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Healthcare is starting to get its act together in regards to healthcare applications. We see more and more health systems trying to develop that muscle of application development. Why is this happening? What is driving this change? In the past, everybody remembers the ‘going to be down for maintenance’ notification, right? Well now we have more modular versions, where you're able to take out and update different portions. This means that now, more than ever, the digital front door could not be more important. After the pandemic, health systems needed to rewrite their digital front door and in the process of doing that, they recognized that they needed to supply the framework. And then as partners came in and worked within the framework, because they set up that digital front door, they were able to work with additional applications as they moved forward, because the architecture was correct. Not only to stay relevant but to provide a version of value based care that’s evolving to where the application itself is more suited to the patient base. Architecture that provides not only agility but also a layer of security, in terms of the framework.

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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 health, a set of channels, dedicated to keeping health it staff current and engaged. Welcome to our digital infrastructure to support the evolving care delivery briefing campaign. We're doing this in partnership with VMware. And I'm excited to get to our topic today. Modern applications were joined by Cameron, Lou Welland, director, healthcare ISVs, and Alliance partners at VMware. This podcast series is gonna culminate in an excellent webinar panel discussion. We're going to have experts talking about enterprise cloud, cloud, native workforce solutions and the ecosystem that brings that all together. Thursday, October 13th from one to 2:00 PM Eastern time. You can check out more details on our website this week, or check out more information in the description box below for registration, and to learn more about the upcoming webinar. We wanna thank our sponsor once again, VMware for making this content possible in supporting our mission to train the next generation of health leaders now onto 📍 our show.

All right. Today we're joined by Cameron Lewellyn, director healthcare ISVs and Alliance partners at VMware. And we are gonna have a conversation around modern applications. Seems like a misnomer to talk about modern applications in healthcare cameras. Welcome, welcome. Back to the show appreci.

Thank you again. I consider it a pleasure.

I didn't mean to open with that, but you know, healthcare actually is starting to get its act together. Healthcare applications. Here's a couple of stats, healthcare applications hosted in the public cloud, expected to rise from 13 to 21% over the next 18 months. 39% of healthcare respondents have accelerated modern application development due to the pandemic. And 33% have instituted secure by design application development. That is so important. Cameron, what's happening? Why is this happening? What's driving this change.

well, I hate to point to the pandemic as being the accelerator for all things, including my own weight gain. But I definitely think that modern applications represent the secondary tier of updating the healthcare systems, just as we're finally starting to modernize legacy, pagers, phones, faxes to meet the modern efficiency models.

The applications themselves needed to be modernized in conjunction with the involving sort of frontier of access security, and of course health outcomes.

Cameron I'm, I'm thinking back to my environment. So 1600 instances of 900 different applications. You're not talking about rewriting the EHR you're talking about.

We had so many. I don't know what, what we would call 'em. We used to call 'em middleware, but right. Those applications that seamlessly pulled together the data. So we had all these islands of data. We had all these workflows that were disconnected because each application wasn't completely integrated. And we wrote code that moved the data that created the workflows that went across the system. I assume that's what we're talking about. We're not talking about rewriting these core applications.

Well, some of the core applications are rewriting themselves, right? There's a major update. That's coming to one of the EHR systems that is going to impact a lot of the major healthcare systems as those get updated.

Again, how those interact with some of those other desperate applications is gonna be significant. So, no, we are not rewriting again, your EMR, but we are trying to take a look at how many of those applications are you still dealing with that are legacy that maybe could be consolidated a lot of times when you have larger healthcare organizations that are trying to grow for whatever reason for expands control because they've done well because they're not doing well.

You wind up getting a lot of mom and pop shops that had, like you said, code that was written for a specific purpose that can now be covered under the umbrella of a larger application, which is simpler to operate a lot cheaper. And of course doesn't take all of the sort of legacy maintenance.

One of the things that's interesting to me is we had an outage, we had a cloud outage with Kronos, and it was, it was not too long ago.

A lot of, lot of bad things around that outage and some bad practices. But the health system leaders had to figure out this was a time tracking and tied to payroll in a bunch of other things. They had to figure out how to solve this issue. And it took several weeks for growns to come back.

It was interesting because several of them had application development capabilities. That's that? Wasn't the norm. If you backed up to, when I came into healthcare in 2012, everybody had sort of jettisoned, their applications said we don't, we don't build anymore. We buy. Right. And it was interesting during that Kronos outage.

The organizations that have that capability, they stood up these applications very rapidly because they already had a security framework in place. They had modern tools to write the code on repository and whatnot. And they were able to do things literally within 48, 48 to 72 hours.

I mean, they pop things up in order to do that. are, are we seeing more and more health systems try to develop that muscle of application development?

We definitely are. Right. And one of the big key things that I wanna call out a sort of population density, if you've got the patient base and the flexibility, then 100% taking that in house makes a huge difference.

Again going back to what you said about K. When we were writing applications in the past, everybody remembers the going to be down for maintenance thing, right. That you would receive first, when it was a physical, physical piece of paper that you would get in your inbox. And then it went to an email, but you're taking down the entire application, this whole big piece of code.

Well, now we have more modular versions of that, right. Where you're able to do and take out and update different portions. And so we definitely see that at some of the larger healthcare systems. However, I wanna be very clear. Updating applications. Isn't just updating your ability to create them or modify them.

It's also working with the kind of partners and giving you the flexibility that you can call in that application ninja team. If you need to, who are looking at you specifically, your kind of environment, one of the problems with when people started to kind of kick applications out the door is you, you got away from the Besto sort of customized healthcare attention that everyone loved when they were writing the code themselves, right.

Things that were specific to your area specific to your population, demographic or your growth trajectory. And so we also see a lot of healthcare systems that are on the smaller side, partnering with people like. Or really are resellers GSIs to develop the applications that they want. Maybe some of them are off the shelf with a couple of different tweaks.

Some of them are completely ground up, but long story short to your original point, without that flexibility, without the ability, really, to make sure that you have a, a handle on your applications, you're more subject to worse outcomes. Like what happened with Kronos?

Yeah. I thought it was interesting what you just pointed out in terms of having partners. I know of some health systems that have rewritten their digital front door and in the process of doing that, what they recognized is they needed to supply the framework. And then the partners came in and worked within the framework. because they set that up for that digital front door, they were able to do it with additional applications as they move forward because the architecture was correct.

And so it's, you start to get this snowball, this acceleration effect of not only writing code for applications. To deliver on experiences that you didn't have before, but also to address some gaps and issues that you haven't had because you, again, once that, once that framework's in place, you can really accelerate it.

Yeah. I mean, and I I'd like to kind of take a step back too, and, and just talk about the applications as an ecosystem, right. For some of our elderly patients that are out there, we are now seeing things like Uber talking about getting into the space. We we've seen it a macro level, a lot of these very large companies like Amazon now getting into the pharmacy space now getting into direct care. What that's going to lead to though are applications and, and that digital front door that you're talking about could not be more important, not only just to kind of stay relevant in your own area, but, to provide this version of value based care that we're evolving to where the application itself is more suited to the patient base. And the information is going back in a way that's suited to your clinical workflow.

these internet applications, the internet architecture for applications is really nice. I mean, you could receive these alerts, you receive, you could trade messages, you can kick off workflow. And, and so as the, the Uber for healthcare and, and even Twilio, we're seeing be used in a bunch of different places.

You have all these different tools, but at some point you have to bring those messages in. You have to act on those messages. You have to incorporate them into the workflow. Gimme an idea of what, what are some of the tools that VMware. Brings to bear on this process.

Right. So for us we've decided to standardize really on, on Kubernetes. Right? And so we've got Tansu Kubernetes grid. We also have the Tansu application platform and really the way that we approach that, though, again, is that we will go in and try to quantify the totality of your applications in terms of your ecosystem, both known and shadow it. I wanna call that out. I can't tell you how many times we've gone in to do one of these sort of application assessments.

And that's when a CIO or CTO was not necessarily horrified, but very sort of eyebrows up to learn what people were using as sort of workarounds. And then of course, after, we, we quantify that, then we qualify the impact to the business. If we were to try to modernize that or change it that's as that's where it goes back into that architectural discussion to make sure whatever you're standing up is not just an add on built on product.

And then after that, of course, we want to add these to the overall modernization plan. That includes. Physical legacy devices, any sort of physical processes that you're trying to remove in the diversity of adoption, understanding that different parts of your healthcare system may not be ready to evolve.

One of the most interesting use cases that I've seen recently is we start to look at what we consider sort of dumb devices, right? Which are since incredibly useful inside of a healthcare system, like wheelchairs, being able to track those, being able to make sure that if you have a medical device, you can find it, believe it or not.

Those things are, are not what you would normally consider part of your application portfolio. But when you're thinking about the diverse nature of work, and now with clinical nurses becoming travel nurses you've got physicians working across all these different health systems, a simple application that just tells you where devices are helps with loss prevention, but also saves time. And so it's not something that you would maybe think about sort of critically upfront, but it makes a difference in your overall level of care.

Yeah, I think the thing I like about this is we, we talked about agility in the first session. So this provides that agility. It also provides security, a layer of security in, in terms of the framework.

And then it, it just accelerates all this work around the consumer, the experience even the clinician experience. It just accelerates the work that we're able to do. It's a great I think movement that we're seeing this muscle that's being developed within healthcare to to modernize these applications. Cameron again, thanks for your time. Always a great conversation. Next time we get together, we are going to talk a little end user computing, which is a space you guys have been in for a while, but that's a space that keeps changing. So look forward to that conversation.

Thanks 📍 again, bill.

what a great discussion, love talking to Cameron fantastic insights into the industry and what's going on. I wanna thank our sponsor for today. VMware, for investing in our mission to develop the next generation of health leaders. Don't forget that this whole series of podcast ends with a great webinar. We have healthcare leaders from several health systems coming together. Experts from VMware. And we're going to hear about multi-cloud solutions, enterprise cloud, cloud, native workforce, and obviously the ecosystem that brings that all together. You can get more information on our website this week top right hand corners where our webinars are. You can also get more information in the description box below. Love to have you join us, please register again Thursday, October 13th from one to 2:00 PM Eastern time. Thanks for listening. That's all for now.


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