Community healthcare provider safeguards key system and cuts costs with Microsoft Azure

Community well-being in the Pacific Northwest 

Legacy Health wants to be essential to the health of its local community. With 13,500 employees, Legacy Health is one of the largest community-owned, nonprofit healthcare systems in the Portland, Oregon, area. Comprising hospitals, clinics, and medical facilities, the system serves one of the largest shares of Medicaid and Medicare users in Portland and is among the top private employers in the metropolitan area. 

For Legacy Health, being a community healthcare provider means caring for people not just when they’re in need, but also providing preventative treatments to ensure ongoing well-being. And that requires consistent, barrier-free access to medical records and other clinical data. With Microsoft Azure, Legacy can now provide always-on availability to vital patient information.

Avoiding disaster

Legacy Health uses an electronic medical record (EMR) system from Epic to support clinical performance, to provide easy and consistent access to the medical records of every Legacy patient, and to safeguard their private information. The health system needs to defend the accessibility and reliability of its Epic system against disaster—everything from a mega-earthquake on the Cascadia subduction zone to user error or equipment malfunction. So, Legacy began modernizing its disaster recovery (DR) environment to help eliminate unnecessary downtime.  

“To make sure Epic is always available to everyone, we needed a completely separate disaster recovery infrastructure outside of our geographic area,” says Jeff Olson, IS Technical Director at Legacy Health. “By moving DR to a product like Azure, we could meet that need without the common hardware and software issues of hosting a solution ourselves.”

At the same time, Legacy wanted to replatform the Epic system, upgrading and moving it to a virtualized colocation environment. The shift to a modern platform and a cloud-based, live hybrid and DR environment would free Legacy to concentrate on healthcare instead of IT complexity. 

“Before, we were basically managing everything—the servers, the software, the heating, the cooling, the generator—even ordering diesel for generators,” says Olson. “We created the opportunity to focus on the core business and value-added services instead of all the time-consuming base infrastructure—all by moving our disaster recovery to a product like Azure.” 

One of the world’s first Epic on Azure implementations 

Using Azure Virtual Machines, along with Azure Storage and Azure Backup, Legacy Health built a new, fully redundant live hybrid and DR environment for its Epic system, with higher-tier storage on managed instances of Azure SQL Database. It moved more than 22 terabytes of data, 100 servers, and several production services to the best-in-class Azure solution in just 11 months—an entire month ahead of schedule. 

“We needed all this to happen quickly,” says Olson. “We didn’t have time to procure new hardware or connect with another colocation host. By using a product like Azure, we made everything happen even faster than we had hoped.” 

In production, the core Epic operational database (ODB) runs in the virtualized colocation environment. A Citrix user interface runs redundantly in both the colocation and the Azure DR environment. So depending on demand and load, users access the Epic ODB through either the colocation or Azure front end. With Epic running through Azure, the system can now support 7,700 concurrent users, with about 1,000 production users accessing the Citrix active-active front end through Azure.

Maximum flexibility at low cost

By supporting its Epic environment with Azure, Legacy Health can configure its EMR system to meet the exacting demands of the healthcare industry. What’s more, the nonprofit can now spin up new resources almost instantly, avoiding the huge outlays involved if it had kept its DR systems solely on-premises. 

“With Azure, we leverage the cloud and continue to use the third-party DR systems and security tools that are vital to our organization,” says Olson. “We are able to spin up resources in a few hours instead of months, and we’ve reduced the operational costs of disaster recovery by almost 65 percent. We essentially avoided a half-million-dollar capital purchase.”  

With its modernized live hybrid and DR solution, Legacy has significantly improved the reliability of its EMR system, which means easier access to medical records, better patient care, and better outcomes for those in need of help. Legacy now plans to use Azure for other healthcare applications, including its patient-facing services. 

After the success of the EMR disaster recovery project, Legacy Health plans to support other tier-one systems with Azure. It will be adding more disaster recovery capabilities using Azure Site Recovery, moving more production applications to Azure, and using the analytics and machine learning functionality in Azure to enhance its business intelligence capabilities.

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