Key Considerations for Migrating to the Cloud: A Thought Leadership Roundtable Sponsored by VMware and Intel

The march to the cloud has begun in healthcare, but for many organizations the best path forward is far from clear. Should digital leaders in provider settings choose a hybrid model, putting some applications in the cloud and keeping some in an on-premises data center, or should they go all cloud? Should they use a public cloud, private cloud, multi-cloud? With the industry in flux, when and with whom should they place their bets to ensure best outcomes for their patients and businesses? The College of Healthcare Information Management Executives (CHIME) and VMware, a CHIME Foundation partner that specializes in cloud infrastructure, as well as Intel, invited eight CHIME members to participate in a thought leadership roundtable discussion about their cloud strategies.

CHIME President and CEO, Russell Branzell, moderated the discussion and several representatives from VMware were in attendance. The participating thought leaders were:

• Dave Dully, Vice President of Information Technology, Chief Technology Officer, Baptist Health
• Lynn Gibson, Vice President and Chief Technology Officer, CHRISTUS Health
• Brian Lancaster, Vice President of Information Technology, Nebraska Medicine
• Aaron Miri, CIO, University of Texas at Austin, Dell Medical School
• Imad Nijim, CIO, MEDNAX Radiology
• Rod Smith, Vice President of Information Technology Operations, Arkansas Children’s Hospital
• Monique St. John, Chief Technology and Security Officer, Children’s Hospital of Philadelphia
• Joel Vengco, Senior Vice President, CIO, Baystate Health

Benefits of Cloud Migration

The cloud ecosystem has been evolving quickly, with big name players like Amazon Web Services (AWS), Google and Microsoft entering the healthcare sector. Migrating to the cloud offers several potential benefits, including cost savings, faster access to data, enhanced security, better data backup and recovery, greater storage and increased processing power. For the executives who oversee health organizations’ digital enterprise, migrating to the cloud also holds the promise of freeing up resources and talent that could then be focused on data analytics, innovation and strategic growth.

“I’m looking at the cloud for enablement,” said Brian Lancaster, vice president of information technology at Nebraska Medicine. “The user experience is drastically different. Your ability to connect anywhere is drastically different. It’s also freeing up IT resources to actually understand the business to become a transformation agent.”

Aaron Miri, CIO at University of Texas at Austin’s Dell Medical School, agreed. “I want to go up high for several reasons: One, it gives me automatic built-in redundancy. I don’t have to worry about that anymore. Two, patching. Patch management is taken care of. Three, it de-risks a lot of my environment so I put the risk back onto that company, versus me dealing with it. And four, it frees up my staff.”

The potential for benefit is not the same as experiencing benefit now, the leaders observed. Lancaster challenged claims that cloud migration saves on costs, at least at this point in the journey. Downstream a cloud strategy could bring cost savings by eliminating the need to purchase expensive hardware when legacy infrastructure needs replacement or becomes obsolete. Reducing the physical footprint of a data center also may make room for revenue-generating clinical enterprises.

Gradual or All-In?

Digital leaders must be especially diligent when working on cloud-related contracts, several thought leaders advised. “To say that you automatically get redundancy in the cloud it is a misnomer,” said Lynn Gibson, vice president and chief technology officer at CHRISTUS Health. He said contract specialists need to be nearly as legally astute as lawyers to ensure services meet the needs of a healthcare organization. “One of our biggest issues is contracts and having the right terms and conditions with our vendors and our partners to make sure that we can scale appropriately and be secure,” agreed Monique St. John, chief technology and security officer at Children’s Hospital of Philadelphia (CHOP).

Although some healthcare organizations may be comfortable migrating applications such as web hosting to the cloud, others see clinical app migration as premature. “We go through it application by application,” said Imad Nijim, CIO at MEDNAX Radiology. “But when it comes to clinical apps, those are less likely to be pushed out, for security and nervousness and ownership.”

CHOP has taken a cloud-first approach and expects to have protected health information secured in the cloud in one or two years, said St. John. “As we upgrade on-prem equipment and software, we look to see if it’s available in the cloud, and what the cost benefit is,” she said. “We then try to move it there instead of upgrading an on-prem.” Still, geographically limited systems likely will require an on-premise data presence, too.

Dave Dully, vice president of information technology and chief technology officer at Baptist Health, said that with the exception of legacy equipment, Baptist Health could be predominantly cloud-based within five years. “We’ve moved our top five apps with the exception of maybe PACS to the cloud,” he said. “Three years ago, I wouldn’t have thought that would happen. It’s working, and it’s working awesome.”

Choosing the Right Partners

Determining when to go forward in an evolving marketplace can be challenging. Like Lancaster, Dully said the current cost structure hasn’t lived up to early promises but he speculated that competition might drive cost down over time. Competitive pressures already have compelled AWS, Google and Microsoft to re-evaluate pricing and offer business associate agreements and systems that are compliant with the Health Insurance Portability and Accountability Act (HIPAA), Nijim noted. “Those three are mostly on par when it comes to services,” he said. “Everybody else you just have to make sure to future proof and be flexible in your choices.”    

Looking to the future, digital healthcare executives want flexibility if a cost structure changes. “If we’re going to see this hybrid environment for whatever period of time, we really need one pane of glass so we can manage all workloads regardless of where they’re at,” Lancaster said. Then, if the cost structure changes, a healthcare organization could move an app “back on prem, or maybe to a different public cloud vendor. Basically, I want an exit strategy because I don’t want to be beholden.”

Ultimately, the success of the “what,” “where,” “when” and “how” in a cloud migration may hinge on “with whom.” Identifying the right partners might be a challenge, given the plethora of cloud-related alliances, mergers and acquisitions.

To lead their institutions through a cloud migration, healthcare executives need partners who will stand by them for the long haul. “We’re talking about careers,” said Rod Smith, vice president of information technology operations at Arkansas Children’s Hospital. “I’m the one in the organization saying that this is the direction we need to take the organization.” Given that this is a significant investment both financially and reputationally, he wants honesty and transparency from a partner.

Most organizations have limited resources and need partners who will work alongside them. “Healthcare organizations are betting the farm to a certain degree,” said Joel Vengco, senior vice president and CIO at Baystate Health. “And we don’t have much to bet. We need a partner who’s going to be resilient and focused on solving the problem with us.” St. John agreed, calling for a roll-up-your-sleeves attitude. “You might not know all the answers,” she offered, “but come to the table and have those discussions to try to work it out with us and partner with us.”

The big differentiator between healthcare and other sectors is what’s at stake: human lives. Healthcare organizations want partners in industry who stay the course, Gibson said, rather than flit in and out of healthcare. Miri looks for authenticity, with partners with a deep understanding of the healthcare workflow. “VMware does, and that’s very important because I need to be able to put you in front of our CEO; so that as I make these bets, it resonates and there’s no question that, ‘Yes, they’ve got it.’”

The partnership works two ways, said Michael Robinson, VMware’s vice president of healthcare in North America, citing collaborations with health systems like many of those represented by the digital leaders at the roundtable discussion. “The reality is that we are on a transformation as a company as well, and that transformation will help enable and drive innovation to the marketplace,” Robinson said. “I truly believe that, but we need your help to make that happen, and to make sure that we’re on the right track.”

*About VMware and Intel Partnership: VMware and Intel deliver solutions that enable IT organizations to confidently integrate public clouds to scale and extend their businesses. VMware’s industry-leading cloud technologies and Intel® technology help customers fully leverage hybrid clouds and connect and manage workloads on-and-off premise for increased agility, capacity, transparency, visibility and resilience. The VMware Cross-Cloud Architecture™ and Cross-Cloud Services and Intel’s workload-optimized processor, storage and networking components give IT organizations broad choice and flexibility in how to build, run, secure, and manage any cloud. With a range of private, public, and hybrid cloud solutions, organizations have the freedom to implement a cloud solution that supports their cloud strategy for their unique business, with freedom and control.