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Monday, March 4, 2024

Actual-time Medical Trial Monitoring at Medical ink – migrating from Opensearch to Rockset for DynamoDB indexing

Medical ink is a collection of software program utilized in over a thousand scientific trials to streamline the information assortment and administration course of, with the objective of bettering the effectivity and accuracy of trials. Its cloud-based digital knowledge seize system allows scientific trial knowledge from greater than 2 million sufferers throughout 110 nations to be collected electronically in real-time from quite a lot of sources, together with digital well being data and wearable gadgets.

With the COVID-19 pandemic forcing many scientific trials to go digital, Medical ink has been an more and more helpful answer for its capability to help distant monitoring and digital scientific trials. Relatively than require trial contributors to come back onsite to report affected person outcomes they will shift their monitoring to the house. Because of this, trials take much less time to design, develop and deploy and affected person enrollment and retention will increase.

To successfully analyze knowledge from scientific trials within the new remote-first setting, scientific trial sponsors got here to Medical ink with the requirement for a real-time 360-degree view of sufferers and their outcomes throughout the complete international examine. With a centralized real-time analytics dashboard outfitted with filter capabilities, scientific groups can take fast motion on affected person questions and opinions to make sure the success of the trial. The 360-degree view was designed to be the information epicenter for scientific groups, offering a birds-eye view and strong drill down capabilities so scientific groups may hold trials on monitor throughout all geographies.

When the necessities for the brand new real-time examine participant monitoring got here to the engineering group, I knew that the present technical stack couldn’t help millisecond-latency advanced analytics on real-time knowledge. Amazon OpenSearch, a fork of Elasticsearch used for our utility search, was quick however not purpose-built for advanced analytics together with joins. Snowflake, the strong cloud knowledge warehouse utilized by our analyst group for performant enterprise intelligence workloads, noticed important knowledge delays and couldn’t meet the efficiency necessities of the appliance. This despatched us to the drafting board to provide you with a brand new structure; one which helps real-time ingest and complicated analytics whereas being resilient.

The Earlier than Structure

Clinical ink before architecture for user-facing analytics

Medical ink earlier than structure for user-facing analytics

Amazon DynamoDB for Operational Workloads

Within the Medical ink platform, third social gathering vendor knowledge, internet functions, cellular gadgets and wearable system knowledge is saved in Amazon DynamoDB. Amazon DynamoDB’s versatile schema makes it simple to retailer and retrieve knowledge in quite a lot of codecs, which is especially helpful for Medical ink’s utility that requires dealing with dynamic, semi-structured knowledge. DynamoDB is a serverless database so the group didn’t have to fret in regards to the underlying infrastructure or scaling of the database as these are all managed by AWS.

Amazon Opensearch for Search Workloads

Whereas DynamoDB is a superb selection for quick, scalable and extremely out there transactional workloads, it’s not the very best for search and analytics use instances. Within the first technology Medical ink platform, search and analytics was offloaded from DynamoDB to Amazon OpenSearch. As the quantity and number of knowledge elevated, we realized the necessity for joins to help extra superior analytics and supply real-time examine affected person monitoring. Joins usually are not a firstclass citizen in OpenSearch, requiring various operationally advanced and dear workarounds together with knowledge denormalization, parent-child relationships, nested objects and application-side joins which might be difficult to scale.

We additionally encountered knowledge and infrastructure operational challenges when scaling OpenSearch. One knowledge problem we confronted centered on dynamic mapping in OpenSearch or the method of routinely detecting and mapping the information varieties of fields in a doc. Dynamic mapping was helpful as we had numerous fields with various knowledge varieties and have been indexing knowledge from a number of sources with totally different schemas. Nonetheless, dynamic mapping generally led to sudden outcomes, similar to incorrect knowledge varieties or mapping conflicts that compelled us to reindex the information.

On the infrastructure aspect, despite the fact that we used managed Amazon Opensearch, we have been nonetheless answerable for cluster operations together with managing nodes, shards and indexes. We discovered that as the scale of the paperwork elevated we wanted to scale up the cluster which is a handbook, time-consuming course of. Moreover, as OpenSearch has a tightly coupled structure with compute and storage scaling collectively, we needed to overprovision compute sources to help the rising variety of paperwork. This led to compute wastage and better prices and lowered effectivity. Even when we may have made advanced analytics work on OpenSearch, we’d have evaluated extra databases as the information engineering and operational administration was important.

Snowflake for Information Warehousing Workloads

We additionally investigated the potential of our cloud knowledge warehouse, Snowflake, to be the serving layer for analytics in our utility. Snowflake was used to supply weekly consolidated experiences to scientific trial sponsors and supported SQL analytics, assembly the advanced analytics necessities of the appliance. That mentioned, offloading DynamoDB knowledge to Snowflake was too delayed; at a minimal, we may obtain a 20 minute knowledge latency which fell exterior the time window required for this use case.


Given the gaps within the present structure, we got here up with the next necessities for the alternative of OpenSearch because the serving layer:

  • Actual-time streaming ingest: Information adjustments from DynamoDB must be seen and queryable within the downstream database inside seconds
  • Millisecond-latency advanced analytics (together with joins): The database should be capable to consolidate international trial knowledge on sufferers right into a 360-degree view. This contains supporting advanced sorting and filtering of the information and aggregations of 1000’s of various entities.
  • Extremely Resilient: The database is designed to keep up availability and reduce knowledge loss within the face of varied varieties of failures and disruptions.
  • Scalable: The database is cloud-native and may scale on the click on of a button or an API name with no downtime. We had invested in a serverless structure with Amazon DynamoDB and didn’t need the engineering group to handle cluster-level operations transferring ahead.

The After Structure

Clinical ink after architecture using Rockset for real-time clinical trial monitoring

Medical ink after structure utilizing Rockset for real-time scientific trial monitoring

Rockset initially got here on our radar as a alternative for OpenSearch for its help of advanced analytics on low latency knowledge.

Each OpenSearch and Rockset use indexing to allow quick querying over giant quantities of knowledge. The distinction is that Rockset employs a Converged Index which is a mixture of a search index, columnar retailer and row retailer for optimum question efficiency. The Converged Index helps a SQL-based question language, which allows us to satisfy the requirement for advanced analytics.

Along with Converged Indexing, there have been different options that piqued our curiosity and made it simple to start out efficiency testing Rockset on our personal knowledge and queries.

  • Constructed-in connector to DynamoDB: New knowledge from our DynamoDB tables are mirrored and made queryable in Rockset with just a few seconds delay. This made it simple for Rockset to suit into our present knowledge stack.
  • Capacity to take a number of knowledge varieties into the identical discipline: This addressed the information engineering challenges that we confronted with dynamic mapping in OpenSearch, making certain that there have been no breakdowns in our ETL course of and that queries continued to ship responses even when there have been schema adjustments.
  • Cloud-native structure: We’ve additionally invested in a serverless knowledge stack for resource-efficiency and lowered operational overhead. We have been in a position to scale ingest compute, question compute and storage independently with Rockset in order that we not must overprovision sources.

Efficiency Outcomes

As soon as we decided that Rockset fulfilled the wants of our utility, we proceeded to evaluate the database’s ingestion and question efficiency. We ran the next exams on Rockset by constructing a Lambda operate with Node.js:

Ingest Efficiency

The frequent sample we see is loads of small writes, ranging in dimension from 400 bytes to 2 kilobytes, grouped collectively and being written to the database steadily. We evaluated ingest efficiency by producing X writes into DynamoDB in fast succession and recording the common time in milliseconds that it took for Rockset to sync that knowledge and make it queryable, also called knowledge latency.

To run this efficiency take a look at, we used a Rockset medium digital occasion with 8 vCPU of compute and 64 GiB of reminiscence.

Streaming ingest performance on Rockset medium virtual instance with 8 vCPU and 64 GB RAM

Streaming ingest efficiency on Rockset medium digital occasion with 8 vCPU and 64 GB RAM

The efficiency exams point out that Rockset is able to reaching a knowledge latency underneath 2.4 seconds, which represents the period between the technology of knowledge in DynamoDB and its availability for querying in Rockset. This load testing made us assured that we may persistently entry knowledge roughly 2 seconds after writing to DynamoDB, giving customers up-to-date knowledge of their dashboards. Up to now, we struggled to realize predictable latency with Elasticsearch and have been excited by the consistency that we noticed with Rockset throughout load testing.

Question Efficiency

For question efficiency, we executed X queries randomly each 10-60 milliseconds. We ran two exams utilizing queries with totally different ranges of complexity:

  • Question 1: Easy question on just a few fields of knowledge. Dataset dimension of ~700K data and a pair of.5 GB.
  • Question 2: Advanced question that expands arrays into a number of rows utilizing an unnest operate. Information is filtered on the unnested fields. Two datasets have been joined collectively: one dataset had 700K rows and a pair of.5 GB, the opposite dataset had 650K rows and 3GB.

We once more ran the exams on a Rockset medium digital occasion with 8 vCPU of compute and 64 GiB of reminiscence.

Query performance of a simple query on a few fields of data. Query was run on a Rockset virtual instance with 8 vCPU and 64 GB RAM.

Question efficiency of a easy question on just a few fields of knowledge. Question was run on a Rockset digital occasion with 8 vCPU and 64 GB RAM.

Query performance of a complex unnest query. Query was run on a Rockset virtual instance with 8 vCPU and 64 GB RAM.

Question efficiency of a posh unnest question. Question was run on a Rockset digital occasion with 8 vCPU and 64 GB RAM.

Rockset was in a position to ship question response occasions within the vary of double-digit milliseconds, even when dealing with workloads with excessive ranges of concurrency.

To find out if Rockset can scale linearly, we evaluated question efficiency on a small digital occasion, which had 4vCPU of compute and 32 GiB of reminiscence, in opposition to the medium digital occasion. The outcomes confirmed that the medium digital occasion lowered question latency by an element of 1.6x for the primary question and 4.5x for the second question, suggesting that Rockset can scale effectively for our workload.

We appreciated that Rockset achieved predictable question efficiency, clustered inside 40% and 20% of the common, and that queries persistently delivered in double-digit milliseconds; this quick question response time is crucial to our person expertise.


We’re presently phasing real-time scientific trial monitoring into manufacturing as the brand new operational knowledge hub for scientific groups. We’ve been blown away by the velocity of Rockset and its capability to help advanced filters, joins, and aggregations. Rockset achieves double-digit millisecond latency queries and may scale ingest to help real-time updates, inserts and deletes from DynamoDB.

In contrast to OpenSearch, which required handbook interventions to realize optimum efficiency, Rockset has confirmed to require minimal operational effort on our half. Scaling up our operations to accommodate bigger digital cases and extra scientific sponsors occurs with only a easy push of a button.

Over the subsequent yr, we’re excited to roll out the real-time examine participant monitoring to all clients and proceed our management within the digital transformation of scientific trials.

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