’s thoughts on the strengths each brings to the ecosystem.

Angular

“Using Angular, we can focus on our business logic and develop it once but offer it on all existing platforms to our customers. It’s a full-fledged application framework in which you can build complete enterprise applications. It’s platform agnostic, so you can run it in a web browser or put it into a mobile application to run on all sorts of devices.”

.NET Core and ASP.NET

“.NET Core is an amazing technology. We’ve been building applications on the Microsoft .NET Framework for a long time, but we faced the challenge of offering our software on platforms other than Windows. With .NET Core, our customers can now run the software on a wide spectrum of devices. It also gives us strong benefits with regard to operation costs in the cloud, because we can use it to run some workloads on Linux machines.”

“We are trying to offer a public API to our customers for integrating into their applications, and ASP.NET or ASP.NET Core offers a great way to surface RESTful APIs to an external audience. We really use that to the maximum extent.”

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