Zuyderland Medical Center organized an inspiring CIO ’round table’ on September 12, 2024 to share their transformation to the cloud with fellow CIOs from ten other hospitals. Bert Pfeiffer (CIO, Zuyderland) and Tim Cobben (program manager) took them on this journey, through the cause and approach along the results.

Objectives: improved cooperation with regional partners, integrated security, access to AI solutions and reduction of the registration burden in healthcare.

Ambitions: accelerating care innovation by leveraging cloud technology.

The session not only shared approaches and solutions, but also discussed valuable lessons learned. The cloud transformation is guided by a consortium of KPMG, Rapid Circle and Microsoft. Hylke Kingma (KPMG) and Wilco Turnhout (Rapid Circle) told about the collaboration and shared their insights and experiences.

Reason: ICT strategy with a progressive vision on cloud

In 2020, Zuyderland experienced an impactful ICT outage. This lasted for several days and was the reason for a comprehensive analysis and then the creation of a progressive ICT strategy. Cloud technology was included in this as “cloud unless. Zuyderland then began implementing cloud solutions (including data platform and Office 365). It also started migrating applications from on-premise to the cloud. The decision to offer the new HIS/EPD (ChipSoft HiX), from the cloud, accelerated the cloud transformation program in 2023. Within this program, the migration to HiX is supported by a transition of workplace and infrastructure to the hybrid cloud, with Microsoft Azure as the core platform.

In 2023, Zuyderland started an accelerated cloud transformation program. The goal of this program consists of the following steps:

1. Facilitate the start of the setup of the new ZIS/EPD in October 2024,
2. Successfully launch the new ZIS/EPD in the cloud environment in June 2025, and
3. Phase out the current platform (hosting and workplace) by the end of 2026.

Zuyderland opts for standardization in platforms and aims for SaaS, before PaaS, before IaaS. This means that Zuyderland chooses native cloud software whenever possible; if that is not possible for cloud platforms and only then for infrastructure in the cloud).

Zuyderland wants to take a step forward in its digital healthcare transformation. The benefits of cloud technology are not so much in the ICT domain, but are aimed at supporting Zuyderland’s healthcare professionals. For example, by being able to work much more data-driven, offering AI technology and better facilitating collaboration and data availability. By making optimal use of cloud technology, Zuyderland wants to accelerate care innovation and care transformation.

A consortium supports Zuyderland’s cloud journey

Zuyderland’s transformation has been supported by KPMG, Rapid Circle and Microsoft since October 2023. They are acting as a consortium and have provided a joint approach in which they themselves organize the mutual coordination. This ensures that Zuyderland can count on integral support. Zuyderland chose the consortium partly because of its experience with such transformation programs. The experiences gained at other hospitals, as well as outside the healthcare sector, have been contributed to Zuyderland’s program. Also, important lessons have already been learned during the process in Zuyderland.

1. Transition to the Azure Cloud and the impact on operating costs

When migrating applications to the Azure Cloud, costs shift from CapEx (capital expenses) to OpEx (operational expenses). Traditionally, these costs were characterized as an initial investment where applications were hosted on physical servers. However, with migration to the cloud, these costs change to ongoing operating expenses.

While the transition to the cloud may result in higher operational costs in the short term, it provides a clearer and allocable understanding of the total cost of owning and using applications. In the long run, this can help make decisions about purchasing new technology and phasing out or updating existing applications. This ultimately contributes to cost efficiency within the organization. Currently, more than 60 applications have already been rated as ‘retire’ by Zuyderland, meaning that the application is being phased out completely.

New applications that are purchased are now implemented directly in the Azure Cloud. The costs of these are then also immediately visible. This differs from the situation before, when the costs and visibility of applications were not always clear.

2. Managing IT resources and optimizing HiX

Migrating to the cloud presents challenges, especially for resource-intensive applications such as HiX. This application requires significant IT resources, which can lead to questions about efficiency and performance.

Zuyderland is aware of HiX’s intensive resource needs, and therefore strategies have been developed to optimize performance. Recently, a series of interventions have significantly improved the performance of HiX within the Azure Cloud. This is an ongoing process that requires constant attention and focus.

3. Proactive Measures

The success of a radical change such as migration to the cloud requires a thorough understanding of both the technical landscape and the human side. It is important to hear the concerns of all stakeholders. This allows Zuyderland to create a more insightful and empathetic plan that improves the experience for all parties.

This approach not only helps address the technical challenges of migration, but also helps build trust with all stakeholders and confirm the feasibility of the chosen solutions. It demonstrates the value of a strategic and methodical approach in dealing with concerns surrounding the process of digital transformation.

4. Cost Management and Implementation of FinOps

When moving to the cloud, cost management plays a crucial role. On the advice of the consortium, Zuyderland implemented FinOps, an approach that focuses on the financial management of cloud consumption. This approach is essential to make the Zuyderland ICMT organization ready for the cloud.

It is important to note that the technical requirements projected by vendors are often too high. As a result, the timely scaling back or down of (Azure) resources is essential to control costs. In addition, technical administrators must be made aware of the implications of working in a cloud environment, as it is substantially different from managing an on-premises environment. To avoid human error and unnecessary costs, Zuyderland uses templates.

Awareness has been created within Zuyderland’s technical team about the financial impact of setup choices. This requires increased awareness and strong leadership. Through these strategies, Zuyderland strives to employ effective and sustainable cost management in their journey to the cloud.

5. Consideration and Migration of Applications to the Cloud

Importantly, Zuyderland has made a strategic choice to start migrating to future technology now, even if it sometimes does not provide benefits until later. Zuyderland is also getting used to this technology and the Way of Working that this choice enforces.

When considering application migration to the cloud, Zuyderland is proactively considering whether the “cloud, unless” approach applies to every (new) application. The starting point is the new HIS/EPD in the cloud, which means that linked applications will also be migrated to the cloud. For the remaining applications, a thorough examination of whether the application can be moved to the cloud will be conducted, with factors such as latency factored into the decision-making process.

When migrating applications to the cloud, Zuyderland proceeds systematically with a mix of internal staff and consultants from the consortium. The context in which the application migration takes place is crucial. Teams with an understanding of the application owners’ processes and the processes associated with the application are essential for a successful migration.

A “rebuild” has benefits for applications that have not been upgraded for some time. This is because we cannot fully reap the benefits of a cloud environment until the applications are rebuilt in the cloud. Roadmaps have been developed to perform both “rebuilds” and “rehosts. It is essential to involve the vendor and functional administrators from the departments early in the process.

Zuyderland still maintains differentiated infra and application teams. Although many applications have been moved to the cloud, enough components remain on-premises. A cloud team will be established that can both design and manage. This transition will be gradual.

Considerations for Cloud Transformation

It was argued during the round table that a cloud transformation is not necessary, as one can work on-premises with cloud technology as well. A counter-argument made was the increasing focus on AI and processing of ever larger data sets where cloud technology is a solution.

The business strategy gives direction to Zuyderland’s position in the (future) healthcare landscape. The applications involved require an interoperable and secure environment. Stringent requirements are placed on this environment that are difficult or impossible to achieve on-premise. Thanks to the cloud transformation, Zuyderland was able to clean up legacy systems and now has a very complete overview of the environment. This gives the space and energy to reconsider past choices and optimize the environment.

Finally, an important lesson for Zuyderland proved to be to properly involve the internal organization and the Board of Directors in this type of major change. The business case is not only financial but also describes the qualitative benefits. Among other things, that it helps to make Zuyderland more agile. It is therefore also a strategic choice.