EP. 22 How Is Cloud Computing Transforming Healthcare? with Rob Hall

00:13 - Introduction Rob Hall

Matt Pacheco
Hello everyone, and welcome to the Cloud Currents podcast that navigates the ever-evolving landscape of cloud computing and the impact on modern businesses. I'm your host, Matt Pacheco, the lead of the content marketing team at TierPoint, a managed cloud provider who helps businesses address security, doctor, hybrid cloud and data center challenges so they can stand out from their competition and drive revenue. In today's episode, we're thrilled to have Rob Hall, the cloud director of Intermountain Healthcare, joining us to share his expertise and experiences in leveraging cloud tech in the healthcare industry. I believe this is one of our first episodes of the podcast where we dive into this industry. So I'm really excited to speak with you today, Rob. Rob has over 15 years of experience in the tech industry with a strong background in Windows system administration, database management, and cloud.

In his current role, Rob oversees the Intermountain healthcare cloud strategy, adoption and operations, focusing on balancing security, compliance and agility in a highly regulated industry like healthcare. Throughout this episode, we'll dive into Rob's career, Intermountain Healthcare, cloud adoption and partnership with Microsoft Azure, and the unique challenges and opportunities that come with leveraging cloud and healthcare. We'll also talk about cloud automation, the impact of the pandemic on telehealth adoption, and how cloud tech is enabling specialized care and remote patient access. Rob, welcome to cloud currents. Thanks for joining us today.

Rob Hall
Yeah, thanks Matt. Happy to be here.

Matt Pacheco
We'll dive right in. I'm very curious, can you tell us about your background and what led to you pursuing a career in cloud and technology?

Rob Hall
Yeah, for sure. So it might not have been my focus. My family and my father in particular is a retired surgeon. So healthcare was something I always wanted to be in and looked at going into that myself. After shadowing him for a little bit, I then decided that my talents were better used after getting into it early in my career in a college and university, just found an aptitude for that and found a niche. I always wanted to come back to healthcare. So after working for Novell for a couple years after college, I went to work for Intermountain healthcare as a Windows system admin. Like you've mentioned, I've been there since I think 2008, quite a while. Cloud has been a focus for like the last seven, eight years of my career. I was the cloud manager.

I did take a brief leave from the company to go work for a company here local in Salt Lake called Health Catalyst. It's a healthcare analytics startup company. It was a startup then, it's since gone IPO. I did retain my position at Intermountain during that time. And then when the company went IPO, I came back to my roots here at Intermountain Healthcare.

Matt Pacheco
Very cool. What inspired you to get into cloud specifically, and how has your role kind of evolved over the last few years?

03:15 - Cloud Adoption Journey at Intermountain Healthcare

Rob Hall
Healthcare was a little bit of a late adopter as it came into cloud. As Intermountain started to dip our toes into cloud, I knew that was something that was becoming quite passionate about. So as we started to get into cloud, moving like non clinical and kind of productivity apps such as like email, collaboration, those type of apps, into the cloud, it became clear that cloud was going to be a big focus for Intermountain. I was excited to start adopting cloud and kind of lead that change here at Air Mountain. We've done a lot, but there's still a lot we have in front of us to do with cloud for sure.

Matt Pacheco
Excellent. And you're starting to get into some of my other questions, and we'll jump right in for Intermountain healthcare's cloud adoption. Can you give us an overview of that cloud adoption journey and the key drivers behind that transition to the cloud?

Rob Hall
Yeah, so one of the biggest reasons for Intermountain to use the cloud in general was to provide our patients with the best care possible. And as Intermountain has grown previously, we're kind of a regional entity, mostly based in Utah, but now we're in many of the western states. So providing our patients with that care was very important. And to have the ability for their healthcare records to be available wherever they were at was a high priority of the company. Adopting cloud kind of took, followed that strategy into helping our patients across the many states that we operate in. We do have an on-premises footprint, but as we expanded, it was clear that we needed to adopt the cloud. So we did partner with Microsoft as our primary cloud platform. But we do also have environments on other cloud providers that we use.

But Azure is definitely our primary cloud right now. Connectivity was a big part of that strategy. Getting connectivity to the west coast and then east out to Denver and getting cloud connectivity to the right regions. Washington was probably the first step. We didn't want to rely on like Internet only circuits, so we got dedicated circuits for that cloud connectivity. And then that allowed us to start putting not only collaboration products into the cloud, but also moving production and clinical workloads into the cloud as well.

Matt Pacheco
So you said you're partnering with Microsoft and using Azure, the public cloud. What factors led to you deciding to go with Microsoft and partnering with them? What was the benefit of going with Microsoft over some others.

Rob Hall
We had a previous relationship with them at an enterprise level that kind of led into that. But we did look at all of our other cloud providers that were available to us. I think on the non technical side, their ability to work with healthcare, they have a healthcare vertical where they support a lot of healthcare. Having those Baas and those legal agreements provide us coverage and help us. Some of the regulations such as HIPAA, to help us legally be in the cloud with a partner, I think we're probably the biggest things to help us adopt cloud and go with Azure on that. But like I said, we do work with AWS and Google. GCP did recently open a GCP region in Salt Lake.

And so that makes that enticing to have a region local to us, but have cloud that close gives us some options in the future.

Matt Pacheco
So you've partnered with Microsoft, you're using some of the other cloud providers. What have been some of the biggest benefits of using the public cloud for intermountain healthcare?

07:06 - Benefits and Challenges of Cloud in Healthcare

Rob Hall
Well, with our strategy to move the cloud, one of the biggest things that I learned early on in my career was uptime was very important. This is quite a long time ago, but the first time I was on call as a Windows SA, we had an outage in our data center. It happened to be a washer that fell off one of the UPS's and bridged the connection and brought the power down. We since fixed that issue and we have not had any other outages like that. But that was eye opening to see that patients had to be rerouted to other hospitals because our data center was down. And so the resiliency of the cloud and being able to have things be highly available was a huge enticement for us to move to the cloud.

We're dealing with people's lives, so having these systems up and available is really important to us. So I think disaster recovery and Ha were the two biggest reasons for us to go to the cloud. Also, it helps us to modernize our applications. So one of the first applications that we put on the cloud was our forward facing patient portal for us to connect with our patients and clients and let them schedule time with their doctor, see their test results, pay their bills, do all the things that typically before that they would need to come into one of our offices or clinics or hospitals to work on. They could do that all self service through the application. So that was the first production app that we made primary on the cloud.

Matt Pacheco
And I have to ask you to talk about it on the podcast, we talked about it right before we started, when we met. Can you explain the cloud behind you? Because I think that has some relevance. It's really cool.

Rob Hall
Yeah. So my kids actually, whenever they see something or for Christmas, they like to find cloud things, right? Because they know. They know that I'm working in the cloud. My brother's also in it. He's a computer engineer, and we're working on a project just to. As a fun way with an ESP 32 to have the little cloud behind me change colors whenever there's an issue. So, like looking at Twitter and or, sorry, xDev and getting status updates and if there's a problem with our cloud environment, changing colors of the cloud. And we even joked about, like, if there's a big problem, have lightning and rain come out of it, if there's a big outage, but just kind of a fun little side project to work on.

Matt Pacheco
I love that. It makes me think I should get something behind me. A cloud themed, a little light, probably not that as cool as yours, changing colors. I thought it was very relevant because you talked a lot about uptime, high availability, things like that. So I'd like to talk a little bit about a little bit security and compliance as well, because we often see healthcare companies in the news. Ransomware, oh, there's always something going on. It's a big target, and that data is very important, and it's important to your patients and the people you serve. So I have a few questions about securing that data. What are some of the unique challenges in maintaining HIPAA compliance and data security when adopting cloud tech in the healthcare industry?

Rob Hall
That's a great question. The answer to that is probably why healthcare, I think, has been a little bit slow to get into the cloud. But as we're getting more comfortable, it's definitely picking up. Security is a huge point for us. It is scary to put data on the cloud at some points. It was scary for us. You know, it's always in the back of my mind. And we work closely with our security team to make sure the data is protected and secure, but also it also strengthens our security policy. So to be able to have multiple environments where we can back up our data and have that available. If one set of data that we have was potentially compromised by ransomware, we have other options that we can go to get that data, which is highly leveraged.

So, you know, there's kind of two sides to that. There's the scary part about putting things on the cloud, but also using that as a tool to help us be more secure.

Matt Pacheco
Very cool.

Rob Hall
One thing I should probably add there too is although we are using the public cloud, like Azure's obviously a public product, we're not in the government space using their government side, we're using the public side. All of our environments, though, on the cloud are private to us. So we have discrete networking to the cloud, which are not shared across the Internet. And then our cloud environments use private endpoints within the cloud. So all of our public facing endpoints, which are not many, are always protected by different front end systems. So we don't usually leverage the cloud as maybe other public entities do. It's all private to us. And so that was one way that we're able to be more comfortable with the cloud. Also, we use some other tools as well to audit our cloud environments.

And with the cloud, it's very easy, a lot easier than other environments to audit. And a lot of the cloud platforms that we use have built in auditing against different frameworks. So it's quite easy for us to apply different frameworks and audit environments. You know, PCI, HIPaa, socks, compliancy and to see where we stand there. And then we have a team that watches those and then addresses any concerns there.

Matt Pacheco
So you just talked a lot about compliance and regulatory requirements. How do you balance the need for like agility and innovation that comes with the cloud in such a stringent regulatory requirement industry like healthcare?

Rob Hall
You know, I'm glad you asked that. That's, that's definitely been a sticking point at times. We're always trying to balance our cloud adoption with adhering to those regulations that we have to adhere to. So I will say at the beginning it was tough the first time we would implement like a new cloud technology. You know, going through our processes for reviewing and approving and having our cybersecurity side allow us to use those technologies was tough. As we became more comfortable and started reusing those and then using config as code, we became a lot more comfortable with that, where we could replicate environments and know that we've, if we've approved it for environment a, we could go along and approve it for VNC and so on and so forth. So we're not having to redo that every single time.

And then on the flip side of that, after an environment's been deployed, we also watch those environments. So we have things like drift control that will run to catch anything that's not in our config is code or in terraform to move those back to where they should be. And then our security products watch those environments as well. So if there's any changes there, we'll know about that shortly. Yeah, you know, at the beginning that was tough and it still is. And the thing with the cloud, like it changes week to week and, you know, month to month. So even technologies that we're currently using, they're also changing as well.

And so it's a big part of our team just to stay up on that and seeing, you know, what's coming up and, you know, what our partners are doing in that space and how to react to that. Maybe a little example. Last week, azure resource manager, the arm template or the Arm environment changed from Arm 3.0 or three point x to four, and that changed our whole environment. So we're always having to look at even current environments and make sure that they're up to date with what our cloud partners are doing in the cloud.

Matt Pacheco
That's really interesting. What about technology? Like we talk innovation in the cloud nowadays, we're talking about AI. What are your thoughts on that? Implementing that in the cloud or using the cloud for AI?

15:13 - AI and Data Management in Healthcare Cloud

Rob Hall
Yeah, that's been a huge discussion point. In fact, yesterday I was at an offsite meeting with some of our partners and our executives talking about how AI is going to impact us. And we're already seeing some impact. So we've implemented our own private instances of copilot and chat GPT. We also use other copilot products for Microsoft as part of the M 365 platform. I can say it's really scary and it's really exciting as well. A couple weeks ago I was up in the lake and I was boating and I hurt my knee and ended up in the emergency room at one of our hospitals. And they took great care of me, got me taken care of that night, and I was able to go home the next day I got onto our app to see what the results of my MRI was.

And not being a physician, that was hard for me to decipher, but as a patient, I was able to take the output of that and put it into an AI platform to kind of decipher that down for me, for a layperson to understand. And so that was pretty powerful to me. I did end up meeting with the physician and reviewing the results, but it was good at the moment for me to like use AI to understand what was happening to me. And so I think there's a debate going on right now, you know, whether AI should be used and how to use it. I can see right now, people might be scared for AI, like, privacy reasons. Is AI gonna hallucinate and just give us something that we're not expecting and it isn't correct.

We can't have an incorrect diagnosis for our patients, so, but also, what if AI can be used and it gets good enough into where there might be some patients that are that would say, why didn't you use AI? Maybe if you used AI, you could have caught this beforehand. And so I think over the next five to ten years, we'll see a shift to where AI is used, and then we'll augment the doctors and then maybe be a second or third opinion to bounce off, you know, under the supervision of a doctor to help a lot of things. So right now, we are digitizing all of our pathology slides. They go back to the 1960s and we're getting those slides and digitizing them. So we have a warehouse that all they're doing is scanning these slides.

And then we have a data box that's shipped from Azure every week, and we load that up with data and then we get that data up on the cloud. The idea for this is to de identify all the patients. But in a lot of these circumstances, we can see a patient because of the longitivity of the data that we have and see the lifetime of that patient. Those slides are digitized. We can take that data, and then our clinicians can see if procedure a, B, or c work to help that patient. And so, but we can't do that without that data being there.

So there's a multi year process for us to get this data into the cloud, but it's going to be really eye opening, I think, to be able to turn that over to our research team so they can utilize this data, which otherwise would just be, you know, sitting in a warehouse.

Matt Pacheco
That could be potentially a bright future. Those are really interesting potential use cases. And I love what you did where you took the data you didn't understand through it into a large language model to help you understand. That's a great, I haven't even, never even thought of that. That is brilliant. So I love that. And you're digitizing all these medical records. It seems to be a potential explosion of data in the future between the AI outputs and all of this data that you're digitizing to manage. How are you considering your data management as part of your cloud operation as well?

Rob Hall
You're right. Our data continues to exponentially grow. And I can see in some industries, like the data could be temporary, or they might have this data for a set amount of time. But with the data from our patients, if our patients are young, regulatory requirements specify certain number of years that we hold on to data for. We keep that for a lot longer. And so, yeah, we don't really get rid of our data. So it continues to grow and grow. We have petabytes of data on Azure, and so it's substantial. We do watch that data. There are ways for us to manage the data which are nice. We are able to set policies on that data and move it between hot, cold archive types of storage and have the data that we need to legally have that.

We're able to put that into cool or cold or archive environments where it's not likely to be used. And if it is needed, we can get to it. But then that allows us to make that storage a lot cheaper by tearing down that storage and then the data that we need to have live and hot, like, we're able to have that there and tear that up. So we're able to have that available for whatever project or application we're working on. So that's opened up a lot of options for us. Where before it was, you know, on prem, we didn't have those options. I mean, we could throw things to tape and that brought up other challenges. So using the cloud to be able to manage that data is huge for us.

Matt Pacheco
Great. Yeah, lots of data. Got to do something with it. I like your approach and your answer. Thank you for that. So all this data, all this modernization, all this security usually is resulting in potentially growing costs. It's not cheap to do some of this stuff. How do you guys manage or approach cost optimization for your cloud operations? And what strategies have you found to be effective to manage those costs?

Rob Hall
Finance and healthcare has been really challenging lately, especially after the pandemic. And so we have tried to make our cloud growth net neutral to the company by funding our cloud growth, by transitioning other systems from on prem to the cloud. So far, we've been quite successful at that. In fact, we've found quite a bit of savings doing that in some instances. Some instances, it's been a little bit more expensive, but that's been our charge. To have a net neutral cost to the organization, we have to have a good partner in working with that. And thankfully, we have made some commitments and then receive some discounts in return. And so I think it's been a good partnership with us to financially to get data to the cloud.

I will say that as a cloud director, the financial capabilities of the cloud in reporting are quite strong. So I'm able to see all of our costs. I'm able to allocate that back to the business units or departments or companies that we have and allocate those costs back. It's great working with our FiNOPS team and our finance teams in doing that. We meet weekly with our executive teams to surface that cloud spend data and to make sure that we're following on track to what we're projecting. The tools are there, and it's great for us to be able to have that data. We're actually grabbing a lot of that data and putting it in our data warehouse so our analysts can have that at their fingertips to. To quantify and to help us, you know, be able to tell where we're spending the money.

Matt Pacheco
Yeah, it's really interesting. Look at the cloud cost piece and the data piece. You mentioned pandemic. So I have a few questions about the pandemic and how it impacted cloud operations, some questions about during the pandemic, and then some questions about post pandemic, because I know things have changed in the last four and a half years. How did the pandemic accelerate the adoption of telehealth at Intermountain healthcare, and what role did cloud play in enabling that shift?

23:28 - Impact of the Pandemic on Telehealth and Cloud Adoption

Rob Hall
Yeah, that's a great question and a great success story for the cloud, in my opinion. When the pandemic hit, I know it hit everyone, but it hit us pretty hard in healthcare, changed our whole organization. We did have some teleworking and some working from home, but when the pandemic hit and we couldn't be in our offices, all of our workforce was distributed, and so on, like the collaboration side, we implemented a lot of tools to help our teams do their work, but maybe not be face to face. We set up some triage rooms and let our executive staff be able to communicate with all of the departments and people that they needed to. But for our patients, that was a huge impact to them and for our clinicians to keep them safe as well. So thankful. We do have a very robust telehealth platform.

We do have a lot of patients that are not near one of our larger facilities. So when patients are potentially having stroke symptoms or other big event healthcare events in their lives, telehealth was really critical in filling that gap. We're able to adopt our stroke care protocols to be able to do that remotely. And when Covid started hitting like, it hit our families personally. We lost a family member because of COVID and it definitely hit us very hard. We were all working quite hard to figure that out at once. One thing we're able to do is, I don't know if you remember during that time to get tested. Like, were lining up people in parking lots and driving them through and getting tested, and not physically interacting with a physician or a nurse doing that from your car.

But to do that, before you got there, you had to get pre-registered and get those tests ordered and things. So those were developed very quickly, and those were all developed on the cloud right away. So you could have your QR code that you could scan, you could have the app on your phone, you could show up at a, you could schedule an appointment and show up at a facility and know, because those were changing daily, to know what facility to go to, what line to get in, how to show your order that was ordered, and then go through and get that done. That exploded. And we had millions and millions of tests going through, and then those tests would be picked up and brought to our central lab and processed.

And every day, our teams were looking at those workloads to see where were. And, you know, at first, like, that was a three-to-four-day turnaround. Quickly got that to under 48 hours, and then in some instances, before the rapid tests were available to get that under 24 hours. So I don't even know what to say.

Matt Pacheco
It pushed you to evolve and shift.

Rob Hall
It definitely did. And I know the world saw that, but in healthcare, that, you know, that was a huge turning point from us. Like, hopefully we don't have that in the future. But, like, just knowing that were able to get through that and to care for our patients the way we did, I think, was really huge.

Matt Pacheco
So post pandemic. So during the pandemic, a lot of companies and a lot of industries adopted the cloud. They adopted cloud tech. They've kind of streamlined the adoption and quickly adopted, but are now re looking at, did we get, did we do what we really needed? Did we over buy? Did we do too much? Do you. I don't know if you see that in the healthcare industry, but how do you see, is that happening, one, in the healthcare industry as you're managing a cloud organization, and then two, how do you see that evolving in the future for telehealth and remote patient care?

Rob Hall
We had a five year plan to move the cloud, and Covid did impact that. But after Covid was finishing up, were able to readdress our cloud strategy. And at that time, we worked with our partners and we made a five year plan with Microsoft and then made a commitment financially with them and they back to us to provide those services. So we've been marching towards that plan. We didn't see like a huge adoption and then a huge falling off of that. It's been more of a steady increase over the years. And so, you know, I credit our executive team for that. Intermountain Healthcare is a nonprofit company, and so we're there for our communities that we serve, but also not out there for shareholders or making a profit.

So our executive team has done an excellent job at putting us in a financial position to care for our patients, but not see as many peaks and valleys as I think some organizations have seen.

Matt Pacheco
Love to hear that.

Rob Hall
Yeah, me too.

Matt Pacheco
So now we're going to start closing out, but a few more fun questions for you about the future and all that great stuff coming in the healthcare industry and cloud landscape. And you might have talked about this a little with the AI piece, but looking ahead, what emerging cloud tech or trends do you think will have the most significant impact on the healthcare industry?

28:57 - Future Trends in Healthcare Cloud Technology

Rob Hall
Like you mentioned, I think AI is going to have a huge impact for us. As I've heard of some teams that are starting to look at AI, radiology kind of easily comes to people's minds, where obviously we have talented radiologists that look at all the images that come across their desk. But if there was a way for AI to get to be trained, and they're working on that right now, and for AI to identify things, work alongside radiologists in determining what's happening in those images, I think that could be really powerful. So one thing that we've seen not at intermountain, but talking to some of our partners is, you know, AI is learning a lot, and it's going to catch things that trained professionals might not see. They'll see trends and they'll see some things that our doctors might not be able to see.

So I think having that, I mean, that would be a really powerful tool for our physicians to see that right now, when our physicians are treating and meeting with our patients, even in person, we do use software for our medical records to help transcribe those interactions and be able to automatically chart those interactions. So I can remember as a child, I mentioned my dad was a physician going to visit him, and he would sit there with the dictation phone, and for hours after seeing patients all day, he would have to dictate and create those medical notes for his patients. Now that's happening on the fly, it's being charted in real time and it's accurate and it's useful.

And then we can take different physicians, sometimes chart differently, and we can standardize that and bring those charts together and that's been super powerful and all the while doing that very securely and protecting our patients. I think just if we can have our doctors and physicians and nurses and staff be more productive and doing the things that they want to do and help out patients, rather than doing paperwork or making sure documents are accurate, if that's just happening, like that's going to free them up to do the thing that they want to do and help.

Matt Pacheco
Out people, it's going to save a lot of lives and improve a lot of lives. So that's amazing, really interesting. And then the future is bright over there. That's so cool. Last question for you. What advice would you give to other healthcare organizations looking to embark on their cloud journeys?

31:25 - Advice for Healthcare Organizations Starting Cloud Journeys

Rob Hall
There are a lot of good cloud adoption frameworks out there. I know all of the major cloud providers have them. If you're looking to expand into a vendors platform, would heavily look at that and look at what the industry says as a whole about their adoption framework. And then you're going to have to take that framework and change it to fit your industry or your particular instances of whatever you need, you're going to need to adapt that for you. But I can say that us having that cloud adoption framework working to implement that was a huge driver in the success that we've been able to see in the cloud. So spend your time upfront working on that cloud adoption framework.

There are things that you can do at the beginning that will save you years down the road by getting them right at the front. So make sure your connectivity is there, make sure your identity is in the right place, make sure your security team is right by your side going along with you. Make sure your teams are all getting trained up. And not just the cloud teams, but all of the it teams are going to need to be trained to use cloud. So get a robust training program to get these ancillary teams trained in knowing cloud until they know how to use it and modernize their apps. Those are small steps that can be taken at the beginning that will save you years down the road.

If I could go back in time, we did a good job at that, but if I could go back in time, I would do more of those things to help prepare for the future years.

Matt Pacheco
Great advice and that kind of caps a great episode. So I hope our listeners got a lot out of that because that was excellent right there. Cloud frameworks. That's really good. Thank you, Rob. I appreciate you having you on today. It was a great conversation. I learned a lot, and I'm sure everyone listening and watching learned a lot. So thank you for joining us.

Rob Hall
Thanks, Matt. It's been a pleasure. Thank you very much.

Matt Pacheco
Thanks. And to our listeners, thank you for listening or watching on YouTube. Be sure to like or subscribe and we'll see you soon.