Brookdale University Hospital and Medical Center, a 550-bed safety-net organization caring for an underserved population in Brooklyn, New York, was faced in 2012 with a particularly acute information system challenge. Brookdale, which encompasses nine clinics around the Brooklyn area in New York City, and about 150 employed physicians, as well as a 450-bed long-term rehab care organization, had been part of the Medisys Health System. But Brookdale’s leaders effected a separation from the Medisys system in August 12, and during the decade-plus period in which Brookdale had been a part of Medisys, all of the core IT functions, and the core infrastructure, had been run and owned at the system level. Thus, when Brookdale’s leaders took their organization independent, they were faced with the need to immediately create a new IT infrastructure, a daunting challenge, to be sure.
What’s more, David Reitzel, Brookdale’s CIO, had only joined the organization in April 2012, just months before the transition was to take place. As a result, Reitzel made the decision to quickly move most IT infrastructure to the cloud, for maximum efficiency and cost-effectiveness. He turned to the New York City-based Velocity Technology Solutions, a provider of cloud application hosting for enterprise and business software, as a partner in that venture. Reitzel spoke in March with HCI Editor-in-Chief Mark Hagland regarding Brookdale’s necessitated journey into the cloud, and the lessons learned so far in that journey. Below are excerpts from that interview.
How big is the IT team that you manage in-house at Brookdale these days?
As part of my team proper, we have just over 60 people. And we have a couple of different outsourced vendors, including Velocity, and they provide the human resources for 80 percent of our infrastructure. My resources specifically at Brookdale are involved in maintaining our network, and in maintaining our devices and applications like our PACS [picture archiving and communications system], as well as clinical and back-office applications. So it’s applications and infrastructure support, versus architecture.
Tell me a bit about the background to your migration to the cloud, as facilitated by the Velocity folks.
We’ve got a bit of a unique story, driven out of a separation we needed to do from another health system. We were part of a system Medisys Health System. We left them in August 2012. Brookdale had been part of that network for 10 or 12 years, and a lot of the IT functions had been centralized to reduce cost. So had to construct and rebuild IT from the ground up. That’s a monumental set of tasks, isn’t it? Yes, because all of our contracts were through the health system, not the hospital. In terms of the EMR [electronic medical record], we were primarily paper-based for inpatient at the time of the separation, and we had a few specialty applications, including in the ED.
So when did you go live with an EMR?
We made the decision to go with Epic in January 2013, and went live in November 2013 with both inpatient and outpatient EMR. And we needed to make some pretty strategic decisions. We as an executive team decided it was best not to build our own data center, but to select a partner that offered us the security, reliability, and scalability we needed. And Velocity provided very strategic services for us. As we migrated our systems out of Medisys, they were able to provide disaster recovery capability for us as well. So as we took our lab system out of Medisys and to the data center in St. Paul, Minnesota, they provided not only the hosting, but the disaster recovery as well. What was the timeframe for that set of activities? We ran that in parallel as we were doing the Epic project. So I had a team of people focused on migrating the applications out of the Medisys umbrella and into the data center via Velocity.
What were the biggest challenges involved in doing all that work at the same time?
Where to begin?? Honestly, the biggest challenge was just the education and execution of it. And what I mean by that is that I was part of a new management team to establish and run the hospital; I came in April of 2012. So I was learning a whole new environment, while at the same time helping to migrate solutions like Lawson and Kronos, and get new licenses; we did all that through Velocity. And we had to test and check our systems, and of course, run payrolls every month. And my CEO said, this is like changing all the wheels on an 18-wheelerwhile driving it. How many people were dedicated to the migration process? At any given time, between 15 and 20 people were working on it. What have the biggest lessons been learned so far in all this? I think they would be around the mode of delivery, meaning that historically, Brookdale was an environment with fat-client PCs, and not a lot of flexibility around Citrix, but we were thinking about how to make it more of a thin-client environment even before shifting to the complete Citrix environment, and being cloud-based. And as we look to maintain our current environment, we also need to address new compliance issues.
Where is your organization right now in terms of meaningful use?
We’re in the middle of that process. We are going to be doing our year 1 Stage 2 attestation starting on April 1 on Epic. Due to our volumes—80 percent of our admissions start in the ED [emergency department]—for Stage 1, year 1, we had enough volume to utilize our existing EMR, MPower, within the ED. So we did that attestation through that process, in March through May of 2013, while implementing Epic. So now that we’ve got the inpatient and ambulatory pieces done, we’re going to be attesting for that system starting in April.
Do you have any advice for other CIOs who might find themselves in your position?
I think other CIOs need to strongly look at the cost savings of not having to maintain onsite resources and infrastructure. This has provided us a platform to have that 24/7/365 oversight that I didn’t need to build here. And as organizations are continuing to be pressured on overhead, that is important. Plus, I have complete disaster recovery and business continuity coverage. I look to Velocity for their services.