AWS re:Invent 2023 - Reimagining healthcare delivery by migrating critical workloads to AWS (HLC202)

good afternoon and welcome to reimagining healthc care delivery by moving by migrating critical workloads to AWS I'm Angela Shippy senior physician executive and clinical Innovation lead for nonprofit Healthcare I'm an internal medicine physician by training practiced as a hospitalist for many years and also held chief medical and quality officer roles so I have been an enduser of healthcare technology my entire career I'm thrilled to be here today with Dan Bennett the chief technology officer of Ginger Health who's helping to lead their digital transformation today we want to talk to you about who is AWS what we're hearing from Healthcare customers AWS Healthcare and upskilling for the future now I want to get a sense for who's in the room with us how many of you are are clinicians all right how many of you are chief technology officers Chief Information officers analytics all right there's a few hands there how many of you are Builders you're at your organizations building and making this happen how many of you are from provider organizations all right Healthcare and Life Sciences more Health Tech fantastic well it's great to have all of you here and I know that all of us are consumers of Healthcare in one way or another whether that means that you directly have been a consumer of healthcare or indirectly with family or friends and so you might be familiar with the picture that's up on the screen right now this is an operating room with a clinical team in it and you see a clipboard with a piece of paper now it's been a while since there's been a lot of clipboards around they've been replaced with workstations on wheels or they might be mounted to the wall but the goal would be can we get to this can we get to an operating Suite where there is data and images and the realtime monitoring of the patient right in front of them so that really they're going to just look up and in their line of sight is all of the information so that they can have an optimal outcome well at AWS we're Mission driven just like the organizations who were providing this care for over 17 years organizations have lay leveraged aws's Global Cloud infrastructure with the broadest and deepest set of services to have a secure and true truly reliable platform and for over 9 years there's been a dedicated practice to healthare and life sciences that has Physicians like me and other Specialties nurses researchers pharmacist Chief Information officers analysts all who have walked in the shoes of many of you in this room and it is this group who's working in collaboration with customers bringing the industry knowledge and Technology together to be the trusted advisor to Global Healthcare organizations so when we have the opportunity to talk to customers this is what we're hearing from them three big themes one is the decrease in margins there's been a degradation there are three major reasons why this is happening one is the cost of Labor supply cost and the other is the overall cost of Care Now traditionally these were easily managed but more recently there's much more volatility and variability and it's getting a little harder the next is the workforce Workforce that's demanding to be in an environment and have the tools and training that's needed right at their fingertips allowing them to work at the top of their license or the top of their skill set and we know that when workers feel like they're doing their best work that's a top factor in resilience and then lastly what we've heard is about the consumer the patient across the Continuum of Care who's saying I now want an experience where I can achieve my best health have access to care when and where I want it and be a member of The Care care team to ensure that that care is being delivered in a way that's meaningful to them at AWS Healthcare we are invested to innovate on behalf of customers to it to really address those challenges I just mentioned and with that leading to the development of unique purpose-built services that are focused on what's important in healthcare and life sciences take AWS Health omix providing organizations with the opportunity to be able to take data multimodal analytics from DNA to health records to Medical Imaging and to be able to utilize it to have more insights improve clinical outcomes and really help Advance scientific discovery how about AWS Health Lake a HIPPA eligible service that provides for secure transferred of transfer of unstructured data and unlock powerful query and search capabilities how about AWS Health Imaging allowing providers and software providers to run their medical imaging app applications in the cloud and with that be able to decrease the cost and help improve the infrastructure and then lastly how about AWS Health scribe the opportunity for a vendor to be able to take clinician and patient interactions and be able to transcribe them and summarize those notes and make them readily available all of these services to make it easier to help achieve those outcomes that consumers want to achieve the outcomes that the workforce wants to help healthc care and Life Sciences continue on their mission and achieve their goals and we know that in the highly regulated healthcare industry it's extremely important to be able to do this and a plat form that's secure that's reliable and helps to improve those digital relationships and lastly can enable Innovations like generative Ai and we've been talking about that the entire week so here are some key areas where gen can be used so for medical research how about being able to fill in some missing data automatically helping to improve those data sets being able to enhance therapeutic development and identify rare diseases and accelerate the time to advance Therapeutics what about clinical efficiency how about summarizing large patient volumes and increasing the time it takes to decrease the time it takes to do that then you're allowing more access to care now there's an opportunity a better understand a patient's clinical journey and personalize it for them how about operational efficiency utilizing gen aai with operational efficiency provides that opportunity to take manual tasks duplicative tasks and make them easier automate them so that you can improve efficiency decrease cost improve the access and this would be a great opportunity to bring in Amazon q and how about patient experience how about using conversational chat Bots agents to be able to make it easier for patients to get the information that they need and to be able to have it in a way that's personalized just for them and then again digital Health where we're giving patients the access when they want it how they want it answering those questions any time of the day or night well in order to do all of that there has to be an understanding of the cloud and not just the technical folks in an organization but everyone and there are lots of ways to get there so one is we have over 600 courses online and we're happy to help you curate that content for certain roles in the organization within and outside of it for those who really want to accelerate their learning and receive certifications we can help you with training with that as well and then there's Global conferences just like this one like reinvent where you've had the opportunity to come and hear in real time what's next and to talk to each other and partners about how you can continue to evolve and improve your Cloud infrastructure and just like it says here in this quote from Forbes it really is about the people it's more than services and servers it's about upskilling the workforce to be able to sustain that ongoing development so everything I just talked about is absolutely possible it's not just aspirational and I would like you to hear from AWS customer Dan Bennett who is the chief technology officer at Gingher to walk you through their journey and what they're doing right now please welcome Dan to the stage thank you good afternoon it's good to see that some of the folks that are involved in the project came to see and uh we'll have some time at the end for some question and answer so uh we'll be able to take some of it here or out in the hallway uh this is actually a real fun thing for me because we were here last year on the uh stage as well with some of uh similar information similar content but it was more this is what guy singer is going to do this is what we want to do this is the plan and now we're back to really give an update on what's transpired in the last 12 months where our Journey's gone and some of the things that we have um in sight for the next uh year as well so a little bit about Ginger Ginger is a Pennsylvania based integrated delivery Network as the slide shows here uh we're not just just in the provider space we also have a health plan we have a school of medicine School of Nursing and we round that out as well with uh research so part of what makes us I think successful in some of this space is we've been able to integrate and transform and find efficiencies across all of these different business lines and segments using technology ginger has been a very technology forward company for many years and this was one of the logical next steps for us to really start jumping in to uh Cloud environments Cloud native services and you know expand our data center reach beyond the traditional brick and mortar so you know I think a lot of people get tired of talking about covid right we've kind of come out of that and what Ginger did which was a little unique not across the whole sector but it was definitely the minority in healthcare was when that hit and margins thinned and all of those headwinds started hitting the industry and many of us we started doubling down on transformation we started spending money additional money um ramping up and accelerating many projects across the organization to try to tackle things like Supply chains things like diminishing um payments you know uh loss of margins all those kind of things make us more efficient and really prepare the organization for the for the future because the whole industry was kind of pushed into and down a hole in order to respond very quickly with sending workforces that had never worked from home home thousands of people and we did it in a matter of a week two weeks went from maybe a thousand to five or 6,000 people working from home so that highlighted our our need to be agile quickly deliver services and be able to Pivot for the organization again as a nonprofit Healthcare organization you still have to have a slight margin so you can continue to reinvest in your company the community you serve the buildings and the facilities that you deliver care so many of these projects that we kicked up were aimed at that as well and then ultimately being a healthcare organization our number one mission is to better serve the community and provide better care right Better Health easy is one of our um lines and we take it very seriously so again many projects were spun up in the organization many of them are still going some of them have been completed one of these many projects was our Cloud transformation and there was two other ones that we're going to talk about in the presentation around how to get your organiz ation ready how to get your application portfolio ready when we doubleclick on those three areas that we were focused as an organization to continue to modernize and push ourselves to be better these were the three kind of pillars with a little double click of some of the things that when we were spinning up those transformation projects they were focused on so when you think about Cloud transformation and how it relates to each of these because again you can't deliver better care if you're not performing well you can't perform well in this industry anymore if you're not adaptable so when you think about cloud and the agility and the plays in that space it covers a lot of these things from a optimizing your operational financial performance so we'll talk a little bit more about this later but the idea of reducing your technical debt over time not having Hardware sitting in your data center not have unused capacity sitting in your data center and getting to a more just in time type model forward focused business model covered on that that is where again we're looking forward not backwards and where we need to go as an industry and and as a company driving efficiency um we are just scratching the surface I would say from a cloud perspective in the efficiency space but that is going to be one of the major benefits that we've already seen some fruits of but we'll continue to double down on that and then finally innovate in innovate and Technology technologically advanced healthc care you I firmly believe you can't do that if your infrastructure and your services and your it team and your data and everything else is not in lock step with that the company Healthcare today cannot be Innovative without a strong technology backbone and a strong technology Workforce to support it so this quote from the hard harbard the Harvard Business review piggybacks on the previous one that really targets one of the biggest Investments that we did as an organization and it wasn't the biggest Financial investment it was the biggest time investment where we spend a ton of time training and educating and getting the entire organization up to speed on what the cloud is because ultimately as you'll see as we go through this this project moving to Amazon web service moving the organization although was a it transformation project was an entire company transformation project at this point you would be hard pressed walking through the hospital or walking through a facility and finding somebody that has not been involved in some aspect of this project whether testing providing feedback and other things there so one of the critical components in one of our additional transformation projects was around its's new operating model so prior to this project and others we were a traditional it shop we had application accountability across multiple leaders we had uh infrastructure teams we had all those normal things and all their nice little silos and their Stacks so one of the things that we spent a lot of time on is thinking about what do we need to look like for the future what are the skills and how do we get our current staff what they need to be successful because they were they were they were vested they've been they've been knocking things out of the park for years and now you know we've come and say hey we're going to go to Amazon so we had to really step back do a skills Gap assessment find the right trainings and again those trainings were not just for the technologists we put a lot of them through training a lot of them got certification but we did executive cloud training so people that want to know what is the cloud what is Amazon so folks in the business we taking courses things like that and then ultimately as we did this and we're now in the far side where we're in this iterative build and constantly thinking about do we have the right resources applied in the right spot at the right time and how do we be nimble so historically when you think about an operating model it's very rigid it's very HR based right you report to who and so on and so forth we've gotten to the point now where we've kind of collapsed some of those silos we have a single executive in charge of all applications we have U myself in charge of cloud and infrastructure and identity and access we have all of those things now kind of spaced out where they need to be and we've started cross-pollinating and collaborating across teams that normally would not have necessarily talked and we continue to look look at um as we go into an application reduction slide next you'll see as you reduce your portfolio you free up time for folks to start cross trining and and cross-pollinating those skills so that we can build a Workforce for the future as we sustain the current so the second big piece and one that was tackled as we were in the design phase of the cloud so this one kicked off very early for us in the overall project was around application rationalization and to be honest we talked about this for many years we tried to do it many times but ultimately the way that the industry has changed and the headwinds and everything else we were forced to get it done so we went through our application portfolio we found duplicate applications we found applications that weren't used and we went and we trimmed hundreds of applications out of our portfolio um We are continuing to do this today this has now become an operational um an operational type activity the business is involved or business stakeholders is involved it is involved and as we bring on new applications that we need we look to Sunset other applications and as contracts renew we look to make sure that there's still a valid application and is it the right thing for ginger in the future because part of modernizing our infrastructure is also modern ing our application portfolio so the next two slides you're just going to give you a little glimpse into what Ginger's overall infrastructure looked like pre-project so this is one of these exact same slid as last year this is where we started okay so at the end of the day most of our servers were virtualized so we were a heavy heavily virtualized environment which set us up for a lot of this stuff as well because you virtualize one you virtualize the next so a lot of concerns when you're a a major physical Hardware type shop and doing physical to Virtual conversions things like that um I wouldn't say didn't come into play but it was less challenging we also were a heavy Windows shop and then the alternative for that is Linux as well so our two main um operating systems function well in almost any public cloud so we were set up very successfully there again X8 x64 architectures we had a good healthy divide between production and non-production and overall you'll see some of the distributions there across the different things this one is the interesting slide for me and this is one from an automation perspective that I would say we've barely scratched the surface on so far but our doing analysis on all of those servers in the previous slide that were in scope for migration the applications that run on them we ran and looked at okay what's the CPU utilization what's the memory what's the disc how much technical debt is sitting there right how much stuff did we over bu because a vendor X said you need this or vendor y said you needed that so we actually ended up getting the data for this and it was a compelling part of the business case that as we get to the Cloud and as we optimize which is one of our big focuses for 2024 is to start looking at these systems and starting to actually customize and Ratchet down certain resources that aren't actually needed independent of what the system requirements of an application says and we'll have an example of this when we talk about our EHR that we migrated to AWS here in September about how being in AWS allowed us to be agile with that deployment and also with the upgrades that we've done post move have been able to actually reduce compute and not have technical debt in our data center so as any Healthcare organization we have one of the you know one of the popular electronic health records out on the market um we were one of their very first customers and this kind of sparked one of the business cases for change and again for us Cloud isn't solely a play on cost savings as an organization okay some things you put out there will cost you less some things you put out there will cost you more but ultimately when you look at these you have to look at more than just cost but agility time to deliver and all of those other things that you get so when we're looking at these things and our spend and everything else with the cloud and on Prem we were able to take our electronic health record over the course of this project we had multiple environments and we started moving with our training environment first right the one that everybody plays on and as part of that we did extensive testing with the EHR vendor as well as our uh partner we did use an implementation partner uh it was Del and they brought some tools to bear and ultimately we were able to show that performance on AWS exceeded many of the performances we had on Prem now now part of that was when you think about your spending and being physically responsible we knew this was coming we knew we were doing this so we didn't replace systems on Prem that should have been life cycled because there was no need to so what was really good with that is training went well so we said great let's move on then we put another environment out there that's closer to production we did a bunch of testing and worked great there are some bumps along the way each time we did it we learned something new to apply to the next one then we got to the point where our last environment before our disaster recovery and production we put that out there it continued to perform very well so in September we had planned to move our entire organization from operating on our EHR on Prem in central Pennsylvania to AWS in Virginia and run it for one week so that we could see performance what do we need to do to be better at it for the big go live here at the end of the year what did we miss in our prep what did we miss in our steps right how do we make sure that we reduce the impact to the users when we when we finally pull the trigger here next week and we put it out there we had a couple bumps but the issues list was much shorter than anybody anticipated and ultimately the biggest issue that we ran across was the wrong license was applied to some of our virtual gear that limited the interface engines from being able to send their stuff as quickly as possible so they backed up once that was identified and remediated they flushed out in a matter of a couple hours and about two three days into it it wasn't the executives it was the engineers it was the application owners it was the end users of the organization that started saying wow this is working better it's faster do we really have to go back so there was many people that sent me emails hit me up on teams talk talking to other Executives that said do we really need to move this back so we sat down Wednesday after the go live from the previous Friday and had that discussion and we made the decision to leave it there there was risk we're now operating in a hybrid environment with our production EHR in the cloud and our disaster recovery on Prem on completely different infrastructure completely different model and we've been running that way since we went through an upgrade of the EA R since this we upgraded both on Prem and in the cloud with minimal bumps we also implemented new features of the EHR that required many new servers since then in the cloud and on Prem with very few bumps and on top of that one of the great benefits that we've realized as part of this is when we did those upgrades these systems typically when you have to do an upgrade or you have to add a module to it it's you need these couple hundred service for this you need these couple hundred servers for that and if you don't have it you go out you buy it right you bring it to the data center you stand it all up and then you do your upgrade in this case we overshot from a Citrix perspective by I think a couple hundred servers the guys in the back can keep me honest but a lot of servers that typically we would have virtualized they would have been run on VMware all that great stuff but because we were on the cloud we just turned them off right we didn't pay for them anymore they were gone we had another instance again with the EHR where with the uh the big uh module we implemented they started seeing that they didn't need all the servers based on performance metrics so I think for about a week they started turning off 20 servers at a time until they found the right the right thing historically we would have bought the hardware for those granted it may not have been much because we were heavily virtualized but still it would have been sitting there in my data center depreciating for 5 years heating cooling everything else and in this particular case we were able to just turn it off take it out no technical debt Left Behind we're also taking this journey with our claim system so that's about 70% out on AWS right now it's open enrollment season so we're obviously not moving production right now but uh that's slated to be done here in the uh February March April time frame but the one point that I kind of jumped over is by us leaving it out there the teams calculated we saved over a thousand hours of human capital by leaving it there instead of bringing it back we've also prevented two additional downtimes to our enduser community where because it it took us three and a half four hours to flip the or from on-prem to EHR and the cloud and during that time things were up and down so we didn't have to do that again so next week and for the rest of this year and the beginning of next year our final EHR environment will go in our second region of Amazon and then we will start performing Dr testing flipping between multiple regions of Amazon instead of flipping on Prem to the cloud and back so with that we've been able to minimize impact on the unuser community and also saved countless hours of it as well as everybody involved in testing this slide highlights many of the Amazon native services that ginger has uh used and implemented this isn't all-encompassing but it's also meant to kind of spark the conversation of you know did we do it all Native and the answer is no so as far as the way our architecture was and the one thing that we did which I think may be unique in a way especially in our industry is when this project started we green fielded it it was blank sheet of paper so we have a combination out there of infrastructure service so you're lifting shift right and and we've got product based applications that we've built on AWS as well so when we thought about how do we support what I'll consider a traditional it architecture on top of the cloud as well as thinking about adaptability Innovation and everything else we need a product based model as well so when we did that we built the network design brand new right we inter interjected collocation centers to be able to have dedicated um connections as well as diverse paths to the cloud as well as that we even Diversified the technology that's used on those lines to get us to the colos some Fiber some not different geographic regions for the paths of the cables as well as everything else so we took the opportunity to look at this from the time it leaves our physical facilities to Amazon and back and then when we talk about security and a data center that you've had for many many moons you've been building Security on top of the data center for many years putting a little bit more here a little bit more there but this is brand new so we took a an approach being able to separate out business units at a network layer production non-production putting more guide rails and protections in between those things to help protect these applications we used a lot of these native services but we also worked with some of our key Partners so our Amazon or a AWS instance and environment is not just strictly this we we brought with us you know uh top grade firewalls that and part of the reason we did this and things like citric and F5 technology and others is we already had those skills we have the management interfaces so part of that was to be able to blend the new native with the tech technology that we had before so that when we're Skilling and we're looking we're able to tackle this all at once so so with that we're also in the constant cycle of okay well we've used that can we go to a cloud native at some point what are the things we need that may not be there and having those conversations again with our integration partner with our AWS technical teams things like that so again a lot of this we've used a lot of this has been extensively leveraged and some of this is on the horizon for us as well as we continue to move down this path some lessons learned across all three of our transformation projects and I highlighted one in each column as kind of the ones that stood out as we were thinking about this as an organization and when you think about your operating model model governance and partnering across the organization promoting Automation and self-service to increase productivity and speed is critical and we're laser focused on that we haven't gotten there yet we do a lot of automation within our data center we do a lot of automation within the AWS environment but that's one of our big priorities for 2024 is to continue to build our tool set out continue to skill our teams continue to take traditional infrastructure and think differently about it infrastructure's code application developer mindset versioning control being able to recreate things with scripts instead of the traditional way of having to go through screens or rack and stack a new piece of Hardware things of that nature the other thing with the app rationalization is to drive Enterprise standardization and consolidate redundant applications so we'll have an analogy later but ultimately you don't want to take stuff to the cloud first of all that won't run in the cloud and secondly you don't want to take stuff to the cloud that you know at the end of the day you're not going to need anymore it's going to be shut off or it's going to go away or you have four of the same things with five with four different vendors so early on on this was one of our critical success factors was to really step back and look at what are the applications in our portfolio and how do we how do we handle those and then on the infrastructure side the largest thing from a Lessons Learned and probably the biggest thing that I would encourage everybody to think about is how were you going to do organizational change management that's not it change management where I'm going to change this config this is how do you change your organization to think differently for our project this project was sponsored at the top level of the organization so this had top down approval top down buyin and it really allowed us to change the way that we operate look at the way we deliver services and really engage with our user Community because I wasn't joking at the begin of the presentation when we did this project at as we spun this up there was so much testing and so many people in the organization involved we host our electronic health record for Community Partners they were involved they're they're not even our employees they were involved in testing so this project span a very large large set of team members and colleagues so you got to make sure you're investing in the organizational change you're investing in the Skilling and the education to make your team successful because again you've got a lot of um smart adaptable resources within your organization and one of the best things I think we can do for folks like that is offer them a path for career development and a path for Change and in order to do that you've got to really invest in the people so this was a quote from our CIO that really kind of sums up and Nails home the organ the executives in the organization as well as many of us myself included the amount of time and hours and energy that our folks put into this to make this successful with again one of the smallest issues lists I've ever seen with a go live for a system as massive of that is a testament to the skills and the abilities and the drive of our staff right and their willingness to step up and change with the organization and again you know we were supported by AWS and deoe and many of our technology Partners when we went live we had Citrix Pao other ones like that they were online and live at 1:00 a.m. when we were doing this in case we needed them right so again I can't say enough about the amount of people organizations and teams that were needed to make this successful and you know it brought teams together that had never worked before together so I'm going to ask Angela to re come up to the stage okay like is that not amazing hearing that story about what they've done at geing her I think Dan deserves a round of applause for sharing what they've been doing well it's really for those guys in the back and everybody else that like you said you've got the leaders and then you got the people that actually do it they're those those four guys back there are some of the guys that knocked us out of the park as well as our partners up front with Amazon and deoe absolutely a round of applause for everybody that's why it was so important for us to know who was in the room it's the builders it's the partners um it's all of you who are making a difference because we really do think this is a new day in healthcare it is time to start looking at this a little bit differently and it's also time to start saying we can really get to that o Suite in the future so Dan and I wanted to talk about what is it that you need to do on Monday to get started or to advance what you're already doing yeah so this is the application rationalization piece right think about getting your house in order are you and and and the operating model are you structured in a way is your organization ready to change the way that it's done definitely especially if it's in an industry or an organization that's very traditional and I don't mean traditional it I mean traditional business models traditional you know project management all of those kind of things you have to think about are you ready to do that and then you have to start thinking about what's your Tech debt and your application debt because I've moved only a couple times many of you have probably moved a lot and we always pack stuff in boxes take it with us and then never look at it again so the idea with this and this analogy is don't pack stuff in boxes that you don't need get rid of it because we're all going to fill our basements up with those boxes and eventually go back and wonder why we even brought it to the next house no that's a great point the next is sometimes it can be overwhelming within an organization to say we want to do something new whether you're going to migrate for the first time or whether you're just going to modernize or you're continuing to advance your current infrastructure so what are your strategic goals that's a great place to start so you can look at which resources you're going to utilize and prioritize where you're going yeah yeah and as far as your 612 and 18-month plan there's a couple key things that you need to think about and one of them is are you able to do this yourself right um we had a lot of smart capable people some with Amazon experience because we dabbled it with it with research and other things in the past but we didn't have the amount of Labor needed to do a project like this right in some cases we needed some skills added in order to do it so you need to think about do you you need a trusted implementation partner to help you and your team and your organization get there do you want to accelerate faster things like that the other piece is do not discount planning okay even though we're talking about being agile and fast and speed the delivery and all that don't rush through your design of your initial environment um that probably should have been one of our lessons learned we had things that we had to go back and re architect because certain little pieces might have been rushed so part of our lessons learned and things there is take the right amount of time for your organization to design your foundation because you're not going to want to go back and blow it up and redo it again and there was a significant amount of time spent this week on what's next what is the emerging technology you're going to want to use so now is the time to start thinking about that as we look at those challenges that were discussed earlier about the workforce part of the the stress on the workforce is sometimes we're in to hurry up and get it done mode and Healthcare organizations by having a plan following that path and knowing where you want to go with the merging technology then you're taking the whole organization along and you heard from Dan how important that is and the final piece I think I've beat this one into the ground during the presentation but upskill your people they're smart they're hungry so get them the training and the skills and everything they need to take you into the future of where you need to go um because there's a lot of talent I know there is in our organization and again it's not just IT training you need to educate the workforce and the Executive Suite and others on what this really means so thank you all thank you Dan for telling us your story and sharing it with us it is a delight to have you

2023-12-11 19:45

Other news