Tag Archives: battle

Healthcare APIs get a new trial run for Medicare claims

In the ongoing battle to make healthcare data ubiquitous, the U.S. Digital Service for the Department of Health and Human Services has developed a new API, Blue Button 2.0, aimed at sharing Medicare claims information.

Blue Button 2.0 is part of an API-first strategy within HHS’ Centers for Medicare and Medicaid Services, and it comes at a time when a number of major companies, including Apple, have embraced the potential of healthcare APIs. APIs are the building blocks of applications and make it easier for developers to create software that can easily share information in a standardized way. Like Apple’s Health Records API, Blue Button 2.0 is based on a widely accepted healthcare API standard known as Fast Healthcare Interoperability Resources, or FHIR

Blue Button 2.0 is the API gateway to 53 million Medicare beneficiaries, including comprehensive part A, B and D data. “We’re starting to recognize that claims data has value in understanding the places a person has been in the healthcare ecosystem,” said Shannon Sartin, executive director of the U.S. Digital Service at HHS.

“But the problem is, how do you take a document that is mostly codes with very high-level information that’s not digestible and make it useful for a nonhealth-savvy individual? You want a third-party app to add value to that information,” Sartin said.

So, her team was asked to work on this problem. And out of their work, Blue Button 2.0 was born.

More than 500 developers have signed on

To date, over 500 developers are working with the new API to develop applications that bring claims data to consumers, providers, hospitals and, ultimately, into an EHR, Sartin said. But while there is a lot of interest, Sartin said this is just the first step when it comes to healthcare APIs.

“The government does not build products super well, and it does not do the marketing engagement necessary to get someone interested in using it,” she said. “We’re taking a different approach, acting as evangelists, and we’re spending time growing the community.”

And while a large number of developers are experimenting with Blue Button 2.0, Sartin’s group will be heavily vetting to eventually get to a much smaller number that will release applications due to privacy concerns around the claims data.

Looking for a user-friendly approach

We’re … acting as evangelists, and we’re spending time growing the community.
Shannon Sartinexecutive director of the U.S. Digital Service at HHS

In theory, the applications will make it easier for a Medicare consumer to let third parties access their claims information and then, in turn, make that data meaningful and actionable. But Arielle Trzcinski, senior analyst serving application development and delivery at Forrester Research, said she is concerned Blue Button 2.0 isn’t pushing the efforts around healthcare APIs far enough.

“Claims information is not the full picture,” she said. “If we’re truly making EHR records portable and something the consumer can own, you have to have beneficiaries download their medical information. That’s great, but how are they going to share it? What’s interesting about the Apple effort as a consumer is that you’re able to share that information with another provider. And it’s easy, because it’s all on your phone. I haven’t seen from Medicare yet how they might do it in the same user-friendly way.”

Sartin acknowledged Blue Button 2.0 takes aim at just a part of the bigger problem.

“My team is focused just on CMS and healthcare in a very narrow way. We recognize there are broader data and healthcare issues,” she said.

But when it comes to the world of healthcare APIs, it’s important to take that first step. And it’s also important to remember the complexity of the job ahead, something Sartin said her team — top-notch developers from private industry who chose government service to help — realized after they jumped in to the world of healthcare APIs. 

“We have engineers who’ve not worked in healthcare who thought the FHIR standard was overly complex,” she said. “But when you start to dig in to the complexity of health data, you recognize sharing health data with each doctor means something different. This is not as seamless as with banks that can standardize on numbers. There, a one is a one. But in health terminology, a one can mean 10 different things. You can’t normalize it. Having an outside perspective forces the health community to question it all.”

AWS Cloud9 IDE threatens Microsoft developer base

As cloud platform providers battle for supremacy, they’ve trained their sights on developers to expand adoption of their services.

A top issue now for leading cloud platforms is to make them as developer-friendly as possible to attract new developers, as both Microsoft and Amazon Web Services have done. For instance, at its re:Invent 2017 conference last month, the company launched AWS Cloud9 IDE, a cloud-based integrated development environment that can be accessed through any web browser. That fills in a key missing piece for AWS as it competes with other cloud providers — an integrated environment to write, run and debug code.

“AWS finally has provided a ‘living room’ for developers with its Cloud9 IDE,” said Holger Mueller, an analyst at Constellation Research in San Francisco. That fills a void for AWS as it competes with other cloud providers — especially Microsoft, which continues to extend its longtime strengths of developer tools and relationships with the developer community into the cloud era.

Indeed, for developers that have grown up in the Microsoft Visual Studio IDE ecosystem, Microsoft Azure is a logical choice as the two have been optimized for one another. However, not all developers use Visual Studio, so cloud providers must deliver an open set of services to attract developers. Now, having integrated the Cloud9 technology it acquired last year as the Cloud9 IDE, AWS has an optimized developer platform of its own.

AWS Cloud9 IDE adoption 

“There is no doubt we will use it,” said Chris Wegmann, managing director of the Accenture AWS Business Group at Accenture. “We’ve used lots of native tooling. There have been gaps in the app dev tooling for a while, but some third parties, like Cloud9, have filled those gaps in the past. Now it is part of the mothership.”

Forrester analyst Michael FacemireMichael Facemire

With the Cloud9 IDE, AWS offers developers an IDE experience focused on their cloud versus having them use their top competitor’s IDE with an AWS-focused toolkit, said Rhett Dillingham, an analyst at Moor Insights & Strategy in Austin, Texas.

“[They] are now providing an IDE with strong AWS service integration, for example, for building serverless apps with Lambda, as they build out its feature set with real-time paired-programming and direct terminal access for AWS CLI [command-line interface] use,” he said.

That integration is key to lure developers away from their familiar development environments.

“When I saw the news about the Cloud9 IDE I said that’s great, there’s another competitor in this market,” said Justin Rupp, systems and cloud architect at GlobalGiving, a crowdfunding organization in Washington, D.C. Rupp uses Microsoft’s popular Visual Studio Code tool, also known as VS Code, a lightweight code editor for Windows, Linux and macOS.

The challenge for AWS is to attract developers that already like the tool they’re using, and that’ll be a tall order, said Michael Facemire, an analyst at Forrester Research in Cambridge, Mass. “I’m a developer myself and I’m not giving up VS Code,” he said.

That’s been the knock against AWS, that they provide lots of cool functionality, but no tooling. This starts to address that big knock.
Michael Facemireanalyst, Forrester Research

For now, Cloud9 IDE is a “beachhead” for AWS to present something for developers today, and build it up over time, Facemire said. For example, to tweak a Lambda function, a developer could just pull up the cloud editor that Amazon provides right there live, he said.

“That’s been the knock against AWS, that they provide lots of cool functionality, but no tooling,” Facemire said. “This starts to address that big knock.”

Who is more developer-friendly?

AWS’ reputation is that it’s not the most developer-friendly cloud platform from a tooling perspective, which hardcore, professional developers don’t require. But as AWS has grown and expanded, it’s become friendlier to the rest of the developer community because of its sheer volume and consumability. And the AWS Cloud9 IDE appeals to developers that fit in between the low-code set and the hardcore pros, said Mark Nunnikhoven, vice president of cloud research at Dallas-based Trend Micro.

“The Cloud9 tool set is firmly in the middle, where you’ve got some great visualization, you’ve got some great collaboration features, and it’s really going to open it up for more people to be able to build on the AWS cloud platform,” he said.

Despite providing a new IDE to its developer base, AWS must do more to win their complete loyalty.

AWS Cloud9 IDE supports JavaScript, Python, PHP and more, but does not have first-class Java support, which is surprising given how many developers use Java. Secondly, Amazon chose to not use the open source Language Server Protocol (LSP), said Mike Milinkovich, executive director of the Eclipse Foundation, which has provided the Eclipse Che web-based development environment since 2014. Eclipse Che supports Java and has provided containerized developer workspaces for almost two years.

AWS will eventually implement Java support, but it will have to do it themselves from scratch, he said. Instead, if they had participated in the LSP ecosystem, they could have had Java support today based on the Eclipse LSP4J project, the same codebase with which Microsoft provides Java support for VS Code, he said.

This proprietary approach to developer tools is out of touch with industry best practices, Milinkovich said. “Cloud9 may provide a productivity boost for AWS developers, but it will not be the open source solution that the industry is looking for,” he said.

Constellation Research’s Mueller agreed, and noted that in some ways AWS is trying to out-Microsoft Microsoft.

“It’s very early days for AWS Cloud9 IDE, and AWS has to work on the value proposition,” he said. “But, like you have to use Visual Studio for Azure to be fully productive, the same story will repeat for Cloud9 in a few years.”

Cloud pricing models reignite IaaS provider feud

As the biggest cloud providers battle for customers, the main tactic always comes back to cost.

A few years ago Amazon, Microsoft and Google engaged in a public cloud price war after Google Cloud Platform (GCP) entered the market and began to undercut the other two hyperscalers. Prices continue to drop, though the fanfare and rapid-fire back and forth has largely subsided. But in the past month, the public cloud war has reignited in a new way, as these vendors add more cloud pricing models to reduce users’ costs.

The first salvo in the latest round of one-upmanship came from Amazon Web Services (AWS), with last week’s long-anticipated departure from per-hour billing in response to per-minute billing available on GCP and Microsoft Azure. Amazon jumped ahead with per-second billing, only to be matched days later by Google – which stated that its customers will feel less impact from the change than users of a certain unnamed vendor that used to charge on a per-hour basis – a thinly-veiled shot at AWS.

Not to be outdone, Microsoft this week added Reserved VM Instances, through which users can purchase advanced capacity in one- and three-year increments and save up to 72% compared to the on-demand price. It’s roughly modeled after AWS EC2 Reserved Instances, but adds a decidedly Microsoft slant, with even bigger discounts for users that incorporate Azure Hybrid Use Benefit to transfer Windows Server licenses to Azure.

The race around cloud costs has become less about direct cuts and more about cloud pricing models that give users a variety of ways to design their workloads, said Greg Arnette, CTO and founder of Sonian, an archival storage company Waltham, Mass., whose service works with AWS, Azure and GCP.

“At some point, it feels like pricing has to bottom out, so it has to be about more creativity on how to design and develop software for how you use the cloud to find more savings,” Arnette said.

Microsoft may have trailed competitors in this area because cloud pricing models are different than how it’s used to selling to enterprises, but its customers likely see these options on AWS and GCP and ask why they can’t get the same thing on Azure, said Owen Rogers, who heads up the Cloud Price Index at 451 Research.

“For the most part, Microsoft has been really slow to tackle the issue of cloud economics,” he said. “It’s almost like Azure is now playing catch up with Google and AWS when it comes to cloud economics, but they’re also trying to be more flexible.”

Between Microsoft’s quickened pace to adapt its pricing options and Google and Amazon’s shift to per-second billing, there’s constant pressure to show ongoing value to users, Rogers said.

The per-second shift likely won’t impact users much for now, particularly for VMs that run constantly, Rogers said. He does, however, see potential benefits in the future, as users move to short-lived workloads that run on containers or are constructed around serverless functions.

Microsoft’s me-too updates go beyond price

These types of discounts aren’t new. AWS and GCP have had spot instances for years, an option Microsoft finally added in May. AWS has built out its EC2 Reserved Instances program so extensively that some worry it’s on the brink of being too complicated. Google has a set of discounts for continued usage, and added its take on reserved instances earlier this year.

The me-too updates aren’t limited cloud pricing models. Microsoft took its turn to play catch up this week with a spread of important features to coincide with Ignite, one of its major annual IT conferences. Among the new tools, which have popular equivalents on other cloud platforms, is Azure Data Box, with which users mail up to 100 terabytes of data from private data centers to the cloud. Microsoft also added multiple availability zones within a region, another major upgrade for customers that want more resiliency and high availability. This service is available in two regions now (East US 2 and West Europe) with previews for additional zones in the US, Europe and in Asia by the end of the year.

Trevor Jones is a senior news writer with SearchCloudComputing and SearchAWS. Contact him at tjones@techtarget.com.