Strategies for Maximizing Your Investment in a Cloud-based Data Warehouse

Antony Guerra 0:06
Good afternoon and welcome to ‘Strategies for Maximizing Your Investment in a Cloud-based Data Warehouse,’ the healthsystem CIO Media Inc. Production, sponsored by 314e. Just a little housekeeping before we get started. My name is Anthony Guerra, I’m the Editor-in-chief of healthsystem CIO, and I'll be your moderator today. We're looking forward to your participation. You can send in your questions or comments anytime in the Q&A box, and we'll take those later in the program. Just so you see how we're going to spend our time today. First, we're going to have our main panel for about 35-40 minutes featuring Chris Hutchins, VP, Chief Data and Analytics Officer with Northwell Health. Beth Lindsay-Wood, VP and CIO at City of Hope, and Dr. Siv Raman, Chief Product and Analytics Officer with 314e, and then we'll have our Q&A. So let's jump right in; Chris, let’s start with you. Can you give us an overview of your organization and your role?

Chris Hutchins 01:04
Certainly, first of all, thank you for having me. I am happy to be here with my esteemed colleagues. I would let you know we are based in New York and spread across Long Island in New York City area. We are about 23 hospitals and roughly 90 outpatient facilities. The latest tally I heard was 83,000 employees of the health system. We are the largest private employer in the state of New York. We have a medical school, a nursing school, a very robust research division, and a pretty healthy venture arm, as well. We are doing a lot of work in the innovation space, heavily focussed at the moment on AI and opportunities for commercialization.

Anthony Guerra 01:59
Very good. Chris. Thank you, Beth.

Beth Lindsay-Wood 02:02
Yes, I'm Beth Lindsay-Wood, Senior VP and CIO at City of Hope. City of Hope is based out of Southern California. The headquarters are in a small town called Duarte, right outside of LA. The organization just recently acquired Cancer Treatment Centers of America, which is in other states in the United States. So we are now in National, the only, I believe National Cancer Treatment Center in the nation. So we're very proud of that. I'm trying to deliver high-end cancer care across the states. So we again started in LA, a lot of growth and expansion, a lot of very high-end cancer treatments, heavy research as well; and so we are in the throes of the integration of an acquisition; but very excited to be working and part of the CDC organization, that are coming in.

Anthony Guerra 03:16
Very good, thank you, Siv.

Dr. Siv Raman 03:19
Hello everyone. I'm Siv Raman, and I'm the Chief Product and Analytics Officer of 314e. We are a Health Information Technology company that has been in existence for about 17 years. We've done Health IT services work on the provider side, EMR implementations, especially Epic cloud migration data and analytics, and we made the foray into products about four years back and we have products in the domain of practice management and reputation management systems, data archival systems as well as Health Data Platforms and digital adoption and Learning Management Systems, all focused on the healthcare space.

Anthony Guerra 04:08
Very good, Siv. Thank you. Alright, let's jump right into it. Chris, we’ll start with you. Please talk about some of the applications and workloads you've migrated to the cloud. Why did you select the applications in that order? What was your motivation, and what did you hope to gain?

Chris Hutchins 04:26
Great question. The first things that we were thinking about were enterprise clinical data sets, part of the motivation was that we had a timetable where we had to get off some technologies that we were currently using that were on-prem, from the technology being sunset. So I knew I had to have a different option available by the time we had the sunset, and so at that point, the organization had already started to do some exploration, and we were really challenging us to start thinking about putting things into a cloud environment. Hopefully, over time, we reduced our data center cost, there are some interesting thoughts around that, and I'm sure that will touch upon the cost aspect. It is frequently misunderstood and misrepresented, that also, was a part of the thought process that we used to determine which things we were going to start with. So when you are thinking about data and analytics, having people consume them, you know, from a visualization standpoint, it makes a lot of sense to do that when they're having to do a lot more interaction, and they're like, wanting to download things. I don't know about the rest of you, but I know the minute we start putting out an application there, people start asking if we can print it? But the interaction was really the piece that we had to gauge in terms of which we put there and which we keep on an on-prem solution. What was subtle was because we had knowledge of which components of the data were really critical, which ones were we don't want to put everything into, a limited, by which the things that are really going to be supporting analytics.

Anthony Guerra 06:27
Was the printing? Is that a security concern?

Chris Hutchins 06:29
No, the whole idea of doing visualizations, hopefully, you can get to the top, I don't know, the 30 things that you're curious about, then admitting and understanding how to adjust something. You know what, historically, you had to get an analyst to go do this work, only to find out the answers to your question; apparently they had to go deeper, and so instead of waiting in a queue for you know, for someone to do that work, we're enabling them to see the things that they're most concerned about, at their fingertips. Why would you want to print that? I don’t know; that’s just a mindset that you still want copies.

But we are trying to move away from that. That’s the reason for having kind of tools with a visual representation of the data.

Anthony Guerra 07:19
Very good. Beth, your thoughts?

Beth Lindsay-Wood 07:22
I think, for me, you know, started migrations of things like email way back. We did that ten years ago or something, but I'm just looking at when certain technologies were available in the cloud, certain applications were part of it, and that's evolved for us. In terms of, you know, our researchers do a lot of file sharing. So, you know, being able to do some of that in the cloud was important. But just generally for us to store documents in the cloud was, was up with our starting point and then looking at any platforms that were cloud-based, you know, date of cloud. The preference would be to do that versus on-prem. I think for us we know our more recent types of things are our data warehouse that is used by research and clinical with a lot of genomic data. A lot of data are coming from other sources on genomics. So being able to have that in the cloud, looking at the compute capabilities and tools, they're similar to what Chris was saying around visualization. All of those kinds of things, being able to do all of that, it was critical. So again I think that was a need in the organization to simplify and put some relief on the data center side as well. But now we are at a point where we're doing static storage backups. All those kinds of things in the cloud; we are on a hybrid cloud model on purpose. But I think that where we are now, looking at the big things like the next one might be our Electronic Medical Record. We already have our ERP cloud-based or our CRM. A lot of our big platforms are already cloud-based, EMR, Electronic Medical Records are probably the last bastion on that. So that would be another one that we would do. The motivation for us candidly is, you know, living in both worlds on-prem and cloud is the most cumbersome option in terms of staffing. And, and I think that the idea would be, we would like to just not have data on-prem, data centers is a risk to deal with, you know, where it's located. Keeping up with the end of life, all the refresh those things are a motivator for us, particularly right now cause we are looking at trying to take one of our data centers out of the equation here. So I think that was why we still have ways to go again with the EMR being a big one. And then, as we are replacing products looking at, you know, in the RFP process, even making sure that their cloud-based.

Anthony Guerra 10:34
Beth, so, you're saying that hybrid, hybrid world, living in a hybrid world is, is not the best. It's resource intensive. I've heard other people say either somewhere close, they think our way long way off, or they think they'll be on-prem forever. It might have been some of these genomic type intensive things, could be some imaging stuff, it was sort of the very heavy kind of workloads, but do you have a different vision where eventually you're going to have that all out there in the cloud?

Beth Lindsay-Wood 11:08
I think. I think, eventually I do think for us, imaging PACS and digital pathology, and some of those components are probably the last ones to move completely, although we are looking at that right now. You know, I do have concerns just about, you know, storage. Now, big images that we have on our side so, and research PACS images too. But the intent is to consider moving in that direction and certainly looking at reducing our footprint on-prem. So the hybrid ideas, of course, some is driven by the vendor, the software vendor that you work in some cases and for us, you know, we have multi-cloud on purpose because we don't want to be relying on one, so we can rehost under different clouds you know over time, but that's that's kind of thought. The expensive part is really just about the kinds of staffing. Do you have a cloud architect? You have a lot of different kinds of skills that you have to bring to bear when you're sort of living pretty heavily in both worlds.

Anthony Guerra 12:22
Great. And I want to follow up on that a little bit, but Siv I want to bring you in. What are your thoughts to what you're hearing, your comments?

Dr. Siv Raman 12:31
I think, you know, I agree with most of the things that my panelist, co-panelists have talked about. We, for example, have done application migrations to the cloud for some of our clients. We did it for a large, Midwest not-for-profit Health System. Migrated their legacy, Microsoft, Microsoft, sequel, server parallel data warehouse from on-prem to the cloud with multiple systems, like Epic, SAP, and Press Ganey patient experience data in it ,and then we did a large, for a large academic Medical Center on the East Coast, we integrated data from more than 60 different systems into a databricks-based modern lake house. So, I think the selection of applications and what order you go there, mostly for us depends on customer requirements, but it's also related to cause you can't migrate everything all at once. You have to make sure that the existing business processes that are running and which are mission-critical and they are revenue-generating and other things in the company that I need to stay on. So you do not want to address those. But first, you want to address the ones that you know a lot more peripheral, and then move on as you gain more experience to the critical systems and then might need them as well. And in terms of legacy infrastructure, most companies, you know, they're motivated by cost, as well as better management, and that's what we see in most of our clients, as well.

Beth Lindsay-Wood 14:39
I think the supply chain issues, are another driver these days, With the equipment.

Anthony Guerra 14:41
Beth, you mentioned multi-cloud and not wanting to be sort of beholding or owned, as it were, by any one vendor. And then I think you briefly mentioned that you need a talent mix in house that can handle each one of those. If you're not just going to do one, it gives you a little more freedom, but it also requires more in-house talent. I would imagine that you need talent that knows how to manage each specific environment. Is that correct?

Beth Lindsay-Wood 15:13
Well, I think that, you know, if, if you have someone that is, their experience is cloud from an architectural perspective, yes, there are nuances, I think with every service provider but in general, knowing and understanding that environment is different than for folks that are working with on-prem solutions right now and storage architects and some of the things that you have to have. But I think that just from my perspective, we are seeing that we're not really reducing on-prem types of skills because we stopped at maintaining that. But we're also adding to that new skills, whether it is a security architect. Just a lot of operations types that you know, particularly in the infrastructure area even some cyber, that feels a little bit different as well. So that some of those are being additive, you know, it's not that we're replacing, we're adding because the environments, you know, they are different.

Anthony Guerra 16:25
So, Chris, that's interesting, right? We want to, we want to reduce, but also want to go to the cloud, maybe get rid of on-prem, but at least for a while, we have to live in both worlds. We want to have a multi-cloud environment to give us freedom, but we still need the on-prem talent. We need general cloud talent and perhaps at least certifications in different specific cloud environments. So it sounds like during this transition period, instead of being able to reduce cost and expenses, it goes up at least for a short period of time. Does that make sense?

Chris Hutchins 17:01
That’s consistent with my own experience as well. Moving things carefully, for all the reasons that everyone would expect, our finance team is certainly very, very close to the conversations in the planning because they need to understand what the real impact is. You know, one of the things that I challenged on a couple of occasions, they were discussing around some applications that had really high IO, input-output, and those were ones that was dip our toe with something that's maybe a little less transactional activity, so it can really understand what that cost looks like. Just reducing our footprint in the data center doesn't necessarily mean the cost is coming down, so we need to make sure that we're monitoring it. But the challenge was that it is not only kind of testing the waters, but then the other piece of its readiness. There's not every application is a candidate right now for us on this. A good chunk of them, that we are getting it ready for her cloud, is on a road map, but the vendors are anywhere near the point where when they're ready for us to do to do any kind of migration. So it's not as easy as one would hope, but there's definitely an interim model where it is probably more expensive.

Anthony Guerra 18:26
Siv, when you are talking to clients, advising potential clients, we’re looking at this kind of migration; how would you describe it to them? You know, one of their goals is cost reduction. At least on-prem, how would you paint the picture for them about the resources they're going to need to allocate in the road that they're going to be going down to; may not be at least initially as rosy in terms of dropping cost right away. Do you try and sort of prepare them for that?

Dr. Siv Raman 18:51
Yeah. So I think you know it's a big difference between opEx versus CapEx. If you're going with us, some sort of a public cloud that you ever the pay-as-you-go model that becomes more of an operational expenditure. But if you're wanting to have total control and actually set up a private cloud that is very similar in the expenditure of domain to your old on-prem. Where you had a lot of CapEx. So I think that's one of the things. The other thing that I have seen with a lot of clients is that the first few bills are invoices that come in, and always surprised the client; either they're too high or too low, depending on the usage of the cloud. And that's something that's very different from having an on-prem system where you know, compute and things like that, pretty much free. You don't get, it's not a pay-as-you-go use, or pay-for-what-you use. So I think we do prepare our clients for those things.

Anthony Guerra 20:08
Chris, one of the things that we've heard speaking to individuals about this type of issue is that you need to really have good governance around the environment. So that you know, it's like I would use a Sandbox example. Everybody wants to play, you know, they say this is great. You've given us these toys we can play, but if there's no governance around spinning things up, when you get that bill, you find how much they've been playing, and it doesn't work out well for you. So what are your thoughts around that?

Chris Hutchins 20:37
That's a great point. And fortunately, when we launch things, here when we first started using one of the solutions, and there is a central area where those things are routed. So you know, for example, we have I think, now four different groups who come to us, wanted in their own cloud environment to work in, so we work with them to set that up, but they are kind of more from a funding standpoint, it's there at the bit to provide their costs are, and that's where the charges going to show up. But we are monitoring those things on their behalf as well, but it comes through a process, it's not anyone can ask for it, and it's free to do that work. We're making them accountable for the expense of making sure they understand what there is what they're getting into.

Anthony Guerra 21:32
Beth, is it challenging, or you just going to put the right structure around it, this shouldn't be a big deal as long as you understand the right way to do it?

Beth Lindsay-Wood 21:39
Well, you know, because we have research. I'm sure Chris experiences that still with really high-end computing needs. We can charge back for their time, right? For what they're using. It's all you can do it. You can do it on-prem for cycle time, but do you have to build in the equipment and all the different things that you have to take into account? Is it complicated to do it? So it is interesting for people to see how they're using even for data storage or even file storage. You know, it's a surprise when people see the kind of growth, you know, is that people and on, on the, on the other side, from my perspective, as we look at this, yeah, you do have to have good controls in place. You should be monitoring what's going on. But, you know, on the other hand, when we have when the data center, when we had our high-performance computing, in the data center, you're buying a lot of machine that you're not using 24/7. You have to, you’re building for growth in the future, so you're paying for it now and but you're not going to use it. Also, if it's a five-year life on something, you know, you're buying something that you'll need at the end, right? And so there's waste there, you know, and so that's important, I think. When you're looking at things like, you know, performance, the high-performing types of work that goes on, you know, it doesn't go on always 24/7, you know.

Jess Cornelia 20:00
Are CMO. And we meet every other week and we talk about changes, and we look at things from different perspectives. And our main EHR vendors are also included in those meetings. So there's no secrets we really try to treat. And we want to convey this in all instances that our vendors are not vendors, they are partners, and they're in this with us and our success, their success and vice versa.

Anthony Guerra 23.24
So, Siv, that's an upside for the way the cloud charges. Yeah, cause you're using your, you may be using a lot, but at least you're, you're paying for what you use, as opposed to it, with Beth is talking about, in the old model, you had to sort of pay ahead excess capacity. You might not need, may never need, or might need far down the road. But Siv, do you have any thoughts on this idea of making sure the usage doesn't get out of control and that there's governance around it, and that the things that are being spun up or the things that your organization should be spending up.

Dr. Siv Raman 23:57
Yeah. So, you know, one of the things that our clients love about a cloud-based warehouse or analytics environment is the fact that they can scale when needed and then scale back down. Now, what we do always, in this case, is, we do set up monitors that are able to figure out, you know, how much of a cost is being run up as some of these massive computer operations are being deployed, so it should not be something that you track only every 15 days of every week. But on a daily basis, you should be getting some idea of what are the big computer operations and what are the costs that are being that up. So we make sure we do that.

Anthony Guerra 24:53
Yeah Beth, I think you would want those researchers to have some sort of barely real-time feedback on the bill as it's going up. So they said I didn't know this was going to happen, and right I mean, you almost need that real-time feedback.

Beth Lindsay-Wood 25:09
Well, you can get it because you can actually see what’s depending on how you setup the cloud. And in that case, for us, at a minimum, IT needs to be prepared for a show back so that they can see what they're doing and figure out, you know, in some cases, grants can help pay for things like that. But, you know, a lot of cases, coming right out of, you know, right out of the company's coffers, obviously. So I think that, in any case, we have a better opportunity to show where the cost is being, what is really happening out there, and where we are seeing growth, you know, on the cloud side.

Anthony Guerra 25:56
Alright, very good; next question. This is sort of the big one. Chris. Let's go with you. Some organizations have not realized the hoped-for benefits after cloud migration; what are some reasons this could happen, and how could they be avoided? And then it was sort of, where are you on your journey in terms of realizing those, you know, that's the theory here, is that you can miss some things in the way of structuring it or executing it that will leave you not having realized the hoped-for benefits and we want to talk about that. So Chris, your thoughts?

Chris Hutchins 26:32
I think a lot of it comes down to having the right expectations going into it. Sometimes the goals are a little bit uninformed, and I think that's where they can be some unintended consequences. Probably one of the biggest ones that, you know, we had to really socialize with the executive team. I think you already referred to as, but there is a pivot from capital spending versus operating spend. And if you're an organization that's got an aggressive growth strategy, like we do on this, a lot of reasons you have to, you know, keep that balance properly. You don't want to adversely impact your operating expense and have it go sky-high at a point in time when you are planning for some significant growth in the organization, whether it's acquisitions or investments that you want to make. So I think that's one of the things that have, you know, if you're early in your journey, definitely make sure that you're spending some time with the finance folks, find the one that's most interested in the topic so that you could have a good partner, to really explore it. But again, I think that moving too quickly is probably another significant risk to not achieving what you were expecting to achieve. I think you got to have a little bit of experience under your belt before you really hit the gas pedal and move as fast as you want. The idea of shutting down data centers and everyone wants to save that money, but the realities are that you're going to learn along the way like you do with me or even doing typical development activities for development software activities or just data and analytics, there's going to be some surprises, and you really have to walk before you run. I guess that's it. It seems cliche, but I think that’s it.

Anthony Guerra 28:30
Very good. Beth?

Beth Lindsay-Wood 28:32
So I would just continue that line of discussion. The moved opEx is pretty dramatic and, in many cases, because it directly affects their, but those that is not always well received and being able to, you know, people do a lot of shopping in the organization and then at the end of the year when the bill comes, people get a little bit surprised. So keeping the organization up to speed on exactly what's happening, and what it's going to mean is important when we probably have 700% or more increase in our SAAS line item. But we haven’t reduced our spend in maintenance yet, because we still have a lot of the data center stuff in there, right? So, so it's really incremental cost to some degree, that we're dealing with. And the other thing is, once it's in the cloud, depending on, from us, and financial treatment of that asset or is it is not an asset. So if you upgrade it or have a big project around it, you can't capitalize on that work. So it means for us, we are very capital-intensive projects, but now, you know, based on guidelines finance guidelines, that even doing big upgrades doing anything at all, which requires operating expenses, Not just the actual run, everything associated with it is now operating. So it is; it means doing less in some cases their projects, if budget is an issue in your organization. In our case it is growing extremely rapidly with large construction initiatives. Again the acquisitions, there's a lot going on and so you can't be, can't stand still, but what it's doing for us, as it leads to its increasing, our overall spend, beyond natural growth. So I think that organization has leadership. Particularly finance really has to understand what this means ahead of time, not after the fact. Explaining, it later isn't helpful, you know, it's preparing them and it in there for what's coming.

Anthony Guerra 31:04
That's great. Great stuff. You both talked about working closely with finance so to imagine the CFO and Beth you talk about that 700% increase, and that the other numbers haven't come down, that just makes me think how important it is. You said you got to get ahead of it, but you have to tell a story, right? I mean, you have to craft a vision, and you have to craft a story ahead of time, and you have to do, you said, you have to explain these things. You can't be surprised if you say it’s ahead of time so that when it happens, you can say, yeah, I explained that this was how it was going to go. That sounds like a key here, Beth.

Beth Lindsay-Wood 31:38
Well, you know, CIOs are in the sales business. We have to do that, and we can't just do it once; you have to do it all year long. Tell me what they have other jobs. This isn't where their minds are at, at the senior executive-level organization. So, keeping up, y'all can find opportunities to explain again and again without being dull, but just make sure that they know. Throughout the year, all work, we're getting ready to do this, this will mean and or just a reminder, you know, we will see an uptick in our opEx because of, you know, the fact that we added another huge organization. There's a lot of growth of users and headcount, licensing, and all that kind of stuff. So, you know, it is just letting people know all the time about what's happening with IT. And also having your back pocket a little bit about benchmarks with other or similar organizations. Or just what's happening in the industry around us around cloud migration. And what, you know, it may mean that percent of the IT organization is now 7% or 5% of total revenue or expense because of where we're trying to head overall. So this is one piece.

Anthony Guerra 32:58
Siv, your thoughts?

Dr. Siv Raman 33:01
So I would identify, based on our experience with clients, three major issues relating to why organizations may not have realized that hoped-for benefits, you know, from cloud migration. Number one, in my opinion, is the skillset, right? So when an organization that is transitioning to the cloud, for, let's say, a data warehouse, the people who have been managing the on-prem warehouse may not have the skill set to migrate efficiently to a cloud-based application. So that's one of the things that is overlooked. Everybody thinks you can just train people in most cases, you can, but then you have to plan for that. The second is what my co-panelist already talked about. Many customers don't anticipate the variances in cost for cloud services, I had an example of a data science team that runs some process for a client that lasted two or three days. And you know that huge server doing some predictive model training ran up $2,000 in 3 days, and then the third one is no issues around cloud security and performance. Theoretically, it should be better than on-prem because you can secure most of these popular cloud providers much better than you can do a data server. But again, it requires the right resources who are trained in cloud security and then also in performance.

Anthony Guerra 34:45
Siv, what's the main reason that customers bring you in, in your organization in what's the number one thing? They need help with server more specifically. That's if they try and do it on their own, they might have some trouble.

Dr. Siv Raman 35:02
As I said, that's the first one. Among the three reasons, I listed the skills that right? It's tempting to try to do things yourself. But then, mature organizations realized that it's better to get a vendor or a consultant to do that initial implementation, another sort of TurnKey way, and then handed over to the existing technology teams to maintain and run. That's the main reason we are sought after by our clients that we have expertise doing the start of migration for years on end for tens or scores of clients. And so, you know, it's a risk-free way to migrate to something better without any negative business impact.

Anthony Guerra 35:54
And do you train up the in-house talent so that they're ready to then take on those roles, or is it just that you do the work and they have more time to go out and get training on their own?

Dr. Siv Raman 36:05
We have done some training for particular clients. Most of the time in order, the clients deal with the training of that stuff on their own. But we have done some training for specific clients to ask for it because they said, you know, we would like our resources to be working with your resources and then learn on the job.

Anthony Guerra 36:31
All right, very good. Chris, start with you on this. Who are the key executives, IT leaders need to work with during cloud migration and optimization? Obviously, we hit on finance pretty hard. So, I think we got that one. But who are some of the other folks that you need to work with to get this done?

Chris Hutchins 36:47
Well, I would say that there would be a 1A and 1B, I think finance would be one, and CISO would be the other one. Hands down from my perspective, the only reason I can sleep at night is because I know that the CISO and her team, are the ones I have staying up every day, and I'm sure that you can probably hit us to the number of insane, that number of attempts did, are happening on a daily basis, to breach our systems, so I'd say that's probably one of the key ones to get on board right away. And make sure that they're involved in. Our legal team and the procurement team, go through the great amount of rigor when it comes to any kind of contracting that we do, but for me that I have to say the CISO is most probably the most critical one among the others, but, I think when you're dealing with the large research division, you definitely want to have a really strong leader in that space as well that can really understand. In the grasp, what we're talking about because one of the challenges, I always get his research doesn't have a lot of funding, and they're always telling me that, so they don't want to pay a lot of money for this, for the support, they said that they need to do their work. But you know that really necessitates that really tight relationship there so that you can work through things together cause you do have to figure out how to help them advance. But you know, someone's going to have a really good understanding of what it really means. From a cost perspective to make the kind of transitions they are meeting to make.

Anthony Guerra 38: 27
Excellent. Chris, thank you, Beth?

Beth Lindsay-Wood 38:29
I absolutely agree with what Chris said. I think it's all of those people; data governance probably is another group or discipline that is important. In terms of knowing where the data is. And in healthcare, we are always worried about HIPAA data. So I think it's involving them in understanding where these things said, knowing where they said, when you are working with cloud vendors to is important. But by far, you know, cyber, that's kind of a thing. But still, that's, that's a key piece of this. We involve our enterprise architecture group pretty heavily, but again, that's somewhat internal. So compliance, legal, finance, all critical who really doesn't care as opposed to our customers. Yeah, they don't care. As long as they can do their work and your system, you know, I think that they do research is a different animal and it is very different model. So for them, I take it. That's a great point. Chris that they are, they are pivotal in terms of engaging them on two kinds of things at unique kinds of things that they do. That other areas of the organization do not.

Anthony Guerra 39:51
Very interesting with the research elements. Siv, your thoughts?

Dr. Siv Raman 39:52
I think, you know, the Chief Financial Officer for sure. The Chief Information Security Officer, I would say the chief legal people, the risk management people need to get involved, and sometimes it's not necessarily executives, but you also need to bring on board people at a slightly lower level application development managers, and cloud security engineers and program managers cause they're the ones who are making it happen.

Anthony Guerra 40:27
Excellent. All right, we're going to do my favorite section here. Ask a co-panelist, where we find out what the panelists want to learn from each other. So, Siv, I'm going to let you go first, you have a question for one or both of your co-panelists?

Dr. Siv Raman 40:44
What would you say has been your best and your worst cloud migration, if you've done more than one?

Anthony Guerra 40:53
Chris, you want to jump in?

Chris Hutchins 40:57
I think for the organization, some of the early successes have been in the app development space were its new capabilities that we're developing, and it's not a high transaction volume on to the gate. That was one of the early wins that we had, and it gave us a good opportunity to really assess. What is this really going to look like now you know what, what's, the impact from a processing standpoint, and what’s the cash impact? And after the first couple of months seeing what the bills look like, I think we’ve been going pretty cautiously over the last three or four years anyway, and we probably slowed down because of the pandemic, wouldn't be surprised if others in the healthcare sector did. But we’ve been fortunate, and we haven’t switched to a whole bunch of things, all at once, I'm grateful for that.

Anthony Guerra 42:01
Very good. Beth?

Beth Lindsay-Wood 42:04
I would have to say, you know, I think for us, the more challenging is yet to come. But I'm curious about, you know, how as we go through this. You know, when we get into somebody's deeper things, how it goes, so far, so good. I think the easiest things are sort of static storage, you know that nobody really uses it and gets it out of your data center. It's great to have it up there, but you'll find a low-cost but good service to store it, but those are sort of easy, you know. email the whole migration for all of the email suite on all, say, Microsoft in this case. But you know it's not as easy for customers. Because if there is a little bit of uniqueness there so that might have been actually believe it or not, one of our, I’ve done it twice. So each time, it's been a little bit of a different way of working for the people to use the applications.

Anthony Guerra 43:15
Beth, I would imagine, you know, you don't want to get overconfident, right, 'cause we're starting out with very sought of, more simple projects because that makes sense. But it sounds like there's such a drastic difference between those simple projects and the big heavy ones that we don't want to get.

Beth Lindsay-Wood 43:32
Yeah, DevOps is a great example because although it's very important, it is, it's not as central to the work that everyone, where everybody's connecting every day. You know. So it does those things are a little easier to dip your toe, and yeah, we're getting to the point now where it's, it's getting to be pretty big platforms that were talking about, and some are already there with vendors. You know, that they supply it, so that's different.

Anthony Guerra 44:04
Very good. Alright, Chris, do you have a question for one or both of your co-panelists?

Chris Hutchins 44:08
Actually, yes. I know imaging, images have been mentioned them, but I wouldn't, but I would love to know what kind of experience either of you might be having that you can speak to it. We're in the process of trying to figure out what's the right solution for us to start moving like DICOM images. I think that you mention digital path, that's something that's what we're looking at at the moment as well. Would love to know what you can share in terms of what we should anticipate from a cost perspective as we pivot from on-prem.

Anthony Guerra 44:46
Beth, you want to go first?

Beth Lindsay-Wood 44:47
I'll try that, but we're still in the throat; we just were getting ready to pull the trigger on storage on, PACS, particularly in the cloud, and where we’re looking at it right now. We're trying to figure out how to get there. I think we think about research and some of how they handle imaging; that's probably an easier foray in because if you don't have the physicians trying to read these images, right? And pull in images for day-to-day, working with patients and it out there, they have to, they have to have this right now. So I think, I think it's if it's easier to do some of the imaging where it isn't, you know, where it isn't that patient-intensive for us. So I don't know, we are right now working on whether or not we're going to move it into the cloud this year or whether we're going to hold off for a little bit. So I'll be happy to tell you when I get there, but I think the storage, you know, of images for something like research seems to be that seems like something that would be a little less pressure.

Dr. Siv Raman 46:03
So, I can’t say that we've migrated a PACS or a DICOM-like system with images over to the cloud, but we have done archives on the cloud, which include images. So that has been pretty well received. It's been able to manage costs, and it gives you a live archive, not a dead one on tape or something like that; that the physicians and others at a provider system can access for patients whom they are looking at today in their EMRs.

Beth Lindsay-Wood 46:51
I agree with you, Siv. I think for us, we do that for documents, scan documents, things like that. It's just that interaction, right? That makes me a little bit uncomfortable, but yeah, that's a great use case for it.

Anthony Guerra 47:05
Very good, alright, Beth, do you have a question for one or both of your co-panelists?

Beth Lindsay-Wood 47:10
Well, this is just a curiosity more than anything, but, you know, edge computing is the new thing, right? It'll eat cloud computing, at the lunch, for cloud computing is the word. What is your, what if anything, are you doing along those lines, particularly because we have IoT, patients at home. All kinds of things happening. Just curious about whether either one of you are moving into that space as well.

Anthony Guerra 47:40
Chris, you want to jump in?

Chris Hutchins 47:43
I know that there's definitely a couple of areas of focus within parts of the IT organization. We're walking softly because we are, hopefully, very, very close to agreeing on putting some standard systems in here. Growth by acquisition. sometimes can be painful, and I think we were we are a good use case for what that pain could like. We have literally every EHR under the sun, with the exception of Epic in our health system right now. Still, as we've grown my acquisition, it seems as though the shopping list only contains those organizations that have systems we haven't seen yet. I think that's primarily to make my team lose their marbles, but it was definitely a challenge to we're moving very slowly because we have to pay that; we've got to make a change and get on to cloud and platforms. So you can probably imagine where that’s going to lead us.

Dr. Siv Raman 48:48
I actually haven't seen much Edge Computing in the healthcare world, if I'm wrong, and I don't know, but it looks like it's more in our telecommunications, finance, and many other industries are adopting Edge Computing at a faster pace. Healthcare is more of a centralized model even now. So at least from the clients that I've been interacting with, we don't hear anything about Edge Computing.

Anthony Guerra 49:19
All right, not too much there. Shockingly health care is not on the cutting edge right now. We're all shocked with that.

Alright, we just have a few minutes left, so just want to get some final thoughts. Let me frame this up by saying; your best piece of advice based on your experience so far, we have you where you've had success in out in the areas we discussed today. You're best piece of advice for someone in your position at a comfortable size organization. What it, what would that be? Chris, let’s start with you.

Chris Hutchins 49:54
If you can have the mindset that you got a Superman cape on, take the cap off, you need people, you need relationships to take to be successful. And you know what, I think we covered with it. We even identified some of those key individuals within an organization that you really need to make sure that you're communicating pretty consistently with regard to what the injectors in the goals are, and you need their input, in the end, their advice in terms of how to navigate within the organization as well as you're tasked with it, making this kind of transition.

Anthony Guerra 50:30
Very good, Beth?

Beth Lindsay-Wood 50:32
I would say that, you know, make sure that your approach, your plan, your migration plan is well understood and that you're not doing it to do it. You're doing it with a, with a, with an outcome in mind, and be clear on that because cloud for cloud sake, it's not the right answer, and people off will do that, you know, because in IT, sometimes we can. But I think understanding the approach and being able to articulate that, along with the financial impact of that plan, is critical.

Anthony Guerra 51:13
That's a great point is a great point. It is going to be tied to the vision of the organization and how it's going to help your decision to achieve that vision. Very good points. Siv, we're going to give you the final word, your best piece of advice for folks that are looking at moving down this road.

Dr. Siv Raman 51:28
So I think, you know, four points come to my mind; one would be to make sure you have the people trained to do this sort of stuff. I need people who are cloud-certified with modern cloud technology skills. Application Rationalization is the second one. You don't need to move everything to the cloud all at once. So make sure you're moving rightly chosen applications first. Identify potential issues, well ahead of the migration because you're not the first company doing this, so you can learn from the mistakes that others have made. And identify potential issues that could crop up, and you know how you're going to mitigate them. And then, lastly, a really well-defined cloud security strategy.

Anthony Guerra 52:24
Yeah, certainly cyber. Siv was just talking about correlating with finance to a lot of great information for the folks attending today that's about all we have time for today. Regarding continuing education, you could use the final slide in this deck for your certificate. You will receive an email when the on-demand recording is ready for viewing. If you want to sponsor an event with us, you can reach out to Nancy Wilcox from our team and go to our website to register for upcoming panels. With that, I want to thank our wonderful panel today. Chris Hutchins, Beth Lindsay-Wood, and Dr. Siv Raman, I want to thank 314e for sponsoring and you for attending, and with that, everybody have a wonderful day. Thank you.