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Azure HIPAA/HITRUST Health Data and AI - with (IaaS Extension)

Deployment guide

The components for deploying the solution can be downloaded from the Azure Security and Compliance Blueprint - HIPAA/HITRUST Health Data and AI repository on Github. For integration with PowerShell, it is necessary to have Git for Windows installed.

CAUTION The script adds domain users to the Azure Active Directory (AD) tenant that you specify. We recommend creating a new Azure Active Directory (AD) tenant to test this solution.

CAUTION It is recommended you use a clean Windows 10 (or similar) VM to deploy the solution to ensure that the correct PowerShell modules get loaded.

CAUTION If you encounter any issues during the deployment, see FAQ and troubleshooting

CAUTION Deployment script must be monitored while the deployment is running. You will be prompted for the global admin username/password during the deployment.

CAUTION To add enhanced protection of the deployment, it is highlight recommended that MFA be used on ALL deployments.

Deploy the solution

You need to copy, or clone the repository. Once you have a copy of the Blueprint automation, you can deploy the solution by using the deploy.ps1 PowerShell script. Once the PaaS solution deployment has been created, you can then deploy the IaaS extension element using deployIaaS.ps1, as documented below.

Required administrator roles

The person installing the blueprint must be in the Global Administrator role in the AAD. The installing account must be an Azure subscription administrator for the subscription being used. If the person doing the install is not in both of these role, the installation will fail.

Further, the install is not designed to work with MSDN subscriptions due to the tight integration with AAD. A standard Azure account must be used. If needed, get a free trial with credit to spend for installing the blueprint solution and running its demos.

  1. Once the repository has been copied, or cloned change your working directory to Deployment:
cd  .\Deployment\
  1. Run deploy.ps1 with the installModules switch to install and verify all necessary powershell modules are ready:
.\deploy.ps1 -installModules
  • It is recommended that if an error is flagged during deployment, that the errors be resolved prior to proceeding or retrying.
  • Time to deploy the solution will be approximately 25 minutes.
  1. Once the modules are installed, run deploy.ps1 again to deploy the solution. For detailed usage instructions, see deploy.ps1 usage
  • NOTE: The script asks you to supply a value for the globalAdminPassword parameter; enter the password for the administrative account you are using for the -globalAdminUsername parameter. The script then deploys the solution, which may take some time, monitoring the 25 minute deployment is recommended, since during the deployment Global username, and Password pop up dialog windows will appear.

  • The script will be complete when the results of the \deployment\output\<deployment-prefix>-deploymentOutput.json displayed onscreen.

deploy.ps1 usage

Deploys or manages the Azure Solution for Healthcare.

Example 1: Installing required modules

            .\deploy.ps1 -installModules

This command validates,and installs missing PowerShell modules that the solution requires.

Example 2: Deploying the solution in a test environment

.\deploy.ps1 -deploymentPrefix <prefix>
             -tenantId <tenant-id>
             -tenantDomain <tenant-domain>
             -subscriptionId <subscription-id>
             -globalAdminUsername <username>
             -deploymentPassword <password>
             -enableMFA

This command deploys the solution and sets a single common password for all solution users, for testing purposes.

Uninstall the solution

.\deploy.ps1 -clearDeploymentPrefix <deployment-prefix> 
             -tenantId <tenant-id>
             -subscriptionId <subscription-id>
             -tenantDomain <tenant-domain>
             -globalAdminUsername <username>
             -clearDeployment

Uninstalls the solution, removing all resource groups, service principles, AD applications, and AD users.

NOTE- Do not uninstall the solution if you are going to deploy the Health Extension.

deployIaaS.ps1 usage (Health Extension)

DeployIaaS.ps1 should be run once the deployment of the PaaS solution has completed successfully. This health extension will provide additional capabilities, including the addition of at Windows Server VM, and SQL server deployment.The purpose of the extension is to show-case best practices such as the following:

  1. “Start Secure” – enable security capabilities and monitoring of the IaaS VM work-load before any sensitive data or work-load processing takes place.
  2. Extend the existing PaaS sample to show secure co-existence between PaaS and IaaS VM work-load elements.
  3. Illustrate recently introduced security and deployment capabilities of ASC, ARM templates, and powershell automation.
.\deployIaaS.ps1 -deploymentPrefix <prefix>
             -tenantId <tenant-id>
             -tenantDomain <tenant-domain>
             -subscriptionId <subscription-id>
             -globalAdminUsername <username>
             -deploymentPassword <password>
             -enableMFA

This command deploys the IaaS solution for testing purposes.

Extension deployment Example

.\deployIaaS.ps1 -deploymentPrefix <prefix> [Any max 5 length prefix e.g. demo1, test99, etc]
             -tenantId <tenant-id> [“XXXXXXXX-XXXX-XXXX-XXXX-XXXXXXXXXXXX”] 
             -tenantDomain <tenant-domain> [“XXXXXXXX.com”]
             -subscriptionId <subscription-id> [XXXXXXXX-XXXX-XXXX-XXXX-XXXXXXXXXXXX]
             -globalAdminUsername <username> [Pass provided Username, if any]
             

Description of files specific to the IaaS extension

  1. deployIaaS.ps1 - Deployment script for IaaS extension. Executed after PaaS deploy.ps1 has completed execution. Includes code to setup resource group, service identities and AD configuration, keyvault key for SQL TDE, and ARM templates deployment.
  2. scripts\pshscripts\PshFunctionsIaaS.ps1 - Powershell deployment script helper routines: 1) Preparation of SQL VM payload artifacts (sample data set, and code to install it). 2) Code to setup MSI access to SQL PaaS instance, and configure firewall, 3) code to create azure key vault key for SQL TDE, and update SQL IaaS extension configuration.
  3. templates\WindowsSqlVirtualMachine.json - ARM template which does SQL VM deployment, creates keyvaults, and configures several VM extensions.
  4. templates\WindowsSqlVirtualMachinePayload.json - ARM template which uses CustomScriptExtension to execute and report status of sql-setup.ps1, within the Sql IaaS VM.
  5. stage\sql-setup.ps1 - Powershell code that executes on the SQL VM, which resets the adminstrator credential to a new random value, and then configures SQL TDE with keyvault integration, imports sample data set, and executes query against PaaS SQL instance using managed service identity (MSI) for authentication. See comments at the top of sql-setup.ps1 file for more info.
  6. stage\artifact\LengthOfStay-IaaSDemo.csv - Sample data set, imported to SQL IaaS instance.
  7. stage\artifact\patientdb_schema_nolos.sql - Schema associated with LengthOfStay-IaasDemo dataset.
  8. stage\artifact\sql-setup-functions.ps1 - Helper function used by sql-setup.ps1 to facilitate administrator impersonation.
  9. IaaS extension howto.txt -description of key code elements that implement the solution.

Parameters for deploy.ps1 and deployIaaS.ps1

At least one parameter must be present to successfully run the script.

-clearDeployment Uninstalls the solution, removing all resource groups, service principles, AD applications, and AD users. Must be used with the -clearDeploymentPrefix switch

-clearDeploymentPrefix Uninstalls the solution, removing all resource groups, service principles, AD applications, and AD users. Must be used with -cleardeployment switch

-deploymentPassword If this parameter is set, all of the passwords used within the solution are set to the supplied value. The deploymentPassword parameter is intended for testing purposes and should not be used in a production environment. If this parameter is not used, the script generates and displays strong passwords for every role/account.

-deploymentPrefix A string of 1 to 5 alphanumeric characters that is used to create distinct resource group names. If you run the script multiple times, you must choose a different prefix each time to avoid conflicts with other resources.

-enableADDomainPasswordPolicy Only applicable to deploy.ps1. Include this switch when deploying the solution to set the password policy to 60 days at the Domain level.

-enableMFA Only applicable to deploy.ps1. Include this switch when deploying the solution to enable multi-factor authentication for solution users.
This feature - is optional - but highly recommended. Enabling MFA will require additional configurations outlined in the following Azure MFA documentation. Using MFA for all administrators, including global administrators is highly recommended to prevent unauthorized use of the subscription Global Admin.

-installModules Installs and updates all necessary PowerShell modules. Run the script with this switch before performing the deployment to ensure that all necessary modules are present.

-globalAdminUsername Typically, this is the username of the user performing the deployment. Use a valid Azure Active Directory OrgID username (example: "alex@contosohealthcare.onmicrosoft.com") rather than a Microsoft or corporate account name (example: "alex@contoso.com").

-subscriptionId For the subscription ID, sign in to the Subscriptions view in the Azure portal. The subscription you are using should be listed in the table, along with its associated subscription ID, a GUID.

-tenantDomain The tenant domain is the default directory name listed under your account name in the dashboard followed by ".onmicrosoft.com" (example: "contosohealthcare.onmicrosoft.com").

-tenantId To find the Azure tenant ID, click Azure Active Directory in the dashboard sidebar, and under Manage, click Properties. The tenant ID is a GUID in the box labeled Directory ID.

-appInsightsPlan

Only applicable to deploy.ps1. Provides the ability to select your Application Insights plan level. Default is set to 1. 0 – Set up App Insights with Application Insights Basic Plan. 1 – Set up App insights with Application Insights Enterprise Plan. 2 – Deploys App Insights without any billing plan. Subscriptions such as BizSpark, where there is a spending limit, the use of option "2" is required. -appInsightsPlan 2

Grant permissions in Azure Active Directory

  1. Log in to Azure portal using Alex_SiteAdmin

  2. In the Azure portal, click Azure Active Directory in the sidebar.

  3. Click App registrations.

  1. Select dropdown and change My apps, to All apps.

  2. Click <deployment-prefix> Azure HIPAA LOS Sample.

  3. Click Required permissions.

  4. Click Grant Permissions at top. Select grant permissions for all accounts in the current directory. Click Yes.

When deployment is complete, an output json file is located in .\output called <deployment-prefix>-deploymentOutput.json. It lists all the components installed. The demo script requires this file to continue.

Integrate Application Insights

Use the Microsoft Operations Management Suite portal to integrate Application Insights into the Log Analytics tool.

  1. In the Azure portal, select Log Analytics

  2. Click <deployment-prefix> -los-analytics-dev.

  3. Click OMS Portal

  1. In the OMS portal, click the Settings icon at the top of the page. Click Data on the left, and then click Application Insights.

  2. Under Select a subscription, select a subscription that has Application Insights resources, and then under Application Name, select one <deployment-prefix> -los-insights-dev.

  3. Click Save.

Uninstall solution and clean up deployment resources

To uninstall the solution, run the deployment script again with the following parameters:

.\deploy.ps1 -deploymentPrefix <deployment-prefix> 
             -tenantId  <tenant-id>
             -subscriptionId <subscription-id>
             -tenantDomain <tenant-domain>
             -globalAdminUsername <username>
             -clearDeployment

if deployIaaS.ps1 was used to deploy the IaaS extension, the following can be used to remove the IaaS elements:

.\deployIaaS.ps1 -deploymentPrefix -tenantId -subscriptionId -tenantDomain -globalAdminUsername -clearDeployment

The script asks you to supply a value for the globalAdminPassword parameter; enter the password for the administrative account you are using for the -globalAdminUsername parameter. The script then removes all resource groups, service principles, AD applications, and AD users.

Deploying and running the demo OVERVIEW

The following overview will provide you understanding on the provided demonstration of the blueprint.

The Blueprint was designed to provide you a demonstration that will:

  • INGEST data raw sources including FHIR data source
  • STORE sensitive information
  • ANALYZE and predict outcomes
  • INTERACT with the results and perditions
  • IDENTITY management of solution
  • SECURITY enabled features

Upon completion deploying the solution, IDENTITY, SECURITY enabled features are available to be used in your Azure Portal. The remainder of the demonstration steps are as follows:

  • The sample dataset used throughout this demonstration can be reviewed in Blueprint\Deployment\trainingdata.
  1. INGEST, STORE, ANALYZE (Import and Train a Machine Learning experiment) The sample data contains 100,000 sample, anonymized medical records. This data is imported, and secured using the sample functions, at the same time the data is used to train a sample R-function Machine Learning experiment created in Azure Machine Learning Studio. The experiment was designed to predict the duration a patient would likely stay in the hospital based on the health conditions collected in the sample data.

  2. INGEST, STORE, ANALYZE (patients admission) Once the Experiment in Azure Machine Learning studio is trained, the sample applet is used to admit 10 new patients .\Deployment\scripts\demoscripts\admit by the care line manager (health provider). This data is stored securely, logged, and the Experiment provides a predicted length of stay for each patient.

  1. INTERACT (Data visualization) using PowerBi reflects the last step of the demonstration.

More information about data science and Azure Machine Learning can be found on in Azure documentation on Azure Machine Learning.

Deploying and running the demo STEPS

NOTE Do not proceed with running the demo before following the previous instruction to configure permissions correctly; "Grant permissions in Azure Active Directory".

STEP 1 - Import and Train a Machine Learning experiment (Database Analyst role)

After deploying the Blueprint, the first step in running the length-of-stay (LOS) demonstration project is for the user created by the deployment script to input the sample historical patient data into the solution.

To input the data, navigate to the \Deployment\scripts\demoscripts\ directory in PowerShell and run the following script:

.\HealthcareDemo.ps1 -deploymentPrefix <deployment-prefix> -Operation Ingestion

<deployment-prefix> is the prefix you selected when installing the solution.

To confirm that the data has been successfully ingested, log into the Azure portal using the Danny_DBAnalyst account. Click SQL databases in the sidebar, and then click patientdb. Click Data explorer (preview) to open an interface for executing SQL queries. To check the number of rows in the PatientData table, run the following query:

SELECT COUNT (*)
  FROM [dbo].[PatientData]

It should return a result of 100,000 rows, representing several years' worth of historical patient data. To check the integrity of the data, run the following query:

 SELECT TOP 100 *
  FROM [dbo].[PatientData]

Will displays the first 100 rows from the table. You can observe that the first, middle, and last names of each patient are now encrypted at rest in the database.

STEP 2 - Patient admission (Care Line Manager role)

Chris, the care line manager, adds newly admitted patients to the database by uploading their information in FHIR format. These records are stored in 10 individual .json files, one for each patient, in the \Deployment\scripts\demoscripts\admit directory.

To upload these records, navigate to the \Deployment\scripts\demoscripts\ directory in PowerShell and run the following script:

.\HealthcareDemo.ps1 -deploymentPrefix <deployment-prefix> -Operation BulkPatientAdmission

A browser window appears asking for credentials. Log in using the credentials for the Chris_CareLineManager account. The PowerShell window shows the progress of the upload. (If permissions are not set correctly, this step results in an error. For more information, see "Grant permissions in Azure Active Directory" in the deployment documentation for more information.

To confirm the addition of the new records, log into the Azure dashboard using the Danny_DBAnalyst account. In the SQL query window, run the following query:

SELECT COUNT (*)
  FROM [dbo].[PatientData]

It should report 100,010 records, 10 more than after import step.

Option step - Patient discharge (Care Line Manager role)

Chris, the care line manager, is also responsible for keeping track of patient discharges by uploading discharges in FHIR format. As with the admission records, the discharge records are stored in individual .json files, in the \Deployment\scripts\demoscripts\discharge directory.

To upload these records, navigate to the \Deployment\scripts\demoscripts\ directory in PowerShell and run the following script:

.\HealthcareDemo.ps1 -deploymentPrefix <deployment-prefix> -Operation BulkPatientDischarge

A browser window appears asking for credentials. Log in using the credentials for the Chris_CareLineManager account. The PowerShell window shows the progress of the upload. To confirm the discharges, log into the Azure dashboard using the Danny_DBAnalyst account. In the SQL query window, run the following query:

SELECT TOP 20 *
  FROM [dbo].[PatientData]
  ORDER BY EId DESC

It shows that the six most recently admitted patients have been discharged.

Machine learning (Data Scientist role)

Machine learning enables computers to learn from data and experiences and to act without being explicitly programmed. The length-of-stay solution includes two Azure Machine Learning experiments written in the R statistical programming language that can be used to predict how long a newly admitted patient is likely to remain in the hospital.

To work with these experiments, visit the Azure Machine Learning Studio website at https://uswestcentral.studio.azureml.net/ and log in using the Debra_DataScientist account. Click the server drop-down list in the upper right, select West Central US as the region, and then ensure that the correct resource group (the one beginning with your deployment prefix) is selected under Workspace. Two experiments display.

  • Healthcare.Blueprint-Predicting Length of Stay in Hospitals runs when the historical training data is ingested and when patients are discharged. It imports each patient record into a multidimensional space in which each column containing relevant health information---gender, pulse rate, body mass index, blood glucose level, and so forth---is plotted in its own dimension.

  • Healthcare.Blueprint.Predictive Experiment - Predicting Length of Stay in Hospitals is the predictive experiment. For each new patient, it plots the patient's intake statistics in the multidimensional space and uses a clustering model to predict a discharge date based on the length-of-stay figures of other patients that are close to it.

You can modify these experiments and create new ones to explore new machine learning possibilities. For more information, see Azure Machine Learning Studio documentation for more information about Machine Learning Studio and working with experiments.

STEP 3 - Data visualization (Chief Medical Information Officer and Care Line Manager roles)

The solution provides a simple Microsoft PowerBI visualization of the solution. Microsoft PowerBI is required to open the sample report located (Using PowerBi free edition works for this demo, but will not allow for reports to be shared) Blueprint\Deployment\Reports\

To use the report, you will be required to download a local copy of both fills located in the reports folder.

  • Healthcare-CLM,CMIO Report.pbix
  • Microsoft_DIM.xlsx

The xlsx file provides local look up of data to help create additional dimension to the results.

The PBIX file contains cached data when first opened. To connect it to your live data source:

  1. In the Home tab of the Ribbon, click Edit queries on the Home tab of the Ribbon, and then click Data source settings.

  1. Select the database and click Change source. This will be required for the Microsoft_DIM.xlsx file as well.

  1. In the Server text box, change the name of the server to .database.windows.net. You can find the SQL server name in the Azure dashboard. Click OK.

  2. Click Edit permissions, and then click Edit.

  3. In the left column, select Database. Enter SqlAdmin under User name, and enter the global deployment password under Password. Click Save.

  4. Click OK, and then click Close.

  5. Repeat the process and update the source location of the Microsoft_DIM.xlsx file.

  6. In the Ribbon, click Refresh. Data is loaded from the database.

If you receive an error saying that your IP is not allowed, you need to grant permission for the computer that Power BI is running on to access the database. Log in to the Azure dashboard using the Danny_DBAnalyst account, click SQL databases in the left column, select the correct database, and click Set server firewall in the bar at top right.

If you are logged in to the Azure dashboard on the computer on which Power BI is running, you can click Add client IP to automatically grant the computer access to the database. Otherwise, enter the IP address manually. Click Save and you should be able to connect to the database by clicking Refresh again in Power BI.

Disclaimer and acknowledgments

July 2018

This document is for informational purposes only. MICROSOFT AND AVYAN MAKE NO WARRANTIES, EXPRESS, IMPLIED, OR STATUTORY, AS TO THE INFORMATION IN THIS DOCUMENT. This document is provided “as-is.” Information and views expressed in this document, including URL and other Internet website references, may change without notice. Customers reading this document bear the risk of using it. This document does not provide customers with any legal rights to any intellectual property in any Microsoft or Avyan product or solutions. Customers may copy and use this document for internal reference purposes.

Note

Certain recommendations in this material may result in increased data, network, or compute resource usage in Azure, and may increase a customer’s Azure license or subscription costs.

The solution in this document is intended as an architecture and must not be used as-is for production purposes. Achieving Health compliance (such as HIPAA, or HITRUST) requires that customers consult with compliance or audit office.

All customer names, transaction records, and any related data on this page are fictitious, created for the purpose of this architecture, and provided for illustration only. No real association or connection is intended, and none should be inferred. This solution was designed by Microsoft with development support from Avyan Consulting. The work in its entirety, or parts are available under the MIT License. This solution has been reviewed by Coalfire, a Microsoft auditor. The HIPAA, and HITRUST Review provides an independent, third-party review of the solution, and components that need to be addressed.

Disclaimer

The deployment script is designed to deploy the core elements of the Azure Security and Compliance Blueprint - HIPAA/HITRUST Health Data and AI. The details of the solutions operation, and elements can be reviewed at aka.ms/healthcareblueprint Copyright (c) Microsoft Corporation, Avyan Consulting Corp., and KenSci - All rights reserved. Permission is hereby granted, free of charge, to any person obtaining a copy of this software and associated documentation files (the "Software"), to deal in the Software without restriction, including without limitation the rights to use, copy, modify, merge, publish, distribute, sublicense, and/or sell copies of the Software, and to permit persons to whom the Software is furnished to do so, subject to the following conditions: The above copyright notice and this permission notice shall be included in all copies or substantial portions of the Software. THE SOFTWARE IS PROVIDED "AS IS", WITHOUT WARRANTY OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE AND ONINFRINGEMENT. IN NO EVENT SHALL THE AUTHORS OR COPYRIGHT HOLDERS BE LIABLE FOR ANY CLAIM, DAMAGES OR OTHER LIABILITY, WHETHER IN AN ACTION OF CONTRACT, TORT OR OTHERWISE, ARISING FROM, OUT OF OR IN CONNECTION WITH THE SOFTWARE OR THE USE OR OTHER DEALINGS IN THE SOFTWARE.

Solution Team

John Doyle (WW Health Industry Microsoft)

Scott Feild (Azure Core Security)

Frank Simorjay (Azure Core Security)

Rajeev Rangappa ( Azure Global)

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