For healthcare organizations, transitioning to the cloud is no longer a pipe dream; it’s a core strategic objective. “This is where the future is going,” said Andrew Rosenberg, MD.
And that means not only “building out a robust, wide-area network with a lot of redundancy,” as Michigan Medicine has been doing, but also fostering transparency with vendor partners. “The level of comfort with communicating uncertainty has to mature even more,” he noted. During a recent Keynote, Rosenberg – who has served in the role since 2016 – broke down his cloud strategy, shared key lessons learned, and discussed how the current M&A environment can influence decision-making.
Rosenberg speaks from experience, as Michigan Medicine merged with Sparrow Health in 2023, further adding to the health system’s scope, and putting him on course with a large percentage of healthcare leaders.
Andrew Rosenberg, MD
“The contemporary healthcare CIO was defined mostly by the EHR implementations from the 2010s to about 2018,” he recalled. “Then we had Covid and the disruptions that came with it. Now, with consolidations, you’re seeing a lot of new Epic implementations as consolidated health systems are trying to rationalize their EHRs or they’re integrating along strategic applications, platforms, and infrastructures.”
Michigan Medicine, of course, is no exception. “We’re deeply into that work right now,” he said.
One of the challenges for CIOs in his shoes is in reaching consensus among the different entities, and striking the difficult balance of empowering local practices while also cementing their place as part of a larger organization.
Achieving that, he noted, requires more than just technical knowledge. “Technology, and especially IT within technology, is only a component of how the business needs to shift the way it works,” Rosenberg said. The person leading that needs to understand how tools like ambient listening can help relieve the administrative burden. They need to understand the nuances of a nursing flowsheet, and the difference between physician notes written in the OR versus the clinic.
In short, leaders must understand the business and where opportunities exist that can help improve efficiency and increase satisfaction. “They have to understand where they work has to change.”
One change his team is eager to make? Getting out of the data center business, which includes several steps: develop a redundant architecture (in partnership with AT&T) and working with Digital Realty on data center services and co-location. And although they have landing zones with AWS and GCP, Microsoft Azure is the strategic partner that will help drive the migration.
And that’s just part of it.
“We have identity issues to work through. We have security, we have software-defined networking issues, all of which are new to us, and we have upskilling of our talent,” Rosenberg said. Because there are so many pieces, his team is moving at a deliberate pace, one that he feels they can continue. “It’s not cloud-first. It’s a contemporary, strategic enterprise platform. Our challenge is to figure out what we need to do, and do it as efficiently as we can.”
What that requires is more focus on tactics than strategy, according to Rosenberg, who shared some of Michigan’s wins. The first entailed an “unusually detailed service design document,” which they developed with Deloitte and NetApp to support the level of granularity needed by hyperscalers to provide actionable data.
Not an easy road, but one he believes is worth taking.
“The amount of effort we put in to get those levels of detail actually slowed down our process by probably a year, but I suspect that level of pre-work will pay off,” he said. “The level and details of our service design document should leapfrog us by at least a year,” while also providing a model for other organizations – at least, those who are Epic customers.
Another critical piece of the puzzle is cultivating more transparent relationships with partners, according to Rosenberg, who, like most (if not all leaders), craves the brand of honesty he has seen from Epic in recent years. “They’ve been showing us where they are, where they know they'll be in a year, and what they're thinking about, with no expectation that what they're thinking about will happen on time.” That, he believes, is “an example of a co-maturation,” as well as a step in the right direction. “I believe that as we go more and most hosted, the hyperscalers are going to have to mature to a level of discomfort to say, ‘here’s our best estimate. We’re not going to be held to it, but we’ll give our best effort.’”
Finally, he advised CIOs and other leaders not to focus solely on the finances of cloud migration.
“I didn’t lead with, ‘We want to save money, so we’re going to the cloud,’” he cautioned. “That's absolutely wrong, because if we don’t do it right, we could easily spend more money.”
The true driver, Rosenberg added, should be business continuity, particularly given the alarming number of cyberattacks and outages in the past few years – some of which have proven extremely costly. Even if ransomware victims are back up after 6-8 weeks, they’ll still feel the effects of the attack for months, he noted.
This is where having solid partnerships can make a significant difference. “We’re going to have outages. What it comes down to is how fast they correct it versus how fast we would. That’s going to be really important.” For leaders, that means doing due diligence around not just the strategic vendors, but also the redundant and WAN architectures that can provide a significant upgrade from on-prem solutions – if organizations are willing to invest dollars and sweat equity.
“I was skeptical about the cost of cloud,” he said. “Now, I’m much more reassured that it’s probably going to be neutral at worst, and I think we have opportunities to distinctly show where we can add savings.”