If ever there were a company for which an all-cloud IT infrastructure made sense, it’s one where much of the workforce is out in the field with clients literally all the time. And that is exactly the case at VNA California.
VNA California is a non-profit visiting nurse association with some 500 employees, more than 200 of whom are clinical staff who spend all of their working time visiting patients, mostly in their homes, over a territory that covers 15,000 square miles.
“They are traveling nurses who are never in the office but need access to patient information 24x7,” said Gerrard Gier, CIO and CISO for the organization. “They’re not using desktops because they’re out and about.”
Cloud-based applications are a perfect fit for such an environment because employees can access the applications and data they need from wherever they may be. That’s why the company has been making the transition to an all-cloud environment since 2014.
Reforming IT around the cloud
When Gier arrived at VNA California three years ago, he found an IT group that primarily offered concierge services. When an employee wanted something, IT would do its best to provide it. His job was to help create a more mobile, interactive environment – without increasing his IT staff of just five, including help desk.
Gier figured a heavy dose of cloud would be the best way to stretch his IT resources. “Our thinking was to stay small. We don’t want to grow IT in terms of headcount,” he says. “We want healthcare people, not administrative or corporate staff.”
First up was the company’s electronic medical records (EMR) application, which had been somewhat languishing on older hardware with inadequate performance. Gier worked with the company’s EMR vendor to deliver a cloud-based version of the software, which the vendor would host and manage.
Negotiating for cloud success
In the process he had to negotiate changes to address security issues, implementing self-service password resets and two-factor authentication, for example. A single sign-on capability for the EMR and other applications was also important, “to make sure technology doesn’t get in the way,” for clinicians in the field, he says.
The company went with an office suite that can be configured either on-premises or online and opted for the cloud-based version. “We wanted to have someone else manage it, because I only have five people,” Gier says.
Next up is migrating human resources, enterprise resource planning and financial applications. ERP and HR will be moving to SaaS-based offerings. “Everything we purchase now, we look at SaaS offerings first,” he says. “That’s our model.”
Financial applications are currently on an in-house Citrix desktop virtualization platform, which Gier likewise expects move to a cloud-based version managed by Citrix.
He expects all remaining in-house applications to be in the cloud in 2017. “We feel that’s easily attainable,” he says.
Addressing cloud vendor lock-in
One of the risks associated with cloud-based platforms, of course, is vendor lock-in. “That’s where I spend most of my time,” he says. “Do I really have control over my information or am I locked in? What would I do if I need to change out of one platform and move to another?”
He talks frequently with his vendors about such topics but, more importantly, puts verbiage in contracts around what will happen in the event he wants to make a change. That’s a lesson he learned the hard way, having had to switch vendors for a cloud offering that had no such language in the contract.
“We ended up taking on a lot more resources to make the move because the process wasn’t laid out as to who does what,” he says. By contrast, he’s now in the process of moving to a different EMR cloud vendor and it’s a different story. “In our contract, it’s stipulated how it’ll be done, it’s all laid out.”
His advice to others looking to implement cloud offerings is to think of the relationship as a partnership, but to always have a plan B in mind.
“It’s about risk management. If I’m moving to the cloud, I need a plan for moving to another cloud or back in-house,” Gier says. “Sometimes we tend not to to think that through in our contracts.”
