Showing posts with label EMR. Show all posts
Showing posts with label EMR. Show all posts

Wednesday, February 21, 2018

A Tale of Two Hospitals—How Dynamic Healthcare Economics in Belgium Hastens Need for Modern IT Efficiency

Transcript of a discussion on how two Belgian hospitals are adjusting to dynamic healthcare economics by leveraging the multilevel benefits of composable infrastructure and pay-as-you-go buying options for data centers.

Listen to the podcast. Find it on iTunes. Get the mobile app. Download the transcript. Sponsor: Hewlett Packard Enterprise.

Dana Gardner: Hello, and welcome to the next edition of the BriefingsDirect Voice of the Customer podcast series. I’m Dana Gardner, Principal Analyst at Interarbor Solutions, your host and moderator for this ongoing discussion on digital transformation success stories. Stay with us now as we learn how agile businesses are fending off disruption -- in favor of innovation.

Gardner
Our next data center agility interview explores how two Belgian hospitals are adjusting to dynamic healthcare economics to better compete and cooperate. We will now learn how a regional hospital seeking efficiency -- and a teaching hospital seeking performance -- are meeting their unique requirements, thanks to modern IT architectures.

Here to help us understand the multilevel benefits of composable infrastructure and software defined data center (SDDC) in the fast-changing healthcare field are our guests, Filip Hens, Infrastructure Manager at UZA Hospital in Antwerp, Belgium. Welcome, Filip.

Filip Hens: Thanks.

Gardner: We’re also here with Kim Buts, Infrastructure Manager at Imelda Hospital in Bonheiden, Belgium. Welcome.

Kim Buts: Thank you.

Gardner: What are some of the top trends disrupting the healthcare industry in Belgium? Filip, why do things need to change? Why do you need to have better IT infrastructure?

Hens: That’s a good question. There are many up-and-coming trends. One is new regulations around governance, which is quite important. Due to these new rules, we are working more closely together with other hospitals to share more data, and therefore need better data security. This is one of the main reasons that we need to change.

Hens

In Belgium, we have many hospitals, with some of them only a few kilometers apart. Yet there have been very few interactions between them.

New demands around augmentation of services means patient data are a growing concern. So it’s not only the needs of new governance but also the demand for providing better medical services across hospitals.

Gardner: Kim, how are the economics of healthcare -- of doing more with less -- an ongoing requirement? How are you able to conserve on the costs?

Buts: We are trying to do everything we can across the financial possibilities. We are constantly looking for good solutions that are affordable. The obligation to work in a [hospital] cluster provides us with a lot of new challenges.

A major challenge for us was around security. We have invested hugely in security. Many of the new applications are now shared across the hospital cluster. So we chose to take on the role of innovator. And to continue innovating, we have to spend a lot of money. That was not foreseen in the annual budget. So we took advantage of Hewlett Packard Enterprise’s (HPE’s) new financial services approaches, to make things happen much faster than usual.
How HPE Digital Solutions
Support Healthcare
And Life Sciences
Gardner: We’ll get back to some of those services, but I’d like to help our readers and listeners better understand this interesting combination of needing to compete -- that is to attract patients -- but at the same time cooperate and share data across hospital cluster. Filip, tell us about UZA and how you’re unique compared to a regional hospital. What makes you different?

Sharing is caring, and saving


Hens: Our main focus remains patient care, but for us it is not necessarily general medicine. It is more the specialist cases, for such things as specialized surgery. That is our main goal. Also we are a teaching hospital, so we have an emphasis on learning from patients and from patient data.

Gardner: You have unique IT and big data requirements from your researchers. You have more of an intense research and development environment, and that comes with a different set of IT requirements?

Hens: Yes, and that is very important. We are more demanding of the quality of the data, the need to gather more information, and to provide our researchers a better infrastructure platform.

That is one difference between a general hospital and a university hospital. A teaching facility has more complex patient analytics requirements, the need for complex data mining and stuff like that.

Gardner: Kim, how are you in your healthcare cluster now able to share and cooperate? What is it that you’re sharing, and how do you that securely to creating better healthcare outcomes?

Buts: A big difference for us is financial. Since we are a smaller hospital, we must offer a very broad portfolio of treatments. That means we need to have a lot of patients to then have enough income to survive. The broad offering, that portfolio of treatments, also means we are going to need to work more together with the other cluster members.

Buts
We are now trying to buy new IT equipment together, because we cannot afford to each buy for every kind of surgery, or for every kind of treatment. So we have combined our budgets together and we are hosting different things in our hospital that are then used by the other cluster members, too.

Financially, due to the regulations, we have less income than a university hospital. The benefits of education funding do not get to us. We only get income from patients, and that is why we need to have a broad portfolio.

Hens: Unlike a general hospital, we have income from the government and we also have an income flow from scientific research. It is huge funding; it is a huge amount. That is really what makes us different. That is why we need to use all of that data, to elaborate on scientific research from the data.

If not an advantage, it is an extra benefit that we have as university hospital. In the end, it is very important in that we maintain and add extra business functionality via an updated IT infrastructure. 
If we maintain those clusters well -- the general hospitals together with university hospitals -- then those clusters can share among themselves how to best meet patient needs, and concentrate on using the sparest amount of the budget.

Robust research, record keeping, required


Gardner: You are therefore both trying to grapple with the use and sharing of electronic medical records (EMR) applications. Are you both upgrading to using a different system? How are you going about the difficult task of improving and modernizing EMR?

Buts: One big difference between our hospitals is our doctors; they are working for the hospital on a self-employed basis at Imelda. They are not employees of the hospital as at UZA. The demands of our doctors are therefore very high, so we have to improve all of our facilities -- and our computer storage systems -- very fast.

We try to innovate for the doctors, so we have to spend a lot of money on innovation. That is a big difference, I think, between the university hospitals because the doctors are employees there.

Gardner: How does that impact your use of EMR systems?
How HPE Digital Solutions
Support Healthcare
And Life Sciences
Buts: We are in the process of changing. We are looking for a new EMR system. We are discussing and we are choosing, but the demands of the doctors are sometimes different from the demands of the general hospital management.

Gardner: Filip, EMR, is that something you are grappling with, too?

Hens: We did the same evaluations and we have already chosen a new EMR. For us, implementing an EMR is now all about consolidation of a very scattered data landscape, of moving toward a centralized organization, and of centralizing databases for sharing and optimization of that data.

There is some pressure between what physicians want and what we as IT can deliver with the EMR. Let’s just say it is an opportunity. It is an opportunity to understand each other better, to know why they have high demands, and why we have other demands.

That comparison between the physicians and us IT guys makes it a challenging landscape. We are busier with the business side and with full IT solutions, rather than just implementing something.

It is not just about implementing something new, but adaptation of a new structure of people. Our people rethink how everybody’s role is changing in the hospital, and what is needed for interaction with everybody. So, we are in the process of that transformation.

Gardner: What is it about the underlying IT infrastructure that is going to support the agility needed to solve both of your sets of problems, even though they are somewhat different?

Filip, tell us about what you have chosen for infrastructure and why composable infrastructure helps solve many these business-level challenges.

Composable confidence


Hens: That is a good question, because choosing a solution is not like going to the supermarket and just buy something. It is a complex process. We still have separation of data storage and computing power.

We still separate that kind of stuff because we want to concentrate on the things that really bring added value, and that are also trustworthy. For us, that means virtualization on the server and network platforms, to make it more composable.

A more software-defined and composable approach will make us more independent from the underlying hardware. We have chosen for our data center the HPE Synergy platform. In our opinion, we are ready because after many years as an HPE customer -- it just works.
For me, knowing that something is working is very important, but understanding the pitfalls of a project is even more important.

And for me, knowing that something is working is very important, but understanding the pitfalls of a project is even more important. For me, the open discussion that you can have with HPE about those pitfalls, of how to prepare for them and how to adapt your people to know what’s to come in the future -- that is all very important.

It’s not only a decision about the metal, but also about what are the weaknesses in the metal and how we can overcome that -- that is why we stick with HPE, because we have a good relationship.

Gardner: Kim, what are you doing to modernize, but also innovate around those all-important economic questions? How are you using pay-as-you-go models to afford more complex technology, and to give you advancement in serving your customers?

One-stop shopping


Buts: The obligations of the new hospital-cluster regulations had a huge impact on our IT infrastructure. We had to modernize. We needed more compute power and more storage. When we began calculating, it showed us that replacing all of the hard drives at one time was the best option, instead of spreading it over the next three to four years.

Also the new workload demands on the infrastructure meant we needed to replace it as fast as possible, but the budget was not available at our hospitals. So HPE Financial Services provided us with a solution that meant we could replace all our equipment with very short notice. We exchanged servers, storage, and our complete network, including our Wi-Fi network.

So we actually started with a completely brand new data center thanks to the financial services of HPE.

Gardner: How does that financing work? Is that a pay-as-you-go, or are payments spread over time?

Buts: It’s spread over the coming five years. That was the only solution that was good for us. We could not afford to do it any other way.

Gardner: So that is more like an operating costs budget than an upfront capital outlays budget?
We actually started with a completely brand new data center thanks to the financial services of HPE. We could not afford to do it any other way.

Buts: Yes, and the other thing we wanted to do was do everything with HPE -- because they could offer us a complete range of servers, storage, and Wi-Fi networking. That way we could reduce the complexity of all our work, and it guaranteed us a fast return on the investment.

Gardner: It is all more integrated, upfront.

Buts: Yes, that is correct.

Gardner: At UZA, what are you doing to even further modernize your infrastructure to accommodate more data, research, sharing, and security?

Hens: It is not about what I want to deliver; it is about what the business wants that we can deliver, and what we can together deliver to the hospital. So, for me, the next step is the EMR program.

So, implementing the EMR, looking for the outcomes from it, and offering something better to end-users. Then those outcomes can be used to further modernize the infrastructure.

That for me is the key. I will not necessarily say that we will buy more HPE Synergy. For me, the key to the process, as I just described, that is what will set the margins of what we will need.

Gardner: Kim, now that you have a new data center, where do you take it next in terms of people, process or even added technology efficiencies? Improved data and analytics, perhaps?

Cloud in the Cluster?


Buts: That is a difficult one because the cluster is very new for us. We are still looking at good ways to incorporate and decide where the data is going to be placed, and what services are going to be required.

It is still brand new for us, and we have to find a good way to incorporate it all with the different hospital cluster members. A big issue is how are we going to exchange the critical patient data, and how we are going to store it safely and securely.

Gardner: Is cloud computing going to be a part of that?

Buts: I do not know. Everything is “cloud” now so, maybe. I am not a huge fan of public cloud. If you can stay in a private cloud, yeah, then okay. But public cloud, I do not know. In a hospital, regulations are so strong and the demands are so high.

Gardner: Maybe a shared private cloud environment of some sort?

Buts: Yeah. I think that could be a good solution.
How HPE Digital Solutions
Support Healthcare
And Life Sciences
Hens: For public cloud in general, I think that is a no-go. But what we are doing already with our EMR, we can work together with a couple of hospitals and we can choose to build a private cloud at one of the sites at our hospitals.

You do not need to define it as a cloud. Really, it’s like public Internet cloud, but you have to make your IT cloud-aware and cloud-defined inside the walls of your hospital. That is the first track you need to take.

Buts: That is why in our hospital cluster, we chose to host a lot of new applications on the new hardware. It gave us the ability to learn and adapt quickly to the new innovations. And for the other hospitals, we are now becoming a kind of service provider to them. That was for us a big change, because now we are more a service level agreements (SLA)-driven organization than we used to be.

Gardner: I’m afraid we’ll have to leave it there. We have been exploring how two Belgian hospitals are adjusting to a dynamic healthcare and economics environment. They are both competing and cooperating. And we have learned how multi-level benefits of composable and software-defined data centers are helping them to meet many of their transformation requirements.

So please join me in thanking our guests, Filip Hens, Infrastructure Manager at UZA Hospital in Antwerp. Thank you.

Hens: Thank you also.

Gardner: And Kim Buts, Infrastructure Manager at Imelda Hospital in nearby Bonheiden, Belgium. Thank you.

Buts: Thank you very much.

Gardner: And a big thank you as well to our audience for joining us for this BriefingsDirect Voice of the Customer digital transformation success story. I’m Dana Gardner, Principal Analyst at Interarbor Solutions, your host for this ongoing series of Hewlett Packard Enterprise-sponsored interviews.

Thanks again for listening. Please pass this content along to your IT community, and do come back next time.

Listen to the podcast. Find it on iTunes. Get the mobile app. Download the transcript. Sponsor: Hewlett Packard Enterprise.

Transcript of a discussion on how two Belgian hospitals are adjusting to dynamic healthcare economics by leveraging the multilevel benefits of composable infrastructure and pay-as-you-go buying options for data centers. Copyright Interarbor Solutions, LLC, 2005-2018. All rights reserved.

Wednesday, November 06, 2013

Efficient Big Data Capabilities Help Cerner Drive Needed Improvements into Healthcare Outcomes

Transcript of a Briefings Direct podcast on how a large provider of healthcare services is providing insight into patient outcomes as well as EMR system performance.

Listen to the podcast. Find it on iTunes. Download the transcript. Sponsor: HP.

Dana Gardner: Hello, and welcome to the next edition of the HP Discover Podcast Series. I'm Dana Gardner, Principal Analyst at Interarbor Solutions, your moderator for this ongoing discussion of IT innovation and how it’s making an impact on people’s lives.

Gardner
Once again, we’re focusing on how IT leaders are improving their business performance for better access, use and analysis of their data and information. This time we’re coming to you directly from the recent HP Vertica Big Data Conference in Boston.

Our next innovation case study highlights how a healthcare solutions provider leverages big-data capabilities. We’ll see how they deployed the HP Vertica Analytics platform to help their customers better understand population healthcare trends, as well as to help them run their own systems internally.

To learn more about how high performing and cost effective big data processing forms a foundational element to improving healthcare quality and efficiency, please join me now in welcoming our guest, Dan Woicke, Director of Enterprise Systems Management at Cerner Corp. based in Kansas City, Missouri. Welcome, Dan. [Disclosure: HP is a sponsor of BriefingsDirect podcasts.]

Dan Woicke: First of all, thank you very much for having me. It’s my first time in Boston. So I'm having a blast here.

Gardner: Terrific. Let’s start at a high level and talk a little bit about why, in the healthcare industry in particular, big data is super important. We're going through some major transitions in how payments are going to be made and how even the definition of good care is defined. We're moving from pay for procedures to more pay for outcomes. So tell me about Cerner, and why big data is such a big deal.

Woicke: Obviously, you hit the nail on the head. The key element here is that the payment structure is changing to more of an outcome model. In order for that to happen, we need to get all the sources of data from many, many disparate systems, bring them in, and let our analysts work on what the right trends are and predict quality outcomes, so that you can repeat those and stay profitable in the new system.

Gardner: It’s interesting that, on one side of the coin, you're looking to bring large data sets together to analyze what’s going on in the field, but in order to allow you to better serve those needs, you also have big IT systems. They're putting out a lot of data, and you need to analyze them. Tell us a little bit about two ways in which big data is being employed there at Cerner.

Woicke: We’ll touch on more of the clinical side of how we are processing this data in the new model. My direct responsibility is to bring in massive amounts of performance data. This is how our Cerner Millennium systems are running.

We have hundreds of clients, both in the data center and those that manage their own systems with their own database administrators (DBAs). The challenge is just to have a huge system like that running with tens of thousands of clinicians on the system.

We need to make sure that we have the right data in place in order to measure how systems are running and then be able to predict how those systems will run in the future. If things are happening that might be going negative, how can we take the massive amounts of data that are coming into our new analytical platform, correlate those parameters, predict what’s going to happen, and then take action before there is a negative?

Effect change

We want to be able to predict what’s happening, so that we can effect change before there is a negative impact on the system.

Gardner: Everybody, almost across any business you talk to, wants to be more proactive and get out in front of these issues. Tell me how big data and the ability to manage big data gets you closer to the real time and then, ultimately, proactive.

Woicke: Since January of this year, we've started to bring in what we call Response Time Measurement System (RTMS) records. For example, when a doctor or a nurse is in our electronic medical record (EMR) system is signing an order, I can tell you how long it took to log into the system. I can tell you how long you were in the charting module.

Woicke
All those transactions produce 10 billion timers, per month, across all of our clients. We bring those all into our HP Vertica Data Warehouse. Right now, it’s about a two-hour response time, but my goal, within the next 12 months, is to get it down to 10 minutes.

I can see in real time when trends are happening, either positive or negative, and be able to take action before there is an issue.

Gardner: That’s impressive. Tell us a little bit about Cerner and describe the company -- what they do, and this idea that you have not just your own systems, but you're managing systems that other people use as well.

Woicke: We have two data centers in Kansas City, Missouri and we host more than half for our clients in those data centers. The trend is moving toward being remote-hosted managed like that. We still have a couple of hundred clients that are managing their own Millennium domains. As I said before, we need to make sure that we provide the same quality of service to both those sets of clients.

Gardner: So you're used primarily by healthcare organizations. Tell us how you actually function within healthcare and the services that you provide to these organizations.

Woicke: We run the largest EMR in the world. We have well over 400 domains to manage  -- we call them domains -- which allows us to hook up multiple facilities to those domains. Once we have multiple facilities connecting into those domains, at any given time, there are tens of thousands clinicians  on the system at one time.

Gardner: I'm still trying to tease out a little bit of more understanding of the function that you provide to these health providers. Are you doing their medical records inventory for them or do you have a set of applications in addition to that? Help us understand better what services you provide.

Single database

Woicke: Cerner Millennium is a suite of products or solutions. Millennium is a platform where the EMR is placed into a single database. Then, we have about 55 different solutions that go on top of that platform, starting with ambulatory solutions. This year was really neat. We were able to launch our first ambulatory iPad application.

There are about 55 different solutions, and it's growing all the time with surgery and lab that fit into the Cerner Millennium system. So we do have a cohesive set of data all within one database, which makes us unique.

Gardner: Before we go to some more insights about the healthcare industry, population health, and some of the great analytics that can be brought there, let’s drill down a little bit into what you're doing on site. Where does the data come from primarily? Is this log information. Do you have a set of management systems of your own, and how much data we are talking about?

Woicke: We're talking about quite a bit of data, and that’s why we had to transform something away from a traditional OLTP database into an MPP type database, because those systems that are now sending data to Cerner. 

We have claims data, and HL7 messages. We're going to get all our continuous care records from Millenium. We have other EMRs. So that’s pretty much the first time that we're bringing in other EMR records.
What that's going to do is bring the total cost of your healthcare down, which is really the goal.

We have health-plan enrollments, and then of course, within Millennium, we're going to drill down into outcomes, re-admissions, diagnosis, and allergies. That’s the data that we need to be able to predict what kind of care we are going to have in the future.

Gardner: Now, you're also looking to how you can better understand the marketplace and provide insights, so that people can literally change on a dime, change the wings on the airplane while it’s still in the air, if you will, in healthcare and population health. What are the insights that you can get there and what are the data sets that you need in order to do that?

Woicke: The data sets are similar to what we just discussed. You’ll have that claim data that comes in from multiple sources, multiple EMRs, but the whole goal of population health is to get a population to manage their own health. That means that we need to give them the tools in their hands. And they need to be accurate, so that they can make the right decisions in the future. What that's going to do is bring the total cost of your healthcare down, which is really the goal.

Gardner: So it seems to me that we talk about "Internet of things." We're also going to the "Internet of people." More information from them about their health comes back and benefits you and benefits the healthcare providers. But ultimately, they can also provide great insights to the patients themselves.

Do you see, in the not too distant future, applications where certain data -- well-protected and governed of course -- is made into services and insights that allow for a better proactive approach to health.

Proactive approach

Woicke: Without a doubt. We're actually endorsing this internally within the company by launching our own weight-loss challenges, where we're taking our medical records and putting them on the web, so that we have access to them from home.

I can go on the site right now and manage my own health. I can track the number of steps I'm doing. Those are the types of tools that we need to launch to the population, so that they endorse that good behavior, which will ultimately change their quality of life.

Gardner: Then, there is also this notion of anonymized patient information, where you can take an aggregate and find out what works and what doesn’t work when it comes to behavior, patterns of fruition when it comes to things like weight loss. Tell me how that grander view, the holistic view of the data, comes to bear as well. 

Woicke: Right now, we're in production with the operation side that we talked about a little bit about earlier. Then, we are in production with what we call Health Facts, a huge set of blinded data. We hire a team of analysts and scientists to go through this data and look for trends.
You can see what that’s going to do for the speed of the amount of analysis we could do on the same amount of data. It’s game changing.

It’s something we haven’t been able to do until recently, until we got HP Vertica. I am going to give you a good example. We had analysts log a SQL query to do an exploratory type of analysis on the data. They would log that at 5 p.m., then issue it, and hopefully, by the time they came back at 8 a.m. the next day, that query would be done.

In Vertica, we've timed those queries at between two and five seconds. So you can see what that’s going to do for the speed of the amount of analysis we could do on the same amount of data. It’s game changing.

Gardner: Let me ask you, Dan, about that process through which you acquired Vertica. How did you adopt it? What were some of the requirements, and why didn’t some of the other alternatives work out?

Woicke: There were a lot of competitors that would have worked out, but we had a set of criteria that we drilled down on. We were trying to make it as scientific as possible and very, very thorough. So we built a score sheet, and each of us from the operation side and Health Facts side graded and weighted each of those categories that we were going to judge during the proof of concept (POC). We ended up doing six POCs.

We got down to two, and it was a hard choice. But with the throughput that we got from Vertica, their performance, and the number of simultaneous users on the system at a given period of time, it was the right choice for us.

Gardner: And because we're talking about healthcare, costs are super important. Was there a return on investment (ROI) or cost benefit involved as well?

Extremely competitive

Woicke: Absolutely. You could imagine that this would be the one or two top categories weighted on our score sheet, but certainly HP Vertica is extremely competitive, compared to some of the others that we looked at.

Gardner: Dan, looking to the future, what do you expect your requirements to be, say, two years from now? Is there a trajectory that you need to take as an organization, and how does that compare to where you see Vertica going?

Woicke: Having Vertica as a partner, we navigate that together. They invited me here to Boston to sit on the user board. It was really neat to sit right there with [HP Vertica General Manager] Colin Mahony at the same table and be able to say, "This is what we need. These are our needs coming around the corner," and have him listen and be able to take action on that. That was pretty impressive.

To answer your question though, it’s more and more data. I was describing the operations side, where we bring in 10 billion RTMS records. There's going to be another 10 billion type of records coming in from other sources, CPU, Memory, Disk I/O, everything can be measured.

We want to bring it into Vertica, because I'm going to be able to do some correlation against something we were talking about. If I know that the RTMS records show a negative performance that's going to happen within the next 10-15 minutes, I can figure out which one of those operational parameters is most affecting that outcome of that performance, and then can send the analyst directly in to mitigate that problem.
By bringing in more and more data and being able to correlate it, we're going to show all the clients, as well as the providers, how their system is doing.

On the EMR side, it’s more data as well. On the operations side, we're going to apply this to other enterprises to bring in more data to connect to the experts. So there is always somebody out there. That’s the expert. What we're going to do is connect the provider with the payers and the patient to complete that triangle in population health. That’s where we're going in the next few months.

Gardner: I certainly think that managing data effectively is a huge component of our healthcare challenge here in the United States, and of course, you're operating in about 19 countries. So this is something that will be a benefit to almost any market where efficiency, productivity, quality of care come to bear.

Woicke: At Cerner Corp., we're really big on transparency. We have a system right now called the Lights On Network, where we are taking these parameters and bringing them into a website. We show everything to the client, how they're performing and how the system is doing. By bringing in more and more data and being able to correlate it, we're going to show all the clients, as well as the providers, how their system is doing.

Gardner: Well, great. I'm afraid we’ll have to leave it there. We've been learning about how a healthcare solutions provider has been leveraging big-data capabilities, and we've seen how at Cerner Corp. they've deployed HP Vertica Analytics Platform to help their customers better understand population health trends, as well as to gain terrific insights into their own systems and the systems that they host for others.

So, a big thank you to our guest, Dan Woicke, Director of Enterprise Systems Management at Cerner Corp. Thanks so much, Dan.

Woicke: Thank you for having me.

Gardner: And thank you also to our audience for joining this special HP Discover podcast coming to you directly from the recent HP Vertica Big Data Conference in Boston.

I'm Dana Gardner; Principal Analyst at Interarbor Solutions, your host for this ongoing series of HP sponsored discussions. Thanks again for joining, and don’t forget to come back next time.

Listen to the podcast. Find it on iTunes. Download the transcript. Sponsor: HP.

Transcript of a Briefings Direct podcast on how a large provider of healthcare services is providing insight into patient outcomes as well as EMR system performance. Copyright Interarbor Solutions, LLC, 2005-2013. All rights reserved.

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Wednesday, October 09, 2013

Need for Quality and Speed Powers Sentara's Applications Modernization Journey

Transcript of a BriefingsDirect podcast on how a healthcare provider is deploying and monitoring IT operations and services for better patient care.

Listen to the podcast. Find it on iTunes. Download the transcript. Sponsor: HP.

Dana Gardner: Hello, and welcome to the next edition of the HP Discover Performance Podcast Series. I'm Dana Gardner, Principal Analyst at Interarbor Solutions, your moderator for this ongoing discussion of IT innovation and how it’s making an impact on people’s lives.

Gardner
Once again, we're focusing on how IT leaders are improving their services' performance to deliver better experiences and payoffs for businesses and end users alike, and this time we're coming to you directly from the recent HP Discover 2013 Conference in Las Vegas.

Our next innovation case study interview highlights how Virginia Healthcare provider Sentara Healthcare improve its IT operations and services delivery at higher quality and higher speed.

We'll learn how it’s improving the IT service management (ITSM) maturity, making IT an internal business-service provider, and how that’s helped them in deploying better services, but also monitoring those services to oversee their applications’ activities.

To learn more about how Sentara Healthcare excelled at application and data delivery and has progressed towards an automated lifecycle approach for high performance management, please join me in welcoming our guest, Jason Siegrist, Manager of Enterprise Management Technologies at Sentara. Welcome. [Disclosure: HP is a sponsor of BriefingsDirect podcasts.]

Jason Siegrist: Glad to be here.

Gardner: Let’s paint the picture. Apps, of course, are always important, but in your business, healthcare, getting those apps so the people seems to be more important than in the past. Is there a shift here, where the emphasis is on speed and access to data? How has the notion of an application been changing for your users?

Siegrist: At Sentara Healthcare, and actually most healthcare organizations, the interest has been trying to get to electronic medical records (EMR) to make it easier and to reduce risks associated with caring for patients.

Patients are looking to get access to that data quicker, be able to see lab results in a timely manner, and be able to schedule appointments with doctors. We're trying to make those systems available to them in a secure way so that they're confident that their personal information is safe and protected.

Gardner: Of course, as end users, they just see the apps, but there's a lot going on behind the scenes to make sure that they are performing properly and that they get to where they are supposed to. Tell us why maturity and progressing toward better application culture and behavior has been important for you.

Better healthcare decisions

Siegrist: In healthcare, the face of healthcare is still our doctors, nurses, and technical staff. However, we're trying to make sure we can enable those doctors and nurses to make better healthcare decisions and allow them to work interactively among each other, even when they're not in the same building.

Siegrist
Our environment has grown so significantly, even with things like X-rays being all digital these days. Now, a doctor can go back and review case studies, without having to wait to request those images and have them shipped. If someone is sitting in their office and they have an X-ray, they can go to priors very quickly.

So all these systems -- in Sentara there are about 17 of them -- have to be integrated in such a way that we guarantee that their work being collected and going to the right patient, and at the same time, when they're requesting information, they're getting the right patient data back.

Gardner: Those are the requirements, that’s the goal, but what about inside your IT organization? How have you been able to change and adapt so that you can deliver these and improve? What's the underlying shift internally.

Siegrist: Our big secret isn't really a secret anymore. Previously, every organization always looked at IT as being a very expensive cost center. We've been working very hard internally to change that discussion to be that we're enabling the business.

We've done that by doing some creative and unique processes. We bring in the pharmacist, for example. We make him the owner of the pharmacy app. Now, we have direct buy-in from a pharmacist who is a part of the IT process that selects the application and figures out how to integrate it.
We're trying to make sure we can enable those doctors and nurses to make better healthcare decisions.

Through that process, he's able to act as our champion in the pharmacy space and talk to his fellow pharmacists, saying "We have selected this, and I've been a part of that process." So we're involving them in the process, and at the same time, it's not an IT-focused or IT-forced initiative. We really are enabling business.

Gardner: It’s impressive to me that you're doing this at significant scale. Tell us a little bit about Sentara, how big it is, how many apps you have, and  the fact that you're distributed over fairly large geographic area in Virginia.

Siegrist: In the healthcare space, you measure it by hospitals. I think we're at 11 hospitals these days. We're always looking to expand and grow. We're out on the western edge of Virginia in the Blue Ridge Parkway area, as well as Hampton Roads and up to DC. So, we're in Virginia and a little bit in North Carolina.

Having these maturities in these processes has enabled us to include the business in the IT decisions. As we start building the monitoring, we start building the proactive analysis, in the troubleshooting. Our mean time to repair has gone down. We support larger populations with fewer staff, whether that's with internal systems or internal hardware. We built these automation processes and we built these systems with the idea that we want to be as lean as possible, and at the same time, deliver quality healthcare services.

Maturity roadmap

Gardner: It’s impressive to me too that you have charted out a maturity roadmap for yourselves and you've been in it for several years. Tell me where you evaluate yourself now and where you came from.

Siegrist: Like anybody, this really is an organizational learning process as well as a cultural shift and change. Several years ago, my boss, Betsy Meadows, had started the process about how we want to deploy ITIL. It all started around measuring network performance.

Ultimately, that grew into the idea that in order to do that, we have to do with network monitoring. We have to capture incidents and we have to capture that downtime, and by the way there is downtime that’s legitimate because we are doing maintenance.

Then, we had to think about how to capture maintenance events as downtime? So this process grew and grew. Over the last 8 to 10 years, we went from being very new in the process to where we are today. This is something every company goes through as far as maturation process.
As more and more young people under the workforce, they are coming with a predefined set of skills.

Today there is a scale out there. It says, 1 to 5. I’d say we are solidly 4-point something, if you do the math. But we have adopted a lot of processes at level 5 and at level 4. It’s allowed us to make smart decisions and make smart financial decisions as well.

Gardner: What have been some of the important tools that you've used to get there and what do you look to in terms of getting to that higher level of maturity? What are some of the ways that technology can come to bear on that?

Siegrist: Well, the reality is the workforce. As more and more young people under the workforce, they are coming with a predefined set of skills. I'm still young at 40, but my son can operate an iPad and he is three. He has no problems at all navigating that space.

The reality is that a younger workforce has an expectation of services and delivery. To that end, we're trying to enable our customers to have the ability to go out and do some of these things themselves. It's like an a la carte process, where they can say, "I want this level of monitoring. I want my application monitor this way. I’d like to see this dashboard here."

The application performance management suite that’s available from a software-as-a-service (SaaS) solution, has given us one more tool in our arsenal of solutions that allowed us to pass that out to the customer and say, "If you want to go make your monitor and you have a synthetic transaction or you want diagnostics-level knowledge about your application, here is a delivery channel to do that."

Gardner: You're a big user of HP. Tell us a little bit about the Business Services Management (BSM) suite, your involvement, and also the performance.

Several iterations

Siegrist: Ten years ago, we started out with HP Network Node Management (NNM), which is the network monitoring solution, and then moved into HP Open View (OVO), which is now called Operations Manager. So it’s been through several iterations, but over the last 10 years, we made lots of decisions about what tools to use.

We've always tried to go with best-of-breed where appropriate, and it happens to be that for us, the best-of-breed for us has been the HP solution set. It’s enabled us to get deeper into the applications and given us multiple ways to solve different problems.

Nothing is free in life. So we always want to try and give our customers options for which path they want to take and what level of the knowledge they want in the application space.

To this end, with the APM SaaS solution, it’s an operational expense. They don’t have to buy it in whole. They don’t have to deploy everything. They can just start. So, as I said It's an a-la-carte model. It let’s them just choose just a little or a lot, and then you can bite off the bigger pieces of pie that they're willing to tolerate.

Gardner: How do these tools support your drive towards greater mobility and development of applications so that there is a lifecycle where the development, the deployment, and then the operations can relate to each other for a higher efficiency, productivity, and benefit of the users?
The value is that the face of customer care in healthcare is still doctors and nurses.

Siegrist: Our customer base is interested in trying to have a way to interact with the doctors, and as more-and-more tablets and PCs and smartphones hit the market, we're looking for delivery solutions that provide that.

Our partner for our EMR is Epic. We use their solution for contacting and working with the doctors. It's called MyChart, and that tool gives them the ability to do that. As more-and-more of these devices get out there, the population gets younger. They have an expectation of service delivery through that channel, and Sentara is working to meet that expectation. This gives us the ability to monitor that application to make sure it's working properly.

Gardner: Are the doctors welcoming these technology shifts? Has there been any change because you have been able to do this with delivery, services orientation, and service bureau types of benefits? Do you see a reaction in terms of their acceptance of it?

Siegrist: Well, the value is that the face of customer care in healthcare is still doctors and nurses. Where we often have run into problems is when you start doing things like transcription or prescription order writing.

Today, the doctors are doing those themselves and they are documenting their own notes. There was initially some push-back because it's different than what they were used to. The reality is that they're able to make the notes and to do it very quickly, and they are able to review those.

Perception of savings

In the past, they had to go to a transcriptionist, and transcriptionist would type it. Then, they’d have to validate what the transcriptionists wrote, so they really didn’t save any time through that other process. All they had was the perception of time savings.

The adoption rate has been pretty high. Again, we have younger doctors hitting the market. They're looking for similar types of behaviors, and it allows them to be able to provide better customer service as well.

Gardner: You mentioned earlier that it’s about SaaS and the ability to pick and choose the type of deployment model for your apps, services, and even infrastructure. Do you have any thoughts about where you're heading in terms of more choice in hybrid or cloud models?
We're trying to make sure that, as we move forward with monitoring these things in the data landing in the cloud, we are protecting patient data.

Siegrist: For most health organizations, and I'm probably in line here with my peers as well, there's always a concern about HIPAA. We're trying to make sure that, as we move forward with monitoring these things in the data landing in the cloud, we are protecting patient data. We are moving tentatively into that space and doing a little bit at a time to prevent and avoid any risk associated with patient data loss.

Gardner: Well, great. That makes a good sense, and I appreciate your spending some time with us. We've been learning about how Virginia healthcare provider Sentara Healthcare has improved its IT operations and services delivery for higher quality and speed, and we have seen how Sentara gained an IT service management maturity and deployed monitoring dashboards to better oversee and advance their applications.

Please join me now in thanking our guest, Jason Siegrist, Manager of Enterprise Management Technologies at Sentara. Thanks, Jason.

Siegrist: Thanks, Dana.

Gardner: And thank you too to our audience, for joining us for this special HP Discover Performance podcast, coming to you from the recent HP Discover 2013 Conference in Las Vegas. I'm Dana Gardner, Principal Analyst at Interarbor Solutions, your host for this ongoing series of HP-sponsored discussions.

Thanks again for listening, and come back next time.

Listen to the podcast. Find it on iTunes. Download the transcript. Sponsor: HP.

Transcript of a BriefingsDirect podcast on how a healthcare provider is deploying and monitoring IT operations and services for better patient care. Copyright Interarbor Solutions, LLC, 2005-2013. All rights reserved.

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