The Allscripts prescription for agility: lift and shift to the cloud

Harmonize development and hosting

Thousands of hospitals, health systems, community practices, and pharmaceutical companies rely on Allscripts software to deliver smarter, more effective patient care. The Chicago, Illinois–based company makes a wide range of software applications used by a spectrum of healthcare players to build open, connected communities of health. Pharmaceutical companies use Allscripts software to run clinical trials more efficiently. Hospitals and clinics use its electronic health records, financial management, and population health management systems. And, hospitals and pharmacies use its electronic prescribing solution. 

By collaborating with payers, health plans and programs, pharmaceutical and life sciences companies, and employers, Allscripts has a panoramic view of the care process and uses that perspective to develop innovative tools that lower costs, improve care, and enhance both patient and provider satisfaction.

Writing and delivering software that fulfills a wide range of client needs while also protecting confidential patient data takes great skill—both in creating new functionality and in deploying and running enterprise-grade software applications reliably and securely. 

“A portion of our client base consumes our products using a software as a service model, which means that their Allscripts applications run on our infrastructure,” says Peter Tomlinson, Director of IS, Technology Operations, at Allscripts. “We have to ensure that our infrastructure is bulletproof in terms of security, availability, and performance.” 

Allscripts maintained six development/non-hosting datacenters around the world but wanted to curb datacenter sprawl and consolidate and centralize these facilities to reduce costs, simplify management, and increase security. Also, synchronizing the hosting and software development sides of the business was challenging. 

“Development teams would build software solutions and then hand the solutions to the hosting teams, but this siloed methodology introduced inconsistent product deployments and support issues,” says Tomlinson. “We wanted to change the way we worked from a siloed to a collaborative approach where development and hosting work together to design, architect, and deliver products.” 

In 2017, Allscripts acquired two companies with datacenter assets that needed a home, and fast. Combined, the two companies brought dozens of applications—business-critical systems such as human resources and life sciences—and Allscripts had nowhere to put them and their 1,000-plus virtual machines (VMs).

“We had to decide how to quickly integrate these companies into our business so that they could generate value as soon as possible,” Tomlinson says. “We either had to purchase servers and storage to provision hundreds of VMs or move the assets into a public cloud.” The applications included a mixture of older versions of Windows Server and Microsoft SQL Server, which were facing end-of-support challenges. The remainder ran on the Linux operating system, which presented migration challenges of its own. 

Generate value quickly with do-it-yourself cloud migration

The Allscripts development team had been using Microsoft Azure for years, to gain rapid access to development infrastructure and the ability to scale development, test, and training environments during peak use and deallocate them when not in use. 

“People sometimes refer to Azure as ‘just another datacenter,’” says Jeff Brady, Senior Program Manager, Azure Transformation at Allscripts. “But I cringe at that description because it is not just another datacenter. Azure provides a wealth of sophisticated services and incredibly elastic computing and storage resources that we can turn on and off as needed. This lets us move quickly and with amazing cost efficiencies.” 

Allscripts chose to rehost its newly acquired assets in Azure. In addition to its positive development experiences, the company’s decision was influenced by the Azure platform’s global datacenter footprint and its significant security posture, particularly with regard to healthcare regulatory compliance. Microsoft provides Allscripts with a Health Insurance Portability and Accountability Act (HIPAA) Business Associate Agreement, which states that Microsoft maintains personal health information (PHI) and overall HIPAA compliance in its datacenters. “No other cloud provider offers us the level of PHI protection that Microsoft does,” Brady says.

Using a lift and shift strategy, Allscripts rehosted the acquired applications to Azure infrastructure as a service (IaaS) offerings—Azure Virtual Machines, Azure Storage, and Azure Virtual Network—in just three weeks. “By moving our acquired applications to Azure, we were able to get them up, running, and adding value to the business in three weeks versus the three months needed to requisition servers and storage,” Tomlinson says. “And we made the migration with no data loss and great reliability.”

For one of the acquired companies, Tomlinson’s team used Azure Site Recovery to replicate on-premises VMs to Azure and then fail the VMs over from the primary site to the Azure datacenter. “Using Azure Site Recovery, we were able to easily move 500 development VMs running critical healthcare applications to Azure,” Tomlinson says. “These applications ran an open-source stack—Ubuntu, CoreOS, MySQL, and Docker—and moved glitch-free.” 

For systems that could not be migrated to Azure, Allscripts moved them to an Allscripts datacenter and set up a VPN between that datacenter and the Azure datacenter in hybrid fashion. “For all practical purposes, these applications appear to be running on our internal network, but they’re running in Azure,” Tomlinson says. “Everyone thinks of Azure as being a Microsoft product–focused cloud, but when you look at the long list of operating systems and networking appliances supported by Azure, many are Linux-based.” 

The second acquisition already had 16 Azure subscriptions, so the Allscripts team simply moved the subscriptions to the Allscripts Azure enrollment agreement. That company also had 600 on-premises VMs that still had to be moved to Azure, most of which ran older editions of Windows Server and SQL Server. For these, Allscripts took advantage of the Azure Hybrid Benefit, an offer that lets customers reuse their existing on-premises Windows Server and SQL Server licenses in Azure and realize licensing savings of up to 82 percent. 

“With Azure, we had an easy, flexible way to quickly get our acquired intellectual property into a safeguarded, reliable place with very low risk,” Tomlinson says. “Later, we can use the appropriate Azure service offerings to modernize and rationalize the applications.” 

In some cases, Allscripts took advantage of Azure SQL Database Managed Instance to gain platform as a service (PaaS) benefits while taking a lift and shift approach. Using this deployment option within Azure SQL Database, existing SQL Server customers can migrate their on-premises applications to the cloud with minimal application and database changes. And they can benefit from built-in PaaS capabilities such as automatic patching, backup, and high availability.

Beyond the 1,000 acquired VMs that Allscripts quickly migrated to Azure, the company is using a similar strategy to migrate another estimated 5,000 to 6,000 VMs to Azure over the next couple of years. “By migrating workloads to Azure, we’ve already closed or moved three of our datacenters, one of which was in Singapore,” Tomlinson says. “It’s much easier for us to manage systems in Azure than hardware in a datacenter half a world away.” 

Transform products faster and more cost-effectively in the cloud

As mentioned earlier, Allscripts has been developing software in Azure for some time and enjoys dramatic time-to-market and cost-saving benefits by doing so. “When we had an IaaS-based development model, we produced one solid product release a year,” Brady says. “Our clients often resisted deploying those big releases because, understandably, hospitals don’t like the disruption involved. But with an Azure PaaS model, we enhance our product functionality quickly and continuously and give clients the flexibility to deploy small enhancements or not.” 

One enhancement, a solution called the Real-Time Benefits Inquiry (RTBI), helps doctors locate the lowest-cost drug prescription source for patients. The solution had been a gleam in Allscripts’s eye for four years before Azure came along. “It never passed the business case test,” Brady says. “The cost of the development hardware alone was $900,000, and we couldn’t get approval.” 

By using Azure, his team was able to fire up development resources for a modest $34 a day. “By using Azure, we can proceed with all manner of clever ideas that were previously off the table because of high development costs,” Brady says. 

In building RTBI, Brady’s team had instant, cost-effective access to services such as Azure Service Fabric, Azure Cosmos DB, Azure Service Bus, and Azure SQL Database, which would have taken weeks and thousands of dollars to source or write from scratch. 

“As a developer, having access to a cloud service that takes just a few hours to hook up is gold,” says Jose Molina-Melendez, Software Engineer at Allscripts. “Azure Cosmos DB provides so much right out of the box and seems to have an answer for all our needs, like configurable TTL, encryption, RESTful API, and speed—oh, is it fast! These are all features we did not have to implement so we could instead focus on the business layer of our application. Azure Cosmos DB and the other Azure PaaS services allowed us to ramp up our development cycles, which had a multiplicative effect. The best part is, Azure Cosmos DB continues to evolve; I can’t wait to unlock its full potential.” 

The team further used services such as Azure Application Insights, Azure Log Analytics, Azure Monitor, and Azure Security Center to create a sophisticated monitoring and alerting tool for RTBI. The cost to use all these services? About $15 a day. 

Brady’s team introduced a layered deployment framework that Allscripts development teams use to build applications. This framework ensures that development environments meet Allscripts governance policies and security requirements. It also provides easy ways to requisition needed database and application infrastructure and prescribes business continuity/disaster recovery protections. 

“Our development teams don’t need to reinvent the wheel to set up a project, which accelerates our teams on day one,” Brady says. “They just fill out a spreadsheet, and the Azure resources are there waiting for them in hours. We’ve eliminated months of work for every development project at Allscripts.” 

Concludes Tomlinson, ”Using Azure has dramatically accelerated both our acquisition time and our new product development time. We’ve been able to shut down older, inefficient datacenters and focus more resources on developing great software. This is one factor that moves us ahead in a very competitive market.”

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