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The case for an Agile Intelligent Datacenter the Dimensions of Change- Structure, Systems, Process,

"Even more than what you think, how you think matters," Atul Gawande, MD

A quick glance at most healthcare balance sheets- thin operating margins and in some cases supported only by excess margins, would leave one to believe, that this sector is highly inefficient.

It is estimated that the healthcare system wastes a quarter of its annual spend or over $765 Billion every year.(

The unsustainable cost of healthcare needs to be arrested- that means operational efficiencies, process optimization and with a shift from volume to value patient risk assessment and management, in particular the management of chronic patients.

All of this requires change from the old ways of working . Change in healthcare is inevitable and change is being driven by

  • Market forces- there is growing evidence that hospitals that deliver higher quality attract more patients

  • Industry forces- Integrated delivery networks, Patient experience, Accountable care, Patient centered medical homes, Chronic care, Population health management, virtual care

  • Economic forces - the shift from volume to value based purchasing models and penalties for unacceptable performance

  • Industry trends - the growth of digitization in healthcare as well as greater focus on patient satisfaction, the need for patient access and the increased pace of mergers and acquisitions taking place

As healthcare retools its enterprise architecture to value based or accountable care models- IT finds itself at the cross-roads attempting to respond to the needs of the business. IT Datacenter(s) find themselves stymied by Infrastructure diversity, some due to donations of IT capital equipment, decentralized IT procurement by independent ministries with little focus on an enterprise architecture, no single change management board or policies. The datacenter is at a stress point trying to support the current business.

Hitherto about 74% of the IT budgets was focused on Run the Business initiatives, 16% on Grow the Business initiatives and just about 10% on Transform the Business initiatives.

Business demands more agility with reduced CAPEX. The dollars, with budgets shrinking, need to shift from run the business to grow and transform the business. To do that with an infrastructure that is already crumbling is a tall order.

There is a growing realization that cloud offers a quicker path to success. After all cloud offers a solution to shrinking CAPEX budgets with the economies of scale, modularization of the infrastructure that need not be under or over provisioned, saving on maintaining real estate, and a more focused and skilled staff. Healthcare IT needs a forklift upgrade from captive datacenters to an operationally and fiscally responsive agile cloud.

Change is multidimensional:

Change programs need to align to business strategy. Does the change support business growth, patient safety or service quality, improves operational efficiencies, process and workflows, improves collaboration, brings in new capabilities and opportunities, improves business agility , drives innovation, reduces costs?

What are the change impacts on organizational structures, process, systems and people?

Will the change require new capabilities, new skillsets?

An approach to move to the cloud:

There could be multiple approaches to a move to the cloud- Bi modal IT, focus on digital transformations, identify cost optimization opportunities, those that drive business agility or business outcomes as well as enforce architectural consistencies.

Storage OPEX can be over 40% of the Storage CAPEX:

Then there is the data deluge- EMR's are growing, PACS are expanding- 16 slice MRI's give way to 64 slice MRI's, pathology is digital, genomic and proteomic data is expanding, registries are growing. Data is also key to transformation- big data, little data as well as dark data are needed in providing valuable insights, improve outcomes, segment patient populations by risk, understand security information and events.

Enable -Engage - Empower:

The goal of IT is to support the business. To achieve this objective it needs to enable, engage and empower the workforce. That requires capabilities to mature:

  • The system of Record

  • The system of engagement

  • The system of operations

  • The system of Intelligence and then and then only

  • The system of transformation or disruption

Moving from a captive in-premise datacenter to a cloud is a challenging initiative. It needs a measured approach with a discovery and horizon scan. What are the organizational or transformation opportunities, initiative alignment to business needs and imperatives and identifying organizational capabilities.

One needs to design and quantify - value maps, business case, service levels, vision from current state to future state as well as understand cost models.

There will be the need to formulate the enterprise architecture, a change management board, a governance process, stakeholder alignment, adoption and transition planning.

How does the organization respond to a move from decentralization to centralization?

The shift from in-premise datacenter to the cloud requires a vendor management and governance process, cloud service integration, managing contracts, operational planning and spend management, budgeting, approvals and change management, organization wide IT roadmaps, focus on security and risk management as also new capabilities.

There will be new or stronger capabilities and skillsets needed - Program Management Office, Enterprise Architects, Business Analysts, IT Ambassadors, Application admins, Cloud architects, Emerging technology analysts, Integration specialists, API Managers, Data custodians, Information security analysts, Certified network analysts, Data scientists, Bi-modal IT support specialists, migration specialists, Change managers, Governance and policy specialists to name a few.

There will be impacts to organizational process, assess risks and identify appropriate mitigation. The systemic landscape in Healthcare is huge and

complex with a combination of operational, clinical solutions, biomedical and compute infrastructure, network and storage.

Cloud enables an economy of scale, frees IT of operational resources, shifts focus of IT from a support system to a stakeholder in business transformation. Utilize the freed dollars in this shift to growing and transforming the business.

The prediction

"I predict that five years from now none of us will have data centers," John Halamka, CIO Count Beth Israel Deaconess Medical Center

may well be a reality.



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