Jeremy Marut, chief of digital modernization at Tufts Medicine, recently described his organization’s design, development, and implementation of a cloud ecosystem that includes its new Epic EHR implementation and more than 40 disparate applications.
“Everyone has the EHR at the center of their world, but the actual experience at any organization is made up of what we determined to be about 40 mission-critical, third-party integrations,” Marut said. “Our goal is to get out of the data center entirely. We wanted to move Epic and all those critical integrations into the cloud, so that they can all take advantage of the same levels of high availability, the same levels of business continuity, and the same modern technologies available to us in 2022.”
Marut was speaking at an Amazon Web Services (AWS) healthcare and life sciences online summit on June 16.
Launching in the AWS Cloud, Tufts Medicine said it was able to move more than 3 million health accounts into the Epic EHR in record time. Had the system been using on-premise servers, this task would have taken approximately 200 days; with the new cloud-based system it was completed in 71 hours.
Tufts Medicine is comprised of Tufts Medical Center, Lowell General Hospital, MelroseWakefield Hospital, Lawrence Memorial Hospital of Medford, an expansive home care network and a large integrated physician network. Before it consolidated on Epic, Tufts Health had six different EHRs and more than 100 different patient portals in its system.
“We've been live for about six weeks on our brand-new Epic implementation, as well as a migration and some new implementations of over 40 third-party integrations into Epic.” He said when they started on this journey, he expected that perhaps they would get only four of those application vendors to join them in the cloud, “but that list grew and grew. And we were actually successful on every single one of these applications. It was a very, very hard, arduous process to convince these companies to come over,” he added, “but what we found is that everybody wanted that opportunity and a reason to move, and we finally gave it to him. We're based on relationships — within the organization, but also and maybe more importantly, very tight relationships with our technology partners. We want to bring people in to show it's possible.”
Among new developments made possible by the move to the cloud, patients can now interact with a multi-lingual chat bot powered by Amazon Lex, an AWS service for building conversational interfaces for applications using voice and text. In addition, Tufts Medicine has adopted and deployed Amazon Connect, a cloud-based contact center, that powers Tufts Medicine’s telehealth and virtual care services.
“Epic’s been seriously exploring the public cloud for many years. They are on a journey. They are by far not a SaaS product,” Marut said. “So in general, our Epic implementation is really an Infrastructure as a Service implementation. But with that said, AWS allowed us to be able to take a lot of their modern services and apply them to a more monolithic product, and still get advantages out of it. We've developed many levels of automation to help in our Epic support, make it more manageable, make it more precise, make it more efficient to operate.”
As they prepared for go-live, several times they had to bring in more systems and data, and set up new environments. “Instead of having to go and find hardware or storage to be able to bring something up and take weeks to do that, within a matter of less than an hour, we're able to stand up a brand-new environment,” Marut explained.
“We've defined all of our infrastructure as code, so for us to turn around and bring up another hospital, another environment, another system is literally a matter of hours, as opposed to days, weeks and months,” he added.
Tufts Medicine has a goal of transitioning 300 applications to the cloud eventually. “The digital health landscape is ripe for disruption and advancement – and Tufts Medicine is leading the charge through the use of AWS,” said Shafiq Rab, M.D., chief digital officer and chief information officer at Tufts Medicine, in a statement. “By undertaking the process of migrating more than 300 applications to AWS, we are providing a personalized, connected care experience for our patients, as well as a data-driven, modern clinical environment. This digital healthcare ecosystem will support a more efficient, equitable, and insightful healthcare industry and deliver high-value patient outcomes.”
