Clinical staff at ULSTMAD have more time, less stress with Azure API Management

When Storm Kirk tore through Portugal in October 2024, trees fell across roads and thousands of people lost electricity. The winds were so strong they even sent a crane toppling onto four buildings, including a house.

The country’s largely rural northeast was among the worst affected regions. The chaos there threatened not only to increase emergency admissions but also to disrupt the local health authority’s other services. Medical staff at one of their primary care facilities lost access to broadband internet during the storm.

Until recently, this would have prevented them from viewing or updating patient records and accessing other crucial systems. But thanks to a recent switch to Azure Virtual Desktop (AVD), staff were able to log in using mobile internet.

“With the old system you couldn’t use phone data because you needed a VPN and it required too much bandwidth, plus each machine had to have quite bulky applications installed,” says Victor Costa, ULSTMAD’s Director of Information Management Services.

Today, staff can securely access centralized records from any device without a VPN, and the bulk of the computing and processing happens in the cloud.

The Trás-os-Montes e Alto Douro region has a dispersed population of around 380,000, many of whom are elderly and have limited access to public transport. Last year, its physicians and nurses made over 100,000 home visits.

This means that, even during calm weather, the new virtual desktop makes the lives of clinicians much easier.

“There were times before when staff hadn't installed an update on their machine so they couldn’t access the system and couldn’t work,” Costa says. “AVD solves a lot of these technical problems and reduces stress. I think anything we can do to give medical staff more freedom is worthwhile.”

The virtual desktop is part of a broader transformation at ULSTMAD, one in which technology is helping to “bring healthcare from inside the walls of care facilities and out into the communities where patients live,” Costa says. This, in turn, is part of its mission to put the patient at the center of its operations.

Among other changes, the healthcare provider has moved its medical imaging storage into a hybrid cloud environment, connected disparate legacy systems to create an integrated overview of patients, and achieved a holistic view of the security status of its connected medical devices.

It’s a level of digital maturity that some might not expect from a smaller, rural operation. But Costa says the challenges posed by ULSTMAD’s size and location are precisely the reason it is so forward thinking.

“When you don’t have resources, and when it’s difficult for patients to travel to you, you need to do things differently to get results,” he says. “You also need to create new ways to attract professionals who might otherwise go to work in big cities.”

This transformation has been supported by the Microsoft Unified team, which worked closely with ULSTMAD.

Clinical staff have more time with patients

Perhaps the most remarkable change ULSTMAD has made is to create a dashboard that provides an array of real-time information about patients all in one place. The dashboard collates data from various legacy systems using Azure API Management and Power Apps.

“The big problem in hospitals is legacy systems; we have a lot of channels with different software and structures, so there are interfaces spread across many servers and applications in a very complex way,” Costa says. “We wanted to simplify this.”

The dashboard is visible on monitors in nurses' offices, as well as via Azure Virtual Desktop on staff members’ devices. It automatically updates with notifications about, for example, the number of beds available, patients’ oxygen levels, the severity of their conditions, and whether or not they need a wheelchair.

Before this information was brought together, clinical staff spent a lot of time logging in and out of systems to check information about patients, and if they were too busy to do so they might be left in the dark.

“Nurses might be on the ward talking to patients and not know that a physician has issued a new prescription,” Costa says. “If they didn’t log into the system they wouldn’t see it. It was very time consuming for professionals to always be in front of a monitor—and a lot of work. Healthcare professionals are badly affected by burnout from using these systems because it’s so heavily regulated. You need to register everything.”

Costa’s team is surveying clinical staff about the impact of the new dashboard, and he is confident that the results will show it has reduced burnout and saved time.

This in turn is likely to have a positive impact on patients. “If clinical staff aren’t stuck in front of monitors, they have more time to spend with patients or more time to spend thinking about their conditions, which improves the quality of care,” Costa says.

“I think this is one of the most important changes we’ve made in recent years,” he adds. “This is the role technology should play and it’s one of my main goals in this job: to reduce the amount of pressure professionals are under, remove problems for them, and give them more freedom. And we need to give them that freedom without increasing risks.”

IT team freed up to work on projects with clinical experts

A similar philosophy applies to non-medical staff: the less time the IT team needs to spend on routine maintenance and repetitive tasks, the more they can use their expertise to help tackle clinical challenges.

“Our long-serving staff are very valuable to us,” Costa says. “We can’t just hire someone with institutional knowledge about ULSTMAD from the market; it takes years for them to develop that. The IT team here is not very big and if we have a lot of things to do, we can’t be as effective, so being able to streamline things like infrastructure and security is very important.”

One key way the team has been able to do this is by offloading the storage of medical imaging to Azure as well as managing their on-prem infrastructure in a centralized way using Azure Arc.

Before 2020, images such as X-rays and CT scans were stored on premises. The Covid-19 pandemic brought an influx of patients and a large increase in the amount of imaging that ULSTMAD processed, which triggered the move to the cloud.

Medical imaging files are very large, and hospitals are not allowed to delete them because of laws governing medical data. “Even after a patient dies we have to keep them,” Costa says.

Processing more than one terabyte of images on premises created a lot of work for the IT department, while the new streamlined system has made things easier to manage.

During the transition to the cloud, it was crucial to ensure sensitive files were protected, so the team used Defender for Cloud to create a centralized view of its security landscape.

“We couldn’t correlate different sources of security information before, but Defender for Cloud gave us the opportunity to integrate everything,” Costa says. “If you open the doors to the outside by making things available on more devices, you increase the risks, and it’s very important to us that the only risks we need to focus on are related to users’ behavior, and not anything technical.”

In 2021, the team connected all of ULSTMAD’s medical devices, from blood pressure machines to heart monitors, to Azure Log Analytics, which enabled them to view the devices’ logs centrally and prevent malfunctions with predictive analytics.

Greater simplicity means that IT staff can turn their attention to working on new projects in partnership with clinical experts.

“Security consumes a lot of human resources and if you cannot create automation and simplify, your team will just be stuck on a treadmill and unable to think about bigger ideas,” Costa says. ULSTMAD uses Microsoft Sentinel’s SOAR capabilities to simplify security operations.

“For me, the IT team should be leading projects and creating solutions with professionals,” he adds. “Infrastructure and security are equally important, but I prefer to see them applying their expertise in the clinical area, because that ultimately benefits the patients.”