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9L0-509 - Server Essentials 10.5 - Dump Information

Vendor : Apple
Exam Code : 9L0-509
Exam Name : Server Essentials 10.5
Questions and Answers : 90 Q & A
Updated On : February 14, 2019
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9L0-509 Server Essentials 10.5

Study Guide Prepared by Apple Dumps Experts 9L0-509 Dumps and Real Questions

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9L0-509 exam Dumps Source : Server Essentials 10.5

Test Code : 9L0-509
Test Name : Server Essentials 10.5
Vendor Name : Apple
Q&A : 90 Real Questions

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Apple Server Essentials 10.5

windows Server 2012 Beta essentials accessible for down load | Real Questions and Pass4sure dumps

On Wednesday, the home windows Server 2012 Beta essentials made an look on Microsoft’s download web site, proposing the business’s clients with the possibility to download it and give it a try.

windows Server 2012 essentials is the brand new name for the windows Small company Server essentials, and is designed to healthy the wants of groups with as much as 25 clients and 50 devices.

prior this week, the Redmond-primarily based utility colossal unveiled the new windows Server 2012 offering, announcing 4 SKUs for it, for accelerated simplicity.

The essentials flavor of home windows Server 2012 changed into intended for small corporations, and guarantees vital can charge discounts, in addition to multiplied productiveness.

based on Microsoft, “home windows Server 2012 Beta essentials is an important first server, and it may also be used because the basic server in a multi-server environment for small agencies.”

through the use of home windows Server 2012 Beta necessities, small groups can be capable of improve insurance policy of their functions and guidance.

at the same time, they're going to additionally advantage from more advantageous centralization, organization and accessibility to their purposes from basically any gadget.

additionally, the product can grow as the enterprise evolves, proving to be a versatile solution wherein businesses could have the opportunity to buy and operate an in-vicinity conversion to home windows Server 2012 general if essential.

The hardware necessities for home windows Server 2012 Beta essentials encompass a sixty four-bit 1.four GHz single-core or 1.3 GHz multi-core (minimum) to 3.1 GHz multi-core (informed) or quicker processor, together with 2 (minimum) to 8 (informed) GB RAM or greater.

furthermore, the platform requires 160 GB disk area, and can be used with windows 7, home windows 8 and Mac OS X edition 10.5 to 10.7 as client operating techniques.

The home windows Server 2012 Beta necessities prerelease is attainable for down load from Softpedia as smartly, by way of this link. On the down load page, you are going to discover both the setting up ISO picture, which weighs 4GB, as neatly as the restore graphic, of best 560.9 MB.

home windows Server 2012 essentials Hits RTM Stage | Real Questions and Pass4sure dumps


home windows Server 2012 essentials Hits RTM Stage
  • with the aid of Kurt Mackie
  • October 10, 2012
  • windows Server 2012 essentials turned into released to Microsoft's hardware manufacturing partners on Tuesday.

    The subsequent milestone for home windows Server 2012 essentials could be established availability on Nov. 1. Microsoft expects that common device producers will delivery shipping the server items through the conclusion of this 12 months.

    The liberate-to-manufacturing (RTM) milestone signifies the impending availability of Microsoft's most recent server for small corporations and residential offices sometime this yr. The server offers backup for organizations, administration and security support for home windows 7 and home windows eight PCs and Mac OS X computer systems (types 10.5 and higher), mobile machine assist and integration with external information superhighway-primarily based capabilities by the use of a simplified graphical person interface (GUI). those desperate to verify the new server can access a 180-day evaluation replica of the application right here.

    Microsoft issued the RTM of essentials two months later than windows Server 2012, which hit RTM status in August. windows Server 2012 essentials is the successor product to the home windows Small company Server (SBS) 2011 product, which will now not be offered after June 2013. Microsoft is also discontinuing sales of windows domestic Server on December 31, 2013.

    Ease of UseWindows Server 2012 essentials is new and constructed "on the actual same home windows Server 2012 code base," in keeping with David Fabritius, senior product manager on the windows Server marketing crew, in a phone quick conducted last month. Microsoft has put in one of the vital server roles by default and has configured them in response to optimum practices for a small business atmosphere. as an instance, lively directory and cyber web counsel services are turned on by default in necessities. Setup is simplified and users can comfortably connect to Microsoft's cloud-based functions.

    whereas turning on these elements with the aid of default is rarely always most appropriate for bigger businesses, Fabritius asserted that it's appropriate for a small enterprise, adding that "where here's your first server, then we can make certain assumptions about what the server should do so as to add cost on Day 1, and so this is what we do."

    home windows Server 2012 essentials helps PowerShell, for these businesses that cherish to do scripting. although, the Server Core configuration is never obtainable, in accordance with a Microsoft spokesperson.

    The earlier product, Microsoft SBS 2011, came with licenses to make use of Microsoft's change email server. With home windows Server 2012 essentials, Microsoft doesn't consist of alternate. clients have the choice of getting their e mail provider via setting up their personal on-premises exchange Server or they could tap the Microsoft office 365 service, or entry a third-birthday celebration hosted e mail service.

    In frequent, Microsoft has designed essentials with a consumer-friendly dashboard that organizes tasks into a tab-like layout. The tabs include "home," "users," "contraptions," "Storage" and "functions." Microsoft offers a utility development equipment and a brand new set of net services APIs that may also be used to construct add-ins to prolong the server's functionality, together with adding new tabs and subtabs to the server dashboard. The functions tab has a Microsoft Pinpoint menu option that lets clients discover applications which are developed through Microsoft's partners. the new SDK and APIs are constructed upon, and hold "compatibility" with, the add-ins mannequin used for home windows SBS 2011 essentials, according to Microsoft's "comparison e book." The e-book and different resources for windows Server 2012 necessities may also be downloaded at this page.

    The dashboard GUI in essentials is there to support groups that will not have lots of IT help capabilities. for instance, it gives an "alert viewer" that suggests a gadget fitness record, which displays assistance such as missing customer OS updates and out-of-date virus definitions on customer devices. In contrast, different variations of windows Server 2012, corresponding to basis, commonplace and Datacenter, may also require stronger IT abilities to run, in accordance with Microsoft.

    Microsoft additionally consolidated some add-in features into the dashboard of home windows Server 2012 essentials that was once not obligatory.

    "if you are widespread with the add-ins that necessities had in the past, one of the vital providing become the windows 7 knowledgeable Pack add-in, which allowed you to push out a collection of group guidelines to support offer protection to the pc, turn down things like folder redirection and set guidelines to be sure the firewall became became on," Fabritius talked about. "it really is now been built-in within the dashboard, so it's now not a separate down load."

    The neighborhood coverage integration in home windows Server 2012 essentials extends to both windows 7 and home windows 8 client instruments.

    Microsoft is additionally claiming superior software support for home windows Server 2012 necessities. Now, there may be a single windows Server brand certification software for purposes. in the past, apps weren't all the time so appropriate with the necessities products, Fabritius mentioned.

    Scalability and UpgradesWindows Server 2012 necessities is for small organizations, assisting up to 25 users and 50 gadgets. The prior product had supported simplest 25 instruments. The licensing is simplified in that it would not require the purchase of customer access Licenses (CALs) and supports up to two processors per server. In distinction, windows Server 2012 foundation helps up to fifteen clients on one processor. The regular and Datacenter versions are identical products aside from virtualization rights and each are licensed on the server-plus-CALs mannequin.

    Macworld UK offers Apple’s Mac OS X 10.5 Leopard Server four out of 5 stars | Real Questions and Pass4sure dumps

    Giving Apple’s Mac OS X 10.5 Leopard Server 4 stars out of a possible 5, John C. Welch studies on what he sees as the new OS’s professionals and cons for Macworld UK:

    pros: New Calendar server; developed-in wiki and running a blog functions; easier installing modes; improved administration and monitoring equipment; superior move-platform integration.

    Cons: Many capabilities don’t work well with non-Mac clients; GUI administration tools can also be limiting for experienced administrators; some elements obtainable in easier setting up varieties no longer obtainable in advanced setting up; limited client aid for CalDAV and iChat Server.

    Welch writes, “Is Mac OS X 10.5 Server value the £319 [US$499] retail rate (for the 10 file-sharing user edition; an enormous customer version, no CALs required, sells for £629 [US$999])? (in case you purchase a brand new Xserve, you get it at no cost.) It depends. in case you don’t have already got a directory carrier or dedicated servers, and are only now brooding about implementing such things for the first time, Mac OS X 10.5 Server is a compelling product; just bear in mind that a few of its features don’t work in addition to they should still in a heterogeneous environment. on the other hand, if you’re an skilled administrator, you’ll doubtless be frustrated with the aid of the obstacles in Apple’s GUI server tools; happily, OS X Server is in response to Unix, so you can have all of the handle you want by way of the command line.”

    Full huge assessment – counseled – here.

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    Server Essentials 10.5

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    Complete Guide to Apple Certification and Training | real questions and Pass4sure dumps

  • Post
  • apple_logo1

    Although I’ve been supporting Macs since they came out in 1984 (when I was in high school), I haven’t received any “formal” training. It has mostly been learning by doing, reading the occasional book and now of course, TheAppleBlog. Does formal certification really make a difference as a technician? You tell me.


    Recently I got into an argument with a vendor that somehow thought a technician who first started repairing Macs sixth months ago trumped my 25 years experience. Did certification make this person a better technician? Having done quite a bit of hiring myself, I’ve too often found that certification only verifies your ability to take a test and may not have bearing in the real world.

    Now that the market has changed and everyone seems to be competing for scarce resources, perhaps a certification would be an additional edge? What’s the business strategy for independent Mac technicians wanting more? The answer took a lot of research — even Apple wasn’t able to answer my questions — so learn from my journey.

    Credit goes to both Brian Best of BestMacs and Doug Hanley of MacTEK Training, because without them I wouldn’t understand the alphabet soup of ACSP, ACMT, ACTC, ACSA, AASP, ACN and more. Didn’t we all become Mac users to avoid mysterious terms? As many of you know, the ease of the Apple user interface is equalled only by the frustration of trying to understand Apple’s certifications programs. Figuring out this path was much harder than any video game I’ve ever played, but a “game” may be the best metaphor to describe the process.

    The Game

    You begin the “game” as a general Mac user. The three worlds you’ll generally see in the game are IT, Pro Apps, and Sales. As an IT person maybe you have skills, maybe you don’t. Nothing stops you from simply repairing Macs on your own, unless you do things that specifically void the warranty and you get caught doing so. You do not need permission per se from Apple to work on Macs. Many folks are happy at this level collecting coins one by one, but you can’t proceed any further unless you get a certification — the key that unlocks the next level in the game.

    The first certification most go for is Apple Certified Support Professional (ACSP) which used to be known as an Apple Certified Help Desk Specialist (ACHDS). This certifies your ability to understand the operating system and is earned based on the OS version. Therefore, you are an Apple Certified Support Professional in 10.5 (or soon 10.6). Each OS requires certification, but your certification does not expire. Therefore, if you are a ACHDS in 10.3, you can call yourself certified without understanding 10.5 at all. Your can take the test without training (many do), self-study via materials from Peachpit, or attend an instructor-lead course at an Apple Authorized Training Center (AATC). MacTek is one of those centers. You’ll take the test at a Prometric testing center and pay around $200. The test takes about 90 minutes or so and you get the results immediately.

    Apple Consultants Network

    While certification is the means, the end you may be reaching for is the ability to join the Apple Consultants Network (ACN). Joining the ACN requires any Apple certification, such as the ACSP discussed above, or any number of other certifications (described below, though one source says not all certifications are valid, so beware). Keeping with the video game analogy, the ACN is like an entire new area of the video game you want to explore, but the boss that must be defeated first is Apple, and your weapon is a certification!

    After getting a certification you can then apply to join the ACN. The application fee is $60 and the actual fee to join is $395 as a sole proprietor. The full requirements are here. You’ll get lots of benefits such as product discounts as well as the ability to network with other Macintosh consultants. As an ACN, Apple store employees may hand out your card to customers in the store. Now your business can really expand as every Apple store customer is a potential customer for you.

    ACN membership is great and many stay at this level of the “game” using the ACN membership as a multiplier for their income. However, you still can’t do hardware repairs under warranty nor order Apple parts. As with the video game, you’re stuck at this level unless you explore further and try to defeat the next boss. Apple always controls the rules. Accept it as part of the game. Fail to accept it and you’ll get slapped back to the beginning of the game quicker than you can click the home button.

    Server Administration Certification

    From this point, you have a couple directions you can go. You can focus on repair and service, or you can focus on server or advanced software administration (many folks will do both). I will discuss the server administration certifications and the hardware services certifications. You can think of each of these as two separate worlds in the game. You can choose one or the other, or explore them both.

    The first level server administration certification is another 4-letter acronym: ACTC: Apple Certified Technical Coordinator. In addition to passing the test for ACSP, you’ll face the Server Essentials test. This extends your workstation abilities to servers. An even higher level of certification within the server realm is an ACSA — Apple Certified Systems Administrator. For the ACSA, you’ll need to pass four tests: Server Essentials, Directory Services, Deployment, and Mobility and Security for 10.6 (or Advanced System Administration for 10.5).

    Apple also offers the ACMA (Apple Certified Media Administrator) which includes Server Essentials, Xsan, Final Cut Server and as an option, Support Essentials, Deployment, Directory Services, or Final Cut Level 1. Other certifications are not necessarily IT related and are software-focused. That’s a realm I’m not exploring as we chose the IT track at the beginning of the game.

    Hardware Repair Certification

    Moving on from server administration to actual Apple hardware repair, the primary certification you will earn is the Apple Certified Macintosh Technician (ACMT), formerly the Apple Certified Portable Technician (ACPT) and Apple Certified Desktop Technician (ACDT). This certification means you are theoretically qualified to do warranty repairs on Apple Macintosh equipment. The skills required for ACMT are those of hardware repair and software troubleshooting. You don’t need an ACSP to be an ACMT, but many people earn both. The educational process for hardware repair is more intense and it’s less likely you’ll pass the test without some training. At this level, you can also go to an AATC and pay about $4,800 for both the hardware and software aspects of the course, or your can purchase self-study materials from Apple called “Apple Care Technician Training” for $299.

    Apple Authorized Service Provider

    Similar to how passing the ACSP allows you to join the Apple Consultants Network, passing the ACMT allows you to enter the realm of an Apple Authorized Service Provider (AASP). You may not automatically become one though, and only AASP’s get reimbursement from Apple for warranty work. However, being an ACMT is very helpful if you want to get a job as an AASP. You may also apply to do warranty repairs for your larger organization of over 50 Macs via the Self-Service program. If you want to advance to being able to do warranty repairs for anyone, you’ll face that same boss again, Apple. Note that becoming an ACMT will not necessarily earn you any more money than an ACSA or ACTC. Facing the next boss may be too expensive and too restricting, but if you do want the next level, read on.

    Getting to that AASP level is really the final level of the game. You’ll need to have an ACMT on staff and follow stricter requirements than joining the Apple Consultants Network. Generally you’ll need a real store front and not be a one-person operation. Apple grants exceptions (doesn’t every game have cheat codes?), but don’t count on it. Once you have your AASP you can be listed with Apple as a service provider and get reimbursed for warranty repairs.

    So I’ve loaded the game and pressed Start. Is certification worth it? What about ACN or AASP? Which training should I go for? Is instructor lead training worth it? Any training vendors willing to sponsor me? What about the self-study programs? Share with me your experiences in the game and let’s develop a definitive guide including “cheat codes.”

    Apple-authorized Organizations

    ACN (Apple Consultants Network)What it is: Network on Apple professionals, receives discounts and assistance from Apple, and can be referred from Apple retail stores.Requirements: Any certification.

    AASP (Apple Authorized Service Provider)What is it: Business that is permitted to do Apple warranty repairs for reimbursement and order parts from Apple.Requirements: Have an Apple Certified Macintosh Technician on staff, among other requirements.


    Apple Certified Support Professional: Basic understanding of the client Mac operating system and troubleshooting.

    Apple Certified Technical Coordinator: Deeper understanding of the Mac OS, including the Mac OS X Server and Server Essentials.

    Apple Certified Systems Administrator: Even greater technical understanding of the Mac OS X Server, including passing tests on Server Essentials, Directory Services, Deployment, and Mobility and Security.

    Apple Certified Media Administrator: This is a sister track of the “Apple Certified Systems Administrator” with a focus on the needs of media management, and includes training in XSan or Final Cut.

    Apple Certified Macintosh Technician: You can do Apple hardware repairs, both in and out of warranty. Required to start (or get a job with) an Apple Authorized Service Provider, or self-service your large organization.

    HP upgrades EVA midrange SAN array, launches virtualization bundles | real questions and Pass4sure dumps

    Hewlett-Packard (HP) Co. updated its storage portfolio today with a new EVA midrange SAN array, a set of pre-packaged storage and compute bundles tuned for virtual environments, and a new Windows-based NAS. The company also laid out plans for a building-block approach to future data storage products that would involve more bundling of its storage, server and networking products.

    The launch came during the opening day of HP’s Discover 2011 user show in Las Vegas. HP didn't upgrade its flagship 3PAR storage platform that it paid $2.35 billion to acquire last year, although 3PAR storage is included in one of its new VirtualSystem bundles.

    EVA gets thin provisioning, but not 3PAR’s

    The HP P6000 EVA will have thin provisioning and native iSCSI support for the first time, as well as support for 2.5-inch 6 Gbps SAS drives and LUN-level tiering for data migration. Two new models -- the P6300 and P6500 -- replace the P6400 and P8400 models, but the software that enables thin provisioning, tiering and iSCSI support will be available to existing EVA customers.

    The P6500 scales to 480 TB with 2 TB SAS drives, while the P6300 scales to 240 TB. The other major difference is that the P6500 uses 8 GB of cache vs. 4 GB for the P6300. Both are two-controller systems.

    HP revealed in May that it would refresh the EVA this month, amid speculation it would kill the platform after acquiring 3PAR. Tom Joyce, vice president for marketing, strategy and operations for HP storage, said the 10-year-old EVA platform has 100,000 customers, and “a lot of those customers have been looking forward to a refresh for quite a while.”

    Joyce said many EVA customers want a system that's easy to use and less expensive than 3PAR, comparing 3PAR to a Ferrari or Mercedes and the EVA to a pickup truck. He said EVA thin provisioning leverages “expertise” from HP’s 3PAR and LeftHand platforms but its code is unique to the EVA. “EVA customers wanted thin provisioning and tiering, but not in a way that was challenging. EVA is stripped down to its essentials,” Joyce said.

    Joyce said the P6000 EVA will support solid-state drives (SSDs) later this year, but the EVA doesn't support automated sub-LUN tiering that competitors EMC, Dell (through its Compellent acquisition) and IBM, or even HP’s 3PAR, provide for efficient placement of data on SSDs.

    A year ago, HP launched the EVA Cluster that connected two EVA arrays with the Storage Virtualization Services Platform (SVSP) product HP sold through an OEM deal with LSI. But at the end of 2010, HP discontinued the EVA Cluster and SVSP. “We didn’t get a great response,” Joyce said of that product. “That didn’t maintain the EVA’s value around simplicity.”

    VirtualSystem: An answer to Vblock?

    HP sees its VirtualSystem bundles as competitive to the EMC-Cisco-VMware Vblock bundles for virtual environments and storage clouds. The bundles are based on HP storage and servers, including the BladeSystem Matrix Converged Infrastructure systems that packages servers and networking as an answer to Cisco Systems’ Unified Computing System (UCS).

    There are three VirtualSystem bundles. The smallest uses HP ProLiant servers, LeftHand P4500 SANs and HP Virtual Connect switch modules. The medium-sized bundle includes P4800 LeftHand storage running on an HP BladeSystem server with Virtual Connect and the largest bundle is a BladeSystem with 3PAR storage. The high-end system includes Fibre Channel SAN switches from Brocade.

    The bundles include VMware or Microsoft Hyper-V hypervisor software. They can also be upgraded to HP Cloud System packages to create hybrid clouds.

    Midrange Windows-based NAS

    HP is also introducing an HP X5000 G2 Network Storage active-active NAS system based on Windows Storage Server (WSS). It's HP’s first multi-node product built on WSS, and it also supports iSCSI. The X5000 uses the same hardware as the HP E5000 Messaging System for Microsoft Exchange that HP launched earlier this year based on ProLiant blade servers.

    “This is bringing Windows NAS to the midrange,” Joyce said of the new X5000.

    In addition, HP upgraded its X9000 NAS system that uses a clustered file system acquired from Ibrix in 2009 and said it will no longer sell software it acquired from PolyServe with the X9000. After buying Ibrix, HP continued to make NAS systems available with PolyServe for high-performance markets; it will now use Ibrix with all its clustered NAS.

    “We want to focus on things that are game changers or winners,” Joyce said.

    HP is also adding snapshots and WORM file locking for data retention to the XP9000. “We didn’t have the things you needed to go after broader-based opportunities,” Joyce said.

    Storage360: More bundles coming

    Joyce said HP will add more products based on its storage building blocks plus Converged Infrastructure as part of what it's calling its Storage360 architecture. Storage360 consists of LeftHand, Ibrix and HP's StoreOnce deduplication software merged into a common platform.

    “They came from different places, but over the last 18 months we’ve taken the underpinnings of those three products and moved them to a common platform,” Joyce said. “In the future, we will run BladeSystem with Ibrix and LeftHand software in the same box. We’ll also build a large deduplication facility into Ibrix. First, we had to get these things running on common code.”

    HP launched StoreOnce for its low-end disk backup appliances in 2008 and last year said it would be expanded for other HP products. It remains relegated to backup, but Joyce said he expects an announcement of StoreOnce on other platforms late this year.

    He said HP is also dropping the StorageWorks brand from its storage products.

    Is it enough?

    Like other server vendors, HP has been losing storage market share to pure-play storage vendors EMC, Hitachi Data Systems and NetApp. The latest IDC storage tracker numbers released last week show HP with 10.5% of the external storage market last quarter. HP grew 16% year-over-year compared to NetApp’s 38%, Hitachi Data Systems' 27% and EMC’s 25% revenue increases.

    Analysts question whether modest EVA enhancements and bundles of existing products can help HP reverse the tide.

    “HP has [less than] 11% of the external storage market. Compared to everywhere else HP competes, that’s miserable,” said Mark Peters, a senior analyst at Enterprise Strategy Group. “That tells you HP’s not even getting its far share among people who buy their computing products. HP has to get some better perception around its storage. I don’t think adding blocks of compute will change the storage success of HP. I’m assuming if you like HP, you’ll like VirtualSystem, if you like EMC you’ll buy Vblock, and if you like NetApp you’ll go with FlexPod.”

    Jeff Boles, a senior analyst and director, validation services at Taneja Group, said the VirtualSystem architecture isn’t completely new for HP because it already sells LeftHand systems on ProLiant and BladeSystem servers.

    “It’s interesting to see HP throwdown wholeheartedly with its converged infrastructure,” he said. “That started with LeftHand, and it’s gone well. I think that’s influenced their thinking for this building-block approach.

    “It’s interesting to see them deploy so much on blade server and rack servers," Boles added. "It’s easier to scale storage when it’s in the rack. When you have different form factors for storage and servers and manage them separately, it introduces latency and inefficiencies.”

    Boles said HP’s EVA upgrade “came as a surprise to everybody” after the 3PAR acquisition but should make EVA customers happy. “There are a lot of shops out there running a lot of EVAs,” he said. “I know people with 15 or 20 of them, and it would be a big effort to replace all of them.”

    Architecting Your Healthcare Application for HIPAA Compliance, | real questions and Pass4sure dumps

    18 — the number of reported breaches so far this year in the health care and medical provider industry

    10.5 million — the number of people who had data compromised in just the last breach alone.

    The healthcare landscape of the United States is rapidly changing. We are at a crossroads in the medical IT industry today where the legacy (often meaning paper) systems of the past are making it very hard to properly secure patient data.

    Due to new regulation and patient demand, startups such as Syapse and Flatiron Health have begun to leverage the AWS cloud to develop new technologies that are not only changing the way in which our healthcare is delivered but are also raising the bar for keeping patient data safe.

    Syapse is driving the transformation of healthcare through precision medicine, enabling healthcare providers to streamline operations and improve clinical outcomes. Leading healthcare systems are now using Syapse Precision Medicine Platform to integrate complex clinical and genomic data, and deliver actionable insights at the point of care.

    Of course, all this must be done within the highly regulated environment of HIPAA. “Most of what HIPAA prescribes is good business practice for handling any customer data. In today’s environment, there is more focus than ever on patient data security, and our customers need to know that we have a rock solid security program,” says Tony Loeser, Syapse CTO and co-founder. “AWS’s commitment to security-oriented services and responsive, expert support give us confidence to build on their platform.”

    Flatiron Health is a company that specializes in data analytics and workflow tools that dramatically improve the treatment of cancer patients and accelerate research. According to Alex Lo, engineering manager at Flatiron, “AWS is a reliable service provider that provides us great tools for managing and processing large amounts of patient data, in a HIPAA-compliant way. S3 with Server Side and TLS encryption meets all our document and image storage requirements. Encrypted EBS gives us great performance and security for our processing nodes. We also utilize its powerful audit capabilities.”

    This blog will walk an interested startup through the background on healthcare today, the current regulated environment and where inventive startups may find opportunity to build on the compliance features offered by the AWS infrastructure and achieve success in the health technology space as Flatiron Health and Syapse have.

    A Primer

    As somewhat recent transplants to Seattle from New York City, my wife and I have started the process of transferring our healthcare to new providers. This means a LOT of filling out paper forms. Just a few years ago, the CDC reported that only 4.4 percent of physicians had a fully functional electronic medical record system.

    Even at premier medical centers in the United States, the following picture seems to represent the pinnacle of data collection technology in healthcare.

    Let’s see, when was my last tetanus shot? Probably less than 10 years ago? Sure, why not. When was that surgical procedure? 2003. No wait, 2005? Medications? How do you spell that drug again? Eh, close enough.

    Okay, I guess I can get the records I need from NYC. All I need to do is submit requests at each one of my medical providers and…who were all of my doctors again? Assuming I am the average patient, my records are stored in about 19 locations. Oh, and it looks like my dermatologist retired. And of course once I do request the records, the API of the healthcare world is still the FAX machine, so all the handwritten notes scribbled by my physicians over the years will be rescanned and sent for additional [mis]interpretation, and, not to mention, additional fees per page. Perhaps this reliance on patient memory and struggle to obtain records is a contributing factor to why there were more than a million patient safety incidents caused by medical errors between 2000 through 2002.

    Maybe this was the best we could do back in 1996 when HIPAA was developed, but this was a time when phones had wires, film was dropped off to be developed, the quickest way to contact someone was to page them, and connecting to the Internet involved an AOL CD-ROM accompanied by a strange crackling sound. However, in today’s fast-paced information age companies like Amazon have redefined a new normal. I can now ask my Amazon Echo to tell me the world’s news, I’ve replaced my trip to Blockbuster with Prime Instant videos, my Amazon Kindle holds more books than my local library did, provisioning a server now means a green light on the Amazon Web Services web page, and I’ve even fully automated the delivery of my groceries. It should be less than a shock to anyone who is paying attention that the IT systems of the healthcare industry are ready for an overhaul, and AWS might just be the company that can enable this change.

    How did healthcare records get so left behind in the march toward digitalization? Much of it has to do with the fact that the understanding of human ailments and diseases is not a business process that can be easily automated. Many measurements used in practice are correlative measures obtained in very uncertain situations that require deep reasoning abilities to properly decide on a course of treatment. A lack of the latest IT capabilities does not necessarily exclude one from being a great doctor, nurse, or even scientist.

    As computerized systems did make their way to healthcare providers, too often the goal was focused on billing capabilities instead of clinical care improvement. Even with electronic medical records, it was still the paper records that were consistently seen as the gold standard.

    This led to the unfortunate environment where caregivers see the IT infrastructure as an unwanted intermediary between patient care and the patient. As a result of this contentious relationship, all too often the mark of a successful IT department in healthcare is simply providing the minimum essentials with the utmost stability as opposed to offering real technical improvements to the healthcare process. Of course, to quote Aldous Huxley, “stability isn’t nearly so spectacular as instability.” Healthcare technology needs to move past maintaining the status quo, and this blog can serve as a starting point for understanding a basic AWS HIPAA eligible architecture, which can be used by startups that want to take healthcare into a brave new world.

    Regulated Industry

    The Health Insurance Portability and Accountability Act (HIPAA) that was passed by Congress in 1996 was one of the first major regulations that enabled the healthcare industry to move towards digitalization of healthcare records. Among other items, this act provided industry-wide standards for health care information on electronic billing. There were also additional regulations in this act, which made entities legally responsible for protecting this data and gave the patient rights associated with their own information. These safety controls are broken out into two subcategories of HIPAA:

  • Privacy Rule — deals with the individual identifiable patient information and provides guidance on protections, disclosures, and patient rights.
  • Security Rule — deals with the administrative, physical, and technical safeguards
  • Additional elaboration about each of these can be found on the HHS site.

    Of course, as often is the case with healthcare legislation, there were some unintended consequences of all these HIPAA safeguards. Developers with great ideas for new and innovative ways to approach patient healthcare might quickly shy away from tackling the problem for fear of the heavy regulations and privacy compliance laws.

    Repercussions from data hacks, such as the ones made infamous by Premera, the UCLA health system and many others, caution startups from venturing into the field. Innovation seems to be thwarted simply by mention of the dreaded “HIPAA” regulation.

    In the healthcare industry, electronic systems that store, process, or transmit patient data need to be given extra attention. Healthcare providers should do everything they can to protect the privacy of the patient and ensure that the systems they architect to handle Protected Health Information (PHI) follow the guidelines set forth under HIPAA and HITECH regulations.. Your medical information is worth 10 times more than your credit card information on the black market. Unlike a credit card number, which has a fleeting availability for use, medical records data that is sold includes names, birth dates, social security numbers, policy numbers, and diagnosis codes, and cannot simply be canceled. This data can be repeatedly used to create fake IDs to buy medical equipment, purchase drugs, or file false claims.

    I won’t be presumptuous and say that maintaining HIPAA/HITECH compliance is an easy thing to do or that AWS offers a one-size fits all solution. Maintaining proper security and compliance of your data requires ongoing diligence by all parties involved. There are many aspects of HIPAA that fall under the responsibility of the healthcare provider such as breach notification, risk analysis, limiting uses, and many other controls that are necessary to keep patient data safe.

    However, companies that choose to build on AWS are at a major advantage when it comes to patient data security. According to security experts, “cyber criminals are increasingly targeting the $3 trillion U.S. healthcare industry, which has many companies still reliant on aging computer systems that do not use the latest security features.” AWS offers leading-edge security features that are designed to eliminate much of the undifferentiated heavy lifting necessary for maintaining HIPAA compliance and make storing and accessing PHI data less risky.

    The Times They are A-changin’

    HIPAA was not the last legislative attempt to move healthcare into the digital age. As part of the American Recovery and Reinvestment Act of 2009 (aka: the federal stimulus package), the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed, which allocated 19.2 billion dollars of funding to increase the use of Electronic Health Records by physicians and hospitals. The HITECH Act outlined plans for this adoption through three stages of what is called “meaningful use.” The stages are the following:

  • Data capturing and sharing
  • Advanced clinical processes
  • Improved outcomes
  • The first two stages are underway now, and the third stage coming in 2017 (although still not finalized) is designed with eight proposed objectives, some of which are going to make for very interesting technology challenges. Clinical decision support, providing patients electronic access to their information, and home health reporting are just a few examples of areas where a nimble startup could come and find their niche among the major healthcare IT vendors.

    The HITECH Act is not the sole legislative driver of improved IT in healthcare. The Patient Protection and Affordable Care Act (ACA) of 2010 (aka Obamacare) has also played a role in pushing quality measures through programs such as Physician Compare and Hospital Compare.

    This new law has opened the doors for large medical records companies such as Epic to introduce frameworks for interoperability that can provide clinicians access to the patient data needed for proper care. Epic achieves this through the exchange of standardized Continuity of Care Documents. This standardization of the medical record makes it possible for startups to now build on to the existing features of the EMR system without needing to duplicate existing functionality.

    We have already started to see many AWS startups making real progress in both patient care and patient health. These companies have leveraged AWS to build highly secure, HIPAA eligible systems that have been paying off both for patients and the companies’ financial success.

    Make Your Web Application HIPAA Eligible

    As a first step to understanding HIPAA compliance, it is recommended that you take a look at the Architecting for HIPAA Security and Compliance whitepaper. You might also want to review the AWS HIPAA Compliance FAQs for additional details on topics like the Business Associate Agreement (BAA) that AWS offers as well as which services can be used for storing and processing PHI. There is also a video from last year’s AWS re:Invent conference on Architecting for HIPAA Compliance on AWS that is worth a look. Be on the lookout for an upcoming 2015 update to this video.

    AWS provides multiple services to deploy a highly available, scalable, secure application stack, which can serve a limitless variety of healthcare applications and use cases. In our next blog, we will embark on our journey into HIPAA-eligible architectures by providing an example HIPAA architecture, which can be adopted as a starting point for building a HIPAA-eligible, web-facing application.

    Christopher Crosbie MPH, MSHealthcare and Life Science Solutions Architect

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