Healthcare (Outpatient Clinics)
US
5
10 weeks
The client is a small healthcare organization operating outpatient clinics in the US. Internal teams depend on a web application for patient scheduling, eligibility checks, and billing exports, which is tightly integrated with their EHR system.
The application was business-critical and any downtime directly affected clinic check-in processes and downstream billing operations.
The client was running the application on an on-premises VMware environment that was becoming increasingly risky to operate.
Infrastructure components were approaching the end of life, unplanned downtime disrupted daily operations, and remote access for administrators and support teams was limited by VPN bottlenecks. Inconsistent patch management and auditability increased operational and compliance risks.
At the same time, the organization needed to move quickly. Revenue operations could not tolerate a long refactor or modernization project, so the team chose a lift-and-shift (rehost) approach (migrating first and deferring optimization) while maintaining HIPAA-aligned security controls.
Crunch-IS executed a controlled lift-and-shift migration to AWS, prioritizing speed, stability, and minimal application changes.
We designed a lightweight, production-ready AWS environment, establishing a dedicated VPC with clearly segmented public and private subnets. Web and database tiers were isolated within private networks, with controlled access granted to clinic staff and administrators.
Baseline EC2 configurations were prepared for Windows workloads, including a patching strategy, hardened AMIs, and a repeatable instance provisioning process.
To minimize risk and meet tight timelines, application refactoring, architectural redesign, and major EHR interface changes were intentionally deferred and kept out of scope for this phase.
Before execution, we mapped dependencies to identify EHR interfaces, scheduled export jobs, authentication flows, and supporting services.
The migration was structured into clear waves:
Each wave included defined rollback steps and risk mitigation measures for performance, connectivity, and data consistency.
Given the lift-and-shift constraint and the need to minimize application changes, we implemented a SQL Server migration approach compatible with the existing environment.
Data synchronization was handled using low-impact methods compatible with the client’s SQL Server edition, keeping the system operational until the final cutover. During migration, write activity was briefly paused, a final sync was completed, and connections were switched after validating key transactions and reports.
Only essential configuration changes were introduced, such as database endpoints, internal URLs, and certificates.
Infrastructure was codified using Terraform to ensure repeatability and reduce manual intervention. A controlled deployment process for configuration updates replaced ad-hoc “RDP-and-click” changes, reducing operational risk.
Security was integrated into the environment from the outset. Data was encrypted at rest and in transit, access was restricted using least-privilege IAM roles, and broad administrative access was eliminated.
Auditability was enhanced through centralized logging and CloudTrail. HIPAA-aligned operational controls were documented, including backup retention policies and incident response procedures.
Validation addressed both technical and operational readiness. Data reconciliation checks ensured consistency between billing and encounter data, while performance tests simulated clinic morning-rush scenarios.
The final cutover was completed during off-hours, with the on-prem environment maintained during the initial stabilization period. Post-migration support included monitoring dashboards, aligning patch cadence, and improving cost visibility to support future optimization.
As a result of the controlled lift-and-shift migration, the client achieved the following outcomes:
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