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Comment by fishpen0 | Hacker News Reader

We have investor pressure to use specific cloud providers. This is the Healthcare version of Walmart not letting their partners use AWS. Due to their (Amazon, Google) vertical integration slowly moving in on healthcare turf, many healthcare partners/payers/investors are adding contractual pressure to exit AWS or GCP and move to Azure specifically. Wondering how your cloud support in general looks. Your previews are all AWS-centric

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We currently support AWS but use terraform for deployment, which is pretty cloud agnostic. So far, we haven't gotten any major requests for expanding to other cloud providers and most of our incoming customers are already on AWS anyways.

One of the main reasons why healthcare players were moving onto Azure was for in-built HIPAA compliant OpenAI access. We've been able to help our customers directly sign BAAs with OpenAI so this wasn't a concern.

> for in-built HIPAA compliant OpenAI access

Sorry but what?

A lot of healthcare companies are wanting to use GPT4, Whisper, and other LLMs from OpenAI, but these aren't HIPAA compliant out of the box. You still have to sign a BAA with OpenAI and get on their zero data retention (ZDR) plan.

Because of the close partnership with Microsoft and OpenAI, Azure makes it easy to get HIPAA compliant access to certain OpenAI models without having to go through OpenAI directly. This is why a lot of AI healthcare companies were building on Azure at first. Hope this clarifies!

> We currently support AWS but use terraform for deployment, which is pretty cloud agnostic.

Nothing could be further from the truth.

You’re right but the kind of people who buy this service buy into the perception that Terraform is cloud agnostic, and perception is reality.

Another POV is that the compliance companies sell the holistic social experience of compliance. The people for whom this matters need checkboxes and don’t mind paying for consulting disguised as a CSA. In fact they may even prefer it.

At the end of the day, whether its AWS S3, GCP Buckets, Azure Blob Storage, or EKS, AKS, GKE — there are services to serve as drop in replacements for their competitors. The principles of deployment will remain the same as it pertains to access and compute allocation, but obviously the resource definitions, and the definition syntax, is unique. We’re solely focused on building out our AWS support (a function of market pull), and plan to use the same architecture design for additional cloud providers when it comes time to make that jump.

Completely get where you’re coming from w.r.t. organizations looking to check a box. If we wanted to sell to those organizations, we would stop short of architecting their infrastructure and implementing best practices. A checkbox is never enough, and a point in time review can be easily gamed.

While you're right about the access to AI models on Azure, I wouldn't tie my infrastructure to Azure just for that. Sure, you might have to use them for that service, but ship the queries in & the results back to a cloud of choice; especially LLMs in most uses cases won't represent a huge amount of data; the costs of egress < the costs of dealing with Azure.

We're (now only partially) on Azure for reasons stated upthread: desire from the industry. We've partially moved since, and the experience as a whole has soured me on Azure as a reliable cloud provider (I've had to engage with support far more often). Their support, in particular, is terrible¹, and a lot of their offerings IME are less stable or harder to work with than AWS. I'm now moderately experienced with GCP, and I think GCP has them beat, too.

¹missed SLAs, a huge desire to close tickets prematurely, failures to address things asked of them, really bad communication skills, constantly divorcing replies into new threads, dredging up asked & answered stuff, repeatedly asking questions covered in the original ticket's opening set of answers, asking the customer for stuff they should know, etc.

Sorry to hear that your experience with Azure has been sub-par. I know there was a sizable wave of people that migrated over to Azure for the AI models but haven't heard too much from them since. Interesting to hear about your experience...

I'm in banking and we have similar pressure to leave AWS, but for different reasons. Simply too many banking services are already on AWS, and if a single could goes down it mustn't take most of banking infrastructure of a country.

I figured most of the big banks still use AS400s. Have they finally shed those?

Surely mainframes?

I work at a mega bank and I haven't heard this angle yet. We are pushing lots to cloud. We have "yes, we're serious" resiliency and regulatory requirements though.

Regulatory is where a country in which we do business has requirements for how we run our infrastructure. Luxembourg is notorious for being the most demanding.

https://dantheengineer.com/bank-of-england-worried-about-con...

Interesting, haven't heard of this. Always figured aws and gcp were ahead of azure in terms of Healthcare

They are, so I want to smash my face in once a month or so when this boogeyman is dragged up out of hell during executive calls

They're ahead technically, but, for example, Microsoft has its claws in a lot of the NHS in the UK.

AWS is fine for building out HIPAA services. They have a decent portal at https://aws.amazon.com/compliance/hipaa-compliance/ explaining their compliance, which services you can use, and how to get them to sign a Business Associate Agreement (BAA).

I haven't done healthcare stuff in GCP or Azure so I can't compare, but AWS is _not_ a blocker for HIPAA.

> I haven't done healthcare stuff in GCP

My understanding is that Google will not agree to any of the liability provisions inherent to a BAA, no matter how large your size.

Someone else linked to https://cloud.google.com/security/compliance/hipaa which says:

> Google will enter into Business Associate Agreements with customers as necessary under HIPAA.

Huh! That's a pleasant surprise.

I've heard that that page is outdated and instead if you sign into G Suite as an admin, go to the admin console (admin.google.com/ac/companyprofile/legal) and then go to "Security and Privacy Additional Terms" you can review sign a BAA.

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