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Solution Showcase: Cloud Migration Lessons and Strategy with Chuck Christian and Charles Anastos

[00:00:00] Chartis, A leading healthcare advisory firm, works with more than 900 clients annually to materially improve the delivery of care.

With more than 1,350 professionals, Chartis helps providers, payers, technology innovators, retail companies, and investors, create and embrace solutions that help reshape healthcare for the better. Learn more@charts.com.

I am Bill Russell, creator of this Week Health, where our mission is to transform healthcare, one connection at a

time. Welcome to today's solutions showcase on the keynote channel where we spotlight innovations, making real impact in health systems. Let's take a look at what's working today.

Bill Russell: All right. It's a solution showcase. And today I am excited to be joined by Chuck Christian with Franciscan Health and Charlie Anastas with HealthLink Advisors. Now also a part of chart. Gentlemen. Welcome to the show. Well,

Chuck Christian: thanks Bill. [00:01:00] Thanks for having us, and glad to be here.

Bill Russell: Well, I'm looking forward to this conversation. This is one of those topics that comes up an awful lot as people are trying to map out their path to to the cloud and how they're gonna do it and how they're gonna do it effectively. And so, Chuck, I'd love for you to set the stage for us.

What was, What was driving Franciscan Health's uh, move to the cloud and, and what were you guys actually looking at?

Chuck Christian: Well, I mean, a lot of things. I joined Franciscan back in 2019 and one of the decisions that Bill Laker, the, a previous CIO, I'm the CTO Charles Wagner's, the CIO had made was they needed to make a significant investment in order to modernize their infrastructure, both in their primary data center and their secondary data center.

And so they decided they would go to a hosted situation, and that was. I think they made that decision in 2017. And so, long story short there wasn't a whole lot of people hosting epic at that time other than epic. but Dell Technologies [00:02:00] or Virtue Stream which was a wholly owned subsidiary of Dale were, we were their first customer.

For that. And so, they decided to go with a private cloud hosting. I joined the organization in April of 2019, and we moved to that hosted situation in May. Was very successful. I took full credit for everything, so, as I should no, just kidding. They had a great team. They did a wonderful job of.

Moving to the cloud and that we were in that private cloud for five years. And we knew and Charles and I had a lot of conversations about you know, what do we need to do later on down the road and, you know, the cloud strategies and that kind of stuff. When I joined the organization, everybody told me, well, we have a cloud first strategy.

And I said, oh, really? So everything we have can run in the cloud. They said, well, we're not sure. I said, so we did some analysis and what we have is a workload placement strategy. Where should it appropriately run? [00:03:00] Because Bill, you know, in healthcare there are certain things that have absolutely no tolerance for network latency and things that have to be at the edge, at the facilities and things.

And so, we went ahead. Our purchasing policies at Franciscan require us for an investment of this size that we have to go out for RFP. We just can't automatically renew. And so, we engaged Charlie and his team. HealthLink advisors, I've known Charlie for a very long time. They did this very similar RFP process for St.

Jude's in Memphis. And I know Keith, the CIO there, they did a great job and so we engaged them to come and do the same thing for us. And we I think we. Charlie, we've put out what, six different organizations, both,

Charley Anastose: that's right. '

Chuck Christian: cause we, we were doing managed services too with Virtustream.

We sent it to Virtustream, we sent it to Epic. We sent it to AWS who brought two different groups, consulting groups to the table. We sent it to Microsoft and a managed service [00:04:00] partner with them because you know, we wanted a managed services. Partner. But we wanted the engagement a little bit different.

With Virtustream, it was all in the same family. We had the lease of the hardware or the infrastructure and the managed services are all bundled in one. And we wanted to design this one where if for whatever reason the managed services partner wasn't meeting our expectations, or if they did something that, you know, caused them to do to perform less than what we wanted. I think we could disengage them, but we would still be in a a enterprise level infrastructure. And so it's basically an iPads situation. So, long story short we actually chose Virtue Stream. To go back for another five year deal because we, no one that we could see out there of our size.

We're a, you know, 12, 13 hospital system. We've had Epic install since 2011. We didn't see anybody our [00:05:00] size going to the cloud. There were a lot of people are doing pieces, parts. They were doing DR and a few other things, but there was nobody just wholesale moving everything our size. And part of it was that some of the storage was not fast enough to handle the grafs and stuff that we required.

And so, during that time that we were renegotiating that agreement Dell made the business's decision to move virtual stream into Dell Technologies. And once they did that, the leadership of Dell Technologies made the decision they were getting out of the hosting business. And so I have less hair on my head now than I did because of that.

'cause we had to pivot. And so, I remember the day Charles walked into my office because I told him, I said, you know,, the you know, easy button is because, you know, the contract with Dell and Virtue Stream is ending. We've gotta get out of the data center unless we're gonna come up with a bridge agreement that'll, you know, keep us there.

Is we just need the easy button just is going to [00:06:00] epic and just letting Epic host it. And so, Charles walked in my office one day and shut the door and sat down. He said, we're going to the cloud, and I'm going, okay. And so we did. we looked at Amazon. We looked at the business partners that they had brought to the table.

At that time not a lot of folks had done anything of any consequence with Amazon. And so, Microsoft you know. Offered to help us financially get there. They offered an investment you know, kind of bridges for that first year of compute and stuff. It wasn't everything, but it sure did help out.

And so we chose Microsoft and we haven't looked back.

Bill Russell: Did you have to kick off another RFP process or did the. Initial RFP process? Just sort of,

Chuck Christian: yeah. The initial RFP carried us through. We just it was you know, negotiating. I think that Charlie, there were seven different contracts with Microsoft that we had to get through.

Yes. One of them was a Mac you know, there was a. A guaranteed that we would spend x number of dollars in [00:07:00] five years with a 12 month grace period after that. So we actually have six years. We won't have a problem spending it because the idea was, you know, once we put Epic there, we're gonna put more things there.

We've built the data Lakehouse in our tenant. And so for data adjacency and we're moving a whole bunch of other stuff there as well. So. We opened up the floodgates. We're gonna be moving a whole bunch of stuff there and managing it appropriately. And so knowing that we were eventually going to the cloud, one of the things I did back in 23 is I created a position called Cloud cost Analyst.

I had a gentleman on my team that was a business analyst if, and he's heard me tell this joke Bill, that if you look under anal in the dictionary, you'll see Eric's picture guy detail, we

Bill Russell: call it detail oriented.

Chuck Christian: Well, that's true. He's extremely detail oriented and and that's all he does. His job is to watch and manage and understand [00:08:00] how.

The expenses run inside of Epic, and that man has saved us hundreds of thousands, if not millions of dollars a year. Because he's always finding different ways of Massaging our reservations, our quotas and understanding that we also have another business partner Mark Cooper, who is an independent contractor who helps us with our finops and is taught Eric a, a great deal.

He's got some proprietary tools. He's built using some of the APIs and stuff inside of Azure. And so, you know, you just can't throw stuff up in the cloud if you're not committed to managing the cost it's, it, you know, I've read a lot of different stories about, you know, people are just, you know, spending an inordinate amount of money, so they're starting to move things back into their own data centers.

I don't think that we're going to do that because we've been able and been successful in saving a significant amount of money a variety of different ways.

Bill Russell: All right. That's the [00:09:00] genesis. Charlie, I wanna ask you, so, I wanna go back to the RFP process and Chuck, we will have another conversation at another time about moving to the cloud 'cause Okay.

There's an awful lot to unpack there, but I wanna talk about the. The the process of evaluating six different vendors. So you came in, HealthLink Advisors came in as an independent third party. Walk us through what that engagement looked like. What was what was your role behind that and what did it look like evaluating those six partners?

What were you looking for?

Charley Anastose: Well, first I would say it was not just us doing this. This was really a collegial partnership with, everybody that was involved, you know, all the vendors including Franciscan Health moving forward, the, I think the important part about it was that early on we set strategic initiatives in place.

What I mean by that is that really we had some decision criteria that were identified. We also had some non-negotiables as well, so we set them up early, we get the governance put in place, and it was extremely important that, you know, governance was strong. Because there were a lot of opinions that played out this whole [00:10:00] process.

But I think the most important thing was that, you know, as Chuck mentioned this was not a lift and shift. This was really a strategic transformation for the organization, and everybody was on board with that because it was setting 'em up for the future. So once we got everybody's, the governance set up and the whole framework identified in terms of what we were trying to accomplish, things sort of fell in place.

Now you get in into the RFP process and the vendors tend to do what vendors do, which is sometimes they respond, you know, as asked and other times they opine on different perspectives and you know, we had to sort of weed through a lot of that and make sure we boiled it down to what was important to Franciscan Health.

Bill Russell: Charlie, we call that painting themselves in the best light, is what we call that.

Chuck Christian: Yes. Very articulate. Yes. Well, I'll give you my definition of an RFP in a few minutes, bill.

Charley Anastose: Yeah, that's why I like working with Chuck. There is nothing's hidden there. It's all up there, but it was a good process. It was a lengthy process.

I will tell you that the you know, there was some things that at that, if I look back in terms of how we could have done better, one of the [00:11:00] challenges I think we had, and I, and Chuck please, you know, chime in here, but you know, we were still working in an era where people were remote. You know, this is not too far after COVID.

Right. And it was a process that we were working on zoom and other web services to, to have the meetings, the real. Value was face to face when we were able to get people together in a room and go, and that includes the vendors as well as the Franciscan folks as well and ourself to sit down and really think about what we were looking to achieve and how the vendor was going to provide that for us, the vendors themselves, you know, that's really where we got through a lot of what I would consider the fluff and we're able to have some really meaningful discussions and, you know, anytime you can do things in a face-to-face situation, it's just much more productive.

Bill Russell: From the beginning, were you I've heard both of you sort of allude to this holistic approach. You weren't just saying, Hey, epic hosting, you were saying no. Look, this is a, this is almost a re-platforming of the health system.

Chuck Christian: The thing you have to remember, bill, that we [00:12:00] were not only negotiating a platform you know, a place to, you know. The hardware to put it on. But we were also in the middle of negotiating and finding a managed services partner that's going to basically manage the organization's kran jewels, which is our Epic environment.

And we had to get comfortable and everybody had to get comfortable with each other and the other thing I would say, I think Microsoft, during our process, they learned a lot. It was a learning process for all of us going through there because, you know, Microsoft, you know, in the beginning I believe that they thought that they were just gonna be, you know, a warehouse.

We're just gonna drop our stuff into their. Their building and we'll maintain it. Well, that's not the case. There's, there is a significant amount of skin in the game that they had to put in because if their platform is not working, our stuff doesn't work. And so we had very specific requirements, as Charlie mentioned, non-negotiables in the RFP.

And, you know, we have s and [00:13:00] performance, duties on both sides of both for Microsoft and for our managed services partner. So it was I was really glad I had Charlie and his team. We had a team of folks and we had some other people. We had a couple people that worked for Microsoft at that time that had previously worked at Franciscan.

And had helped move our, you know, to implement Epic in the very beginning. And he now is on his own. And they, he and a few other people start their own consulting firm to do this very thing. So. It's it was a learning experience for everybody. You know, it's, and I think it's something that you know, I wouldn't say that we've craved the pattern, but we've, I think we've created an opportunity for success that others can learn from.

Bill Russell: Well, let's talk about the learning experience. You know, one of the things we've had recently is a bunch of cloud outages in the industry. Mm-hmm. And security is something that we've, the three of us have talked about before as well. It's not like, Hey, I went into Microsoft's cloud and they're gonna take care of security.

Chuck Christian: Yeah. Yeah.

Bill Russell: It's, I mean, there's an awful lot to that [00:14:00] talk. Talk about the nuance of negotiating a or looking at the RFP process it to identify which platform was going to be able to handle the requirements that you had. I mean, especially in those two areas, resilience and security. Charlie I'll start with you.

Charley Anastose: Well, I'll tell you one thing. I think the biggest importance for us in this whole process with Chuck had a a great resource to Fcan Health J Bot, who is a ciso. Yep. And has, you know, a lot of very detailed experience around this area. So he was able to bring forward topics that forced the handle of the vendors to really deal with quite honestly.

I think they were one of the things that we realized that there were a lot of different. Approaches and that the different vendors would take to secure the system and provide resiliency. And Jay really put a lot of effort into he, he was the the hammer on this one as it relates to just drilling and to make sure that they, that everything, every item was covered and that the organization felt secure.

And I, I. Quite [00:15:00] honestly, he was really the jewel in that ground.

Chuck Christian: I would say Bill that as we started continuing to the conversations about it, you know, there was a plan of how that they were going to secure that. You know, Microsoft's got their tools. We use a lot of their tools, but then the managed services partner had to bring.

That expertise in as well. And as we got through beginning through some of the implementation processes, after all the ink was drawn on the paper, it became painfully apparent that the approach they were gonna take were not gonna be the standards that Jay and his team and the organization had set.

And so Jay and his team stepped up and said, we're gonna do it. You know, they're, you know, we they put the firewalls in. They did all the segmentation and they manage it. We have our own our own sim. Everything flows right back to, hurricane Labs who's we've met our managed services, a partner for our sim.

So I agree with Charlie. Jay did an outstanding job and still does today. And a really interesting thing, and I say this about [00:16:00] Jay he's an attorney. He has a jd. He doesn't like it when I say that, but I will tell you that it. There, it has benefits. Now, you know, Jay and I don't just, we don't agree on everything, but I think that we partner well together because he'll do policy strategy and that kinda stuff, and then we'll implement from the infrastructure and the hardware side.

So, We have a very mature security program. It's far more mature than the, you know, six years ago, almost seven years ago when I stepped in the building, Jay had six people. He has a department now and it's important to the organization. And, you know, the other thing that we've we did, we just finished doing Bill back in October.

Our. Primary production side is in South Central was in San Antonio, and our DR side is in Chicago. We flipped up to Chicago and ran for 30 days, and then we just flipped back to San Antonio In the 14 years that we've had Epic, [00:17:00] we've never, ever done that. We've never, we've. Done Dr. Trials and stuff just to make sure everything was okay.

But you really don't know until you have to have it. And I don't wanna see it fail. So we ran it for, we could have ran there for six months if we wanted to, but we flipped back because we had some other upgrades and stuff we wanted to do. So it, so, so

Bill Russell: you could really do that, you could now flip back and forth.

Yes, sir. And do I? Yep.

Chuck Christian: I sure can.

Bill Russell: That's beautiful. Charlie, I'm gonna come back to you in a minute, but Chuck I, you know, you have enough gray hair. Um, No, I somebody, somebody would probably be asking like, why did you bring in HealthLink? Why did you have to bring in HealthLink? I mean, you're pretty experienced, you've done Yep.

These kinds of things before. Why'd you go down? You sort of alluded to it in the beginning, but you know, I'm curious why you and what value you saw in bringing them in.

Chuck Christian: I, I think one is experience because you know, you don't know what you don't know. And you know, sometimes when you think, you know,

you have a fool for a customer your own self. You know, it's kind of like doctors [00:18:00] don't treat yourself. And so, and the thing about it is, I know Charlie, charlie and I served on the Chime board together for several years. And I knew what they had done with at St.

Jude's and some other organizations. I know Charlie's team you know, z and several other folks they brought in. The other thing they, it brought in was a extra set of eyeballs, hands, and, you know, a structure. You know, I still had a health care organization to run while we were doing this process.

I, I just couldn't think I could. Do the RFP as important as this is, and as big as it was, and as broad as it was it needed structure and it needed you know, documentation. Because, you know, I've told you, I'd give you the, my definition of an RFP and an RFP for me is an opportunity for the vendors to lie.

And so, I've done way too many of 'em, and I don't like RFP processes. I'd rather do scenario based, you know, show me how this works. And we're using that in a couple of things [00:19:00] we're working on right now. So I think it was really important to bring in that expertise and that discipline and the structure around how we're going to do it, because we had a project manager that, charlie's team brought in to help manage that side of not only the RFP process, but also We had our own project manager at Franciscan and they worked in tandems. And I will tell you that from time to time and Charlie's team stayed with us through the entire implementation.

We engaged them after the RFP process. And I will tell you that it was invaluable because it's many times we had to do good cop back. Is you know, z and the team, you know, they, you know, he, I don't know how he remembered everything that they said during the RFP process and the conversations, but he would do his best to hold him accountable.

And he did a great job, and I think we're in. The position we're in today with both Microsoft and our managed [00:20:00] services partner that we're getting a level of service because we demanded it and we contracted for it, and then we hold them accountable each and every month for those SLAs and things.

Charley Anastose: I think the other thing that's really important is that I mentioned earlier in the conversation this was a true partnership. With Franciscan and the vendors, and it truly was, we not only, you know, in my opinion, brought.

Different perspectives to Franciscans, but Franciscans challenged us. We challenged Franciscan, we challenged the vendors as a team. And it really, and it was all in a collegial fashion. It was to get, to bring the best of the best out of that. And I think that's, having that kind of relationship, it is in invaluable because it's not just very tactical item.

It's very strategic. And we had made sure that all of the desired outcomes. We're in the process to make sure that everybody was successful towards the end. So, and I think that was, yeah, certainly happened

Chuck Christian: and it truly was a strategic partnership. The other thing I wanna mention, bill, and I don't wanna make light of this, you know, Charles [00:21:00] Wagner, who's our CIO, senior Vice President, he was engaging with our senior leadership and keeping them informed of our process.

'cause this was not an inexpensive endeavor. And, you know, he set some of the requirements very early on. Worked out the financing got approval from the board you know, to do what we were doing. We, he asked for, you know, millions of dollars to bridge us between our VIR stream hosting and our Azure hosting very smartly.

And so, you know. Charles was right there with us through this entire process, and I very much appreciate his support in allowing us to, you know, go for and be successful. And you know, one of the things that you know, my litmus test of success when we did this is about 30, 60 days after.

we flipped the switch and we moved to the cloud. I was I attend the central region physician leadership [00:22:00] meeting. And every once in a while Dr. Johnson will ask some of us from it to give an update. And so, you know, I was the one on the phone that day and so I, I told the group. Is that I said, well, we have successfully moved Epic to the cloud.

And they said, well, when did you do that? I said, in October. And they said, well, we never noticed it. I said, exactly. Exactly.

Bill Russell: Nice.

Charley Anastose: That's, yep.

Bill Russell: You know, final question for both of you, for, and there are other health systems in this process for other health systems considering a similar move to the cloud or an epic cloud migration what's the one piece of advice that you would want them to walk away with from our conversation today?

Chuck, I'll start with you.

Chuck Christian: I think as Charlie said upfront, know what, you know, what problem are you trying to solve is you set those strategic expectations and know what you need and and stay firm because you know, it's a negotiation. You know, you're always trying to get moved off and the other [00:23:00] person would, you know, get a better deal.

But, and understanding that. I, and I told everybody that when we, they sat around the table, I'm not looking for a vendor to buy stuff from. I'm looking for a partner. I'm looking for a long-term relationship that we can be successful. So that's, I think that's the one key is to, you know, walk into with your eyes open.

The other thing is, you know. Be willing to not be the smartest guy in the room because I will tell you, there was a couple of people that several of the vendors brought to the table that I threw the Brown BS flag on many occasions because they were trying to blow smoke

charlie will tell you, and Bill, I think you know me well enough now that you know, I it just, I just don't tolerate, I'm a Dumbo country boy from Alabama. And if you're gonna lie to me to now or try to convince me of something then I'm not gonna trust you in the future, and my daddy told me a long time ago, there are two things in this world that you're given is your word.

And your integrity. And you have to [00:24:00] choose to give both of them away. And the one thing I told my girls if you lose my trust it's gonna take you a hell of a long time learning back. And they, every, all four of 'em found that out. So.

Bill Russell: Wow. Listening to that Charlie, man I'm I'm impressed that you guys made it through there, man.

That means you were, you were on the straight and narrow the whole time. That's great. Charlie, what's the one thing health systems should walk away from if they're considering this type of cloud journey?

Charley Anastose: I think first and foremost goes back to the whole foundation of why they're doing it.

Really. I mean, I think it's important and it sounds very consulting lingo, but you know, having a pro, a project charter in terms of identifying what the expected results are gonna be is extremely important. And those non-negotiables are extremely important because chuck mentioned the, you know, part of the issue is the RFP responses come back and a lot of the vendors, I hate to say this, but you know, they all say, yes, we can do this, we can do it, we can do it.

Yeah, you've gotta really. Dig deep and ask them where, how, why all the specific questions and really [00:25:00] work with them, not, and this is not in a combater perspective, this is as a partnership because it, again, it goes back to the fact that this is not just a lift and shift. This has to be a strategic transformation in terms of what you're doing.

The money and the cost is just too great for it not to be.

Chuck Christian: Right.

Charley Anastose: Which brings me to the other point is un make sure you understand the value prop. What do understand the dollars in terms of what you're gonna spend around it, but more importantly, the value's gonna bring to the organization.

If you can do that, and if you can lay that clearly with the vendors upfront, they'll get it. They'll understand this is not a transactional play, this is more of a partnership play for the long term.

Bill Russell: Right. Do you, so you've evaluated this at five years. Are you gonna reevaluate it another five years or are you just gonna

Chuck Christian: Well, I don't know that we'll go out to an RFP process, but those contracts will end. We'll have to renegotiate. And we will and we'll use some of the things we've learned through our current experience that will color the next set of of standards.

Around the contracting [00:26:00] and stuff. And a lot of it's gonna be, you know, cut and dry, but there are some things that that we're going to do a little bit differently, I think. And so, and our scope has expanded quite significantly over time. And it's gonna continue to do that.

You know, health systems are not gonna stay put in the, I wish it would be static. You know, I think your most recent article that you wrote about. It wasn't complacency, but it was comfort. You know, be careful about being comfortable and I have been in healthcare 54 years, bill, and it is not a comfortable place.

It never has been to tell you the truth, but I love it. And that's why I continue to do it.

Bill Russell: Awesome. Chuck. Charlie, I wanna thank you for your time and thank you for moving this part of the industry forward. Appreciate it.

Chuck Christian: Well, thank you Bill. Appreciate the opportunity

thanks for watching this solution Showcase on Keynote with me, bill Russell. We believe every healthcare leader needs a community they can lean on and learn from. Discover more solutions and join our community at this week. [00:27:00] health.com/subscribe. Share this with someone who could benefit from these insights.

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