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Serving Others Starts With
The Right Technology:

A Case Study on Cloud Migration for Delaware Valley Community Health

By Rebeca Kinslow

As a private, non-profit organization, Delaware Valley Community Health (DVCH) has always had the mission of providing care to the underserved, regardless of their ability to pay at the time of service. Now in a time of crises, Isaiah Nathaniel, CIO of Delaware Valley Community Health (DVCH), points to the technology behind their services as the crux that’s kept them doing what they do best.

“This pandemic has put into perspective, truly for our organization as well as for the healthcare industry, how important technology is… not just information technology, but also information systems,” said Nathaniel. Ensuring their information systems meet the goals of the organization is what he’s been tasked to lead for the DVHC for the past 12 years, and most recently that meant establishing a cloud transition strategy from its legacy infrastructure to Nutanix.

We pulled the best parts of our recent interview with Nathaniel to share how cloud adoption in healthcare has set DVCH up for success.

The Benefits of Cloud Computing in Healthcare:

One of the first changes Nathaniel noticed in DVCH’s cloud migration to Nutanix was the efficiency. With Nutanix, the benefits of cloud computing in healthcare have already been realized including:

  • Migrated 9 servers onto Nutanix in less than 7 hours.
  • Performed a disaster recovery in approximately 6 minutes.
  • Went from a traditional backup structure that was 3-4 hours a night, to now only about 30 minutes using a cloud-native infrastructure

Affecting most directly the employees was a log-in time of around 3 minutes. Nathaniel said this impacted several services and added unnecessary stress to the employees’ daily lives. With Nutanix, log-in time is now under 19 seconds, and expected to drop even further. Listen and read as Nathaniel shares his story about the way providers at several of their locations reacted after the cloud migration and upgrade.

Audio bit: 40:07 - 41:31

Isaiah Nathaniel:

It was funny. On the Monday we came back from that upgrade weekend, we were fully live on the new system and I did a little executive walk around to about four of our sites and I just wanted to talk to providers and employees. I was like, "How are things working? How is the system going with the new changes?" And they were like, "We can't give you our full recommendation or our full assessment yet because not everyone's in the office."

And then I chuckle and I smirk and they were like, "Well, why are you chuckling and smirking?" I said, "Because our Citrix sessions are still at the same level. Everyone's working remotely. Everyone's doing the same amount of work. There's no change. But the fact that you think because everyone's not in the office that it's running faster because of that is not true." So from day one, they were like, "Wow, we didn't think it could be." I said, "You guys, 75% are coming in from the WAN, and this is not local LAN traffic. It's actually more. And once I put that into perspective, they just said, "Well, then I think you did good."

Achieving a Fully Integrated Telehealth Solution in a Week

As a result of COVID-19, DVCH needed to turn 75% of their employees to remote work on a dime. While DVCH already had telehealth as an option, they had never pulled the trigger. Hear how Nathaniel’s team managed to have a fully integrated telehealth solution in a week, with active patient portal users up from 500 to 9,000+.

Audio bit: 33:28 - 37:36

Isiah Nathaniel:

Yes. So an FQHC is an urban market. For me as a CIO, I always want to be a step or two ahead, and we've had telehealth as an option for us, but we hadn't pulled the trigger yet because of the payment structure that is not necessarily afforded primary care in urban locations with patients on Medicaid and Medicare that allows the patients to traditionally get to us, which is true.

However, with the changing demographic, you don't have 11% market share as something that was keeping me up. How do we keep these patients engaged enough where they can just go to Walgreens or they can go to CVS and get a physical where that's what we traditionally do as primary care? How do we deal with that changing of the patient?

So when this pandemic happened, I'm going to take it in chunks. I'm going to start with the patients first and then I'll go to internal employees. So once Medicaid, CMS, and Medicare reduced the regulations, it was a quick flip. I mean, all I had to do was make a phone call and say, give it to me now. And then because of the speed and availability of Nutanix to get to our database, we were able to have a new full tele-health, integrated solution in a week.

So we were able to turn quickly on a dime, our complete clinical and operational workflow because we had the speed to be able to do it. One of our challenges was if we do this, what is that gonna do to our database from a remote perspective? But because again, we went from a 64 2007 year-old, 2008 cluster to brand new, 192 gig, five cores and two processors, it was a no brainer. So my executive team, including myself, were able to say, "Yes, we can do this."

And that has changed our trajectory. So now let me take it to the patient perspective. A lot of companies are laying people off. A lot of companies are furloughing employees. A lot of companies are making some tough decisions. Our organization is proud to say we haven't laid off one person. I've actually hired two additional people at this time.

And you know the morale and my moral code is overflowed. Second to our CMO, the single most important executive right now outside of the CEO is the CIO for any organization. Because if you can't provide the technology to your workforce, you can't work. And so if you can't work, your employees can't feed their families. Your employees may be running into financial difficulties, paying rent, paying for childcare.

And so for me, from the moral perspective, the fact that we could shift on a dime ... Now, yes, I lost sleep for about two weeks. But the fact that we haven't laid a person off and we're able to fund and continue to pay our entire workforce through the month of June without question, I'm proud of that. I am extremely proud of that. And if we didn't have a system to be able to do it, I don't know how I would feel, but right now I'm a proud CIO that we are able to continue business and continue funding our entire workforce.

Choosing Nutanix for Healthcare IT

Thinking back to when Nathaniel was initially searching for a new IT solution for healthcare, it was storage that made him choose Nutanix. Here’s what he had to say about the decision:

Audio bit: 11:23 - 12:55

Isiah Nathaniel:

I started looking up hyperconvergence and what it was doing in the market. I was like, this is good. VMware has their product. Citrix has their product, but none of them really touched down to storage and for healthcare, the storage and the read/write and the IOPS for storage databases is important. And our EMR particularly requires a hell of a lot of IOPS just from a storage perspective. So when you talked about hyperconvergence and it was down to the storage level, I was like, Nutanix is the one for us.

And it was the one for us because even though we're a nonprofit running on a $40 million budget, part of that spend takes away from what we can do with employee increases and stuff like that. And so I had to be strategic in how I spent that money. And I wanted to spend that money where that it gives me the flexibility to continue business, but also expand because although we have eight sites right now, we were expecting to have our ninth site built by May of this year.

Now, obviously that's behind schedule because of the pandemic, but we're stopped. We're not going to not have that so, how do I continue to grow because we're growing as an organization? We want 10 sites by 2022. How do I do that? I couldn't do it with the current infrastructure. So Nutanix was the best choice that I've made as a CIO.

Moving Healthcare Forward With a Cloud Environment 

Nathaniel and DVCH are proud that this transition to a cloud environment has changed their service trajectory. Even during a time of hardship, they have had the ability to not only maintain all of their employees, but even hire two more.

“My morale and moral code has overflowed,” said Nathaniel.

Looking towards the future, the question that drives Nathaniel is “How do you compete?” Technology, efficiency, and finding innovative solutions is the key to success. Listen and read here:

Audio bit: 51:59 - 53:38

Isiah Nathaniel:

So for me, my success is that entire process from the top down, including registration. If I don't have the right technology, I’d be running on fumes just concerned with this old, traditional architecture. Yes, it got us to this point, but that's not the future. The future is Nutanix. The future is AHV. The future is HYCU. And the future is this hyperconvergence.

So any CIO out there trying to understand what they need to do, particularly in the healthcare space, they really need to look at hyperconvergence. And how do you as an organization or as just a healthcare entity compete with what's coming into play. We don't have the same money as Amazon or Walgreens or all those companies that are able to do things at a much larger scale very quickly. So how do we compete? We compete with the technology. We compete with the efficiency of being able to process out from start to finish, from walking in the door to discharge, how do we do that?

But then second to that, it's also upon me to make sure that I'm doing my part for the whole healthcare world.. How do I make my imprint? I make sure I keep my patients here. I make sure they use us as a referral source so that they're not going to the ER for the ER. I make sure that our system is able to do the proper referrals so that we don't have to worry about phone calls or faxes or all of that stuff. That's my job.

Read more about Delaware Valley Community Health leveraging private cloud infrastructure to help serve the underserved here.

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