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Too Much Stuff: The Problem of Legacy Data in Healthcare

My family recently moved across the country and in that process we discovered something about ourselves; we have too much stuff. I’m not talking about things we use rather, things that we store which, for the most part, really falls into two main categories: things I have to store, old financial records, and things my wife wants me to store, christening gowns, cherished toys my children have long-since outgrown, tokens from our own childhoods, memories really. It occurred to me that my stuff, thank you Mr. Carlin, isn’t really that different than the legacy stuff that I had to deal with in healthcare.

Legacy [stuff] systems are a problem for every healthcare organization in this country. How could they not be? In the years before ARRA and Meaningful Use the medical record had become, for many, a hodge-podge of semi-connected systems and processes. If you checked into an ER then your medical record may have been electronic but, if you were admitted, then it could have been on paper, unless you spent time in the ICU, in which case it could have been on yet another electronic system.

Matters get even more complicated when you consider that this data is regulated. Individual states require the maintenance of a patients’ legal medical record for between 7 and 28 years, depending upon the state and the age of the patient at the time of treatment. Oddly enough, the need doesn’t stop there. Remember your clinicians? They’ve been documenting SOAP notes for years, not just on paper but, electronically as well, and have an expectation that they are going to be available for future episodes of care.

According to the ONC we’ve made massive progress at the provider level towards the adoption of highly integrated electronic medical records that meet the new federal standards. We’ve gone from a 13% adoption rate to over 56%, as of the latest published data. That’s fantastic progress but, in the wake of that transition, we’ve left behind a virtual graveyard of systems with shards of critical data still clinging to their disk drives; systems that have to be maintained – personnel, equipment, licenses, support – for a long time and are standing squarely in the path of achieving your clinical integration objectives and OpEx dreams.

How do we address this problem?

George suggested buying a bigger house but, as he points out, that rarely works. We need to address it head-on with a strategy that considers all of the risks, garners buy-in from in-house legal and compliance, as well as the clinical oversight, and IT. So, much like my personal problem with “stuff,” healthcare organizations face the same dilemma: data you have to maintain for legal and compliance reasons and data that your clinicians want you to maintain because it will one day be useful.

Stay tuned for more notes from me as we dig deeper and examine different alternatives to address this challenge and meet your organizational responsibilities: archival, common repository, and how tying these strategies into the right cloud might really address this problem once and for all. I look forward to the discussion.

Innovation for Improved Care Through Cross-Functional Teams

Information Technology has become an essential component of care delivery. The Healthcare industry has made significant investments in infrastructure and EMR systems to comply with regulatory guidelines, but the most impactful transformative opportunities remain. Physician Satisfaction and Patient Satisfaction through better accessibility and availability of critical systems and new mobile services are already emerging as a source of competitive advantage in Healthcare.

Deploying these new capabilities requires continual evaluation of new technologies and resources dedicated to the purpose. This is much easier said than done and requires that IT leaders take a strategic look at how IT organizations are structured and how innovation can be made inherent.

Present Challenges: Technology Silos
Most IT organizations in Healthcare are still built around functional disciplines: virtualization, storage, networking, security, desktop, application delivery, etc. While this alignment yields expertise in each functional discipline, it creates silos of communication and leadership. When new technologies emerge that blur the boundaries between the disciplines or require substantial changes across them, it can be extremely difficult to even explore those technologies, regardless of their value to improve Physician Satisfaction, Patient Care, or even reduce cost.

Organizations built around technology disciplines create isolated functions and management that inhibit cross-functional communication and innovation. This is a significant barrier to the review and adoption of new solutions in Healthcare.

Organizations built around technology disciplines create isolated functions and management that inhibit cross-functional communication and innovation. This is a significant barrier to the review and adoption of new solutions in Healthcare.

Disruptive technologies have extraordinary impact, but their very nature creates operational and political challenges. A pertinent example is virtualization itself. The value proposition was outstanding: compelling capital and operating savings, and the impact to availability and change management to support growth had a measurable impact on application availability. Despite these benefits, many organizations saw slow adoption due to challenges across technology disciplines (chiefly server, storage, and networking) who all had to learn new vocabularies and engage in a more collaborative fashion to design, build, and operate the platform. In time, all three have come to understand the relevant concepts, and virtualization has become the standard for x86 infrastructure. In many cases, this change was facilitated by changes in leadership and the creation of a virtualization team with expertise in the relevant disciplines.

Almost identical challenges exist today with several new capabilities and service delivery models: Mobility, Virtual Networking, Microsegmentation, Software-defined Storage, and Hybrid Cloud strategies. Successful adoption requires substantial collaboration and new responsibilities for existing staff.

Solution: Cross-Functional Teams for Lifecycle Stages
The solution can be found in organizations whose core business is technology such as Software as a Service providers. For such companies, the business and technology platform are inseparable, and long-term success requires that the infrastructure and operating platform evolve to leverage the best technologies that enable accessibility, availability, and security in the most efficient manner while controlling cost. These technology companies build innovation and operational excellence into their very structure.

Organizations that are built to support application and infrastructure lifecycle management using cross-functional teams are better equipped to evaluate and implement new solutions that lead to greater return on capital, lower operating expense, and superior clinical experiences.

Organizations that are built to support application and infrastructure lifecycle management using cross-functional teams are better equipped to evaluate and implement new solutions that lead to greater return on capital, lower operating expense, and superior clinical experiences.

Instead of technical silos, evolving infrastructure groups leverage cross-functional teams focused on application lifecycle stages: Architecture, Engineering, and Operations. Each team has experts in the traditional technical disciplines, but the structure requires collaboration and cross-education to succeed: experts in individual areas educate the rest to evaluate new solutions and develop new infrastructure and application models. As new technologies are selected and new designs chosen, there is tight collaboration with the Engineering team to build the infrastructure and input from the Operations team to ensure intelligent monitoring and feedback are part of the design.

Architecture is tasked with exploring new technologies and architectures. Their primary purpose is to innovate: to evaluate solutions that might better serve the delivery of care and the efficient operation of clinicians regardless of the technical discipline. They review technologies through evaluation and small pilots in close collaboration with clinicians and other stakeholders. They answer important questions: How can we better serve clinicians and address their mobility needs? How can we enable service delivery to patients on their own devices? How can we effectively deliver applications as a service to affiliates and partners? What new security capabilities are required to address a complex communications and regulatory environment? What is the right solution for newly acquired clinics and remote users? How do we handle multiple-os clients and user-owned devices? What is the value of Business Continuity, and how can it best be made available to application owners? What does the next generation of our infrastructure look like?

Engineering builds next generation infrastructure and owns change management. The Engineering team works with Architecture on pilots to begin operationalization of new solutions and ensure necessary infrastructure changes are implemented smoothly. When composed of members who are experts in a broad range of technical disciplines, the team as a whole can develop a more comprehensive understanding of the operating environment, which improves design and reduces time to overcome complex challenges that continually encompass more of the traditional technical disciplines.

Operations owns break-fix, monitoring, support, and feedback to Engineering and Architecture to resolve issues in the platform and application stack. The support function is essential to the feedback loop: understanding the clinical challenges as a function of training, infrastructure, or application issues so the solutions can be quickly developed and implemented. This team needs an integrated understanding of the entire environment and access to sophisticated and comprehensive monitoring solutions to ensure that problems with infrastructure and applications can be observed and mitigated before affecting a service delivery. In the event of service interruptions, their multi-disciplined structure expedites restoration with feedback to Architecture and Engineering for relevant design changes.

Build for Change: Improve Satisfaction and Care
Innovation is vital, especially as IT services become ever more critical to new healthcare services delivery. The skills are present in the technology silos in most organizations, and they key to unlocking those skills is within the control of IT leadership. Cross functional teams tasked with designing, building, and running the next generation infrastructure will build platforms for success and ensure the continued advancement of Care delivery and new services to support it.

Real World Use Cases for VMware in Healthcare IT

Do you have vCloud for Healthcare

No, it’s not something you can catch on a cross-country flight or from playing in the rain without a jacket. If you are in Healthcare IT, vCloud for Healthcare is something that you want and need.

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Why do I need vCloud for Healthcare, again? Because VMware has created a bundle of technology solutions and services that map to the healthcare-specific outcomes you are being asked to deliver.

“Well, I didn’t know VMware had healthcare-focused IT solutions.” We do. Many vendors say they have a Healthcare practice because they sell into Healthcare.  At VMware, Healthcare is a true vertical.  We have a team of hundreds of people dedicated to collaborating with a broad range of healthcare ecosystem partners like hospitals, clinical application providers, and industry groups, to help deliver safer and more efficient healthcare solutions. VMware is also a Premier Foundation Member of CHIME and a Diamond Member of HIMSS.

Now, before it sounds like we are tooting our own horn… We understand your mission.  At VMware, our team knows that this is the only industry we are all going to be consumers of one day and we need to help get it right.  No one has all of the answers yet, regarding what Healthcare will look like in the future.  However, VMware has a long history in healthcare going back to helping the pharmaceutical companies achieve faster FDA validation. Maybe we don’t wear lab coats, but we still feel like we are in patient care.

Tell us if we got this right… We know you are being asked to deliver better Clinical Outcomes, improved Patient Experience, and all while driving costs down and increasing Operational Efficiency.  Oh, by the way, your Electronic Medical Records costs are going up, while reimbursements are trending downward.  And as all this is happening, Mergers & Acquisitions are taking place all around you at a frenzied pace, Regulatory and Security requirements are exploding, and everyone wants Mobility and access from anywhere.  Hopefully, you are starting to see that we are in the boat with you, and rowing in the same direction.

You are being asked to go from filling the hospitals (a volume care model) to emptying them (a wellness versus fee-for-service model).  Yet, that is a huge cultural shift which requires more physicians, and no one wants to become a General Practitioner anymore. Phew.

“Sure, that’s all true, but I work in IT.  My challenges are different.”  We live in your world every day and know that you are being asked to take legacy environments and go from system performance and availability (right in your wheelhouse), to somehow helping deliver long-term sustainability, services sharing, cost/revenue modeling, and mature IT analytics.  This new end state is currently a foreign land to many of you.

In comes vCloud for Healthcare… Here is where we can help.  Think of vCloud for Healthcare as a Software-Defined Enterprise with healthcare outcomes in mind.  vCloud for Healthcare offers support for both Legacy and New systems, has built-in IT Analytics and Automation, delivers Mobility and Point of Care solutions, Hybrid and Public Cloud support, Fault Tolerance and Business Continuity, Self-Service capabilities, and even Financial Analytics.

Ignore HIPAA and PCI and just do the jail time. Well, no one is thinking that. vCloud for Healthcare, above all, offers Integrated Industry Security and Compliance, validation by the world’s leading clinical application providers that you know and love, and leverages all of your existing investments in our KLAS-rated vSphere platform.  Thank you for your business, by the way!  Even our vCloud Air offering will sign a Business Associate Agreement and share the risk with you.

So now that you trust us, I’m sure you are thinking, “Am I the first to do this?”… Here is how your peers are leveraging our software in Healthcare, right now, to help drive operational efficiency and better patient outcomes.  Contact your VMware team for specific references.

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Secure Access, Clinical Productivity, BYOD & a Superior User Experience from Anywhere

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Security and Compliance is Baked in to the Platform


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Ensuring Zero Downtime

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Automation and enabling Self-Service is Key to Reducing OPEX

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Running Healthcare IT like a Business

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Seamlessly extending your environment with security, agility, and control


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Reflections on VMware Care Systems Analytics (Now Available)

Post authored by Drew Koerner, Chief Healthcare Solutions Architect

When I started at VMware in March of 2011, I was astounded by the company’s vision to redefine the IT world as we know it. VMware truly had great leadership, engineering, and technology – yet something was missing.

Delivering New Industry-specific Healthcare Solutions

I came to VMware from Poudre Valley Health System (PVHS) in Colorado where I was responsible for the organization’s desktops, infrastructure, security, and of course, VMware environment. PVHS was one of a few health systems to win the Malcolm Baldrige National Quality Award. We took a great deal of pride in winning that award because it recognized what we called our World-Class Patient Care.

We measured World-Class Patient Care as being in the top 10 percent worldwide for different quality measures such as lowest number of falls, hospital-induced infections, and the like. Even though I was in the IT department, our CIO Russ Branzell made quality our mission.

As I transitioned into my new role on the VMware healthcare team and started working on delivering the next great VMware solution, I wanted to maintain that focus on World-Class Patient Care.

I began helping to develop our VMware vCloud for Healthcare solutions framework, which included VMware AlwaysOn Point of Care™. By allowing fast, secure access back to their applications, the solution gives time back to doctors and nurses—one of the greatest advantages in my book. I heard a nurse once say that their job she was becoming a “computer person” because of all of the electronic documentation they had to do. AlwaysOn Point of Care gives time back to doctors and nurses so that they can focus more on patient care.

VMware Care Systems Analytics – Helping Healthcare Organizations to Improve EMR Applications’ Availability and Performance

One of first challenges I saw when I settled in at VMware was that we had great products including virtualization, virtual desktop infrastructure (VDI), and enterprise management, but none was explicitly designed to immediately help clinicians. A doctor or nurse is not concerned about right-sizing a virtual machine, but is severely impacted when a system goes down. My goal was to develop a VMware solution that would help me better answer a doctor or nurse who came to me asking, “Why is the system running slowly?”

VMware has a product that gives IT a great way to understand all of the infrastructure metrics—including network, CPU, storage, memory, and other aspects of the Software-Defined Data Center—for systems doctors and nurses regularly use.  To me, this was only part of the solution they really needed. We also had to get the actual application metrics—the metrics from electronic medical records (EMRs), for example—to know the true health of applications and what the clinicians were experiencing.

Working closely with customers and EMR vendors, we’ve developed the newly available VMware Care Systems Analytics to identify, troubleshoot, and head off potential system problems before they cause disruption to hospital operations.  At a glance, IT staff can see which workflows are running slowly, and if any operational parameters, such as the number of print jobs, are exceeding normal thresholds (which are automatically calculated by the solution).

It’s amazing to see how much IT and clinicians appreciate this visibility. A few of our beta hospitals have told me they plan to put point-of-care dashboards within each nursing unit to show exactly how their workflow values are performing in real time. If you’re in healthcare, I think you’re really going to like Care Systems Analytics.

I’m excited about the availability of Care Systems Analytics, but I think it is just a starting point—the first of many solutions that I hope to help VMware build for healthcare organizations. I believe IT has always been one layer removed from direct patient care but with more systems becoming electronic, IT has now become part of the patient-care contract. For the first time, solutions like Care Systems Analytics allow us to help clinicians provide better outcomes, which in the end, enable World-Class Patient Care.

Learn how you can improve outcomes by downloading the Care Systems Analytics solution brief and joining the conversation on Twitter @VMwareHIT, VMwareHIT on Facebook or YouTube.

Join us at the Online VMware Forum to see what’s new in Healthcare IT

We’re excited to share that Healthcare will be featured in the Online VMware Forum this year! This FREE event is a great place to learn about VMware’s solutions and interact with technical experts. The live event begins on May 8th at 8:00 AM PST and will be available on demand.

In regards to Healthcare, be sure to check out the following when you join the event:

  • New Product Center: We will be featuring our new Care Systems Analytics solution.
  • 11:30 AM PST: Breakout session with live Q&A in the Auditorium titled “VMware Care Systems Analytics.”
  • 12:30 PM PST: Live chat session with Drew Koerner in the Technical Chat Lounge.

Attend the sessions to learn how VMware Care Systems Analytics can improve healthcare IT infrastructure and application performance and uptime. Drew Koerner, Chief Healthcare Solutions Architect at VMware, will be interacting with attendees after the breakout session and during the live chat.

Register for the Online VMware Forum here. We hope to see you there!

Online VMware Forum - May 8, 2014

HIMSS 2014 Photo Album – Booth, Demo Stations, & More

Take a few minutes to check out our photo album from HIMSS 2014 in Orlando, FL.

Live from HIMSS: Videos at the VMware Booth

HIMSS 2014: Quick Look at VMware
Frank Nydam, Healthcare CTO, VMware gives us a sneak peek into the VMware presence at HIMSS14.

HIMSS 2014: Overview of VMware Booth and Demos
Take a deeper look into the VMware presence at HIMSS14 and see demo clips for AlwaysOn Point of Care™, Care Systems Analytics, and vCloud Hybrid Services.

Demo Video: Care System Analytics for vCloud

Watch this CSA Demo by Drew Koerner – this solution was featured in our booth at HIMSS.

HIMSS Day 3 Recap

Wednesday was the final full day of HIMSS14. The show floor opened at 9:30 AM and, again, excited attendees entered the Orange County Convention Center. The VMware booth had a consistent flow of traffic with a wide range of visitors, from current customers to new connections curious about our healthcare solutions.

Orlando Highlights:

  • 11 customer meetings took place in our reserved meeting spaces
  • AlwaysOn Point of Care™ in-booth demo recording, featuring Rory Clements
  • vCloud Care Systems Analysis in-booth demo recording, featuring Scott Carpenter
  • Hillary Clinton Keynote, proudly sponsored by VMware

Stay tuned for links to the in-booth demo recordings, coming soon!

Hillary Clinton’s Keynote attracted a full crowd of 6,000 people to the Valencia Ballroom in the convention center. She discussed a number of items, from healthcare reform to her experiences as Secretary of State. Clinton identified that there is a need for more transparency within healthcare, and one of our goals as an industry should be to improve coordination and communication across all providers that are responsible for a patient’s health. Additionally, we need to help both practitioners and consumers stay informed about patient care practices.

Hillary explained that the Affordable Care Act has liberated people from staying with a job solely for healthcare purposes; Americans no longer need to rely on corporations to provide their health insurance needs.  Our country is on the right track for further improving our healthcare system, but if things aren’t working we need people of good faith to come together and make evidence-based changes.

Wednesday was also the final day of the live HIMSS Online Event. The portal will be available on-demand until May 24, 2014 – it’s not too late to register! Stop by our virtual booth to see videos from HIMSS in Orlando and learn about VMware’s healthcare solutions.

HIMSS Online Highlights:

  • 195 unique booth visitors
  • Message board interaction between booth visitors and VMware experts

We hope you enjoyed HIMSS Orlando and HIMSS Online as much as we did! Tweet at us or post on our Facebook page to tell us about your favorite part of the event.

Hillary Clinton, Keynote Speech

Hillary Clinton, Keynote Speech

Hillary Clinton, Keynote Speech

Hillary Clinton, Keynote Speech

Hillary Clinton talking with Steve Lieber, President/CEO of HIMSS
Hillary Clinton talking with Steve Lieber, President/CEO of HIMSS


Day 2 HIMSS Recap

Day 2 at HIMSS was just as exciting as day 1! Conference attendees began pouring onto the show floor at 9:30 am to kick off a full day of booth visits and presentations. Again, our on-site staff showcased our solutions and their role in the healthcare industry. At the printing station, Chromebooks were used to demonstrate our secure printing solution with cloud-based workspace. Teradici joined us at the booth for the full three days as well to display their accelerated touchscreen imaging solution.

Tuesday was the night of two of our regional customer appreciation dinners, which were a blast! Customers and VMware staff were able to interact in a private setting over great food & drinks.

Orlando Highlights:

  • 17 customer meetings took place in our reserved meeting spaces
  • Eastern Region Customer Appreciation Dinner at Charley’s Steakhouse, 38 total attendees
  • Greater West Customer Appreciation Dinner at MoonFish, 23 total attendees

HIMSS Online has again proven to be as lively as the event in Orlando. Take full advantage of the event by interacting with our technical staff under the “Message Us” tab. Visitors that download an asset from the learning center will also be entered to win a $200 Nike gift card.

HIMSS Online Highlights:

  • 154 unique booth visitors
  • HIMSS14 Recording at the VMware Booth, featuring our AlwaysOn Point of Care™ solution
  • Message board interaction between booth visitors and VMware experts

We hope you’re enjoying HIMSS14 as much as we are! Visit us at booth 2535 to experience our demos and speak with our product experts.

HIMSS Online – visit our booth in the Exhibitor Center. Available on-demand until May 24, 2014.

Demo - Secure printing with cloud-based workspace

Demo – Secure printing with cloud-based workspace

Teradici Demo, Accelerated Touchscreen Imaging

Teradici Demo, Accelerated Touchscreen Imaging

HIMSS14 Recording at the VMware Booth, featuring our AlwaysOn Point of Care™ solution
HIMSS14 Recording at the VMware Booth, featuring our AlwaysOn Point of Care™ solution

VMware booth 2535

VMware booth 2535

AirWatch booth 3574

AirWatch booth 3574

Eastern Region Customer Appreciation Dinner space, Charley's Steakhouse

Eastern Region Customer Appreciation Dinner space, Charley’s Steakhouse