Advocate Health Care is the largest healthcare provider in Illinois. With employees in multiple locations, Advocate wanted to improve its messaging technology to make sure that clinicians and employees could communicate clearly, quickly, and accurately. It decided to unplug its Sun iPlanet email servers and give nearly 29,000 employees subscriptions to Microsoft Exchange Online, a cloudbased email service that is part of Microsoft Online Services. Advocate gained instant access to the latest email software and a foundation on which it can add technologies that contribute to better patient care. Plus,it avoided spending U.S.$4 million on a new email infrastructure. By halving email management work, the IT staff has more time to spend rolling out additional communications technologies. With email running in Microsoft data centers, Advocate has minimized opportunities for business interruption.
Advocate Health Care is the largest healthcare provider in Illinois and one of the top 10 health systems in the United States based on clinical performance, according to information company Thomson Reuters. Advocate operates more than 250 sites of care across metropolitan Chicago, including 10 acute-care hospitals, 2 children’s hospitals, 5 level-I trauma centers, a home health services company, and one of the region’s largest medical groups. As a not-for-profit, faithbased health system, Advocate contributed more than U.S.$462 million in charitable care and services to communities across the Chicago metropolitan area in 2009
For the past several years, Advocate has grown through acquisition and now employs 30,000 people. To help integrate healthcare professionals and other employees spread across a continually growing geography, management made a strategic decision to upgrade and modernize the company’s communications infrastructure. Specifically, it wanted to embrace unified communications (UC), whereby telephony, email, instant messaging, text messaging, video conferencing, and other communications services are connected through an easy-to-use interface. The goal was to provide the best communications medium in any given situation, with minimal integration effort and maximum ease of use. “Prompt, unambiguous communication is critical in healthcare,” says Rance Clouser, Director of ERP and UC Applications at Advocate Health Care. “Research shows that when death or a severe outcome occurs, almost two-thirds of the time communication is identified as the cause, or one of the key causes.
But even employees in operational departments work together all the time and need fast, flexible, accurate communications.” Before it could proceed with its unified communications vision, Advocate needed to replace its 10-year-old Sun iPlanet email system. “As we researched UC, it became very clear that we first needed a solid email and calendaring platform,”
Clouser says. “We learned that many UC vendors had integration with Microsoft Exchange Server but not with the product we were using.” The older iPlanet product had limited email functionality, poor calendar-sharing, no collaboration capability, and a limited ability to access messages from mobile phones. Employees maintained and constantly updated what Clouser calls “cheat sheets” to record colleagues’ availability, which they used to schedule meetings. As new employees joined Advocate, IT staff heard constant complaints about the company’s email system and the recurring question: “Why can’t we use Outlook?” [referring to the Microsoft Office Outlook messaging and collaboration client]. For years, teams at Advocate had discussed moving off iPlanet, but the cost of replacing its messaging infrastructure made the switch cost-prohibitive and would end the discussion.
In mid-2008, Advocate asked Clouser to head a team tasked with moving the company to a new messaging platform on which it could start building UC services. The team was particularly interested in investigating the trends in cloudbased messaging services. By running its applications in the cloud—that is, in third-party data centers and accessed over the Internet—the company could eliminate the need to invest in an expensive on-premises messaging infrastructure. Clear Winner Advocate evaluated four cloudbased messaging systems, including Microsoft Exchange Online, part of the Microsoft Business Productivity Online Standard Suite. Exchange Online is a hosted, enterprise messaging solution based on Microsoft Exchange Server 2007 that provides web-based message access, 25 gigabytes (GB) of mailbox storage per licensed user, and financiallybacked service-level agreements.
In addition to Exchange Online, the Business Productivity Online Standard Suite includes Microsoft SharePoint Online for collaboration, Microsoft Office Communications Online for instant messaging and presence, and Microsoft Office Live Meeting for web conferencing.
After an in-depth evaluation and pilot program, Advocate selected Exchange Online. “Exchange Online was the clear winner, based on a scorecard of features and functions, but it also fits better strategically in our organization,” Clouser says. “When we buy a hospital, there’s a much higher likelihood that it is going to be running Exchange Server than any other messaging software, which would make the migration to our infrastructure easier. Exchange Online is more scalable, supports ongoing growth in unified communications, and is rated higher by third-party analysts.”
The Advocate team deemed the other contenders too “lightweight” for enterprise use—insufficient scalability, no ability to organize email messages into folders, and/or poor calendar coordination. “We just didn’t feel that the others were sufficiently robust to support an organization of our size,” says Clouser. Toward the end of the evaluation, the Advocate technical team visited the Microsoft Technology Center (MTC) in Chicago for a one-day strategy briefing. There, Microsoft experts were able to answer questions about how the solution would be architected, migrated, and supported. “This session was really valuable in selling our technical team on the service,” Clouser says. “With a migration of this size, naturally there were concerns, and the people in the MTC were able to resolve them.” Detailed Migration Plan For help in migrating 29,000 mailboxes to Exchange Online, Advocate brought in Slalom Consulting, a Seattle-based Microsoft Gold Certified Partner. “We compared Slalom with three other vendors, and Slalom brought a more holistic approach to the migration, covering user education, a detailed migration strategy, and the impact on the organization from a changemanagement standpoint,” Clouser says. Slalom became the intermediary between Advocate and Microsoft, escalating issues and brokering solutions. Slalom built custom tools to migrate mailboxes from the older email program to Exchange Online, and it resolved other needs such as syncing Exchange Online to users’ BlackBerry smartphones.
In January 2010, Slalom migrated several pilot groups to Exchange Online. After incorporating lessons learned, it then began migrating remaining mailboxes in waves, staging two migration groups of approximately 500 to 2,000 mailboxes each week from January through June 2010.
One of the most useful services that Slalom provided was creating a user and site readiness plan to help Advocate employees make the switch to a new email program. “We created a site readiness plan that Advocate gave to each of its hospitals. Hospital staff simply provided details on the users being migrated, such as total number of users, whether they were users of Office Outlook or the web-based Microsoft Outlook Web App, mobile device information, mailbox sizes, and organizational alignment. Slalom sent email messages to employees weeks before their migration, letting them know about the switchover, telling them about the new features they would enjoy, and explaining where they could find support. On the day of each hospital’s and office’s migration, Slalom had support staff on hand to answer questions and help users set up their mobile devices. Within six months, Advocate and Slalom successfully migrated 25,000 employee mailboxes to Exchange Online. The company also licensed another 5,000 mailboxes to use for group mailboxes and other needs. Mobile Mail Access and More For executives and heavy email users, the IT staff deployed Microsoft Office Outlook 2007 to their PCs; all other employees access Exchange Online over the web using Microsoft Outlook Web App. Advocate employees love the new ability to access email messages from the mobile device of their choice and see one another’s calendars. Another huge feature has been calendaring.
Employees can now throw away their scheduling cheat sheets and see free/ busy information for colleagues.Other favorite features include increased mailbox size and the ability to access email messages any time, from anywhere. As for the impact on IT staff: “The shift to online email means less messaging work for our staff, plus cloud-based archiving and malicious software protection,” Clouser says. “Plus, it allows them to focus on developing higher-value skills.”
Advocate licensed Microsoft Exchange Hosted Archive, which provides a cloud-based email and instant message repository to help organizations manage retention, compliance, e-discovery, and regulatory requirements. Storage is unlimited and can be used for retention periods of up to 10 years. Advocate also uses Microsoft Forefront Online Protection for Exchange, included with Exchange Online, which provides filters and virus-scanning engines to help protect against spam, viruses, and phishing scams. Clouser says that employees using Office Outlook have taken the initiative to connect that program with other applications in areas such as customer support. “They have figured out that they can send an email message to a customer from within other applications, which eliminates the need to jump between programs throughout the day,” he says. “This will be valuable as we bring in more UC products. We want to start layering technologies by linking email with collaboration, instant message, video conferencing, and other programs.”
By migrating to Microsoft Exchange Online, Advocate Health Care has gained a robust foundation for building unified communications features that will enhance communications and ultimately strengthen patient care. Plus, by eliminating the need to upgrade an on-premises email infrastructure, Advocate avoided spending $4 million over six years. The IT staff spends far less time administering email and Advocate enjoys improved business continuity.
Foundation for Unified Communications and Better Patient Care By abandoning its aged onpremises iPlanet infrastructure and switching to Exchange Online, Advocate is able to move forward with its UC vision. “With Exchange Online, we can create a unified communications infrastructure that will help our healthcare professionals communicate quickly an accurately,”
Clouser says. “This contributes to better patient care.” Because Exchange Server is so widely used for enterprise messaging, it provides broad interoperability with a wide range of products. “UC is very much in a hybrid state,” Clouser says. “The value of Exchange Online is that it enables us to plug in UC components from other vendors.” For example, the company is working to install a thirdparty meeting room–based video conferencing system in each of its hospitals, where doctors can discuss diagnoses and medical outcomes with colleagues in other Advocate hospitals. This conferencing system will pull presence and employee location information from Exchange Online and Active Directory Domain Services. “We could not deploy this product on top of iPlanet,” Clouser says.
In routine communications, Advocate employees save time setting up meetings. “What used to take hours per day for an inpidual to schedule meetings has been reduced to minutes,” Clouser says. “Multiplied by 30,000 employees, the time savings is huge. Some administrative assistants spent virtually all their time scheduling meetings for others. These people can now focus on higher value tasks.”
Cost Avoidance of $4 Million over Five Years Advocate also avoided spending about $4 million by deciding not to replace its on-premises email infrastructure. “Compared to what we would have paid to create a modern on-premises infrastructure, we are realizing a cost avoidance of $4 million over a five-year period by moving to Exchange Online,” Clouser says. “In this economy especially, that savings is significant.”
The ability to transfer messaging costs from the capital expense column to its operating expenses is also significant. “We have an annual capital budgeting process, and there’s stiff competition for capital funding,” Clouser says. “With Exchange Online, email is now part of the operating budget of each site, where it belongs, and the sites also have more control over their email accounts.” Email Management Time Halved IT staff members who used to manage email are now able to spend time on more important things, such as deploying the meeting-room video conference system and other UC components. “Our messaging infrastructure is gone,” Clouser says. “We don’t have to be concerned about replacing, upgrading, or maintaining email servers or software. We used to have four people managing email, and now we have two.” As an additional benefit, the Exchange Online migration was a big success for the Advocate IT staff, generating the goodwill needed to push on with other UC initiatives. “We earned a huge ‘gold star’ from employees with the move to Exchange Online,” Clouser says. “We gave users what they wanted and delivered it glitch-free. We hear all the time about how much employees like this new service. It’s really positioned us well to proceed with new UC services.”
Enhanced Business Continuity Last, but certainly not least, Advocate has a level of email security and reliability that it did not have before. “We have a true disaster recovery solution and a level of business continuity that we didn’t have before, and we don’t have to think about,” Clouser says. “Our email is protected in Microsoft data centers with financially backed servicelevel agreements and performance guarantees. For a mission-critical service like email that always has to be on to deliver quality patient care, this is a valuable assurance.”