The next BriefingsDirect data center financing agility interview explores how two Belgian hospitals are adjusting to dynamic healthcare economics to better compete and cooperate.
We will now explore how a regional hospital seeking efficiency — and a teaching hospital seeking performance — are meeting their unique requirements thanks to modern IT architectures and innovative IT buying methods.
Here to help us understand the multilevel benefits of the new economics of composable infrastructure and software defined data center (SDDC) in the fast-changing healthcare field are Filip Hens, Infrastructure Manager at UZA Hospital in Antwerp, and Kim Buts, Infrastructure Manager at Imelda Hospital in Bonheiden, both in Belgium.The discussion is moderated by Dana Gardner, Principal Analyst at Interarbor Solutions.
Here are some excerpts:
Gardner: What are the top trends disrupting the healthcare industry in Belgium? Filip, why do things need to change? Why do you need to have better IT infrastructure?
Hens: That’s a good question. There are many up-and-coming trends. One is new regulations around governance, which is quite important. Due to these new rules, we are working more closely together with other hospitals to share more data, and therefore need better data security. This is one of the main reasons that we need to change.
In Belgium, we have many hospitals, with some of them only a few kilometers apart. Yet there have been very few interactions between them.
New demands around augmentation of services means patient data are a growing concern. So it’s not only the needs of new governance but also the demand for providing better medical services across hospitals.
Gardner: Kim, how are the economics of healthcare — of doing more with less — an ongoing requirement? How are you able to conserve on the costs?
Buts: We are trying to do everything we can across the financial possibilities. We are constantly looking for good solutions that are affordable. The obligation to work in a [hospital] cluster provides us with a lot of new challenges.
A major challenge for us was around security. We have invested hugely in security. Many of the new applications are now shared across the hospital cluster. So we chose to take on the role of innovator. And to continue innovating, we have to spend a lot of money. That was not foreseen in the annual budget. So we took advantage of Hewlett Packard Enterprise’s (HPE’s) new financial services approaches, to make things happen much faster than usual.
Gardner: We’ll get back to some of those services, but I’d like to help our readers and listeners better understand this interesting combination of needing to compete — that is to attract patients — but at the same time cooperate and share data across hospital cluster. Filip, tell us about UZA and how you’re unique compared to a regional hospital. What makes you different?
Sharing is caring, and saving
Hens: Our main focus remains patient care, but for us it is not necessarily general medicine. It is more the specialist cases, for such things as specialized surgery. That is our main goal. Also we are a teaching hospital, so we have an emphasis on learning from patients and from patient data.
Gardner: You have unique IT and big data requirements from your researchers. You have more of an intense research and development environment, and that comes with a different set of IT requirements?
Hens: Yes, and that is very important. We are more demanding of the quality of the data, the need to gather more information, and to provide our researchers a better infrastructure platform.
That is one difference between a general hospital and a university hospital. A teaching facility has more complex patient analytics requirements, the need for complex data mining and stuff like that.
Gardner: Kim, how are you in your healthcare cluster now able to share and cooperate? What is it that you’re sharing, and how do you that securely to creating better healthcare outcomes?
Buts: A big difference for us is financial. Since we are a smaller hospital, we must offer a very broad portfolio of treatments. That means we need to have a lot of patients to then have enough income to survive. The broad offering, that portfolio of treatments, also means we are going to need to work more together with the other cluster members.
We are now trying to buy new IT equipment together, because we cannot afford to each buy for every kind of surgery, or for every kind of treatment. So we have combined our budgets together and we are hosting different things in our hospital that are then used by the other cluster members, too.
Financially, due to the regulations, we have less income than a university hospital. The benefits of education funding do not get to us. We only get income from patients, and that is why we need to have a broad portfolio.
Hens: Unlike a general hospital, we have income from the government and we also have an income flow from scientific research. It is huge funding; it is a huge amount. That is really what makes us different. That is why we need to use all of that data, to elaborate on scientific research from the data.
If not an advantage, it is an extra benefit that we have as university hospital. In the end, it is very important in that we maintain and add extra business functionality via an updated IT infrastructure.
If we maintain those clusters well — the general hospitals together with university hospitals — then those clusters can share among themselves how to best meet patient needs, and concentrate on using the sparest amount of the budget.
Robust research, record keeping, required
Gardner: You are therefore both trying to grapple with the use and sharing of electronic medical records (EMR) applications. Are you both upgrading to using a different system? How are you going about the difficult task of improving and modernizing EMR?
Buts: One big difference between our hospitals is our doctors; they are working for the hospital on a self-employed basis at Imelda. They are not employees of the hospital as at UZA. The demands of our doctors are therefore very high, so we have to improve all of our facilities — and our computer storage systems — very fast.
We try to innovate for the doctors, so we have to spend a lot of money on innovation. That is a big difference, I think, between the university hospitals because the doctors are employees there.
Gardner: How does that impact your use of EMR systems?
Buts: We are in the process of changing. We are looking for a new EMR system. We are discussing and we are choosing, but the demands of the doctors are sometimes different from the demands of the general hospital management.
Gardner: Filip, EMR, is that something you are grappling with, too?
Hens: We did the same evaluations and we have already chosen a new EMR. For us, implementing an EMR is now all about consolidation of a very scattered data landscape, of moving toward a centralized organization, and of centralizing databases for sharing and optimization of that data.
There is some pressure between what physicians want and what we as IT can deliver with the EMR. Let’s just say it is an opportunity. It is an opportunity to understand each other better, to know why they have high demands, and why we have other demands.
That comparison between the physicians and us IT guys makes it a challenging landscape. We are busier with the business side and with full IT solutions, rather than just implementing something.
It is not just about implementing something new, but adaptation of a new structure of people. Our people rethink how everybody’s role is changing in the hospital, and what is needed for interaction with everybody. So, we are in the process of that transformation.
Gardner: What is it about the underlying IT infrastructure that is going to support the agility needed to solve both of your sets of problems, even though they are somewhat different?
Filip, tell us about what you have chosen for infrastructure and why composable infrastructure helps solve many these business-level challenges.
Hens: That is a good question, because choosing a solution is not like going to the supermarket and just buy something. It is a complex process. We still have separation of data storage and computing power.
We still separate that kind of stuff because we want to concentrate on the things that really bring added value, and that are also trustworthy. For us, that means virtualization on the server and network platforms, to make it more composable.
A more software-defined and composable approach will make us more independent from the underlying hardware. We have chosen for our data center the HPE Synergy platform. In our opinion, we are ready because after many years as an HPE customer — it just works.
And for me, knowing that something is working is very important, but understanding the pitfalls of a project is even more important. For me, the open discussion that you can have with HPE about those pitfalls, of how to prepare for them and how to adapt your people to know what’s to come in the future — that is all very important.
It’s not only a decision about the metal, but also about what are the weaknesses in the metal and how we can overcome that — that is why we stick with HPE, because we have a good relationship.
Gardner: Kim, what are you doing to modernize, but also innovate around those all-important economic questions? How are you using pay-as-you-go models to afford more complex technology, and to give you advancement in serving your customers?
Buts: The obligations of the new hospital-cluster regulations had a huge impact on our IT infrastructure. We had to modernize. We needed more compute power and more storage. When we began calculating, it showed us that replacing all of the hard drives at one time was the best option, instead of spreading it over the next three to four years.
Also the new workload demands on the infrastructure meant we needed to replace it as fast as possible, but the budget was not available at our hospitals. So HPE Financial Services provided us with a solution that meant we could replace all our equipment with very short notice. We exchanged servers, storage, and our complete network, including our Wi-Fi network.
So we actually started with a completely brand new data center thanks to the financial services of HPE.
Gardner: How does that financing work? Is that a pay-as-you-go, or are payments spread over time?
Buts: It’s spread over the coming five years. That was the only solution that was good for us. We could not afford to do it any other way.
Gardner: So that is more like an operating costs budget than an upfront capital outlays budget?
Buts: Yes, and the other thing we wanted to do was do everything with HPE — because they could offer us a complete range of servers, storage, and Wi-Fi networking. That way we could reduce the complexity of all our work, and it guaranteed us a fast return on the investment.
Gardner: It is all more integrated, upfront.
Buts: Yes, that is correct.
Gardner: At UZA, what are you doing to even further modernize your infrastructure to accommodate more data, research, sharing, and security?
Hens: It is not about what I want to deliver; it is about what the business wants that we can deliver, and what we can together deliver to the hospital. So, for me, the next step is the EMR program.
So, implementing the EMR, looking for the outcomes from it, and offering something better to end-users. Then those outcomes can be used to further modernize the infrastructure.
That for me is the key. I will not necessarily say that we will buy more HPE Synergy. For me, the key to the process, as I just described, that is what will set the margins of what we will need.
Gardner: Kim, now that you have a new data center, where do you take it next in terms of people, process or even added technology efficiencies? Improved data and analytics, perhaps?
Cloud in the Cluster?
Buts: That is a difficult one because the cluster is very new for us. We are still looking at good ways to incorporate and decide where the data is going to be placed, and what services are going to be required.
It is still brand new for us, and we have to find a good way to incorporate it all with the different hospital cluster members. A big issue is how are we going to exchange the critical patient data, and how we are going to store it safely and securely.
Gardner: Is cloud computing going to be a part of that?
Buts: I do not know. Everything is “cloud” now so, maybe. I am not a huge fan of public cloud. If you can stay in a private cloud, yeah, then okay. But public cloud, I do not know. In a hospital, regulations are so strong and the demands are so high.
Gardner: Maybe a shared private cloud environment of some sort?
Buts: Yeah. I think that could be a good solution.
Hens: For public cloud in general, I think that is a no-go. But what we are doing already with our EMR, we can work together with a couple of hospitals and we can choose to build a private cloud at one of the sites at our hospitals.
You do not need to define it as a cloud. Really, it’s like public Internet cloud, but you have to make your IT cloud-aware and cloud-defined inside the walls of your hospital. That is the first track you need to take.
Buts: That is why in our hospital cluster, we chose to host a lot of new applications on the new hardware. It gave us the ability to learn and adapt quickly to the new innovations. And for the other hospitals, we are now becoming a kind of service provider to them. That was for us a big change, because now we are more a service level agreements (SLA)-driven organization than we used to be.
By Dana Gardner