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What is the current state of adoption of cloud in healthcare? Adoption requires an understanding of what the cloud is across your entire organization. What is the clinicians role? Do they need to understand it? Do they feel the impact? What about patients? What benefits might they experience? Doug McMillian, former CISO and CTO and current Director of Healthcare at Sirius Healthcare joins Bill Russell to discuss. What does it look like to fail over EHR? How do you start the migration process? How can you obtain a clean inventory of what is in your environment? What do you need to be careful of in the application contracts? And how can you understand the integrations?

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Thanks for joining us. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week in Health IT. 📍 A channel dedicated to keeping health it staff current and engaged.

welcome to our hybrid cloud briefing. I'm excited to get into our topic today, adopting the cloud and the migration to the cloud for your health system. We're joined today by Doug McMillan, former Cisco and director of healthcare at serious health care. This podcast series is going to culminate in an excellent panel discussion.

We're going to have experts who are going to talk about who owns cloud strategy at your organization and how to build out an effective cloud strategy for your organization. Check out the description box below for the registration link and to learn more about the upcoming webinar. We want to thank our sponsors for today, Microsoft and Zerto for making this content possible now onto the show.

All right. We're joined by Doug McMillan Director for Sirius Healthcare around cloud cybersecurity and many other areas as I've found out over time. Doug, welcome to the show. I appreciate this conversation on cloud computing. We've covered four topics to date.

We've covered essentially what is cloud. Cloud roadmap and strategy. Cloud foundations. And our last episode was on cloud security and management. Today we're going to talk about adoption and migration. No, no small task. So let's start with opening question of what's the current state of adoption of cloud in healthcare. You're now on the consulting side. So you're talking to a lot of different healthcare organizations. What's the state of it? Where are we at?

Yeah, so, I think overall what I'm seeing is SAS continues to still be a boom in most organizations, so that software as a service. I think, it makes sense that that's naturally happening. Healthcare again is just generally a little bit slower to accept new technologies. And there's a lot of reasons behind that. Not IT related, it's mostly some of the, the partner side of that.

Has that changed as a result of the pandemic? I'm hearing that we moved faster than we ever have over the last year and a half to two years.

I think definitely it has gotten way better. I actually think, I would say a good impact of, COVID not that there's a lot of those, but COVID really did get healthcare moving into the I would say the more appropriate directions from an IT perspective than, than anything else could have.

So there's obviously, most vendors are looking at how do they bring in software as a service. But then on the flip side of that is organizations are really thinking well, to keep pace with everything that's being required of me also, how do I look at, doing things different internally, which does mean look at the public cloud usage.

So again, across the board, we're seeing everyone asking how do we really get started? And it kind of goes back to some of our conversations, that hybrid DR strategy seems to be, something that is very interesting to a lot of organizations just to dip their toe into the cloud, get that understanding, and then be able to build upon that that understanding to say, how do I, take that forward for any other solution that's coming in?

So adoption is an interesting one. So adoption requires an understanding of what the cloud is across your entire organization. I mean, so we've talked a bunch about your IT organization, really understanding it. We've talked about the business leaders, really understanding it and sort of giving a framework for that.

But you know, one area we haven't talked about is clinicians. And I'd like to touch on that a little bit. When we're talking about adoption, do clinicians need to really understand it or will they feel the impact of a cloud adoption?

I would say if done correctly, they won't feel any negative impacts. I think they should feel some benefits. So again, getting into that nature of being able to scale your environment and even in some situations, depending on how well your organization was around service management, maybe even bringing in some stability. But again, a lot of that has to do with just process and procedure to make sure you're following the best practices.

But again, as you're looking to take advantage of cloud, if you build that in to your cloud framework and your cloud strategy, then you're getting that benefit as well. From a negative standpoint, I don't think they've seen anything negative if done correctly.

In our previous conversation you talked about, Hey, we failed over our Epic environment to the cloud. And my first question was, did the clinicians notice and your answer was no, they didn't. And that's a victory in and of itself because you were able to create an awful lot of agility that they didn't need to know or really understand. But they will appreciate in an outage or something else that, that might hit that area. And to them, the experience of using that EHR didn't change.

Correct. Yeah. And, again, our fulfill over that we did for a week was back in 2020. It was obviously 2020. And that was a plan fell over. So, we saw our core cache database, I would say got just a tad bit slower, but not visible to the end user is more visible to the IC staff, but what made up for it is because again, the way that Epic is doing those quarterly releases and its reliance upon the chip set that we immediately got the new chip set inside of Azure that we didn't have on prem. So actually there are client side and Citrix side performance increased dramatically, but they actually thought as a net benefit, not really anything to do negative,

So you can actually fail over, upgrade your entire environment, fail back in theory?

Yes sir. Wow. Yes sire. In theory, you could do that, obviously cause of the cache mirroring, there's always that downtime for that fill over process from the cache, from the database perspective. But again, you could get that timeframe shortened, so that it's really fast and fell over, and then you would set up your new environment and then mirror backwards.

Yeah. If failing over that EHR was always a tough decision for the CIO. I mean, you would do that as a last resort because you knew there absolutely was going to be downtime in one direction and there was going to be downtime in the other direction, bringing it back and significant amount of load on the IT team as well.

One group we haven't talked about and I'd love to throw it around with you is we adopt the cloud. Let's talk about the patients a little bit. And one of the things I appreciate about the cloud is it's ubiquitous, right? When you move into an Azure cloud, you could serve workloads literally across the country and if you wanted to around the world, but across the country, pretty readily.

And so as health systems start to become larger and grow and multiple markets, and those kinds of things, this moves to the cloud does address some of the challenges of developing applications specific specifically for the patients, wherever they happen to live wherever they happen to be accessing your environment.

Is that what you found and what are some of the other benefits that a patient might experience?

Yeah. So we definitely are seeing that again, as you say I will say that consumer driven approach to healthcare that is kind of changing things with digital front doors you're you definitely are seeing a lot of mobile applications and things like that.

Being served up to try to entice and get your patients to interact with you way more natively than they've been doing in the past, which is, either coming onsite or maybe even picking up a phone, we're trying to use those digital technologies to reach out and engage. And you're right. So you definitely can start to serve them up within any of these cloud data centers that are hosted, pretty much anywhere in the world, knowing that the one thing that we are still seeing across the board is organizations still making sure that anything that's going to be PII PHI, something that needs to be protected. It's probably going to stay within the continental us just because of the legal input and implications that it brings. But again, you can still offer up a variety of that offenders across the United States to be able to spread that out and actually serve your customers way better.

From a patient's perspective. I think, again, that less downtime, again, just the ability to scale with their needs. They might not directly see that, but IT team does. Again, I think about, as we went into COVID and again the telehealth services, if it wasn't for cloud compute I don't know how, our organization would have made it.

Because again, we did not have the infrastructure on site to be able to start spinning up all these new services. We've really had to take advantage of the cloud and that was the benefit. But again, the patient really didn't see that, but that's what enabled all of that to take place.

The closing question to the entire series is a big one. And I have a feeling it'll take a couple minutes. But we've got funding. We've got buy-in, everyone's excited about it. All right. Move us to the cloud. Let's let's get going. Now we're going to start to do the migration process. Is there a methodical approach to the migration? Is there things that you learned as you try to migrate that, that perhaps you could share at this point?

Yeah. So it comes down to a lot of things that would be learned during that application dependency mapping. So, what I would say is number one is making sure you have a clean inventory of what is in your environment. I would say most organizations have some understanding, but maybe not a full understanding.

So you really did need to go through that process because you're going to uncover things that you may not have known and it does need to be taken into account. The other thing that I would also say is making sure that you're very deliberate and understanding of the architecture for that application and how is it going to be hosted post its migration?

I'd mentioned in the past maybe physical based IT. A lot of biomedical devices, just based off of some, let's say legacy equipment, don't allow DNS names. So they're forcing you down entering IP to kind of connect these things. Well, if you've tied that to a physical IP, that's on a physical machine, it becomes very hard to shift things around.

It requires a lot of interaction from your bond medical team or your it team to handle that migration. So that's where things like virtual IP, DNS, aliases, everything that you're doing, again, needs to be thought of, of how do I move it over time? And I'll say less than the impact on all of those teams.

The other thing that I would say is be very careful of some of the application contracts. I ran into a couple of situations where I'm going through planning a migration of an application from on-prem to Azure. And then the vendor came up and told me that I wasn't allowed to do that. And it was in their contract that they had said they, it would be hosted on prem.

Which is very, I say convoluted, I guess I do understand a little bit of bother trying to protect their IP, their intellectual property. But what I would also say, it really doesn't help an it organization. So again, just lessons learned is make sure that you have a really good contract management process as that you're reviewing things and not, I would say shooting yourself in the foot and limiting your options.

And then just making sure that you understand the integrations, right? Because a lot of people I would say operational leaders tend to focus more on software as a service because they're seeing these things maybe as they go to their conferences and talk with their peers. But you do need to be intentional Yes, moving to SAS it does, I'll say lessen the load on your IT infrastructure team, but it might double or triple the amount of time it takes on the integration team. Because what if that has numerous sources of data? Numerous I'll say targets that it needs to send out to. Well, you could end up spending more time on integrations and less time on infrastructure.

So all in all, it really just comes down to making sure you have that full understanding of your environment. And then making sure that you're in that process to keep that up to date, because once you have it is, I would say the goldmine of it being able to understand your environment so that again, you could serve your customers the best you can, as well as protect the data.

Doug. I want to thank you again for your time and for this series. Five part series on the cloud. What it is it? Some of the foundations security management, adoption migration, and roadmap and strategy. I think this is a fantastic series and I'm glad we've been able to host it here on This Week in health IT. So thank you again for your time.

Thank you so much.

What a great discussion we would have. Thank our sponsors for today, Microsoft and Zerto, as well as serious healthcare 📍 who are investing in our mission to develop the next generation of health leaders. Thanks for listening. That's all for now. 📍


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