What Novant Health has accomplished since moving its EHR to the cloud

James Kluttz has served as vice president and chief technology officer at Novant Health for the past six years.

As CTO, Mr. Kluttz spearheaded the Winston Salem, N.C.-based health system when it moved its Epic EHR system to a cloud platform from Virtustream. Since moving to the cloud in February, Novant Health has been able to more focus on what's most important: the patient.

Below, Mr. Kluttz discusses the migration processes as well as his lessons learned from moving to a cloud-based platform.

Editor's note: Responses have been lightly edited for clarity and length.

Question: In simplest terms, how would you define the cloud? 

James Kluttz: When I think about the cloud, I really look at it as an ecosystem. The ecosystem is a mesh of infrastructure services, platform services and application services that are delivered in a way that solves business problems. 

I am a believer in a hybrid cloud approach. There are a number of things that guide you in making smart decisions surrounding cloud adoption. There are some architectures and solutions that aren't built for the cloud. Maybe it's the technical architecture of a solution that requires it to be kept in a different storage area. On the flip side, there are a number of applications that are suited for cloud. The cloud is something that you have to look at every single solution independently and decide what makes technical, economic and business sense. Then you deploy computing, storage, infrastructure and platform services based on the requirements where it's most appropriately applied. 

At the end of the day for me, the cloud is a mesh of infrastructures that extends the power of an organization's ability to execute at the speed it needs to execute based on the requirements of the business and technical architecture. 

Q: In February, you moved your Epic EHR to a cloud platform. What motivated you to move to the cloud? 

JK: Moving the EHR to the cloud wasn't our first cloud endeavor. We have other solutions such as our Microsoft 365 that is already in the cloud environment. We have been doing some work with Azure, analytics and machine learning in the cloud space. 

We've been with Epic since 2011 and have maintained the EHR on an in-house basis up until February. Throughout the years we have kept pace with the Epic upgrades as they came about. We've had to shift and move a lot of the infrastructure staff to keep pace at which the new functionalities were coming from Epic. Around two and a half years ago Epic made an announcement that they were moving away from annual upgrades and more toward quarterly updates. Historically, the large annual upgrades required us to make a lot of shifts and changes to our infrastructure to keep pace. It was enough of a task to do these tasks every 12 to 18 months, but as we looked to these upgrades coming on a quarterly basis we began to look if there was a better model. 

Knowing that it was so costly to maintain our infrastructure on our own, we began to explore cloud economics of a consumption-based model. This would allow us to develop a predictable cost model and turn the infrastructure to a cloud provider who could free up our resources to drive up more value in the health system. 

Q: What was the biggest headache when transferring your EHR to the cloud? If you could redo the process, would you change anything? 

JK: My team would ask for more time to complete the transition. On a technical side, I don't think there is anything that I would change. We did our due diligence and understood what we were moving into. Our architects and engineering teams were at the table since day one. 

Oftentimes when people hear cloud, they think jobs are at jeopardy. So, three or four years ago we started to embrace what cloud offered and could bring to the table. This allowed us to be ahead of the curve. If we hadn't been so upfront and progressive about the transition, I don't think we would have gotten the same buy-in.

However, we could have spent more time on communication and defining roles. As you move into a cloud model, you have to begin to understand shared governance. Going to the cloud means you are relinquishing some control. It's important to then be aware and enhance the communication around this shared ownership model and clearly defining roles. 

Q: What benefits have you seen since moving to the cloud? 

JK: First and foremost, we have freed up a tremendous amount of engineering resource time from having the manage that infrastructure. We have been able to redeploy our resources to focus on business-driven initiatives. We've been able to realign our resources in unique ways that also drive even more cloud adoption. 

Secondly, we went into this understanding what our future cost models would look like. I can tell you we have hit a home run and have been on target for our operational cost models. 

Additionally, we have been able to keep pace with quarterly updates that Epic puts out. We went live in February, and in May we took the last major annual release. What would historically take us three months to architect and complete, we did through a service request in less than a week. 

Q: For hospitals and health systems that haven’t transferred data to the cloud, what would you tell them? What’s a piece of advice? 

JK: I would start by saying go into it with eyes wide open. Moving to the cloud doesn't mean you will be more secure. It also doesn't mean you'll be less secure. It doesn't mean you spend less time in architecture or more time in architecture. My key advice is all the core disciplines that you have established and built within your organization cannot be forgotten or relaxed. There is still a strong level of ownership and responsibility that goes along with cloud architectures. 

More articles on EHRs:
Cerner sends 360 jobs back to Adventist
Vermont hospital to transition to Epic EHR
Cerner unveils population health management tools to lower costs for Medicaid patients

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