Recently, FedHealthIT’s Executive Vice President, Susan Sharer, had the opportunity to connect with Dr. Paul Tibbits, Executive Director of the Office of Technical Integration within Veterans Affairs about moving to the cloud, preparing infrastructure for EHRM and the rollout.

VA and the Cloud

The commercial cloud is a high priority for VA. Using COTS solutions that originate in the cloud and can be implemented in VA, provide opportunities for cost savings, technical risk reduction, and ease the burden of converting older applications into a cloud-compatible software architecture.

“We’re well on our way with the solution architecture for Financial Management Business Transformation (FMBT) already in place. Our next intermediate opportunity is the 70 VistA instances that are currently in the DoD cloud run by the Defense Information Systems Agency (DISA),” says Dr. Tibbits. With DISA closing one of its locations in March of 2020, this initiative will move these to a commercial cloud environment in a specially-configured VA enclave.

“Next, we’ll migrate legacy systems – a more difficult challenge because we must assess whether each application is cloud ready. We need to look at whether it is containerized to understand whether it is built to deal with telecommunications latencies, and whether it can spread across multiple virtual machines, for surge capacity.” There are activities underway to assess VA legacy candidates, he says.

Why Cloud Now

Tibbits says VA is at the stage where “we wish we could move to the cloud faster, but it takes time to plan and to get the work done.” Why cloud now? – For all the reasons the cloud first policy was initially articulated.

“We in VA do not want to own equipment, and, thereby, the management burden and technical debt risk that come along with equipment ownership.” With the evolution in IT technology, the need to move to the next generation comes quickly, he says, making it difficult to keep up in the context of the annual appropriations process.

The knowledge, skills and abilities of Government staff is also key. As technology evolves so do the challenges for workforce recruiting, education, and training. “Where we can offload this challenge to a cloud service provider at the infrastructure level, we have the opportunity to focus training for our staff on higher level roles and responsibilities, preparing them for the work of the future.”

Finally, there is the consideration for high maintenance costs for legacy systems environment, which he says VA believes can be reduced by a commercial cloud and infrastructure as service approach.

Challenges of Cloud

Among the biggest challenges are performance implications, due to things like dependency on long-haul telecommunication. “We need to ensure things like bandwidth, the “chattiness” of the application, capacity of other infrastructure components, connectivity and so on are all there so that the end user experience is the same as it would be for an on-premises solution. We plan to use ongoing monitoring of performance to ensure we are achieving the performance goals.”

There must also be management controls in place. Cloud makes it very easy to surge, so there must be proper governance to ensure large unexpected infrastructure costs are not incurred.

Looking at the model of a hybrid cloud, where solutions exist in more than one commercial cloud location, Tibbits says there is a need to understand the communication pathways where interoperability is a critical success factor. “With respect to commercial cloud, we are looking at best practices from industry, other agencies, as well as our own lessons learned from experience implementing FMBT in the cloud, and in moving 70 VistA instances into the DISA deck, and now out. When we were initiating FMBT we collaborated closely with GSA on the whole program including their lessons learned related to earlier experiences with cloud implementation of the other Federal Enterprise Resource Planning systems.”

Preparing Infrastructure for EHRM

VA has developed a method for sharing of information, including best practices, among OIT, OEHRM, and Cerner. “We’re initiating a market research dialogue with telecom companies to learn from their experience with clients operating in cloud-based EHRs, and we’re looking forward to meeting with Cerner clients to learn how they handled installations and their experience from an infrastructure perspective in preparing for the Cerner application in particular.”

Tibbits says VA is also obtaining additional system expertise on the Agency side to help with the engineering infrastructure to ensure it provides the requisite end user experience. “We’re taking an end to end approach for this, for application performance monitoring and capacity planning from the desktop to the data center, all based on an analysis of the end user experience. Our approach to infrastructure instrumentation will ensure we can do fault isolation, so when the user experience does deviate, we can identify and quickly fix the bottleneck.”

The Timelines

Tibbits says VA’s go-live target for the Spokane and Seattle VA Medical Centers is March 2020. This requires a technical readiness date of six months before to ensure from an infrastructure perspective that everything is in place and stabilized for the Cerner system. “We have a good fix on the next waves of the system and a schedule to full operating capacity. There is interest in accelerating this.”

He says VA is envisioning early roll out of some capabilities, such as the patient scheduling component. There is an analysis underway to accelerate bringing this benefit to VA medical centers.

“The IPO continues to foster and strengthen pathways for collaboration between VA and DoD by sponsoring workgroups with participants from both, and with frequent collaboration activities at multiple levels from top executives to more task-oriented roles.”

About Dr. Tibbits

Dr. Paul Tibbits was inducted into Senior Executive Service (SES) in February 2004 in DoD, and served as Deputy Chief Information Officer for Enterprise Development for VA. He then served as Deputy Chief Information Officer for Architecture, Strategy, and Design, and is now serving as the Program Executive Officer for the Financial Management Business Transformation, Special Program Office. In DoD, he served as Director of the Business Management and Modernization Program and Transformation Support Office, and as Deputy Director of Military Health System (MHS) Office of Transformation.

Dr. Tibbits also served as Program Executive Officer of the $400M Defense medical IT enterprise, supporting MHS health care. He developed and implemented two worldwide medical record systems; restructured IT management, regularly represented IT projects to highest DoD executives and Congress, and implemented the first and largest change management program in support of the largest medical IT program in DoD.

After retiring from a distinguished career in the U.S. Navy as a cardiology and before joining DoD in 2004 as an SES, he was a Principal and Founding Member of MAPA Ventures LLC, providing business development advice to clients, growing the business to 11 partners. He also served as lead consultant for information technology and Veteran transition and on the Presidential Task Force to Improve Health Care for Veterans.

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