St. Luke’s delivers exceptional, scalable service for providers and patients with Epic on Azure

Embracing technology to deliver better healthcare

St. Luke’s University is a regional, non-profit network of more than 17,000 employees providing services at 14 campuses and 300+ outpatient sites. Its leadership takes a forward-looking approach to technology, and this innovative spirit has been nationally recognized. All of its network hospitals have received a top-tier Stage 7 designation from HIMSS Analytics in recognition of their extensive and creative use of electronic health records to improve service, boost quality, and make care more affordable.

Moving to a cloud-first computing model has been an essential piece of the St. Luke’s digital transformation strategy, and the organization chose Microsoft Azure as its trusted cloud platform. “Azure was a natural fit because it helps us become more mobile and more agile, and it has comprehensive, constantly evolving, built-in security features that extend what we can do on our own to protect our millions of patient records,” says Chris Brutschea, Associate Chief Information Officer at St. Luke’s University Health Network. “It also ties in well to the rest of our Microsoft ecosystem.”

One of the most important applications that St. Luke’s uses—if not the most important—is the Epic healthcare system, which accounts for approximately one-quarter of the organization’s IT footprint. “Epic is our core electronic health record for all patients,” explains Brutschea. “We use Epic to track interactions between patients and providers along with billing. It’s an electronic version of what used to be a paper chart.”

With Epic, all St. Luke’s stakeholders have real-time access to data, which has revolutionized providers’ ability to interact with patients. Because Epic is so central to service delivery throughout the network, moving Epic to Azure represents a vital component of the overall cloud transformation—one the organization has approached thoughtfully.

Moving Epic to Azure, from planning through migration

St. Luke’s has been using Epic on-premises since 2015 and began looking at moving Epic to Azure in 2019. Following a slowdown precipitated by COVID-19, the actual migration began in late 2020. Before starting the migration, St. Luke’s assembled a team that included its own staff along with representatives from Microsoft and Epic to evaluate the task and lay out an appropriate plan. “Everyone worked collaboratively, which has been a key to our success so far,” says Brutschea.

The team developed a phased migration plan for Epic, starting with low-impact systems that wouldn’t adversely affect day-to-day operations if there were any problems. St. Luke’s migrated its non-production, test, and training environments before starting to work on production environments. “In order to minimize risk, we peeled it back and took a cautious approach,” says Matthew Woodruff, Systems Architect at St. Luke’s University Health Network.

From the early planning stages for moving its Epic architecture to Azure, St. Luke’s built disaster recovery into every decision and continued that thorough approach each step of the way. St. Luke’s has carefully chosen the virtual machine (VM) series to use in Azure and plans to upgrade the VMs over time to take advantage of increased power and capabilities. “With Azure, we can continue to rightsize our cloud investment, and we gain access to the latest technology as soon as it’s available,” says Woodruff. “To me, that’s a huge advantage.”

St. Luke’s uses Azure ExpressRoute to link to the East US and North Central US Azure datacenters, relying on the high-throughput connections to transfer Epic production cache databases as large as 28 terabytes to Azure. Once the data moves to one Azure datacenter, St. Luke’s can easily restage it to an additional datacenter using Azure Storage Explorer. 

“Storage Explorer makes it easy to migrate managed disks between regions,” explains Woodruff. “I copied all the data from the East US region to North Central over the Microsoft backbone in about 18 hours—I started it up, came back the next day, and it was done! Knowing that my data is now so geographically diverse compared to on-premises is a big deal.”

St. Luke’s also uses Azure NetApp Files as part of its Azure-based Epic architecture to gain functionality the organization lacked with standard file shares. It uses multiple performance tiers within Azure NetApp files, according to the particular needs of an operation. That way, it doesn’t have to use the same Azure resources to do simple backup partitioning as it would to manage large databases, for example.

From a security perspective, St. Luke’s also rests easy knowing that it is well insulated against the effects of malware, ransomware, and other threats thanks to Azure Backup. “Azure Backup has nightly snapshots of all the VMs, and I can just roll them back in one easy step,” says Woodruff. “We’ve tested all that and it works well, which is key for us on the security front. We’ve also partnered with Rubrik to back up the operational database using Rubrik’s Cloud Data Management product running in Azure.”

St. Luke’s has a total of 20 environments in Epic and has successfully migrated all of them to Azure, including the production reporting environment and its related resources. The final migrations happened in December 2021.

Surveying the benefits of Epic on Azure and looking to the future

Azure has proven to be an excellent cloud platform for St. Luke’s to run Epic, and it also provides synergies with other Microsoft products that the organization uses, like Microsoft Teams.

“We want to consolidate our IT systems around a single vendor as much as possible to minimize our application count, reduce costs, and decrease support complexity,” says Brutschea. “By moving Epic to Azure, we get interoperation with Teams, which is becoming our core communications platform. Those sorts of opportunities really help us improve our operations.”

As St. Luke’s continues to grow, having Epic on Azure will provide the scalability and agility the organization needs to respond quickly to market changes, along with a host of other benefits. “We’re looking at cost savings, IT management savings, more-efficient processes, and better performance,” says Brutschea. “We also get transparency into the application and how it is being used—how many people are using Epic, who they are, and when they access it. That will help us better manage our expenses and plan future enhancements.”

For IT staff, running Epic on Azure means that St. Luke’s can integrate newly acquired organizations in record time. “If the CIO comes to me tomorrow and says we’re going to buy three more hospitals and need capacity for another 3,000 employees, I can turn that on with a click of a button on Azure,” says Woodruff. “We no longer need to wait three months to get quotes, procure hardware, set it up, and configure it. We have a six-person core technical team doing this work, and the easier we can make their jobs, the better.”

St. Luke’s feels confident that having Azure serve as the source for its millions of patient records in the cloud will ultimately make its caregivers more efficient and help them provide the exceptional level of patient service that is the network’s standard. “With Epic on Azure, we’ll be able to address our providers’ needs more quickly and give them a system that is highly secure, extremely efficient, insightful, and responsive to growth,” says Brutschea. “We look forward to continuing on this journey with Microsoft and finding new ways to use Azure to gain value from Epic and make life better for our employees while delivering improved experiences and care quality for our patients.”

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