Healthcare IT Under Pressure - Improving Application Performance, Security and Resilience

Healthcare IT teams are under pressure to maintain critical systems’ availability and performance. Medical professionals need patient information on demand. Patients expect digital access to their information, and attackers relentlessly target the sector. Hospitals and other medical delivery organizations present a sizeable attack surface because of remote access, APIs between healthcare systems for data sharing, cloud services and mobile apps such as tablet computers for bedside medical information and image sharing during patient consultations. IT teams must support all of this, often with limited staff, tight budgets and in increasingly complex environments.

In a recent webinar, Healthcare IT Under Pressure: Improving Application Performance, Security and Availability, we explained one expectation that never changes. Medics, patients and administrators need reliable access to applications and data. Whether it’s an Electronic Health Records (EHR) system, an imaging platform, a telehealth app, a patient portal or the APIs that connect clinical systems, the IT simply must work.

This blog recaps the key points covered in the webinar, including application-aware availability and performance, security and hybrid consistency.

Want to watch the full session, including a live demo and the audience Q&A? You can watch the webinar on demand.

When a Slow Application Becomes an Operational Problem

Many organizations think of an IT outage as a system that has gone down. The ideas raised in the webinar ask viewers to picture something subtler. When a physician tries to open an electronic medical record and the login page loads slowly, authentication takes longer than expected and clinical data arrives slowly, this is as much of an issue as the system being offline.

Few people would call a frustratingly slow system a true outage. However, from a workflow perspective, it is effectively down and productivity is affected almost as much. Multiply that experience across hundreds or thousands of users, and a performance issue then becomes a significant operational impediment.

Patient-facing services can be affected in the same way. Patients use portals to review test results, message providers, schedule appointments and complete the forms that accompany their visit. When those systems are slow and hard to use, patients feel frustrated. Support call center volumes climb, and staff often take on tasks patients usually handle themselves.

A technical problem that slows patient systems quickly becomes an operational issue.

Availability, Performance and Security Now Move Together

The webinar grouped the pressure on healthcare IT into three challenge areas:

• Availability- Healthcare doesn’t keep nine-to-five hours. Applications that support emergency departments, clinical systems, communications and administrative functions must remain available around the clock.
• Performance - Physicians constantly move between systems while delivering care. Every delay affects their productivity and patient care.
• Security- Attackers target healthcare more than almost any other industry. Teams must protect applications, APIs, identities and encrypt traffic while keeping everything accessible and usable.

Where does resilience come from? It comes from the application delivery layer, delivered by load balancers such as the Progress Kemp LoadMaster platform. When a physician opens an EHR, a patient logs in to a portal, an imaging application requests an X-ray, or an API receives a transaction request, that traffic doesn’t need to travel directly to the various application servers providing those disparate services. Instead, it should pass through an intelligent management control point that evaluates, manages and optimizes each request before sending it to the appropriate back-end server.

People have long described the application delivery controller (ADC) as a traffic cop. The webinar offered a different analogy for healthcare use: that of an air traffic controller. Air traffic controllers don’t fly the airplanes, but they guide each one safely and efficiently to the right destination. Application delivery platforms perform the same function for data flows and access to healthcare applications.

Picture the architecture from left to right as shown in the diagram below:

Users - Physicians in the hospital, patients accessing portals from home and external partners.

Application Delivery - ADCs that sit at a privileged position on the network, between users and the applications they access.

Workloads- The back-end applications themselves, running in traditional data centers, private cloud environments, public cloud services or a hybrid mixture across all three.

The application delivery layer provides consistency across these environments. Workloads and environments can change while the operational model remains predictable. That matters when healthcare organizations move applications to different back-end platforms. The patient portal may move to the cloud, while the imaging platform stays on-premises and identity services run elsewhere. Devices and web portals can continue to access the application delivery layer, running on load-balancing ADCs and the ADCs will route the requests to the right service.

Application-Aware Availability

Conversations about high availability in healthcare usually start with redundant servers, storage and data centers. All these matter, but infrastructure redundancy alone doesn’t deliver availability. True application availability requires intelligent decision-making.

We used a scenario many healthcare organizations know well - a physician trying to access the EHR system. The infrastructure appears healthy, and the servers are running, yet the physician can’t log in because an application process has failed. A traditional network health check reports that everything is working. From the user’s perspective, the application is completely unavailable.

• Intelligent Layer 7 load balancing- Traditional layer 4 network load balancing distributes traffic. Layer 7 load balancing distributes traffic while understanding the application context. It applies application-specific policies and makes decisions based on URLs, hostnames, application content, cookies, headers or other application data.

• Advanced health monitoring- This is where teams realize the biggest gains. A server may respond to an ICMP ping or show a listening TCP port, while the application itself is unresponsive. Advanced health checks verify whether the application returns a valid response and delivers the functionality medics and patients depend on.

• Automated failover- Healthcare IT can’t depend on manual intervention. When a back-end application becomes unresponsive,the product’s automation capabilities automatically reroute user traffic to healthy resources. If an entire site goes down, it redirects traffic to a healthy site. The goal is for most users to never know a problem occurred.

• Resilient delivery architecture - Many organizations invest heavily in application redundancy but neglect the delivery layer. If traffic management becomes a single point of failure, overall resilience suffers. Teams need to design the delivery layer with redundancy and fault tolerance in mind, both within a single site and across multiple sites.

• Historical uptime views
• Application connections
• TLS/SSL transactions
• Connection distribution across back-end servers

• Balancing demand: Healthcare application activity fluctuates dramatically throughout the day, with spikes during morning rounds, shift changes and patient registration. Intelligent load balancing efficiently distributes current workload across available resources, regardless of what drives the spike.

• Context-aware routing: Different requests often require different responses or routing. Certain traffic may need specific application services or servers and certain users may need specific resources. Application-layer awareness enables smarter traffic-routing decisions than traditional network-layer routing approaches.

• Health-aware traffic management: Sending traffic to an overloaded or degraded server is among the most common causes of poor performance. The LoadMaster solution can distribute traffic based on back-end server load, including the amount of CPU, memory and GPU utilization. It sends each new request to a server with the most available resources rather than to one already busy with other requests.

• Web application firewall (WAF) - Traditional firewalls focus on network-level threats, which remain critical. The LoadMaster WAF capability focuses on application-level attacks. As healthcare organizations expose more applications and APIs, both externally and internally, application-layer protection becomes increasingly important. A patient portal on the internet illustrates the point perfectly - it must remain accessible to external and internal patients while resisting web-based attacks.

• Pre-authentication - Because every application requires users to authenticate, the load balancer is a logical place to handle it. When the application supports it, the LoadMaster platform can enforce authentication before forwarding traffic to the application server. This adds a layer of security on top of the WAF and teams can enable multifactor authentication for additional protection.

• Operational simplicity- Healthcare teams (and others!) often add additional products to solve individual problems. Over time, their security architecture fragments across consoles, policies and reporting systems, increasing complexity and risk. Integrating security into the application delivery layer helps reduce that sprawl. Security, performance and availability become part of the same strategy, improving operational efficiency without sacrificing protection.

• The top 10 triggered rules, top 10 requests by IP address and top 10 blocked URLs.
• A list of false-positive activity you can investigate to understand why the WAF flagged each request.
• A smart rule tuner that builds custom WAF rules to permit legitimate traffic in the future.
• A global map that shows where blocked connections originate, with drill-down from regions to individual countries.

The LoadMaster 360 platform also includes authentication dashboards and widgets. Once you enable pre-authentication, you can view active sessions across published applications, a heat map of successful or failed authentications and lists of blocked users.

Consistency Across Hybrid and Multi-Cloud Environments

Once availability, performance and security are addressed, the next question that usually follows is, “How can we maintain these capabilities when applications span multiple environments?” Very few healthcare organizations operate in a single environment. Some applications still run in traditional data centers, while others have moved to private, public, hybrid or multi-cloud infrastructure.

This creates a challenge that goes beyond technology and becomes operational. The risk isn’t simply that applications live in different places. The risk is that operational practices spread out, with different teams, environments, security models and monitoring tools. Visibility fragments and complexity increases.

That’s why ADC consistency matters. The objective isn’t to put every application in the same location, which often isn’t possible. The objective is a consistent application delivery operational model wherever those applications are run.

The LoadMaster solution supports that model with deployment options that include hardware appliances, virtual appliances and cloud deployments. Add LoadMaster 360 visibility across those environments, and you get a single platform and view into what’s happening, which simplifies management and troubleshooting across platforms.

Two Major Questions From Webinar Attendees

Q: Does site failover rely solely on DNS?

A: The short answer is yes, but the LoadMaster adds intelligence to DNS through global server load balancing (GSLB). GSLB uses health checks to assess application health at each site, so failover isn’t all-or-nothing. You can fail over a single application to a different site, or, if an entire site goes down, fail over all applications. GSLB offers flexibility for multi-site environments spanning data centers and the cloud. It supports both active-passive configurations for disaster recovery and active-active configurations.

Q: Do I need to buy LoadMaster 360 separately?

A: It depends on your LoadMaster licensing model. If you use pooled licensing, your license includes LoadMaster 360, as LoadMaster 360 manages the pooled license. If you use perpetual licensing, LoadMaster 360 requires a separate purchase.

Final Thoughts

Healthcare IT teams can’t control rising staff and patient expectations or the threat landscape. But they can control how they deliver applications. A consistent application delivery strategy improves availability, performance and security across every environment where you run applications.

Explore how the LoadMaster load balancing solution can help streamline your healthcare application delivery.

Arrange a LoadMaster Assessment– Get a detailed analysis of how the product’s security-first architecture and transparent practices can strengthen your infrastructure, along with an expert-led demo.

Download the 30-Day Trial– Experience LoadMaster hands-on via a free 30-day trial backed by full support from Progress’ technical team.

Contact Us– Speak with a LoadMaster specialist about how transparency and architectural simplicity can improve your delivery and security posture.