Cloud computing in healthcare: Creative Solutions goes end to end

Shawn Wiora, CIO at Creative Solutions in Healthcare, pursued an end-to-end cloud strategy, which resulted in improved security, better performance and IT cultural transformation.

A 100%, no-holds-barred leap into cloud is pretty unusual.

In the safety-obsessed and generally IT-conservative healthcare sector, it's a rare thing indeed -- cloud computing in healthcare tends to trail other industries. But desperate times call for drastic measures. That's what Shawn Wiora, CIO of Creative Solutions in Healthcare Inc., concluded when he joined the company two and a half years ago.

Creative Solutions, a Fort Worth, Texas, company that operates more than 49 skilled nursing and 13 assisted living facilities, was running an aging IT infrastructure featuring Windows Server 2003 machines. Those boxes weren't current with the latest security protocols and a patch management program to get them up to speed was marginal at best. In addition, only scant documentation of Health Insurance Portability and Accountability Act (HIPAA) compliance could be found. HIPAA breaches have resulted in significant fines for noncompliant organizations. But the security situation wasn't the only issue. Users experienced slow response times from key applications, such as the company's electronic health records (EHR) system. And email outages were a regular occurrence.

Wiora's early days at Creative Solutions were gut-wrenching.

Shawn WioraShawn Wiora

"The first six weeks on the job it was a perpetual state of nausea," he recalled. "It was very alarming."

Wiora began exploring remedies and decided a complete transition to the cloud was in order. His CIO peers, however, said a healthcare organization couldn't go to the cloud because of HIPAA. Wiora went directly to the regulation -- no light reading assignment at nearly 400 pages -- for insight.

"I read it and didn't find anything in HIPAA that said we could not go to the cloud," Wiora said.

Not the usual migration

A typical cloud transition begins with virtualizing the in-house applications and then moving them a few at a time to the cloud environment. Creative Solutions compressed the virtualization and cloud migration stage into a single initiative. Today, more than 100 applications -- from Microsoft Exchange to the core EHR system -- live in the cloud. Most of those applications are hosted on VMware's vCloud Air infrastructure as a service platform, but the healthcare provider also uses a few one-off cloud providers, according to Wiora.

Wiora said Creative Solutions is the first healthcare company in the U.S. to be 100% in the cloud.

Jeff KaplanJeff Kaplan

Jeff Kaplan, managing director at THINKstrategies, a cloud consulting firm in Wellesley, Mass., said the move puts the company at the tip of the spear when it comes to cloud computing in healthcare.

"Although the healthcare industry is becoming more comfortable moving portions of its operations and data to the cloud, Creative Solutions is in the vanguard with its decision to migrate its entire IT infrastructure to the cloud," Kaplan said. "I expect other healthcare providers to follow their example."

Kaplan suggested that Creative Solutions' move signals a broader trend in cloud adoption. In particular, security concerns -- a deal breaker in the early days of cloud -- are now lower down the list of objections.

"Healthcare providers and organizations in other industries are becoming more comfortable with the security capabilities of cloud providers," Kaplan said. "The providers are working hard to become HIPAA-compliant and have gained a track record of success combatting security threats."

On the flip side, a growing number of healthcare providers, as well as organizations in other industries, now recognize they lack the skills or resources "to fend off today's escalating security threats," Kaplan added.

Paving the way for cultural change

The cloud-computing-in-healthcare shift has resulted in much tighter security, Wiora noted. VMware worked with Creative Solutions to incorporate the healthcare provider's security requirements into the vCloud Air environment. Wiora said the healthcare provider's cloud security regimen is based on a customized version of the Health Information Trust Alliance framework, which covers HIPAA along with NIST, Payment Card Industry and other security controls. Application performance also improved; the time lags that once plagued the EHR system have disappeared.

But the cloud move led to important cultural changes in addition to the security and performance improvements. Creative Solutions' IT department was able to shift from a reactive to a proactive stance. IT staffers aren't just managing cloud service providers: Because they are no longer troubleshooting on-premises technology issues, the techs have time to talk with users about their day-to-day technology experiences.

When you go to the cloud, you can spend more time on innovation.
Shawn WioraCIO, Creative Solutions in Healthcare

The move to the cloud, Wiora said, has freed the IT department.

"When you go to the cloud, you can spend more time on innovation," he noted.

In one example, Creative Solutions has instituted daily IT wellness visits in which someone from IT checks in on every corporate employee every day. Reinforcing the wellness initiative -- the IT equivalent of a doctor's daily rounds -- Wiora refers to tech-enabled employees as "IT patients" instead of users.

"We are empathetic and compassionate," he said.

The wellness checks also help Creative Solutions keep a close eye on potential security issues. While visiting employees, IT personnel may find out about strange emails or odd pop-ups users encounter.

"Going to the cloud … we are able to be proactive in terms of our security approach," Wiora said.

Harvey KoeppelHarvey Koeppel

Harvey Koeppel, president of Pictographics Inc., a management and technology advisory and consulting service, suggested that the IT wellness approach has more to do with the maturity of an IT organization, its leadership, and overall governance and management than moving to the cloud.

For an IT department to make such a change -- moving to a proactive model focused on user outreach -- would require a period of retraining. He said the retraining phase for a receptive IT team, depending on such variables as the size and its current state, could take anywhere from two to three months to four to six months as a baseline.

"It's a bit hard to quantify since proactive outreach is much more of an ongoing process that needs continues improvement as compared with a once-and-done approach," Koeppel said.

He also noted that business users will also need retraining to work efficiently with the newly trained IT support staff.

Employee retention boost

At Creative Solutions, cloud computing in healthcare has also had an impact on employee retention -- both within IT and across the company. The healthcare provider has not seen a single IT staffer leave the company since cloud adoption. The innovative environment, Wiora said, helps hold on to technical employees and also provides a recruiting boost.

"We post jobs and get tons of applications," Wiora said, noting that one prospective employee offered to work one week for free.

Koeppel said the ability to work with cutting-edge technology provides one connection between cloud adoption and IT employee retention.

"IT people, as a profession, generally aspire to, and derive increased satisfaction from, playing with the latest technologies in contrast with the day-to-day generally mundane stuff associated with maintaining legacy environments," he explained. "Having cloud experience on your resume is much more impressive and, likely, more lucrative."

Koeppel also pointed out the extent to which an enterprise's applications -- business processes -- move to the cloud will greatly affect the IT skills the enterprise requires or, in many cases, no longer requires. For example, an organization heavily engaged in cloud would put much more emphasis on such areas as business analysis, requirements development, project management, proactive advocacy and vendor management and negotiation, he said. On the other hand, skills such as program analysis, maintenance programming and technical writing would become much less needed.

At Creative Solutions, meanwhile, the cloud transition also has improved retention outside of the IT department. Wiora said nurses, for example, are less likely to stay in an environment where they can count on email doing down once a month.

"Overall, our retention is up and the ability to attract staff across our footprint is up," Wiora said.

And not to be underestimated is the image boost IT has enjoyed since its pioneering move to cloud computing. The perception of IT within the healthcare organization has changed following cloud-enabled improvements, such as a greater focus on outreach, improved security and faster application performance.

"It changed the culture from IT hate to IT love," Wiora said.

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