>The answer is don't shove application traffic that has tight service level requirements onto the public internet at large and expect the same performance as private circuits or other SLA protected services.

I keep seeing this over and over again in this long thread. What's your suggestion? How does a hospital, with dozens of third party applications/devices across multiple cloud platforms do this?

We have two redundant private lines out of each hospital connecting back to primary and DR DCs and a metro connecting everything together in each region. But for things we do not own that are not hosted locally, what are we supposed to do? We have to go out DIA to get there. Everything we own is connected via fully SLAed private lines. We have zero issues there. I think people vastly underestimate just how much in the healthcare vertical is outside of a medical providers control/ownership.

- Mike Bolitho

On Tue, Mar 17, 2020 at 9:54 AM Tom Beecher <beecher@beecher.cc> wrote:

The answer is don't shove application traffic that has tight service level requirements onto the public internet at large and expect the same performance as private circuits or other SLA protected services.

On Tue, Mar 17, 2020 at 11:40 AM Mike Bolitho <mikebolitho@gmail.com> wrote:

If an x-ray machine won't work because the Internet is down, I'm not sure that is responsible. As inefficient as it may be to have a license server on-prem if there is an option to check against one in the public cloud, for a medical use-case, that would make more sense to me.

Totally agree with you. Unfortunately it's not a problem with the medical providers, it's a problem with the medical devices. Anybody who works in the healthcare vertical will tell you just how bad medical devices are to work with from an IT perspective. And that is part of my original comments.

In your case, I am not sure I have an answer for you, unfortunately. The public Internet is what it is, mostly best-effort. Your applications and use-cases certainly deserve better than that. I'm not sure how to achieve that as your industry shoves more and more activity into the public Internet domain, for one reason or another.  

I don't know what it's going to take either. A general shift in mentality from the vendors we use I guess. I'm not sure how you get a bunch of medical providers to tell these companies they need to fix their stuff. You can't exactly use your wallet to force change either. There are only a handful of vendor options out there so there isn't a ton of choice. It's not like you can buy one of 50 different models of CT machines or EHR systems.

Generally speaking it's not an issue. It's just in crazy times like these where, if congestion on the public internet gets too crazy, that certain platforms might need to be deemed "unnecessary". Is playing Fortnight a right? Is streaming a movie in 4K a right? In cases like San Francisco they have decided that leaving your home for anything other than work or medical care is no longer a right because you're now infringing on other's rights by potentially getting them sick. Maybe 4K Netflix fits into that category if you're causing problems for first responders and hospitals trying to save lives.

- Mike Bolitho

On Tue, Mar 17, 2020 at 2:22 AM Mark Tinka <mark.tinka@seacom.mu> wrote:

On 16/Mar/20 16:54, Carsten Bormann wrote:

> I recently had to reschedule an X-ray because the license manager for the X-ray machine was acting up.  I don’t think people have a grasp for how much of the medical infrastructure no longer works when the Internet is down.

I get this, to some extent. But also, there is a reason hospitals,
airports and military installations are either put on special power
grids or invest plenty of money in backup power.

If an x-ray machine won't work because the Internet is down, I'm not
sure that is responsible. As inefficient as it may be to have a license
server on-prem if there is an option to check against one in the public
cloud, for a medical use-case, that would make more sense to me.

Mark.