Using Virtualization, Communication to Improve HIT Infrastructure

September 19, 2017 - Healthcare organizations going through technological growth are challenged by planning how their infrastructure will expand and what infrastructure technology can do for them.

Nebraska Medicine and the University of Nebraska Medical Center are currently under a massive expansion period, including opening up new facilities. This growth creates interesting opportunities from an infrastructure perspective and how the organization can us IT to leverage that growth, Nebraska Medicine Vice President of IT Brian Lancaster told HITInfrastructre.com at VMworld 2017.

One of the main goals Nebraska Medicine has while improving its IT infrastructure is doing so while achieving an ROI.

“Healthcare is transforming and the needs of healthcare are transforming,” said Lancaster. “To really achieve goals, we have to be investing in new approaches, data warehousing, analytics, and virtual care. All those sorts of things are needed to pivot from fee-for-service to value-based care. That's the macro level.”

“Working in the intersection of healthcare and technology is great because you have all these rapid advancements of technology and all these large needs on healthcare,” he continued. “That's going on across any healthcare provider.”

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Lancaster joined Nebraska Medicine in 2015 and was tasked with the responsibility of taking what was generally seen as a technological commodity and pivot that to use technology as a strategic asset.

“That's very challenging in the financial climate of healthcare, and certainly within our organization,” Lancaster admitted. “That's key to the strategic plan I have in the next four or five years; how do we start to align better with the enterprise to really drive value versus just providing them a computer or software that they kind of like to use but is not really driving the strategic crowd.”

Lancaster had to build a strategy to begin to virtualize and automate Nebraska Medicine’s IT infrastructure so it can be elastic with the organization’s enterprise needs. In 2015, Lancaster’s first project was moving to a new data center, which he states would not have been possible without the high amount of virtualization the organization was able to do.

“Prior to that time, we were about 60 percent virtualized,” Lancaster explained. “Before the move we virtualized every system we possibly could and landed about 80 to 90 percent server virtualization and workload virtualization. That set the stage for what we decided to do with our new virtualized data center. We added more capacity and had the latest thinking architecture, but what were we going to do next?”

The initial migration and increased virtualization of the data center prompted Nebraska Medicine to commit to a four-to five-year plan with the goal of providing IT as a service and enable it as a strategic asset. 

“Part of my challenge early on was how do we start to change the mindset of what IT is?” said Lancaster. “A lot of my superiors were just looking at the cost center and saying, ‘You guys do something over there, and it's more of a commodity.’ How do you really change that perspective on the value of technology?”

“The virtualization story is easy to show value because you have a hard ROI around physical assets,” Lancaster explained. “I need to buy less physical servers. But once you complete that, what's the next turn? And that's where my organization is at right now.”

Nebraska Medicine has further plans for virtualization in its IT infrastructure to continue to automate its environment.

“We have plans for the whole stack, Lancaster explained. “Anytime anyone needs an environment, resource, or an IT service it's now automated and it can be deployed. It's really that whole stack. Right now, we're a private cloud, so it's on-premises, but it's deployed as using virtualization technology.”

“We have a ton of work over the next three or four years, just virtualizing every aspect of the network. So far we've only done our Epic environment.”

Part of Lancaster’s plan involves becoming more optimized and creating more value. The first part of that was around micro segmentation and network virtualization because cybersecurity remains a top priority among healthcare organizations.

“You have this rapid digitation that outpaces security controls,” Lancaster stated. “Then you also have a larger target due to the premium and what people can get for PHI on the dark web; it's a perfect storm. You've got this target, it's not very controlled, and it pays a premium as compared to banking information or other information.”

“The other complexity is the data also has connections to hundreds of different systems, laboratory systems, radiology systems, x-ray systems,” he continued. “We really didn't know what to open or shut. We looked at our environment and discovered we had over five million open ports; the attack surface was huge.”

New developments in advanced technology caused Lancaster to look at his vendors, such as VMware, as a strategic partner rather than just an infrastructure vendor. Virtualization and automation bring value to IT infrastructure and allow organizations to be smarter and more proactive with their environments.

“After implementing advanced infrastructure solutions, we were able to virtualize those ports and we went from millions of ports to a handful of ports,” Lancaster explained. “The direct correlation to the attack surface is amazing. We have a tiny attack surface now, which can translate to a huge return on investment because the potential of a breach is so much smaller.”

The implementation of advanced IT infrastructure also allows Nebraska Medicine to deploy technology more efficiently so it can look ahead to other projects. This let the entity explore IT as a service and what the technology can do for it rather than what Nebraska Medicine can make it do.

“We started talking about, how do we get to IT as a service,” said Lancaster. “IT as a service is defined simply as any time someone needs something from IT, they go to this beautiful self-service catalog. They click a button, and it's deployed.”

“To enable that, I have to have a clear definition of what my services are,” he continued. “How do we have a service catalog? How do we optimize those services so they become self-service?”

To truly embrace advancing technology, Lancaster stresses the importance of establishing positive and open relationships with the vendors and the IT decision-makers within the organization to understand what can realistically be done with the technology available.

“What I’ve witnessed in my career is that IT becomes a protected asset and we really have to establish effective relationships across the board,” said Lancaster. “How can I really understand where my CFO wants to go or my chief strategy officer or operating officer wants to go?”

“We spend a lot of time doing business relationship management, to understand where CFOs and strategy officers want to go,” he continued. “Then we come back as a consultant and tell them what we've heard, the five things we can do today with technology we have, and some technology we probably need to look at to enable our long-term vision."

Lancaster advised IT departments to not become barriers. Instead, they must work with their teams to figure out how to make things happen instead of telling the organization they simply can’t do certain things because the technology is not there.

“Work through what the CFO and strategy officers are trying to achieve and come back with ideas,” Lancaster advised. “Move towards more of a consultant mode and try to establish those relationships within the enterprise.”