As part of the Real World Windows Azure series, I connected with Michael Meagher, President of Cogniciti to learn more about how the company used Windows Azure to build its online brain health assessment solution.  Read Cogniciti’s success story here. Read on to find out what he had to say.

Himanshu Kumar Singh:  Tell me about Cogniciti.

Michael Meagher:  Cogniciti is Canadian-based 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.

HKS:  What is Cogniciti’s mission?

MM: Baycrest doctors and scientists tell us that a natural part of aging is that our memories and attention become less acute. 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.

HKS:  So what did you build to make it easier to clinically assess memory loss?

MM:  We created an online screening tool for memory loss. By late 2011, we had completed most of the clinical work required to adapt a three-hour battery of clinical cognitive tests into a 20-minute, self-administered assessment. We 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, we sought to minimize the distractions, delays, and expenses involved with building a scalable IT infrastructure on its own.

HKS:  Were there key IT requirements you needed to address?

MM:  Yes, 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. Shortening initial time-to-market, remaining agile, and minimizing up-front and long-term costs were also key IT requirements; 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.

HKS:  So how did you select Windows Azure?

MM:  Realizing that a cloud-based solution was a good fit for our needs, we examined offerings from several vendors before choosing Windows Azure. 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. It quickly became evident that partnering with Microsoft was the right approach.

We also chose Navantis, a member of the Microsoft Partner Network because of its healthcare expertise, deep relationship with Microsoft, and extensive experience developing on Windows Azure.

HKS: Tell me about the development process.

MM:  Assessment development 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 to manage all other aspects of the application lifecycle.

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, 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 Windows Azure SQL Database.

The team had a feature-complete assessment running on Windows Azure by early March and finished fine-tuning it in mid-April. We are 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. We expect to deliver our Online Memory Assessment this fall.

HKS:  How did you approach clinical testing of your solution?

MM:  By thinking creatively, we 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. 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.

HKS:  How does the Online Memory Assessment work?

MM: 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. 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.

HKS:  What results can most people expect upon completing the Online Memory Assessment and what should they do with those findings?

MM:  I expect 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. 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.

HKS:  What business opportunities do you see with this solution?

MM: We’re evaluating commercialization models, including partnerships with health-related websites. We also see 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.  It’s the single largest cause of sick leave, with an economic impact of [CDN]$51 billion [US$51 billion] per year.

We also envision expanding our 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.

HKS:  Tell me about some of the technology benefits of using Windows Azure.

MM: By building on Windows Azure, we avoided a large, up-front capital investment. We didn’t have to purchase any hardware, build or rent a data center, or pay to deploy and configure servers. Being able to pay for IT infrastructure out of operating funds is very attractive, especially in the face of shrinking capital budgets. We have avoided buying hardware, and we don’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.

We can also easily scale its applications to any size. Windows Azure gives us a fully automated, self-service hosting and management environment, so we can easily provision or deprovision computing resources within minutes. In addition, because Windows Azure is available in data centers around the world, we can deploy our applications close to customers and partners as it moves to a global syndication model so 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.

We 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.

HKS:  What about some of the business benefits?

MM: We took advantage of Windows Azure to stay focused on developing our online assessment to meet the needs of our clinical teams and consumers—without having to devote technical resources to deploying and configuring hardware. As we collect anonymous data from our online assessments, we can take advantage of Windows Azure to cost-effectively store that information. We can also use the built-in reporting and high-performance computing capabilities in Windows Azure to analyze the data we collect to help drive continual improvement of our Online Memory Assessment.

Brain health issues will affect us all, with the burden on the healthcare system increasing as more and more baby-boomers grow older. 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.

Read how others are using Windows Azure.