eHealth NSW has migrated "a bit over 30 percent" of its workloads into the public cloud, eclipsing a government mandate to have at least 25 percent of ICT services in the cloud by 2023.
In doing so, it has also pioneered the migration of some clinical software platforms to run in the cloud, defeating sometimes heavy pushback from the vendors.
Speaking at AWS re:Invent 2022 last week, eHealth NSW service delivery executive director Farhoud Salimi touted the agency's progress with its public cloud migration on the world stage. It has agreements to use both AWS and Microsoft Azure under a multi-cloud strategy.
"All agencies had to have 25 percent of their workload in clouds by the end of 2023. We've already beaten that, so that's okay - the only agency by the way that's done that," Salimi said.
"By the end of 2024, we've set a mark of [being] 90 percent out of [NSW] government data centres.
"We want to move everything out, but not just migrate it but transform it on the way."
Salimi said the cloud migration program had so far seen eHealth NSW involved in some "world-firsts" in terms of running clinical applications in the cloud.
In a blog post in September, eHealth NSW said its i.PatientManager hospital patient administration system andTrakGene genetics software package are among the "global" firsts.
"Australian firsts were also achieved for cloud optimised and fully automated deployments of enterprise patient repository (EPR) and electronic oral health record (eOHR) on AWS," it said at the time.
"Directory management software Quest Active Tools (QAT) was the first instance deployed on Azure."
Salimi said eHealth NSW first chose to migrate eight of the largest clinical platforms to public cloud.
"Those things had never been done anywhere globally at the time," he said.
Salimi said that eHealth NSW's experience showed the need for perseverance more broadly by the world's health agencies when trying to get the makers of clinical software to modernise their offerings.
"Don't give up - keep pushing those clinical vendors to actually replatform and use cloud as much as possible," he advised.
"They'll give you all sorts of excuses why things won't work, but at the end of the day it does, and if you push them hard enough to change their models of delivery, you're the customer and they will ultimately listen.
"So if all of us do that, I'm pretty sure that we'll get the change that we need."
But he also credited the NSW government's cloud migration mandate for changing the negotiation dynamic.
"It gave us a basis to be able to push back [on the application vendors] and say, 'No, we want a cloud-based solution because NSW government strategy is [to be] cloud-only, not just cloud-first," Salimi said. "So it really forced that conversation."
The migration to cloud of the first eight critical applications alone achieved millions of dollars in "benefits", according to Salimi.
"Just within those eight applications in the eight months since go-live ... we've managed to realise $25 million worth of benefits, and that includes 144,000 clinical hours back to the clinicians."
Making public cloud consumable
eHealth NSW currently supports "over 159 business systems across corporate platforms such as finance, rostering, payroll, clinical systems such as our electronic medical records, pharmacy systems, diagnostic imaging systems, and also our statewide analytics and warehousing environment."
Pre-dating cloud, "all of these environments were hosted on our on-premises VMware environment," Salimi said.
The number of virtual machines in use peaked at about 8000, Salimi said. Internal teams typically need a "six-to-eight week" lead-time for a VM-based environment to be provisioned.
"That's six-to-eight weeks before anyone can get hold of that system to do something innovative."
eHealth NSW's cloud strategy started life as a way to stem VM sprawl. Salimi said he "stopped buying hardware... about three-and-a-half years ago" and started encouraging new environments to be spun up in the cloud instead.
"[That] forced the organisation to rethink about how they would actually host that environment without actually going for the easiest option, which was just to spin up another VM," he said.
In early 2022, Salimi sought to encourage greater cloud use by "puting a new process in [where] even increases in [exising] virtual machine sizes would have to get approved by myself - really forcing the organisation to think about how to change their behaviours to actually take advantage of the new environments."
Alongside that, Salimi - and eHealth NSW's cloud services division - "established our cloud platform as a standardised offering", powering "enterprise-consumable services" for provisioning and consumption.
The agency calls the offering a "self-managed cloud."
"In our organisation, the landing zone is referred to as a self-managed cloud," Salimi said.
"To then enable our consumers to consume it easily, we put our self-service portal over the top, basically meaning that anybody in the organisation could go request a virtual data centre, and once their manager approved it, within 30 minutes they'd have a virtual data centre which was governed and managed provisioned for them to use."
“Since we've gone live with this, we've had over 800 provisions of a self-managed cloud or a virtual data centre in the organisation,” Salimi added.
However, he sought to measure success not via the number of self-managed clouds being spun up, but by the number being torn down.
"The metric [I'm focused on] there is that we've actually destroyed 130 of them," he said.
"You might be thinking, 'Why do you care if you've deleted this?' Well, [it's] relief that people are actually innovating. They're trying stuff and then after they're done, they're giving that resource back - something that really didn't happen on-premises.
"Most of you probably have systems and VMs running that you don't who owns them anymore, so this is actually now working the way we designed."
Healthcare personalisation
eHealth NSW's work is helping to power a broader strategic push by NSW Health to create a personalised, digital-enabled offering for patients, staff and organisations.
The decade-long statewide strategy, and the specific eHealth-related activity that relates to its implementation, is split into three tranches.
"The NSW Health vision across the organisation is for a sustainable health system that delivers outcomes that matter to patients, is personalised, invests in wellness and is digitally-enabled," Salimi said.
"Our strategy for digital health underneath that spans over three horizons across 10 years.
"With horizon one, think about consistent foundations, so really getting all our systems implemented and together.
"Horizon two is about integration and interoperability. Most of you in healthcare would know that integration and interoperability is a major issue.
"And finally, [horizon three is] personalisation of healthcare."
"Each one of these is characterised by a different step change in how we do digitisation, with the first moving from paper systems to digital systems; secondly, shifting from all those fragmented systems and more integrated service delivery; and finally, moving from provider-centric to a patient-centric paradigm."
Kate Weber attended AWS re:Invent 2022 in Las Vegas as a guest of AWS.
