Hennepin County Medical Center

Hospital Saves $1.1 Million Annually by Migrating from Lotus Notes to Exchange Server

In 2006, Hennepin County Medical Center (HCMC)—a nationally recognized hospital based in Minneapolis, Minnesota—struggled with the financial feasibility of its hosted Lotus Notes environment. At U.S.$18 per mailbox per month, the e-mail system was extremely expensive, thus restricting the number of employees who could have an account. In addition, the system created numerous issues with productivity, system administration, and security—including viruses. To address these issues, the hospital deployed Microsoft® Exchange Server 2007 and other software in the Microsoft Enterprise Client Access License Suite including Microsoft Office SharePoint® Server 2007. As a result of its new messaging and collaboration solution, HCMC has cut e-mail costs by nearly $1.1 million per year, accelerated productivity, streamlined mobile access and system administration, and boosted security.

Situation

Hennepin County Medical Center (HCMC) has been ranked among the best U.S. hospitals every year since 1997 by U.S. News & World Report. Founded in 1887, the hospital’s 4,600 employees provide comprehensive medical services including acute, primary, and specialty care. Every year, approximately 100,000 people visit the Level 1 Trauma Center, home to Minnesota’s largest Emergency Department. Formerly owned and operated by Hennepin County, HCMC is now governed by the nonprofit Hennepin Healthcare System.

We spent more than $1.2 million a year for 2,000 mailboxes on Lotus Notes. We were able to reduce that line item in our budget to $50,000 by deploying 4,000 mailboxes on Exchange Server 2007.  Kevin Murphy IT Director of Infrastructure Hennepin County Medical Center

To provide the best possible patient care, hospital employees rely on IT technologies at their desks and in exam and operating rooms. The software includes clinical and productivity programs such as Microsoft® Office Professional Edition 2003 and a new electronic health-record system. In addition, up until 2007, HCMC relied on Lotus Notes for e-mail and calendaring. Hosted through a government provider, Lotus Notes created many issues for the hospital that affected the budget, employee efficiency, and security.

High Costs Meant Fewer Tools

HCMC had to pay U.S.$18 for each mailbox every month. As a result of this budgetary constraint, only 50 percent of employees had an e-mail account. This meant that e-mail was the primary form of communication for only some employees, while others had to use the phone or paper memos. Also to minimize costs, the hospital could not implement features in Lotus Notes such as instant messaging that would give employees another avenue for efficient communication.

“In a healthcare organization, communication between clinicians and all other employees is very important,” says Kevin Murphy, IT Director of Infrastructure at HCMC. “A patient moving through the hospital touches many areas, and so group-to-group, department-to-department, and individual-to-individual communication is really important. We always look for new ways to create efficiencies in communication because it has a big, positive effect on the patient experience.”

Notes Created Productivity Issues

Conference room scheduling was a big source of frustration and lost productivity at HCMC. “Lotus Notes was supposed to send requests to the meeting room’s broker, but it didn’t always work,” explains Murphy. “Chaotic situations occurred when two groups showed up at one conference room, or people thought they had a conference room and they didn’t. Our administrative staffers would first use Notes to schedule a room. But when that didn’t work, they had to identify who the broker was, call that person, and get approval.”

Elaborating on inefficiency, Murphy adds, “Mobility in Lotus Notes was very awkward to use. There was cradle-based synchronization that required the portable device to be plugged into a workstation, but that was cumbersome because we had to use a third-party product called mNotes. Also, Notes could support only a few mobile devices, and it did not easily support cell-phone integration.”

Lotus Notes also impeded productivity because it was not easy to use. As a result, the hospital spent significant time and money on training, and about 100 physicians opted to not use Notes at all. Also, IT personnel had to submit forms to the hosting provider to set up auto-forwarding to the physicians’ personal e-mail accounts.

Hospital Faced Security Challenges

Similarly, IT had to submit forms to the hosting provider to create an e mail group or user account—or to close an account. These requests took up to eight days to be fulfilled, which affected security and efficiency. “Because the e-mail groups weren’t managed well, we had groups that included people who didn’t work here anymore, which created security issues,” says Murphy. “Also, there were always problems keeping user IDs synchronized between our domains and the provider’s domain.”

A patient moving through the hospital touches many areas, and so group-to-group, department-to-department, and individual-to-individual communication is really important.  Kevin Murphy IT Director of Infrastructure Hennepin County Medical Center

The hosted e-mail system created additional security challenges. Because the hosting provider did not protect against spam or viruses, the hospital used Symantec software. However, the product didn’t work well. “Our systems were affected by a virus at least three times between 2004 and 2007,” says Murphy. The hospital also sought better monitoring tools to help facilitate high levels of availability and streamline system administration. “We’ve tried several third-party system monitoring products, but they just didn’t work out,” says Murphy.

In addition, the hospital lacked a central repository that physicians could use to store patient data, which included large files such as x-rays and CAT scans. As a result, employees frequently used e-mail to share patient data. Not only did this create security risks but also large files sent over e-mail consumed valuable network bandwidth and slowed network-access speeds for remote offices.

Solution

After Hennepin Healthcare System took over direct operation of Hennepin County Medical Center in 2007, the hospital contacted several third-party vendors to create proposals for an e-mail solution built on Microsoft® Exchange Server 2007. “We did not even bother to look at other solutions because Exchange Server is the premier solution for e mail and we were already customers of Microsoft for many other products,” says Murphy. “Integration with the Microsoft Office suite of products we had deployed was a clear advantage.”

Ultimately, HCMC chose to work with CDW Berbee. A Microsoft Gold Certified Partner, CDW Berbee had worked with the hospital on other IT projects. After discussing solution options, HCMC decided to acquire Exchange Server 2007 and the Microsoft Enterprise Client Access License (CAL) Suite. The Enterprise CAL Suite includes client licensing for 11 Microsoft products including Exchange Server 2007 and the Microsoft Forefront™ Security Suite—all for the price of 2 products. “The initial projections for the use of Exchange Server 2007 had a return on investment of less than six months,” says Murphy.

Given the cost savings, HCMC realized it could give every employee a mailbox. The hospital would also be able to build a central data repository supported by Microsoft Office SharePoint® Server 2007, another product in the Enterprise CAL Suite, after it deployed the new e-mail solution.

In June 2007, engineers from CDW Berbee and IT personnel from HCMC installed Exchange Server 2007 Enterprise Edition and Forefront Security for Exchange Server on two clustered HP DL580-G4 server computers running the Windows Server® 2003 Enterprise x64 Edition operating system. The Client Access, Unified Messaging, and Hub Transport server roles in Exchange Server run on individual HP DL360-G5 server computers along with the Windows Server 2003 Standard x64 Edition operating system. A storage area network—built on IBM N5300 modular disk storage systems—supports the e-mail system. IT personnel also installed an 802.11a/b/g/n wireless network in the hospital to facilitate system access.

After extensive system tests, the team conducted a pilot trial of the new e-mail environment with 150 employees. Upper management gave each pilot user a shirt with the slogan A Better Outlook (a reference to the Microsoft Office Outlook® 2003 messaging and collaboration client). Not only would the slogan help generate momentum for the new solution, but also the shirts would identify the pilot users so that they could help other employees during the conversion process. To accelerate the learning curve, pilot users attended a one-day training course on Exchange Server at New Horizons of Minnesota, and CDW Berbee provided on-site administrative and technical training.

When we went to Exchange Server 2007, we were able to tell our users that we could support any mobile device or cell phone that runs Windows Mobile. That’s a pretty astounding statement for IT to make.  Kevin Murphy IT Director of Infrastructure Hennepin County Medical Center

Several weeks later, the deployment team began to migrate the 2,000 Lotus Notes mailboxes to Exchange Server. The team used Notes Migrator for Exchange from Quest Software to speed the process. The migration was straightforward and the team did not encounter any issues. “We migrated about 200 to 250 users per night,” Murphy says. “We finished the migration in only about 10 business days. However, we ran both Lotus Notes and Exchange Server environments for about 30 days to be sure the transition went smoothly.”

To help employees learn how to use the new e-mail system, HCMC developed a four-hour, instructor-led course and provided employees with online training through the Microsoft Web site.

Benefits

By migrating to a new messaging solution based on Microsoft Exchange Server 2007, Hennepin County Medical Center can save more than $1 million every year, help employees better access e-mail from any location, minimize security threats such as viruses, and improve employee efficiency and system administration.

Reduced Costs by Nearly $1.1 Million

By switching from Lotus Notes to Exchange Server 2007, bringing its e-mail system in-house, and licensing 11 products for the price of 2 with the Enterprise CAL Suite, HCMC achieved significant cost savings. And it recouped its initial investment in less than six months—even though it doubled the number of mailboxes.

“We spent more than $1.2 million a year for 2,000 mailboxes on Lotus Notes,” says Murphy, noting that the $18 per-mailbox charge represented only a portion of the total cost of the old e-mail system. “We were able to reduce that line item in our budget to $50,000 by deploying over 4,000 mailboxes on Exchange Server 2007.”

Facilitated Employee Mobility

Employees can more easily access e-mail when out of the office, and they have more options for mobile devices by choosing any unit that runs Windows Mobile® software. “One of the biggest and best features of Exchange Server is its mobility options,” says Murphy. “When we went to Exchange Server 2007, we were able to tell our users that we could support any mobile device or cell phone that runs Windows Mobile. That’s a pretty astounding statement for IT to make. We were also able to get rid of mNotes and reduce our cradle-based synchronization instances to almost zero because we have a wireless network in the building.”

Improved Security

Today, administrators can immediately deprovision a user who is no longer an employee, which minimizes security risk. In addition, the new system provides greater levels of unsolicited e-mail and virus protection. “The virus issues have seemingly disappeared,” says Murphy. “We’ve had the new system running only about six months, but during that time we have not had any spyware, spam, or viruses come into our network through e-mail.”

Administrators also have a greater level of control over e-mail, and employees can store patient data in a central repository rather than sending files by e-mail. “With Exchange Server, we have been able to create archival and retention policies that help us better manage the whole life cycle of data,” Murphy says. “And we are creating filters so that employees cannot send patient data in attachments, but use links instead.”

We’ve had the new system running only about six months, but during that time we have not had any spyware, spam, or viruses come into our network through e-mail.  Kevin Murphy IT Director of Infrastructure Hennepin County Medical Center

Increased Productivity

Today, every employee has access to e-mail and administrators can add new users in minutes. “By bringing everyone into the electronic communications loop, we can communicate on a corporatewide scale more easily because we no longer have to print and distribute memos,” Murphy says. “Employee morale has also been boosted because we no longer have a two-class system where either you have e-mail or you do not.”

Office Outlook 2003 is easy to use, says Murphy, and the majority of new employees are already familiar with it when they are hired. As a result, the hospital spends less money and time on training, and employees can be more productive sooner. In addition, almost all physicians now use the hospital’s e-mail system, which minimizes work for IT and means that the majority of employees use the same calendaring system. “Getting every employee on one electronic calendar has created huge opportunities and efficiencies for time management,” notes Murphy. “Physicians have embraced it, and many use the calendar as part of their daily workflow to help schedule things and notify other areas and users of their availability.”

Having most employees on the same calendar has also helped streamline conference room scheduling, which is now a fully automated process. “We have been able to open up conference room scheduling to the entire user population,” says Murphy. “Overnight, it has become a very easy thing for anyone to do.”

Simplified System Administration

Rather than waiting days for an e-mail group to be created by an outside provider, employees can create one in seconds. “We’ve been able to empower the users who have asked how to maintain public groups and personal distribution lists on their own, which saves IT from having to administer groups,” says Murphy. “We have also implemented better controls so that groups can include only employees.”

For the 20 physicians who do not use the hospital’s e-mail system, the process of forwarding e-mail to another account is a single setting in Exchange Server. “Most junior people on our security administration staff can handle it,” says Murphy.

HCMC will realize additional efficiencies after it deploys other products in the Enterprise CAL Suite. For example, the hospital plans to deploy a unified messaging solution with Microsoft Office Communications Server 2007. As a result, users will have access to instant messaging and a single inbox to manage e-mail, voice mail, and faxes.

System management will become easier when the hospital deploys an integrated system administration and virtualization solution. “We are currently testing Microsoft SoftGrid® Application Virtualization, Microsoft System Center Operations Manager 2007, and Microsoft System Center Configuration Manager 2007,” explains Murphy. “These tools integrate well with the rest of our environment, and so far the tests have gone very well. With the increase in reliance on computer systems at HCMC, due to the implementation of e-mail and an electronic health-record system, we in IT need to get a lot better at monitoring and managing availability, capacity, and performance quickly. System Center Operations Manager and System Center Configuration Manager are best suited to provide us with those capabilities.”

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For more information about CDW Berbee products and services, call (888) 888-8835 or visit the Web site at:
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For more information about New Horizons of Minnesota products and services, call (888) 236-2462 or visit the Web site at:
www.nhmn.com

For more information about Hennepin County Medical Center, call (612) 873-3000 or visit the Web site at:
www.hcmc.org

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Document published June 2008