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 medical trials to streamline the info assortment and administration course of, with the purpose of enhancing the effectivity and accuracy of trials. Its cloud-based digital knowledge seize system allows medical trial knowledge from greater than 2 million sufferers throughout 110 nations to be collected electronically in real-time from a wide range of sources, together with digital well being data and wearable gadgets.

With the COVID-19 pandemic forcing many medical trials to go digital, Medical ink has been an more and more precious answer for its capacity to assist distant monitoring and digital medical trials. Moderately than require trial members to return onsite to report affected person outcomes they’ll shift their monitoring to the house. In consequence, trials take much less time to design, develop and deploy and affected person enrollment and retention will increase.

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

When the necessities for the brand new real-time research participant monitoring got here to the engineering group, I knew that the present technical stack couldn’t assist millisecond-latency complicated analytics on real-time knowledge. Amazon OpenSearch, a fork of Elasticsearch used for our utility search, was quick however not purpose-built for complicated analytics together with joins. Snowflake, the sturdy cloud knowledge warehouse utilized by our analyst group for performant enterprise intelligence workloads, noticed vital knowledge delays and couldn’t meet the efficiency necessities of the applying. This despatched us to the drafting board to provide you with a brand new structure; one which helps real-time ingest and sophisticated 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 celebration vendor knowledge, internet functions, cellular gadgets and wearable machine knowledge is saved in Amazon DynamoDB. Amazon DynamoDB’s versatile schema makes it simple to retailer and retrieve knowledge in a wide range 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 concerning the underlying infrastructure or scaling of the database as these are all managed by AWS.

Amazon Opensearch for Search Workloads

Whereas DynamoDB is a good alternative for quick, scalable and extremely obtainable transactional workloads, it isn’t the perfect for search and analytics use circumstances. Within the first era 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 assist extra superior analytics and supply real-time research affected person monitoring. Joins should not a first-class citizen in OpenSearch, requiring quite a few operationally complicated and expensive workarounds together with knowledge denormalization, parent-child relationships, nested objects and application-side joins which are 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 mechanically detecting and mapping the info forms of fields in a doc. Dynamic mapping was helpful as we had a lot of fields with various knowledge varieties and had been indexing knowledge from a number of sources with completely different schemas. Nevertheless, dynamic mapping generally led to sudden outcomes, equivalent to incorrect knowledge varieties or mapping conflicts that pressured us to reindex the info.

On the infrastructure facet, though we used managed Amazon Opensearch, we had been nonetheless chargeable for cluster operations together with managing nodes, shards and indexes. We discovered that as the dimensions of the paperwork elevated we wanted to scale up the cluster which is a guide, 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 assist the rising variety of paperwork. This led to compute wastage and better prices and lowered effectivity. Even when we may have made complicated analytics work on OpenSearch, we might have evaluated further databases as the info engineering and operational administration was vital.

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 studies to medical trial sponsors and supported SQL analytics, assembly the complicated analytics necessities of the applying. That mentioned, offloading DynamoDB knowledge to Snowflake was too delayed; at a minimal, we may obtain a 20 minute knowledge latency which fell outdoors 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 should be seen and queryable within the downstream database inside seconds
  • Millisecond-latency complicated analytics (together with joins): The database should be capable of consolidate world trial knowledge on sufferers right into a 360-degree view. This contains supporting complicated sorting and filtering of the info 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 assorted forms of failures and disruptions.
  • Scalable: The database is cloud-native and might 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 medical trial monitoring

Rockset initially got here on our radar as a alternative for OpenSearch for its assist of complicated 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 mix 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 fulfill the requirement for complicated 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 only some seconds delay. This made it simple for Rockset to suit into our current knowledge stack.
  • Capacity to take a number of knowledge varieties into the identical area: This addressed the info engineering challenges that we confronted with dynamic mapping in OpenSearch, guaranteeing 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 got additionally invested in a serverless knowledge stack for resource-efficiency and lowered operational overhead. We had been in a position to scale ingest compute, question compute and storage independently with Rockset in order that we now 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 assessments on Rockset by constructing a Lambda perform with Node.js:

Ingest Efficiency

The frequent sample we see is a number of small writes, ranging in measurement from 400 bytes to 2 kilobytes, grouped collectively and being written to the database continuously. 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 assessments point out that Rockset is able to attaining a knowledge latency below 2.4 seconds, which represents the period between the era of knowledge in DynamoDB and its availability for querying in Rockset. This load testing made us assured that we may constantly entry knowledge roughly 2 seconds after writing to DynamoDB, giving customers up-to-date knowledge of their dashboards. Prior to now, we struggled to attain predictable latency with Elasticsearch and had 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 assessments utilizing queries with completely different ranges of complexity:

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

We once more ran the assessments 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 a number of 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 fancy 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 constantly delivered in double-digit milliseconds; this quick question response time is important to our consumer expertise.


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

Not like OpenSearch, which required guide interventions to attain optimum efficiency, Rockset has confirmed to require minimal operational effort on our half. Scaling up our operations to accommodate bigger digital situations and extra medical sponsors occurs with only a easy push of a button.

Over the following 12 months, we’re excited to roll out the real-time research participant monitoring to all clients and proceed our management within the digital transformation of medical trials.

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