Creative Solutions in Healthcare, based in Fort Worth, TX, is the largest independent owner and operator of skilled nursing facilities in Texas. The company was founded in 2000 and today operates more than 49 skilled nursing and 13 assisted living facilities with a staff of 6,000 employees. The corporate culture is based on the principle of “do unto others as you would have them do unto you,” and the company prides itself on providing highly trained, compassionate caregivers to meet the needs of its residents.

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The Challenge

Creative Solutions in Healthcare’s focus on compassionate care extends to its award winning IT department, ranked number one in the long-term care industry in the country. The team, which recently won an award for the best health information exchange provider in the state of Texas, has made significant investments in technology to support both patients and staff. However, the company’s on-premises environment, self-hosted in a co-location facility, wasn’t able to fully support critical applications and services. Creative Solutions in Healthcare experienced application outages as well as problems with its backend infrastructure, impacting Active Directory and other services.

The limitations of the existing environment became even clearer when the company planned to update its infrastructure to meet HIPAA and other mandated government requirements. That would mean an additional $15,000 investment in hardware alone. At that point, Creative Solutions in Healthcare decided to simultaneously migrate to a virtualized environment while lifting the core IT infrastructure to the cloud, allowing them to build the infrastructure needed to improve application uptime, host backend services, and comply with HIPAA regulations, the HITECH Act, and the NIST framework.


The Solution

After evaluating several cloud service providers, the team initially chose Microsoft Azure because the majority of its applications and services use Microsoft technology. However, lack of support for Microsoft Exchange in the cloud led the company to abandon its migration to Azure. The IT team focused its efforts on finding another solution to meet deadlines promised to the business, including migrating from its physical environment by the end of the year.

After considering other cloud providers, the team decided on VMware vCloud Air. “The team at VMware understood our timeline, our project, and the applications that we wanted to move to the cloud,” says Shawn Wiora, chief technology officer and chief information security officer at the company. “That’s what differentiated VMware from its competitors. The vCloud Air team had the best onboarding process for any IT project that I’ve been involved with in the last 20 years. We haven’t looked back.”

Creative Solutions in Healthcare migrated to the cloud using the compute, storage, and networking resources offered by VMware vCloud Air Virtual Private Cloud, a multi-tenant, logically isolated core compute service. The IT team started with one node, 10 megabytes of bandwidth, and 20 gigahertz of CPU to build the infrastructure and move its Active Directory workload to the cloud. The vCloud Air team worked with IT during the migration, often with late night phone calls and training, to help them meet their end-of-year deadline.

“The great thing about VMware is the flexibility,” says Wiora. “They allowed us to ramp up so that we didn’t have to make a big investment for our initial workload, plus they allowed us to go beyond the trial period just to make sure we were happy with the solution.”


Compliance and Improved Availability

Running on vCloud Air allowed Creative Solutions in Healthcare to implement the technology required to comply with HIPAA and other health care regulations.

“The infrastructure in a HIPAA-compliant environment needs to be secure with controls for change management and the right firewalls and technology to protect the perimeter,” says Wiora. “Before moving to vCloud Air, we had policies in place, but we didn’t have the infrastructure to support them. On vCloud Air, we’ve deployed technical controls on our core infrastructure and anti-virus and other solutions in a holistic approach to security that allows us to comply with regulations and achieve HIPAA certification.”

Migrating to vCloud Air allowed Creative Solutions in Healthcare to meet its initial goal of building a secure and compliant infrastructure and stabilizing email services by moving Active Directory workloads to the cloud. As the company continued to migrate workloads, the IT team added four additional compute packages and storage to the vCloud Air environment. By migrating to vCloud Air, Creative Solutions in Healthcare reduced application outages by more than 90%, which users noticed immediately.


Leveraging vCloud Air to Transform Patient Care

vCloud Air allows the company to continue to find ways to improve both the patient and staff experience. The company implemented a sophisticated business intelligence (BI) capability with its electronic health record (EHR) system on vCloud Air. The team was freed up to launch the company’s EHR system which replaces paper filing systems, enabling the organization to write orders electronically, order prescriptions online, and share information electronically with hospitals and other health care facilities.

A critical benefit of the EHR system is improved digital access to patient information using secure computers and wall kiosks. One facility recently recorded more than 40,000 entries in the system in just one day without incident. “We have better patient outcomes because of this technology,” says Wiora. “Our use of the cloud translates directly to technology availability and capabilities in the hands of our talented, compassionate staff.”


Business Results and Benefits

By moving to vCloud Air, Creative Solutions in Healthcare was able to migrate to a virtualized cloud environment on time, meet HIPAA requirements for a health care infrastructure, improve availability, and accelerate application deployment — all at a reduced cost. The company has been able to expand beyond its initial goals to launch key applications, such as the electronic health record system, that supports the company’s goals of improved patient care.

As a result of the move to vCloud Air, business units within the company have been eager to work with the IT department. “Running on vCloud Air has been a game changer for IT and the company overall,” says Wiora. “It’s reduced standard deployment from two months to two days. The business units are excited about changes and are coming to us because we can ramp up applications quickly. When we look at where IT is now compared to two years ago, all of our key performance indicators, including patient satisfaction and employee morale and retention, have gone up. It’s where we want to be.”

“If we didn’t have the tremendous resources from VMware, there’s no way the project would have been as successful as it was,” says Wiora. “Our IT department is about 40 people. I would have had to hire 12 more people with the expertise needed for this project. Instead of hiring more people, I can rely on the expertise at VMware.” Wiora estimates that running on vCloud Air has reduced IT’s budget by one-third. “Instead of spending $10,000 on a base server, we can spin up the same exact server and put it in vCloud Air for pennies on the dollar.”

Furthermore, IT has been able to automate the process of building an environment, which it can stand up in minutes. This frees the team to focus on using data to improve applications and systems. “It’s impacted everything we do, from our BI for EHR system to financials,” says Wiora. “We can devote more time to new projects. That’s where the return is to our stakeholders.”

Creative Solutions in Healthcare has been successful growing the company based on a compassionate, caring model. “VMware has helped us focus IT on delivering solutions that the business and our patients need,” says Wiora. “It’s changed how our executives think about expanding the business because now we’re able to provide a solid IT foundation for growth.”


Looking Ahead

Creative Solutions in Healthcare is currently using vCloud Air to build in High Availability and Disaster Recovery capabilities. The IT team is in the process of replicating data files and Active Directory servers, SQL, web and database servers from its data centers in Las Vegas and Dallas to vCloud Air. They added Global Traffic Directory by DNS Made Easy for monitoring and load balancing between data centers. If a server connection fails, the system automatically fails over to vCloud Air.

“We’ll have complete Fault Tolerance when we’re finished,” says Wiora. “We got the infrastructure for this project up and running in a couple months. We already have our data replicated. The vCloud Air team worked with my team to build a robust infrastructure quickly.”

Creative Solutions in Healthcare continues to work with the vCloud Air team to optimize the company’s virtualization strategy. The company has plans to add more facilities and use vCloud Air to scale without significant infrastructure changes. Additionally, the company is considering leveraging VMware for desktop virtualization, a mobility initiative, business continuity and additional levels of compliance. “We’re looking at how to best serve the business and our residents,” says Wiora. “Whatever we do, it’s nice to know that we can call to VMware. The return on our investment is through the roof.”


This article was originally posted “Health care provider improves patient outcomes, reduces costs in the cloud” from Cloud Strategy Magazine.

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