Windows AzureCustomer Solution Case Study

Global Leader in Cognitive Science Chooses Cloud for New Online Memory Assessment

OverviewCountry or Region: CanadaIndustry: Healthcare

Customer ProfileCogniciti is a for-profit joint venture between Baycrest, the world’s healthcare leader in the study of memory and aging, and MaRS, Canada’s premiere innovation center. The company is based in Toronto, Ontario.

Business SituationCogniciti is delivering an Online Memory Assessment to help adults determine whether their forgetfulness is due simply to normal aging or whether they should see a doctor. Cogniciti wanted to avoid the distractions, delays, and expenses involved with building its own scalable IT infrastructure.

SolutionCogniciti chose to work with Microsoft and Navantis and is building its Online Memory Assessment on Windows Azure.

Benefits Low up-front and long-term costs Superior scalability and reliability Rapid time-to-market and strong

business agility Cost-effective storage and powerful

analytical tools

“Windows Azure is helping us ‘change the game’ through the rapid, cost-effective delivery of a clinically valid online assessment for memory loss, and will make it just as painless to scale its delivery to a global level."

Michael Meagher, President, Cogniciti

Cogniciti is a for-profit joint venture between Baycrest, the world’s healthcare leader in the study of memory and aging, and MaRS, Canada’s premiere innovation center. In preparing to deliver its first solution, an Online Memory Assessment to help adults determine whether their forgetfulness is due to normal aging or whether they should see a doctor, the company wanted to avoid the effort and costs involved with building a scalable IT infrastructure on its own. Cogniciti chose to build its solution on Windows Azure, which it can use to rapidly and cost-effectively bring the best of Baycrest healthcare to the rest of the world. And as Cogniciti continues to move forward, it will benefit from low up-front and ongoing costs, strong scalability and reliability, rapid time-to-market, cost-effective storage, powerful analytical tools, and guidance and support from a trusted partner.

SituationLocated on a 22-acre campus in Toronto, Ontario, Baycrest is a global leader in the field of brain health and aging. In 2009, Baycrest partnered with MaRS, the leading Canadian innovation center, to commercialize brain health assessment, management, and rehabilitation solutions based on the science of Baycrest and other respected sources. With the support of the Ontario Ministry of Research and Innovation they formed a for-profit venture called Cogniciti. Cogniciti operates with a small executive team that is supported by the talents of dozens of professionals at Baycrest and MaRS.

Michael Meagher, President of Cogniciti, explains why Baycrest is involved in a commercial venture. “Virtually all public hospitals in Canada are facing financial challenges and are looking for ways to keep providing superior healthcare despite those challenges,” he says. “Over the years Baycrest has done an amazing job on the fundraising front. With Cogniciti and other ventures, Baycrest is innovating by commercializing its intellectual capital to add new revenue streams.”

The starting point for Cogniciti: an online screening tool for memory loss. “Baycrest doctors and scientists tell us that a natural part of aging is that our memories and attention become less acute,” explains Meagher. “The key issue is determining when simple forgetfulness becomes something more serious. Because the early-stage symptoms for memory loss due to aging, memory loss due to highly treatable conditions such as anxiety or depression, and memory loss due to serious diseases such as Alzheimer’s are so similar, people

tend to delay getting checked out—often for years. And during that time, many live in fear that their condition is Alzheimer’s, the world’s second most-feared disease after cancer. Those delays cause needless worry for the well and make treatment tougher for those with an illness. Our mission is to help eliminate the delays.”

By late 2011, Cogniciti completed most of the clinical work required to adapt the three-hour battery of clinical cognitive tests to a 20-minute, self-administered assess-ment. The company then began looking at how to transition that assessment—running on a PC in a lab environment at the time—to the web. In doing so, Cogniciti sought to minimize the distractions, delays, and expenses involved with building a scalable IT infrastructure on its own. “We wanted to remain focused on the science necessary to bring a solution to market, without getting caught up in all the complexity of building an IT infrastructure that could scale globally,” says Meagher. “Shortening initial time-to-market, remain-ing agile, and minimizing up-front and long-term costs were also key IT require-ments; however, we knew that the key factor in choosing a path forward—and a first step toward meeting all our IT needs—was finding a partner we could trust.”

SolutionRealizing that a cloud-based solution was a good fit for its needs, Cogniciti examined offerings from several vendors before choosing Windows Azure from Microsoft. Windows Azure serves as the Microsoft cloud services development, hosting, and management environment, and provides on-demand compute, storage, networking,

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“Being able to pay for IT infrastructure out of operating funds is very attractive, especially in the face of shrinking capital budgets.”

Michael Meagher, President, Cogniciti

and content delivery capabilities through Microsoft data centers. “It all came down to the relationship—we needed a technology partner who could help us envision a solution and then stick around to make sure we were successful,” says Meagher. “It quickly became evident that partnering with Microsoft was the right approach.”Cogniciti also chose Navantis, a member of the Microsoft Partner Network with multi-ple Gold and Silver competencies. “There was no shortage of qualified implement-ation partners; all of the proposals we received were impressive in terms of quality of thought and attention to detail,” says Meagher. “We chose Navantis because of its healthcare expertise, deep relationship with Microsoft, and extensive experience developing on Windows Azure.”

Development Process and TimelineDevelopment of the company’s assessment began in Baycrest labs in mid-2011. By the end of the year, the tool had progressed enough that an online version could be created. That work began in January 2012, with a project team consisting of three full-time developers, one half-time quality assurance resource, and one quarter-time project manager. Developers used the Microsoft Visual Studio 2010 Ultimate development system for coding and relied on Microsoft Visual Studio Team Foundation Server 2010—including its Scrum process template and support for agile project management—to manage all other aspects of the application lifecycle, including source code control, work item assignment and tracking, defect tracking, and reporting. The team chose HTML4 to ensure cross-browser compatibility and designed the

assessment to run entirely in the browser using JavaScript, as required to accurately measure response times. The application’s front-end runs in a Windows Azure web role, which provides a 99.95 percent uptime service level agreement (SLA) and comes preconfigured with Internet Information Services 7 for rapid development and deployment of web applications using popular technologies like ASP.NET, PHP, and Node.js. Data storage is provided by a combination of Windows Azure Blob Storage, Windows Azure Table Storage, and SQL Azure, all of which provide a 99.9 percent uptime SLA and employ replication or failover to maximize availability. The team had a feature-complete assess-ment running on Windows Azure by early March and finished fine-tuning it in mid-April. Cogniciti is now using the online assessment to collect the clinical data needed to code the final component of its assessment: the analysis engine that will examine an individual’s test results and make a recommendation.

By thinking creatively, Cogniciti avoided the typical challenge of finding enough willing test subjects. “Getting volunteers for clinical research usually takes a lot of time and money; a good hospital is lucky to get a few dozen a week,” says Meagher. “We took a different approach, reaching out to a large media outlet that targets people aged 40 to 80 and enlisting its aid in reaching out to people who want to help us ‘make a difference.’ We received more than 1,000 volunteers in the first four days, which validates that people are hungry for what we’re working to deliver.”

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“With Windows Azure, we can simply pay-as-we-go, starting small and scaling on-demand as we bring our Online Memory Assessment and future products to market.”

Michael Meagher, President, Cogniciti

Anonymous Screening ToolCogniciti expects to deliver its Online Memory Assessment in the fall of 2012. After registering anonymously, people will be presented with seven exercises, each lasting a few minutes and proven in the lab to be good indicators of the two cognitive areas most affected by age: memory and attention. The test results will be used to generate an overall assessment of the person’s brain health, calibrated to account for age and educational background. A personalized report will then be immediately presented to the test-taker that answers the question, “Is my memory normal or should I be seeing my doctor?”

“Think of the Online Memory Assessment as a thermometer for the mind,” says Meagher. “Most of us use a thermometer when we’re feeling poorly to help understand whether our temperature is high enough to warrant a call to the doctor. In the same way, the Online Memory Assessment helps us understand whether our memory problems are simply the result of normal aging or whether we should see a doctor.”

Meagher expects most test-takers to fall into the ‘worried well’ category—that is, people with healthy brains who are concerned about the forgetfulness that comes to most of us as we get older. “For these people, we’re hoping that the Assessment will put their minds and the minds of their family members at ease,” says Meagher. “If the results fall outside the norm for someone’s age and education, the Assessment will provide a clear, step-by-step path for how to best prepare for a visit to the doctor. Good preparation can make the doctor’s diagnosis faster and better, which is exactly what most patients are looking for.”

Cogniciti is now evaluating commercialization models, including partnerships with health-related websites. It also sees an opportunity with large companies and government organizations, which could use its assessment to help address lost productivity. “According to the Canadian Mental Health Association, of Canada’s 18 million-member workforce, it is estimated that 500,000 people miss work each day due to brain health issues,” says Meagher. “It’s the single largest cause of sick leave, with an economic impact of [CDN]$51 billion [US$51 billion] per year.”

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Figure 1. Cogniciti’s Online Memory Assessment built on Windows Azure will help people who may be concerned about memory loss to determine whether they should consult a healthcare professional.

Meagher envisions expanding the com-pany’s online assessment model for use in physicians’ offices and adapting it to other areas of brain health, such as depression and anxiety. “An online assessment could even provide a means of ‘baselining’ a child’s cognitive performance, so that, in the case of an accident or sports-related injury, the child can be reevaluated against the baseline to determine if the potential for brain damage may exist,” says Meagher.

BenefitsBy working with Microsoft and Navantis and building its Online Memory Assessment on Windows Azure, Cogniciti can stay focused on the science necessary to bring the best brain health assessments and solutions to the world. The company is quickly commercializing its innovative approach to brain health screening, without the costs, delays, and complexity associated with building a scalable IT infrastructure on its own.

“Brain health issues will affect us all, with the burden on the healthcare system increasing as more and more baby-boomers grow older,” says Meagher. “Windows Azure is helping us ‘change the game’ through the rapid, cost-effective delivery of a clinically valid online assessment for memory loss, and will make it just as painless to scale its delivery to a global level.”

Valuable New Screening ToolThrough its efforts, Cogniciti is delivering a screening tool that is easily accessible, can be used in the privacy of peoples’ own homes, and will be of benefit to all who use it. “Regardless of the test results, the earlier

an assessment is done, the better the outcome,” says Meagher. “People who test normally can rest at ease knowing that nothing is wrong, and people whose memory function may be impaired due to treatable issues such as sleep apnea can work with a physician to address those issues. People who, upon further diagnosis, are found to be in the early stages of dementia can start learning coping techniques, get a head start on under-standing the issues they face, and begin exploring their options for treatment.”

Low Up-Front and Long-Term CostsBy building on Windows Azure, Cogniciti avoided a large, up-front capital investment. The company did not have to purchase any hardware, build or rent a data center, or pay to deploy and configure servers. “Being able to pay for IT infras-tructure out of operating funds is very attractive, especially in the face of shrinking capital budgets,” says Meagher. “Not only have we avoided buying hardware, but we won’t need to pay for people to manage it or invest in additional capacity before it’s needed. With Windows Azure, we can simply pay-as-we-go, starting small and scaling on-demand as we bring our Online Memory Assessment and future products to market.”

Superior Scalability and ReliabilityWith a cloud-based solution, Cogniciti can easily scale its applications to any size. Windows Azure gives the company a fully automated, self-service hosting and management environment, so that Cogniciti can easily provision or deprovision computing resources within minutes. In addition, because Windows Azure is available in data centers around

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“We’re not worried about being able to accommodate higher than expected demand or scaling to a global level because we’re running on Windows Azure.”

Michael Meagher, President, Cogniciti

the world, Cogniciti can deploy its applications close to customers and partners as it moves to a global syndication model. For example, if an organization in China wants to offer a Cogniciti service, it can be localized in Chinese and deployed in data centers in China to minimize latency and performance issues. “We’re not worried about being able to accommodate higher than expected demand or scaling to a global level because we’re running on Windows Azure,” says Meagher.

Cogniciti will also benefit from an IT infrastructure that is always up and always on. Workloads are automatically moved within the Windows Azure cloud to support automatic operating system and service patching, with built-in network load balancing and failover to provide resiliency in case of a hardware failure. Rapid Time-to-Market and Strong Business AgilityCogniciti took advantage of Windows Azure to stay focused on developing its online assessment to meet the needs of its clinical teams and consumers—without having to devote technical resources to deploying and configuring hardware. Navantis was able to immediately deploy interim builds for feedback from Cogniciti during the development process, and can just as easily tweak the application and deploy updates as it continues to support Cogniciti in bringing its Online Memory Assessment and future products to market.

Cost-Effective Data Storage and Powerful Analytical ToolsAs Cogniciti collects anonymous data from its online assessments, it can take advan-tage of Windows Azure to cost-effectively

store that information. In addition, Cogniciti can use the built-in reporting and high-performance computing capabilities in Windows Azure to analyze the data it collects to help drive continual improve-ment of its Online Memory Assessment.

A Trusted PartnerAs Cogniciti took on the task of globalizing Baycrest’s science, a big question was ‘Which company to trust with the firm’s technology?” The decision: Microsoft and Toronto-based application developer Navantis. “The board of directors valued my past successes in growing early-stage businesses,” says Meagher. “And with Cogniciti, I valued the opportunity to have an impact beyond the bottom line as we take the remarkable work being done on Baycrest’s 22-acre campus and deliver it on a global scale to tackle the vitally important field of brain health. Given the magnitude of the opportunity, the biggest question was ‘Which company can help us out?’ Regardless of whether I’m looking back over what we’ve already accomplished or charting a path for the future, I’m delighted in all ways that we chose Microsoft and Navantis.”

Dr. William E. Reichman, President and Chief Executive Officer at Baycrest, confirms the value of choosing the right technology partner. “Baycrest has long enjoyed a close relationship with Microsoft, whose advisors and software have helped make our health-care infrastructure more robust, effective, and secure. We’re building on the power of this relationship to launch one of our most important innovations: an Online Memory Assessment that will help empower millions of adults around the globe.”

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“Given the magnitude of the opportunity, the biggest question was ‘Which company can help us out?’ Regardless of whether I’m looking back over what we’ve already accomplished or charting a path for the future, I’m delighted in all ways that we chose Microsoft and Navantis.”

Michael Meagher, President, Cogniciti

Windows AzureWindows Azure provides developers the functionality to build applications that span from consumer to enterprise scenarios. The key components of Windows Azure are:

Windows Azure. Windows Azure is a development, service hosting, and service management environment. It provides developers with on-demand compute, storage, bandwidth, content delivery, middleware, and marketplace capabilities to build, host, and scale web applications through Microsoft data centers.

Microsoft SQL Azure. Microsoft SQL Azure is a self-managed, multitenant relational cloud database service built on Microsoft SQL Server technologies. It provides built-in high availability, fault tolerance, and scale-out database capabilities, as well as cloud-based data synchronization and reporting, to build custom enterprise and web applications and extend the reach of data assets.

To learn more, visit: www.windowsazure.com

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For More InformationFor more information about Microsoft products and services, call the Microsoft Sales Information Center at (800) 426-9400. In Canada, call the Microsoft Canada Information Centre at (877) 568-2495. Customers in the United States and Canada who are deaf or hard-of-hearing can reach Microsoft text telephone (TTY/TDD) services at (800) 892-5234. Outside the 50 United States and Canada, please contact your local Microsoft subsidiary. To access information using the World Wide Web, go to:www.microsoft.com

For more information about Navantis, visit the website at:www.navantis.com

For more information about Cogniciti, visit the website at:www.cogniciti.com

This case study is for informational purposes only. MICROSOFT MAKES NO WARRANTIES, EXPRESS OR IMPLIED, IN THIS SUMMARY.

Document published May 2012

Software and Services Windows Azure Microsoft Visual Studio− Microsoft Visual Studio 2010

Ultimate− Microsoft Visual Studio Team

Foundation Server 2010

Partners Navantis