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UC San Diego Health: Moving Its EHR to the Cloud, Strategically

August 17, 2017
by Mark Hagland
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UC San Diego Health IT leaders share their strategy around EHR migration to the cloud

Last week, UC San Diego Health, an integrated health system in San Diego that is part of the University of California San Diego, announced that it had moved its electronic health record (EHR) system to the cloud. An August 7 press release quoted Mark Amey, associate chief information officer at the health system, as saying that, “By creating greater operational efficiencies, we can invest more time and resources in patient care. UC San Diego Health has deployed a number of strategies to allow its hospitals and clinics to be more agile and respond to demand at a rapid pace within a robust disaster recovery environment,” Amey said.

“This is our first significant milestone in moving key pieces of infrastructure into the cloud to provide ‘always-on’ solutions from anywhere that can be scaled to our growing geographical print,” Adam Gold, chief technology officer, UC Irvine Health and UC San Diego Health, said in a statement in the press release. “The cloud approach allows us to better provide innovative technology to support outstanding clinical care, research, and teaching.”

The release also quoted a senior executive from the Verona, Wis.-based Epic Systems Corporation, the health system’s vendor partner in the cloud computing implementation, and its core EHR vendor. “Health systems both large and small are seeking secure and cost-effective approaches to providing EMR capabilities to their users,” said Stirling Martin, Epic senior vice president. “UC San Diego Health is the first academic health system to make the migration from their own self-hosted Epic infrastructure to Epic’s state-of-the-art cloud hosting environment.”

The Aug. 7 press release further noted that “The information services team has moved approximately 10,000 workstations at UC San Diego Health to this virtual delivery method, allowing users to access the electronic health record via the cloud. The team has also integrated over a hundred third-party applications that work with Epic within the new cloud environment.” And it added that “UC San Diego Health is the hub for a single electronic medical records system serving UC Riverside Health and community practice affiliates, a cost-saving arrangement that improves coordination of care among physicians. UC San Diego Health will also share its EMR system with UC Irvine Health starting this November.”

The press release also referred to Christopher Longhurst, M.D., UC San Diego Health’s CIO, who is the sponsoring executive for the development of a UC Health-wide data warehouse, integrating patient data across the UC’s five academic health systems, which together comprise the fourth largest health care system in California. Dr. Longhurst noted that this initiative supports medical decision making, clinical research and population health throughout the state.

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Shortly after the announcement, Healthcare Informatics Editor-in-Chief Mark Hagland spoke with Dr. Longhurst and Adam Gold about the broader strategic context around this announcement. Below are excerpts from that interview.

Tell me about the broader strategy around this move into the cloud?

Christopher Longhurst, M.D.: As our group of UC Health CIOs had discussed in our interview with you earlier this summer, we at the five University of California Health organizations are on a shared journey of collaborating together strategically and practically to optimize our IT development across all five organizations [UCSF Health, UC San Diego Health, UCLA Health, UC Irvine Health, and UC Davis Health]. In that context, Adam, who’s been at UC Irvine for 15 years, is now the CTO for both UC Irvine Health and UC San Diego Health. His was one of the initial joint roles that were designated.

So how does this latest move connect to your broader strategic efforts around infrastructure?

Longhurst: Let me give some context. As you know, we’re bringing UC Irvine live on the UC San Diego instance of Epic, and we’re doing that on November 4. In preparation, we needed to be able to scale up our Epic platform for breadth. The implication of that was that we’d be spending millions of dollars on servers in our local data center, which was state-of-the-art 20 years ago. But what happened was that Adam and some of the other CTOs came up with a strategy, focused on moving towards the cloud. So we’re consolidating our 13 data centers across the five UC hospitals, down to two, one northern one, and one southern one. And the least preferable option in that context is local hosting. It may be necessary long-term for things like biomed, where there are latency-dependent applications; but in general, we want to move away from that.

And within the cloud-first strategy, whenever we can host applications at the vendors themselves, that’s our preference, because vendors can provide services as well. Cerner has been doing this for many years, but Epic just started doing this. They’re doing this for new customers, but we’re the first academic medical center and existing Epic customer to go to cloud-based hosting by Epic. We’re very impressed with their infrastructure, including with advanced technology that we don’t have. And the week after we went live, comparing Monday-to-Monday performance, our system was performing better in the hosted environment.

Adam Gold: One of the things that was most compelling was Epic’s security portfolio and posture. They have a very robust security program that clearly they’ve been working on for some time. And as we went through looking at our options, that was one of the things that set them apart. I’ve been very happy with the hosting and the support.

How should the strategic discussion around potential cloud-hosting be initiated in a patient care organization?

Gold: The first thing you want to look at is your customers. We’re looking at the doctors, nurses, and patients—understanding what the expectations are today, and where they’re going. Expectations are growing every day. Twenty years ago, when you were told by the help desk, to restart your computer a few times when it went down—that’s no longer tolerable today. That’s an example I give all the time. So you have to think about what your customers want and need from a service perspective, and also from a growth perspective. And the cloud, whether from Epic or anyone, gives that to us. We can burst and grow, or if needed, shrink. The most important thing is what your customers expect, and matching that, or beating it, once you move to the cloud.

What are physicians’ and nurses’ expectations right now, in terms of health information system performance?

I’m on my way to see patients right now, and when I talk with other physicians, it’s quite clear that the expectations are high. I agree with Adam that reliability and performance of the technology are clear expectations. And our intention is to make technology and infrastructure changes transparent to end-users. The only feedback we want to hear is that the system feels faster. So I agree with Adam that reliability and performance are number one. Number two is efficiency. As we try to become more efficient as the UC hospitals, we’re looking at how we can deliver value to our patients with our physician and nurse partners. And IT costs are a significant proportion of our expenditures. A great example of that is the shared data centers. We’re literally putting racks of equipment next to those of our colleagues from UCLA and Irvine. Check out http://webeatucla.com. It’s good-natured coopetition.

Aren’t you also gaining shared expertise and learning, as well as saving costs, through your pan-UC Health strategic initiative?

Gold: Absolutely. Within the southern data center, with UCLA in this case, we’re gaining expertise with newer technologies that UCLA has already implemented. So we’re not only sharing gear, but we’re standardizing on the same technologies. So we’re learning a lot faster.

Longhurst: And it’s not just about Epic hosting; it’s about our evolving strategy working forward. As you said, health IT has become more expensive. And frankly, the cost of that gets passed onto consumers eventually. And having thousands of separate EMRs and data centers across the healthcare system contributes to that. It’s crazy. So now in this era of mergers, consolidations, and affiliations, we can become more reliable and more consistent.

It seems like this is a moment where we can all learn from each other more readily, because the policy and payment landscape is more unified now, in terms of the shift towards value in healthcare, correct?

Longhurst: Yes, value-based care and policy and payment changes are making us rethink a lot of things. We can do wonderful things in the genomics world, for example. But when we’re talking about integrating data from many different sources, that reduces the value of the data if it’s not readily integrated. So that’s really driving us to scale our EHR across more of our affiliates, so that together, we can provide the high-value care that our customers expect of us.

Gold: And on the technical side, what we’ve seen at UC Health is the coming together around standards and unified processes, when historically, everybody was doing whatever they wanted, differently. And there are a lot of efficiencies to be gained by not reinventing the wheel every time. The mindset ten years ago was how big your data center was and how any servers you had. That’s changed. Now, it’s how efficient and effective you are. We’re constantly, at UC Health, trying to gain some efficiencies here. So it’s a very good path that we’re going down, and it’s allowing us to become more agile and to learn a lot. And none of us can keep up with everything, but all of us can keep up with something, and we can share with each other.

What have the key lessons learned been, so far, on this journey, and what advice would you like to share with CIOs, CMIOs, CTOs, and other healthcare IT leaders?

Gold: My advice would be, be cautious but optimistic, meaning, as you’re going into these new endeavors, not everything is what it seems, so do your due diligence; but most of all, make sure your team understands why we’re doing this. We don’t want people to think they’re losing their jobs; they’re not. If anything, they’re gaining more time to do other things. So think about the social impact, the technological impact.

Longhurst: Just remember not to mess it up!


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by David Raths, Contributing Editor
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Developers could use the server to quickly ingest and manage FHIR datasets in the cloud

Microsoft Healthcare has announced the release of an open source project, FHIR Server for Azure, to offer developers access to software that supports the exchange and management of data in the cloud via the FHIR specification.

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