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. Building a cloud roadmap and strategy. Today we're joined by Doug McMillan, former CISO and current Director of Healthcare for Sirius Healthcare. The podcast is going to culminate with a panel discussion of experts, talking about who owns the cloud strategy in your organization and how to effectively build out that strategy.

You're gonna want to check out the description box below for the registration link to learn more about the upcoming webinar. We want to thank our sponsors for today, Microsoft and Pure Storage for making this content possible. Now onto the show.

All right. We're talking to Doug McMillan Director for Sirius Healthcare around cloud and cybersecurity. Doug we're going to really dive into a cloud roadmap and cloud strategy, and we've established the importance of the cloud in the first episode that we did. Now let's discuss how you get started. How do you develop that roadmap? How do you develop that strategy from within your origanization?

Yeah. So, to me, making sure you have the effective cloud strategy is the core basis before you start to really take on any cloud workloads. So the things that always like to step back and make sure that you're speaking with internal stakeholders, as well as senior leadership in your organization, is to make sure that you understand the core business drivers for your organization.

Making sure that you have a core understanding of the IT strategy, where are they going from an IT perspective. And then also just look at current technology trends and security trends. A lot of that is really, what's going to form up the basis of what you're looking to. And it's, you know, where do you see cloud?

How does it fit into your environment? And I would say how, because while I think we can all agree at some point cloud should be a part of your overall roadmap, but it doesn't mean that it has to be the overwhelming majority. I think that's something that each organization has to set for themselves. So the question really is is how are you going to use cloud and why? And the core of why is that vision of where you're going for your organization.

And that should really be driving all of the other tactics that you set up for. How are you going to deliver on that strategy and what technology solutions are you looking to enable in the environment? And at that point, you really start to develop that roadmap. It's kind of that path to how are you going to make changes?

Where are you going to bring in cloud? How are you going to enable governance to make sure that you're putting the right workload in the right place?

We'll go into the roadmap in a minute. I wanna, I want to stick with strategy here for a couple seconds. When we're talking about strategy, it's interesting.

It comes back to some of the earlier things we talked about. We talked about agility. And I remember when I became a CIO, I asked them where's healthcare going? And, and everyone was like, well, if you can answer that question we could all be millionaires because knowing where healthcare is going is really hard.

And we just experienced that through the pandemic. And one of the things we did back in 2012 is I looked at him and said, all right, if we don't know where we're going, and we don't know how fast it's going to come, you have to design for agility. And we started moving to the cloud back in 2012. And the reason was our organization to find a strategy that s aid look we know where we're going to need to be able to move fast.

We know we're going to have to do it cost effectively. We may be doing M and A, and if we're doing M and A, we may need to take on a lot of resources very quickly and everything they defined to me was, okay, we have to be more agile. We can't be sinking significant amounts of dollars into building projects to build data centers and those kinds of things, because we may need to scale up well beyond what our data center capacity was at any given time.

So you really do need to spend a lot of time understanding the business strategy, but also the financial strategy, right? There's this, there's this operating costs and capital costs transition and conversation you have to have with the CFO as well. Talk a little bit about those conversations you have with the business leaders.

This is actually one of the topics that I think is top of mind for every organization because a lot of us are, again, traditional, I'll say healthcare lagged a little bit. So the conversations around finance authority really, you know, the CAPEX vs OPEX come up on every single conversation.

And it's really hard to, to speak to it, I would say in very general terms, because you really do have to understand each organization and kind of how they're handling it. What I will speak to is at Cone Health, when we were going through this, it was really focused on that five-year TCO and not so much, you know, I'll say hooked on where's the funding coming from? Is it coming from a capital versus OPEX? Because again, I think we all know that depreciation is still coming back through OPEX. Right. So you're still seeing that money. The question is really how is it impacting the bottom line? Right? So as you start to do that TCO, when you say, okay, you know, we can save a hundred thousand dollars. It doesn't matter if it's really coming from CAPEXversus OPEX that each organization has to understand that. But seeing where it's going to really hit from the book's perspectives.

All right. So let's move into the roadmap. What are the elements of a good cloud roadmap for an organization?

Yeah, so I always think that there's, you know, I'll say four foundations that everything has to kind of flow through. So, number one is understanding the skill sets and competencies that you're going to need inside of your organization to really make this take place.

There's a enterprise architecture, right? So you really need to understand, again, all of the architectures for all the applications, making sure that you have core requirements set and built for her, how you're going to shift and change things over time. Governance. I can't say governance enough. And this really comes into cost management.

It comes into workload management. You really need to sit down and make sure that you've mapped all of that out and I'll use some lessons learned here. As we started moving into our cloud, we fought, we had our cost management and tagging framework set up one way. And then as soon as we got into it, we're like, wait, maybe we didn't do that.

Right. And now you've got to go back and do it again. You don't lose the data, but it is harder to report as you change your tagging structure over time. So you really do need to look at it holistically and think of any scenario you can, because you want to be able to consistently paint that picture for leadership.

And if you change tagging structure as well, sometimes that that visibility becomes a little bit hard. Then obviously looking for quick wins, how can you do a proof of concept using hybrid DR as I mentioned to just get a quick win and be able to show some cost savings and then really focusing on optimizing and scaling. And that is a never ending battle and you're kind of always are repeating that over and over.

Yeah. I would imagine those are interesting. I love the fact you start with skillsets. There were some things that required some new skill sets, but there was other things I think people were surprised when we moved into the cloud.

They were like, Hey, you know what? Working with SQL locally or in the data center felt an awful lot, like working with SQL and the cloud and that team, their anxiety level went down significantly. Once they saw the same tools that they were used to, and they were able to really get their jobs done pretty effectively.

Yeah, I agree. And we had the same thing you know, spend a long time with the core DBA team. What I'd also say is where I came into that requirement which actually goes into that one. I mean, managing the SQL server you know, in an I S or on prem is exactly the same, it's it?

That that doesn't make any difference. But when you start to layer in things like managed instances in Azure SQL, well, there are some trade-offs, but again, as you build that competency over time, then as your DBA is, are looking at new solutions coming through, they can actually say, okay, well, Azure SQL makes better sense here and it offloads the time for them having to upkeep, you know, servers and things like that.

All right. So you're throwing out a lot of acronyms. On the off chance that someone's listening to this who doesn't have maybe the technical background. And I know we're going to have some people who are very technical listening to this, but on the off chance that we don't you've thrown out IAS, PAS, SAS you've thrown out Co-location, Edge.

You've thrown out a lot of CTO words, but let's, let's explain those and how we're going to talk about those to the business.

Yeah. Yeah. So S AS is where you're seeing a lot of, I'll say software companies kind of push today. It's just software as a service. So imagine things like Office 365 in the cloud, a Workday in the cloud, that's really, you're just paying for a subscription based software service that you don't have to manage any of the backend infrastructure.

You're really just managing the data that's being used in the integration layer. PAS is platform as a service. So we can see a lot of this in your public cloud providers, as I mentioned, like Azure SQL. So that is a SQL database that you can use in the cloud, but you don't have to manage the actual backend SQL server.

You just get a database and you can start to you know layer in data over time. IASI is an infrastructure as a service. So that's really just shifting your virtual server from your on prem up to let's say Azure, AWS. You're just moving to virtual instance of that server from one place to another, but you're still, again, you have the operating system and you can do anything you want to with it.

Co-location vendor hosted is really shifting out of the data center. So, at that point you're just placing hardware or purchasing hardware and the third party data centers. And what that does is begin it just frees up your team to work on something else rather than the physical hardware that's being placed inside of the data center, as well as the heating and cooling.

And then obviously, which is the big one and I think everybody really needs to understand how this is, because I think especially healthcare, we'll never be able to say we're a 100%, you know, public cloud or SAS based. We're always going to have Eedge use cases. And that's where hybrid comes in, which is really saying you're mixing, matching all of these different types of hosting environments to be able to accomplish your goals.

Yeah. I wish we had another hour to talk about hybrid and how we keep all those all those elements in sync. How we secure all those elements and put our wrapper and our brand security and practices around that. And perhaps for another time, we will definitely dive deep on that, but to close this one out, here's a good closing question.

What's a good entry point into the cloud for an organization? Most healthcare organizations I'm talking to have already taken steps, right. Office 365, you mentioned is a pretty ubiquitous at this point, I'm on so many Teams meetings at this point, it feels like most organizations have some aspect of this. Is that the entry point or are there other entry points to consider?

Yeah, definitely. I think SAS is going to be, you know, a natural use case that comes up just because again, as we mentioned, software vendors are pushing that. So I think again, when you look at Workday, think about that.

How about from a financial TCO standpoint? If I were looking for a quick win for my organization, I mean, those are just you know, those are just costs of doing business. We're just going to go from, I don't know, using on-prem to using, but if I'm looking for a win that I can demonstrate how cloud is more agile or cost-effective , where would I look?

Yeah. And that's where we're seeing a lot of people really taking a hard look at a hybrid DR. And that can be I'll say accomplished in numerous different ways.

So I'll use Epic, obviously as the core EMR for many organizations. Obviously it comes in a three tier fashion to how Epic has actually served up. You have a presentation layer. You have a web and service layer. And then you have the back end database, which is a cachet and IRIS server. So you have all of that infrastructure from a DR perspective, which is replicated.

So what we're seeing is organizations just dip their toe in one of those areas, right? So you could actually say, do the whole DR environment and move it to Azure. If Azure will be able to handle the workload and that really comes down into just performance. Or you could say, just move the presentation tier.

And that's where we're really seeing a lot of people looking very hard to say, well, we know we need, let's say Citrix or VM horizon view or something like that from a presentation layer. Well, why don't we put that inside of a cloud. That way we can actually spin them up, spin them down and save that money.

And as well from an Epic perspective, be able to get to the new chip sets, which is occurring at a very fast rate due to the quarterly updates.

Fantastic, Doug, again, thanks for your time and covering a cloud roadmap and strategy for us.

What a great discussion we want to thank our sponsors, Microsoft and Pure Storage and Sirius healthcare who are 📍 investing in our mission to develop the next generation of health leaders Thanks for listening That's all for now 📍