- Organizations are faced with advancing their HIT infrastructures as more advanced technology proves its worth in increasing workflow, security, and patient care. However, IT decision-makers are challenged by how to tackle pieces of their IT infrastructure and how to architect a strategy that is both cost effective and hi-tech.
Entities moving from a legacy environment to a modern and progressive environment are struggling with how to transform parts of their infrastructure and when, according to Moffit Cancer Center CTO Tom Hull.
Florida-based Moffitt Cancer Center consists of five campuses and nearly 7,000 employees focused on cancer care and research.
Hull explained to HITInfrastructure.com at VMworld 2017 that Moffitt is coming out of a legacy environment and undergoing a massive transformation.
“We had just one whole monolithic datacenter and a lot of single points of failure with no resiliency,” Hull said. “Two years ago, we embarked on this massive infrastructure modernization. We started to build virtualization, then it was a cloud strategy, ability strategy, our datacenter strategy and our disaster recovery transformation.”
Hull had goals in mind when considering how he wanted to transform the data center from a dated infrastructure to a modern one. Hull needed to focus on resiliency and eliminating the single points of failure. Moffitt was at risk of losing business continuity if it had a system failure with no standby.
Moffitt moved to a hybrid environment of multiple data centers and used public cloud as well as a software-defined data center, moving older data out of the legacy environment for the transformation.
“We had several thousand servers, both physical and virtual. Some of them were running Windows 2000, Windows 2003. They were old and susceptible to threats and unable to be patched,” said Hull. “We virtualized all those old physical servers and upgraded them. Now I can recommission those in a very easy way to have a warm standby. It helps with our backup and recovery and our disaster recovery as well.”
Moffit’s IT infrastructure overhaul only begins with the data center. Similar to most healthcare organizations, it had interoperability issues with its EHR as it added more advanced technology.
Moffitt implemented Internet of Things (IoT) modalities with the intent of taking in the information it collects, store it, and be able to access that actionable data from a workstation and connect it to its EHR.
Hull explained that providing clinicians with mobile access to EHRs was an interoperability goal. Implementing PowerChart and PowerChart Touch gave clinicians the option to access their Cerner EHR from mobile devices and incorporating multiple components into their mobile strategy.
Looking at use cases, internal clinicians and researchers, as well as patients and their families spending time in the cancer center are all part of building a robust mobile strategy.
“A mobile strategy needs to allow all authorized users to hook into the internet and give them a place and opportunity to do that,” said Hull. “We have five campuses, so users are moving from one campus to the other all the time. Our mobility strategy has to incorporate the devices that we support and the levels of those devices. We see a really great opportunity for our mobile device management to improve.”
Moffett is currently using Citrix XenMobile for mobile device management.
When looking toward the future, Hull put an emphasis on cloud strategy and leveraging both the public and private cloud.
“We want to take advantage of the hybrid cloud architecture,” Hull explained. “In the foreseeable future, we don't see ourselves getting out of the datacenter business. I think it's going to be the hybrid scenario where we're going to have a sustainable, affordable model of shared drives and still a lot of data that needs to be secured, needs to be maintained in our infrastructure.”
Many organizations are challenged by choosing what data will live where and considering the public and private cloud. Public cloud is a viable option for entities that cannot afford to deploy a private cloud on-premises. However, it may be difficult for organizations to predict public cloud costs.
“The advantage of public cloud is convenience,” Hull stated. “There's also challenges with the public cloud. The number one challenge is that it's an operational expenditure. I can get capital expenditures to buy more capacity for VM cluster here or a VM cluster there. I can add more disk or flash drive, by using capital to buy them.”
“If I go to AWS or Azure software and get those on an expense basis, I've got to predict what that's going to cost every month,” he continued. “That means my operational expenditures are going to go up, and that's not good. The challenges of right sizing what we have in our private cloud and then managing that to put some in public that we'll need for use is the architectural challenge.”
Many vendors and healthcare organizations don’t believe that entities will fully abandon on-premises data storage for cloud storage. Hull thinks that healthcare will eventually move fully to cloud, however, he doesn’t see it happening in the near future.
“I think the close proximity of the data, the ability to secure it, and how we can physically layer security so we have virtual layer security is going to make it even easier for us to manage that data on on-premises systems,” said Hull.
“It's actually less expensive to have on-premise, and healthcare is always going to be concerned about how expensive things are,” he continued. “From HIPAA, CMS compliance perspective, the day that AWS really gets hacked or goes down hard is the day that it'll be even more scrutinized over what's stored there.”
Planning and implementing a modern and future-proof IT infrastructure is more important than ever as organizations are preparing for infrastructure technology to play a more important role in workflow and business practices.
“IT five years from now will have a more important role than we do today, and that's because of the brokering of all those resources,” Hull predicted. “We need to make sure that we've got plenty of resources, we're sustainable, we're affordable and that it's all serviceable. The architecture is that abstraction above that physical layer.”
“I see ourselves as being very strong architects that can easily, and maybe in an automated way, fulfill those requests that are coming from our researchers, our professors, our physicians,” he maintained. “Anytime they need something they should be able to get it from a portal. And if for some reason they can't, then we talk. We want that automated service and automated provisioning. Those resources should be expandable and revisable from the environment that we're building.”
Hull advised that organizations mapping out their infrastructure strategy need to put together an architecture that includes a cloud strategy, mobile strategy, a technology review board that includes stakeholders, and a service management model.
Entities should be able to bring those four things into a framework no matter the size of the organization, he stressed.
“The point is to be able to rate those strategies, govern them through good IT governance, and have that hybrid approach that is expandable,” Hull advised.
“We have one institution that has 17 academic medical centers in a collaboration. Their data warehouse is astronomically huge, and it continues to grow,” he explained. “How are we going to accommodate them? And that should all be answered in the cloud strategy. The time and effort it takes to build those strategies is what to do right from the start.”