To stay ahead of the rapidly changing healthcare business, health systems and hospitals are challenged with improving information technology (IT) services and security and keeping up with ever-increasing demand while also controlling rising costs. Healthcare leaders are tackling these challenges in a number of different ways, such as building new data centers and making improvements to their IT architecture.
Leadership at the six-hospital Baystate Health system, based in Springfield, Massachusetts, recognized the health system needed to change its approach to IT due to rapid changes in the healthcare business with increasing demand by users and skyrocketing operating and capital expenses. And, health system leadership found that rapidly increasing healthcare data requires increasing storage, and siloed infrastructure limits speed and flexibility to support IT needs.
Serving more than one million patients a year across large swaths of western Massachusetts, Baystate Health employs 12,000 people, encompasses an academic medical center, four community hospitals, a children’s hospital, numerous outpatient and primary care facilities, a hospice, a health insurance company, and the only level-one trauma center in Western Massachusetts.
A year and a half ago, Baystate Health launched a project, led by the health system’s CIO Joel Vengco, to rebuild its entire IT infrastructure with the aim of providing physicians and staff a technology platform that provides optimal application performance, accommodates ever-increasing demand, while, at the same time, containing costs. In 2014, the health system partnered with healthcare and business IT advisory firm VertitechIT on the project to update its entire IT infrastructure, and Michael Feld came on board as interim Chief Technology Officer (CTO).
“My mandate is to basically forklift the entire IT department and move it from what’s called a siloed, traditional, less than fully efficient model to something much more modern. And, Baystate’s CIO has tasked me to do this with declining budgets and increasing demand,” Feld says.
“The biggest problem was the data centers, Feld continues. “We had an ancient data center that had water damage, in the basement of a building. We were going to build a whole new data center and decommission the old one. When we looked at the budget for this and within the existing space we had, we budgeted $8 million to upgrade the IT infrastructure.
“It occurred to us, before we do that, we should look at the entire way our data flows, how all of our systems work between the two data centers and the other hospitals, as we had what I’ll call data closets and bits and pieces of IT everywhere. It became clear that there would be a much better way to build things which would also eliminate maybe even the need for this $8 million capital spend,” Feld says.
Leadership at Baystate Health considered the significant costs—capital, real estate, personnel and power—that building a new data center would require and decided instead to target a virtualized hyperconverged infrastructure environment with a reduced footprint.
Baystate’s IT leadership decided to take control at the software layer using Software-Defined Data Center (SDDC) to standardize compute, network and storage infrastructure on more affordable commodity hardware using a streamlined, hyperconverged approach, Feld says.
Baystate Health worked with health IT vendor VMWare to re-engineer tis existing data center. The Baystate team virtualized and converged the health system’s three physical data centers into a single, three-site (what’s called “active-active-active”) data center based on a hyperconverged infrastructure and VMWare’s NSX network virtualization platform. The virtualized data center has “always-on, borderless” capabilities, according to Feld.
“With this hyperconvergence model, we are always available, at all times, with all data, so nothing is failing over, everything is operating communally across all these facilities,” Feld says.
By virtualizing and hyperconverging its data center, Baystate saved about $3.5 million from the original $8 million budget. And, Feld says, the IT infrastructure design is scalable, which gives the health system a stable, yet flexible foundation for future growth.
The network virtualization platform sits strategically between applications and the infrastructure layer, offering better integration with the remainder of Baystate’s VMware cloud stack. The new data center now provides a strong foundation for much of the data and services necessary for Baystate’s population health management, according to health system leadership.
“Healthcare is under tremendous pressure to reduce costs, especially operational costs. With VMware NSX, we are able to create a more fluid, liquid, automated data center that allows us to do more with less,” Vengco said in a statement.
Baystate Health also was able to realize data consolidation and space savings due to the deployment of a virtual SAN shared storage solution, saving data center real estate by a factor of 10 to 1.
“We will be eliminating all our traditional SAN storage, so there will be no traditional racks of Dells, or HP servers,” Feld continues, “Like most hospitals, it’s our imaging that drives a lot of our storage, and with this approach, storage costs are about 50 percent less.”
Centralization, to reduce overhead and converge staff, also has been a key strategy of the new IT architecture. Previously, Baystate’s IT department had been siloed into different functions, such as storage and networking, yet since rebuilding the IT infrastructure, IT leadership has converged the departments into one infrastructure group and cross-trained staff. “Now, we’re big enough to keep the organization “24/7 up,” so it’s resulted in better uptime. Furthermore, this system is stable and largely automatic, so staff are no longer spending all their time with their fingers in the dike, so to speak, or dealing with a crisis such as running out of storage or a network switch crashes. So, now we have staff who are available to work on project backlogs,” Feld says. Essentially staff devote far less time to mundane tasks like resetting user IDs and more time on strategic initiatives.
In addition, Feld says, “since we’re migrating from an old world to a new world, it’s a perfect point within the migration to address deficiencies that we were never able to address before, such as versions of software that were too old and we never got around to updating, and now it’s a part of an ongoing process, and the net result is that we’ll have fewer applications and fewer people to manage them as it’s more automated platforms and a lower cost to operate.” The entire rebuild project will take another 15 months, Feld says, at which point Baystate’s 1,400 applications will be reduced to about 1,200 to 1,300 on the new platform.
Seamless Mobility and Enhanced Security
Baystate Health leadership also wanted the IT infrastructure to include a mobility solution that enables Baystate doctors to log into their desktops from any device, anytime, anywhere. To achieve this, Baystate’s new IT architecture called for deployment of 10,000 virtual desktops using the VMWare Horizon desktop and application solution.
“As we move to an ambulatory setting in healthcare, our doctors are moving around. And a big portion of that is, do we want them to carry around big laptops, or do we want them to be able to go and tap a badge and have their sessions pop up. So as we’ve been able to deploy that and look to put virtualization in place, we’re seeing much greater adoption and excitement among our clinical staff and other users at being be able to work whenever they want to and from wherever they want to,” Patrick Streck, Baystate Health’s Director of IT Services, says.
According to Feld, this mobility solution also resulted in cost savings as the health system was able to shed the cost of maintaining 12,000 computers in the field. Going forward, the health system will purchase fewer PCs as virtualization allows more people to share the desktop computers.
System security and data protection also was a priority with the new IT architecture to strengthen the digital perimeter and align with federal mandates for electronic medical records and ensure regulatory compliance with the Health Information Portability and Accountability Act (HIPAA). The new streamlined, hyperconverged IT infrastructure enabled Baystate to deliver micro-segmentation and multi-tenancy, which means it can control the flow of data at each virtual machine rather than at the perimeter, and security controls are built into the data center fabric, Feld says. This approach enables the health system to securely run multiple logical environments on the same physical infrastructure, and if there is a security concern within one virtual machine, administrators can lock down the machine and contain the threat, he says.
“The fact that I don’t have to worry about data being resident on a disk that is somewhere other than the data center, potentially on a laptop or mobile device in an office that might get broken into and stolen, so being able to have everything centrally managed is huge,” Streck says.
The new IT infrastructure also enables better integration with third-party solutions as, in the past, integrating those into network operations has been a complex, catch-as-catch-can process. “Baystate has a lot of sister-related organizations that deal with data and security models that are somewhat different from the hospital itself. This platform allows for the underlying architecture to separate out, define, report and control. Now with the NSX platform, inherently, it has insight into deepest part of our network, so the amount of configuration is more straightforward and the reports are more meaningful,” Feld says.
Baystate is continuing its infrastructure initiative as it develops its hybrid cloud environment.
IT as a Business Imperative
As the healthcare business environment evolves, Feld, who served as interim CTO at Lancaster (Pa.) Hospital prior to his work at Baystate Health, is seeing more collaboration between IT and other executive leadership, as well as more support at the board level for major infrastructure improvements.
“The focus from the federal government, from insurance companies and, frankly, from the public, is driving cost control into the healthcare business model, so the board is already prepped for needs, for non-cosmetic changes, real changes.” That being said, Feld continues, one challenge with hospitals is “while they are multi-billion dollar institutions, they operate, in many ways, like very parochial small organizations, because they are so integral to their communities, anything that is revolutionary, or any major change, is fearsome to them. The good thing is that there is so much external pressure, that the board members just can’t avoid [change].
Increasingly, C-suite executives at healthcare delivery organizations are regarding IT as a business imperative and as a strategic advantage over competitors, rather than just the piece that keeps the lights on and the infrastructure running, Feld says.
“Healthcare is catching up to where IT sits in manufacturing and banking. If you look at modern hospitals now when they do facilities re-work, they are talking about patient workflow and how do I build my building so that it has the most efficient work flow, so they are not just looking at throwing up brick and mortar anymore. They’re looking at how does that help me reduce the cost of patient care and improve the experience with the patient and reduce readmissions? That’s now coming to IT in healthcare. Leadership is now asking how do I use IT to track the business, and not just keep the lights on? They are realizing it’s not just a cost center.”
Overall, healthcare delivery organization leaders are challenged with operating with restricted dollars, yet also with higher demands and the need for more uptime and these factors are driving health systems and hospitals to look at IT infrastructure solutions.
It’s critical to get all the stakeholders aligned when initiating major IT infrastructure projects, Feld says. “Here at Baystate, Joel Vengco is very much behind this initiative. If you don’t have your IT upper management—your CTO, CIO and maybe your VP of IT operations—if they are not all on the same page, you’ll never get it done.”
He continues, “You have great fear with the rank and file that this new automated consolidated technology is going to lead to layoffs, which in our case it hasn’t. And it hasn’t led to layoffs with any institution that I’ve been involved with, because there is always more work to be re-apportioned. But there’s still very high fear. So what we’ve done is we’ve created the office of the CTO, which takes key managers, supervisors and directors and makes them a part of a committee that controls that entire process, that way there is a buy-in at a fairly deep level.”
Feld also believes that the networking model being implemented at Baystate is applicable to most health systems. “We found a model that really is the model for healthcare in general. If you’re a large healthcare institution, there aren’t that many options you have to control costs.”