Cloud Hosting

Last week, UC San Diego Health, an integrated health system in San Diego that is part of the University of California San Diego, announced that it had moved its electronic health record (EHR) system to the cloud. An August 7 press release quoted Mark Amey, associate chief information officer at the health system, as saying that, By creating greater operational efficiencies, we can invest more time and resources in patient care. UC San Diego Health has deployed a number of strategies to allow its hospitals and clinics to be more agile and respond to demand at a rapid pace within a robust disaster recovery environment, Amey said.

This is our first significant milestone in moving key pieces of infrastructure into the cloud to provide always-on solutions from anywhere that can be scaled to our growing geographical print, Adam Gold, chief technology officer, UC Irvine Health and UC San Diego Health, said in a statement in the press release. The cloud approach allows us to better provide innovative technology to support outstanding clinical care, research, and teaching.

The release also quoted a senior executive from the Verona, Wis.-based Epic Systems Corporation, the health systems vendor partner in the cloud computing implementation, and its core EHR vendor. Health systems both large and small are seeking secure and cost-effective approaches to providing EMR capabilities to their users, said Stirling Martin, Epic senior vice president. UC San Diego Health is the first academic health system to make the migration from their own self-hosted Epic infrastructure to Epics state-of-the-art cloud hosting environment.

The Aug. 7 press release further noted that The information services team has moved approximately 10,000 workstations at UC San Diego Health to this virtual delivery method, allowing users to access the electronic health record via the cloud. The team has also integrated over a hundred third-party applications that work with Epic within the new cloud environment. And it added that UC San Diego Health is the hub for a single electronic medical records system serving UC Riverside Health and community practice affiliates, a cost-saving arrangement that improves coordination of care among physicians. UC San Diego Health will also share its EMR system with UC Irvine Health starting this November.

The press release also referred to Christopher Longhurst, M.D., UC San Diego Healths CIO, who is the sponsoring executive for the development of a UC Health-wide data warehouse, integrating patient data across the UCs five academic health systems, which together comprise the fourth largest health care system in California. Dr. Longhurst noted that this initiative supports medical decision making, clinical research and population health throughout the state.

Shortly after the announcement, Healthcare Informatics Editor-in-Chief Mark Hagland spoke with Dr. Longhurst and Adam Gold about the broader strategic context around this announcement. Below are excerpts from that interview.

Tell me about the broader strategy around this move into the cloud?

Christopher Longhurst, M.D.: As our group of UC Health CIOs had discussed in our interview with you earlier this summer, we at the five University of California Health organizations are on a shared journey of collaborating together strategically and practically to optimize our IT development across all five organizations [UCSF Health, UC San Diego Health, UCLA Health, UC Irvine Health, and UC Davis Health]. In that context, Adam, whos been at UC Irvine for 15 years, is now the CTO for both UC Irvine Health and UC San Diego Health. His was one of the initial joint roles that were designated.

So how does this latest move connect to your broader strategic efforts around infrastructure?

Longhurst: Let me give some context. As you know, were bringing UC Irvine live on the UC San Diego instance of Epic, and were doing that on November 4. In preparation, we needed to be able to scale up our Epic platform for breadth. The implication of that was that wed be spending millions of dollars on servers in our local data center, which was state-of-the-art 20 years ago. But what happened was that Adam and some of the other CTOs came up with a strategy, focused on moving towards the cloud. So were consolidating our 13 data centers across the five UC hospitals, down to two, one northern one, and one southern one. And the least preferable option in that context is local hosting. It may be necessary long-term for things like biomed, where there are latency-dependent applications; but in general, we want to move away from that.

And within the cloud-first strategy, whenever we can host applications at the vendors themselves, thats our preference, because vendors can provide services as well. Cerner has been doing this for many years, but Epic just started doing this. Theyre doing this for new customers, but were the first academic medical center and existing Epic customer to go to cloud-based hosting by Epic. Were very impressed with their infrastructure, including with advanced technology that we dont have. And the week after we went live, comparing Monday-to-Monday performance, our system was performing better in the hosted environment.

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UC San Diego Health: Moving Its EHR to the Cloud, Strategically - Healthcare Informatics