What is the Difference between Windows Azure and Office 365?

Something that I see coming up more and more often recently is the question as to what the differences between Office 365 and Windows Azure are and how the two relate to each other more exactly.

Windows Azure and Office 365 are cloud based services. The components of Office 365 rely on Windows Azure Active Directory services on the back-end although Windows Azure is much more than just Active Directory Services.

First let’s discuss at a high level the different types of cloud services that are available. In the cloud the following services are available:

  • Software as a Service or SaaS,
  • Infrastructure as a Service or IaaS and
  • Platform as a Service or PaaS

Wikipedia defines each of these as follows:

Software as a Service (SaaS)

In the SaaS model, customers are provided access to cloud-based application software, services and databases on a subscription or pay-per-use basis. Providers manage the infrastructure reducing the dependence and need for on-premises infrastructure. This has the effect to significantly reduce infrastructure costs for the customer and simplifies maintenance and support of the application, service or database as well. SaaS is sometimes referred to as “on-demand software”.

Infrastructure as a Service (IaaS)

IaaS clouds offer computing resources often built on pools of hypervisors including Hyper-V or Xen or KVM or VMWare although they can also come in the form of physical resources as well. Virtual-machine disk image libraries, raw (block) and file-based storage, firewalls, load balancers, IP addresses, virtual local area networks (VLANs), and software bundles are resources also provided in this model.

Platform as a Service (PaaS)

In the PaaS model, cloud providers deliver a computing platform, typically including operating system, programming language execution environment, database, and web server. Application developers can develop and run their software solutions on a cloud platform without the cost and complexity of buying and managing the underlying hardware and software layers. With some PaaS offers like Windows Azure, the underlying computer and storage resources scale automatically to match application demand so that the cloud user does not have to allocate resources manually.

Office 365 is SaaS providing an online version of the Office suite (Word, Excel, Outlook, PowerPoint, One Note, Access, Lync, etc.) along with SharePoint, Lync and Exchange.

In contrast, Windows Azure is IaaS and PaaS. Windows Azure can be divided into Compute, Data Services, App Services, Networking and Store.

  • Compute:
    • Cloud Services
    • Virtual Machines
    • Web Sites
    • Mobile Services
  • Data Services:
    • SQL Database
    • SQL Reporting
    • SQL Data Sync
    • Storage
    • HDInsight
  • App Services:
    • Caching
    • Service Bus
    • Windows Azure Active Directory
    • Access Control Service (ACS)
    • Media Services
    • Content Delivery Network (CDN)
  • Networking:
    • Virtual Network
    • Traffic Manager
  • Store

As you can see, Windows Azure is much more than the Active Directory backbone supporting the components of Office 365. Microsoft has released a Windows Azure Poster that describes each of these sections in detail and is quite helpful when comparing and contrasting not only the differences between Office 365 and Windows Azure but in describing all the components and offerings of Windows Azure. The poster can be downloaded here.

As it relates to IaaS, Windows Azure is Microsoft’s Operating System for cloud computing. With the PaaS model, Windows Azure can be used for development, service hosting and/or service management.

Looking back at HIMSS15 — and toward the future of health IT

Attendance at this year’s HIMSS Annual Conference & Exhibition set a new record. Reported at nearly 43,000, this is an increase of more than 20 percent over last year’s 35,509 attendees. This record crowd left Chicago with a clear view of the new era in population health IT and a vision towards a future of connected care and a learning health system.

Five years ago, it would have been hard to predict that Health and Human Services, Centers for Medicare & Medicaid Services, Office of the National Coordinator for Health IT and other agencies would create such an extensive market response to better support value-based payment models. Many of the regulatory sessions at the conference built on the theme of creating an IT platform to continue moving towards paying for quality of care rather than quantity of care.

[See also: Entering a new era of population health]

Population health technology at this year’s HIMSS went well beyond the high-level categories of interoperability,analytics and management tools. It sometimes seemed nearly every vendor was in the business of furthering the cause. So many moving parts are converging to make population health achievable, and it is important that the industry better define and describe “population health” because this term can mean different things to different people based on their solutions and approach. To be successful, providers must see past the hype and seek out solutions that bring real value to their organizations.

Shifting focus to outcomes
Conversations at HIMSS conferences in recent years have been largely dominated by meaningful use. This year, a great deal of talk was about going past MU and beginning to look at outcomes as opposed to process measures. The Stage 3 proposals as well as the sustainable growth rate repeal and the new Merit-based Incentive Payment System lead towards development of alternative payment models while continuing to focus on meaningful use and beyond.

I noticed that many more vendors exhibited solutions that were combinations of products and services, with more of a modular approach than in the past. The industry is responding to greater demands for solutions that work well with others. This is a move in a good direction. Interoperability of systems and solutions is a critical need. (For more on my thoughts on the importance of interoperability see my recently-published “5 things we have to do to make health IT work.”)

Interestingly, I heard more about analytics at last year’s HIMSS than this year’s event. This year, analytics was folded into a broader discussion around population health with a more modular approach to technology deployment, and services layered into the solutions.

More data-rich interoperability
The growing alignment of data aggregation and interoperability was also very much on display at HIMSS. Several demonstrations in the Interoperability Showcase highlighted this in future capabilities. At one well-attended conference session, Argonaut Project leaders presented applications developed with Health Level Seven International’s Fast Healthcare Interoperability Resources, or FHIR,framework. We saw new applications that use web standards and application program interfaces to aggregate data from many sources. These new mobile solutions and medical device integrations will benefit both patients and clinicians.

As seen throughout the exhibit hall, we are making progress on the ability to aggregate data for collaboration across systems. These tools will do more than exchange documents or referrals; they will enable better and deeper collaboration among clinicians with notifications and alerts, and a shared longitudinal view of the patient care record. We’re on the verge of connecting providers more meaningfully than in the past.

More patient-centric care
Along with data-rich interoperability, deeper patient engagement was a pillar of conversation at this year’s HIMSS. The importance of the patient at the center of the individual health data ecosystem was a strong component of many solutions promoted at the show. Patients today are more in charge of clinical data and a more meaningful part of the care team.

I saw many tools to get more patient-generated health data incorporated into health information systems. Health wearables were more visible than last year; this was the first year we’ve seen Apple at HIMSS. There were also many signs that the mobile health movement continues to gain momentum with clinical applications built around patient-centered mobile health. As we saw in the Argonaut Project session, the whole notion of open APIs for data-level access promises to give both patients and clinicians unprecedented access to health information.

Buzz fueled by the nation’s capital
There was quite a bit of talk at HIMSS15 coming out of Washington, D.C. Some of the biggest news that everyone was talking about at HIMSS this year was Stage 3 meaningful use, with many people noting that CMS announced it as the “final stage.”

ONC and CMS presented on the new Stage 3 and certification rules, along with the new flexibility rule. This rule will lower the current requirement for attesting from one year to a 90-day period for 2015.

As the deadline for public comment on ONC’s Shared Nationwide Interoperability Roadmap closed right before HIMSS, it was also still very much on people’s minds.

Additionally, people were discussing the pending repeal of SGR (now complete), that ultimately puts MU into the MIPS.

Of course, it wouldn’t be HIMSS without people weighing in decisively on these issues. The new flexibility rule and reduced attestation period was very well-received. At the same time, the new Stage 3 rules significantly increase percentage thresholds for patient engagement. They have increased from five percent to 25 percent in the case of patients viewing, downloading or transmitting their information, while the flexibility proposal allows for a requirement of only one patient for 2015. Few attendees seemed to like this, but as with all proposals, everyone gets to weigh in during the commenting period. The D.C.-fueled buzz was around the entire industry moving rapidly toward value-based payment models. This was also evident by the solutions on display around the conference center.

Looking forward to next year
I thought HIMSS this year was especially rewarding, with interesting keynotes, many great educational sessions and the general, inescapable shift in the marketplace. This is the year “population health” became mainstream, with tools that support value-based care in very high demand.

Next year we should see even more population health focus. I expect to see real breakthroughs in mashing up claims data with clinical data we’re aggregating across communities to do new and interesting things in support of the new payment models.

I expect we’ll also see breakthroughs in mobile health, including many more consumer-facing health apps with the patient at the center of the conversation. And above it all, I expect we’ll see more of these solutions tied into systems. That’s because health IT is increasingly not about individual solutions capturing data at the point of care, but rather capturing all the useful data we can and applying it across systems and providers for the good of the population as a whole. We have largely digitized our health system, and now we are able to apply tools that turn these data into actionable information.

Brian Ahier