A hospital that decides to place its EPD in the cloud does not make the decision overnight. “The decision to take this step was made a long time ago,” says Han van der Zee, CIO and digital transition manager of the hospital. “We are known as a modern hospital, also in terms of digitization, that was one reason. The second is scalability, which has to do with costs. We did not want to work with a large installed base in the hospital, we need the space to provide care. Thirdly, it is difficult for us as a hospital to keep up with developments in this area, it is not our core business.”

The entire process was guided by service provider Rapid Circle. Chief Strategy Officer Wilco Turnhout says, “It is a step that also fits in with developments in healthcare. The demand for healthcare is increasing, healthcare costs are also increasing but the budget is not. So it is necessary to organize healthcare differently, to seek more cooperation. Technology is needed for this: making data available and shareable.”

EPD in the Cloud

The hospitals are still organized very EPD-centric, but they need to work more platform-centric to be able to share applications and data. Hospitals realize that they need to renew the foundation of their EPD provision for this purpose. This is an enormously important first step in being able to do more with data with new technology and to exchange it safely and efficiently. The movement to the cloud fits in with all these considerations.”

It was a special step that Gelre Hospitals took, as there was no hospital that could serve as an example. “We could look at what was already happening in other sectors in this area,” says Van der Zee. After careful market research in collaboration with KPMG, the choice fell on Microsoft’s Azure. “This provider is leading in cloud services and infrastructure,” he says. “Safety and a high degree of continuity were essential elements in our decision-making. Downtime means that operating rooms and clinics come to a standstill and the ambulance service cannot function.”

Those considerations were decisive, Turnhout confirms: “Microsoft is truly an enterprise provider and has the most people working on security.” Van der Zee: “We already foresaw the risk of cybercrime. Essential to take into account, of course, especially in healthcare where patient data is being worked with.”

Well-prepared go-live

There was certainly also fear of the unknown, Van der Zee admits. “Up to the moment of going live,” he says. “Not only because we were moving the EPD to the cloud, but also because we were switching to a new EPD, HIX from Chipsoft at the same time. We extensively tested everything in simulations beforehand. We concluded that we had to scale up to work efficiently, given the number of workstations and the large data files involved in working with the PACS.

Uploading images used to take thirty seconds. That’s too long for the specialist and for the patient. Thanks to the scaling up, it now takes five seconds.” Only the PACS runs in a different cloud. “The reality for all hospitals will be a hybrid cloud,” Turnhout says. “As a service provider, we see it as one environment.”

There were more exciting steps. For example, the link with medical equipment everywhere in the hospital from which data must be retrieved. The conversion of data from the old to the new system as well. And granting the right authorization to employees.

“Now that we’ve been live for a few weeks, we’ve received 1,500 reports of things that went wrong,” Van der Zee says. “Half of them relate to authorization. Exactly as expected. From Chipsoft, we heard that it is much less than in other hospitals that are transitioning from one EPD to another, without simultaneously moving to the cloud. Keep in mind that we have multiple locations, so the processes between them also had to be harmonized.”

Taking steps

In short, Van der Zee’s statement “So, we did a lot at once” is relevant. “In addition, a few months before the go-live, the business intelligence system was also adapted,” Turnhout adds. “That too is cloud-based and now offers many more possibilities for prediction and analysis than before. It all fits into the strategy of working much more data-driven and providing care.”

The foundation for this is now in order, says Van der Zee. “A logical next step is to set up more portals, to the first and third lines. And exchange more information with other hospitals in the region. After all, care is becoming increasingly network-oriented. We had a big ambition in 2019, but we are now realizing it. I would advise other hospitals to take that step as well. And given the great interest in what we are doing here, that need is clearly there.”

Turnhout goes one step further. “Start right away,” he says. “We don’t know where we’re going in healthcare, but we do know it’s going to change. Establishing the foundation for this change is not just a matter of technology, but also of culture. A culture of being curious about improving and changing and the knowledge of what you could use for that. Such a trajectory takes 5 years. If other hospitals wait until all the lessons are learned, they may be able to shorten the technical transition to four or three years. But the culture change that comes with it will still take five years. In the current healthcare field, you can’t afford to wait any longer.

Want to learn more about this transition? Come and listen and discuss at the seminar Healthcare transformation to the Cloud.