Episode 14: Visionary Voices with Allen Coleman

Larry Kaiser:Hello, and welcome to this episode of Visionary Voices. Today, we’re joined by Alan Coleman, Senior Director at Duke University Health System.

For those that don’t know, Duke is a world-class academic and healthcare system based in Durham, North Carolina, that strives to transform medicine and health locally and globally through innovative scientific research and a rapid translation of breakthrough discoveries. Alan has been at Duke for over 33 years, which is pretty incredible, where he’s responsible for the oversight of integration services, enterprise services, application services, and clinical application support. And additionally, he manages the modernization of Duke Health’s clinical and enterprise application portfolios, which includes cloud adoption.

Which is the topic of our conversation today. I’m also joined by our very first repeat guest, Optimum’s Senior Vice President of Cloud and Digital Transformation, Curtis Hendrick. So today, like I said, we’re gonna be diving into cloud transformation and Duke’s Microsoft Azure journey.

Alan and Curtis, thank you for joining the podcast today.

Allen Coleman: I’m welcome to be here.

Curtis Hendrick: Thanks, Larry.

Larry Kaiser: Alright, so we’re going to dive into our first segment, which all of our listeners know we call Bandwidth Banter, and it’s our fun take on icebreakers. It allows us to get to know our guests a little bit better. So Alan, I know living in Durham, North Carolina, you have to be a NASCAR fan, so I’d love to kind of, you know, are you a NASCAR fan, and, you know, what’s your… who’s your favorite driver?

Allen Coleman: Yes, from… being from North Carolina, right outside of Charlotte, but now in Central North Carolina, where Duke is at in Durham, I am a NASCAR fan, and I’ve had several favorite drivers over the year, but right now, the one on the circuit would be Chase Elliott, car number 9.

Larry Kaiser: Very nice. I had the privilege this year of actually going to the Daytona 500, which was a whole different kind of experience, and I got to experience it on the Spire Motorsports Hospitality Trailer, where I got to stand in the middle. of the entire racetrack, and basically got a 360 view of the entire track.

And it was the first NASCAR race I had been at since I was probably… 17 or 18 years old, and it was quite the experience at Daytona. There are some loyal fans there.

Allen Coleman: Absolutely. I’ve been to, actually, Daytona twice. Interestingly enough, right behind the backstretch is a, runway airport, and the president visited that time.

It was President Bush, and so I saw Air Force One land and take off. For the Daytona 500 there, so it was very great.

Larry Kaiser: Cool experience.

Allen Coleman: But, you know, that’s a two and a half mile track. It’s, really cool to go to a 1.5 mile track, which is the one that’s in Charlotte. You can go to Bristol Motor Speedway over in Tennessee, which is a half-mile track, and the one up in Richmond is a three-quarter mile track.

All of these tracks have different types of personalities, and it is great to see, the racing happen side-by-side in there.

Larry Kaiser: It’s pretty exciting. Pretty exciting. Alright, so then one other question, do you have a favorite movie?

Allen Coleman: You know, one of the movies that I would draw back on, which is an older movie, and it’s called Down Periscope, it’s a comedy. With Kelsey Grammer as the star of it, and I think it’s a little bit related to what we’re talking about today. And he is presented with… he wants to be a submarine captain on one of the top nuclear submarines, and he’s given a diesel submarine.

He’s also sort of given a misfit of staff in order to run it. But as you go throughout the movie, you actually love to learn that they are all coming together, they all have their personalities, they all have their strengths, and if they only work together, they can overcome the challenges and be able to do great things, which they did. And I think that’s totally relatable to what we want to talk about today with our cloud journey.

Larry Kaiser: Very nice, very nice. Well, thank you for that. Alright, so as I said in my introduction, Curtis is our first repeat guest on Visionary Voices, and Curtis, last time you were here, we had a rather entertaining conversation.

Around, a very funny and enjoyable episode of The Office called Scott’s Tots. And it’s literally two days after we talked about it, it was actually on TV, so I got to watch it again, so I got a good laugh out of that. So now that you’re back on the show, I’d love to know, are there any other episodes of The Office that tickle your fancy?

Curtis Hendrick: Yeah, yeah, and Scott Stotz is, like, the only one that my wife won’t watch because it makes her feel so awkward to watch, whatever happens on that show, but… I will say, the other one that’s a huge favorite of mine, I think it’s called First Aid Fail. It’s the one where Dwight sets a fire in the intro scene, and then he’s gotta do, like, the whole safety training, the CPR, where he cuts the face off. That one gets me every time.

And actually, fun fact, I did read recently that, someone had said that they saved someone’s life because they knew the speed to do CPR based upon watching that episode and the song that was taught during it. So, and that’s, like, one case where I guess that episode saved someone’s life. So, that’s another reason why I would say it’s, it’s a top favorite for me, for sure.

That’s my sense of humor, though. That fits my sense of humor quite a bit there. It’s, it’s great.

Larry Kaiser: I have a rather relatively warped sense of humor as well, so I appreciate that episode. But I believe he did see Pierre Staying Alive, right?

Curtis Hendrick: He did, yeah, yeah.

Larry Kaiser: Okay, okay, yeah. So, yeah, there’s, I can watch The Office every day, all day. It’s such a great show.

It relates to everything we do in business. That’s the best part. What you want to do or not want to do, I should say, so…

Curtis Hendrick: Fuck.

Larry Kaiser: Good times. So if anybody’s curious, you can always talk with Curtis about the office, wherever you see him in trade shows across the country. So all right, cool.

Hey guys, I appreciate, some, some levity there. It’s always a good time to learn more about our guests. So, anyway, today, like I said, we are talking about Duke’s, journey with Microsoft.

So, Curtis, you are leading today’s conversation, so the mic is yours, and enjoy the conversation, everybody.

Curtis Hendrick: Thanks, Larry. Appreciate the intro, always enjoy the conversation. All right, Alan, so the thing that I want to start with is kind of the journey, and we phrase this in a way as… I use the term journey because it seems like it’s this long, kind of.

Overall thing where you’re not… it’s not like there’s a start and a finish always to these efforts, but it does seem like it’s this progressive thing, and it kind of weaves and turns along the way. But I would love for just the audience to hear a little bit about the journey that you guys have been on. What have you guys done so far with your cloud journey?

What’s kind of coming next? You know, what are the successes, maybe, that you’ve had in your cloud journey? We’d love for just the audience to kind of hear where you’re at right now.

Allen Coleman: you know, I appreciate that, Curtis. You know, where… It is a journey, and we know that where we’re at, where we started at, and where we’re at today, we are much down the road, but we have a long ways to go. And ultimately, if you think about the three phases, or the three major parts of Duke’s mission that they want, is we want to provide the best patient care, education, and research.

And being able to leverage the compute power and technology and capabilities that the cloud has to offer has different advantages for all three parts of those particular missions. On the healthcare side of the house, on the patient care facing side of the house, we are starting our journey with Epic DR, having a footprint inside of what I’ll call our Duke Azure Cloud. And then, in our research area, in our analytics area, we are building capabilities that we have in order for us to be able to process large data sets, be able to house those large data sets.

that it’s harder to do with on-prem services, with those capabilities. And then lastly, but not least, and I think our education mission goes for both of those as we are training future leaders. But lastly, as Duke continues to grow, we recently purchased and integrated an additional hospital into our system.

Is we want to be able to have the flexibility and agility to be able to bring compute services across a larger geographical area at a faster pace.

Curtis Hendrick: Yeah. Yeah, that makes a lot of sense. We hear kind of very similar, circumstances in data analytics, the resiliency of the cloud, the elasticity of the cloud to be able to help organizations, and I think, you know, kind of the story that you’re highlighting there is, is that, you know, you guys are highly rationalized in the sense of you’re figuring out where is the characteristics of cloud provide you the value and actually differentiate something that, compared to the way that we used to do it, I mean, we’ve been doing it the way on-prem and data centers for 20, 30 years, right?

And before that, with mainframes. And so. You know, kind of with that spirit in mind, I am also curious, you know, kind of the… you guys clearly went through kind of an analysis phase, kind of trying to figure out the value proposition of cloud, and where is there value, and how does that… how do you materialize and actualize that value?

But in a lot of ways, you guys have moved from the analysis phase to the action phase. I mean, I know you’re still doing some analysis for what’s next, which is appropriate. But I’m kind of curious for those that are maybe in the audience listening.

What is it that was the tipping point that moved you from kind of this discovery, analysis, you know, perspective to, alright, it’s time to pull the trigger, let’s go?

Allen Coleman: I think there’s some convergence of several different things that came together. One of them is, and you’ve referenced this in your other comment right before this one, is your on-prem data centers, or your colo data centers versus cloud data centers that you have. is what is the capabilities that we have out of those data centers?

We know that as analytics gets better, as we get these bigger data sets with AI, large language models. We need more compute power, and it’s harder to do that in your on-prem data centers than it is in the cloud to be able to give flexibility there. So I think that’s one of them, is to saying, as we are saying, you know, do we have enough power?

Do we have enough cooling? Do we have enough space in order to handle more compute power workloads? I think that’s one.

Number two has to do with supply chains. Being able to procure. Compute power and actually get it installed in your on-prem data centers is a longer time versus being able to say, how can we be faster to market?

With being able to have the cloud. And I will say there, and I, you know, Curtis, I know that you’re going to probably touch on this later with a future question, is that, you know, we do have a sense of being able to be realistic about a hybrid approach, meaning that there are certain things that we need to stay on-prem. For various reasons.

and then be able to leverage the cloud when appropriate. So, I think there’s an appropriateness that we have between the two. I don’t think one goes over the other in our particular use case that we’re looking at.

Curtis Hendrick: That’s great. Yeah, one of the things you hit on that kind of reminds me of, you know, another customer I’m working with, too, they made a decision to go all in cloud, and we’re kind of doing a retrospective right now of it, and we’re looking at kind of the financials, and, you know, one of the things that has happened over the last, you know, 6 months is the cost of RAM is, in some cases, tripled. And so, you know, they were highlighting, like, look, we weren’t impacted at all, and we had the ability to kind of consume resources where we find, you know, found it most economical.

And, you know, that’s certainly supply chain is something that, just because it’s worked a certain way in the last 5 years or 10 years. doesn’t mean that, you know, it’s not gonna, you know, have some challenges in the future, and there won’t be some cost increases, and with licensing and things like that, right? So, that absolutely makes sense.

Yeah, I think that hits on probably the things that a lot of folks feel. Is true in their space, where they’re always kind of worried about what that next quote’s gonna look like, you know, and how that’s gonna, you know, wreck their budget, or how they’re gonna have to try to figure out how to pay for it. So one of the things that’s always kind of interesting for me is a lot of the conversation around cloud journeys and cloud transformations, we focus on the technology, we focus on the financials and the ROI and things like that.

But I’m really actually kind of curious about the people side of things. I’m curious about your team, your resources. How have they been impacted?

How have they adopted? Have there been resistance? Has there been… you know, talk to me a little bit about kind of how that change has taken place for you guys as you guys have been kind of further adopting cloud.

Allen Coleman: You know, that change has been taking, place over several years now, but it’s affected a larger part of our IT community of recent than it was a couple of years ago. We did start being able to build what I’ll call a foundational cloud team that’s run by one of my colleagues here at Duke. And that has matured over time, and people got into it.

I will say about our overall IT community is the whole gamut of emotions happen.

Curtis Hendrick: People are…

Allen Coleman: They were excited about it, but then at the same time, they were anxious about it. And I think the anxiety goes about it because the current work and our workflow happens That work is not going away overnight, and it truly is, we call it a journey, it truly is a transformational, of how do we get from point A to point B, in order to be able to make the shift of being able to provide IT resources without bringing down one of our service lines that we’re currently offering with that. So I, you know, ultimately, I believe that our IT community has gotten on board with that.

One of the things that falls up under my organization, and it’s more than, than my part of the organization of IT, We run a Center of Excellence, and we have communication channels. We actually, every two weeks, we have a one-hour meeting that has presentations about a variety of stuff. We have a cloud center of excellence that has a theme on that same platform.

We have communication channels, digital communication channels that we’re doing, in order to allow people to engage with one another, and share with people’s journey, and feed off of that energy of being able to get people excited about it. But I will say, though, that the people access ultimately is what’s going to be your success. And you need to be able to get the right people excited about it going in the right direction in order to have that success.

Curtis Hendrick: Yeah, and I would just highlight your guys’ accomplishments in those areas, not only just from, like, an evangelist perspective for cloud and communication and things like that, but as someone that gets to work with a lot of customers, you guys have actually done a phenomenal job of having your team be on board, and your team be, like, engaged and excited about it, and then having just that right level of flow of communication so it’s not a silo. That’s been a really kind of cool and encouraging thing to see you guys be so successful in during this journey. So, kudos for that.

Shifting a little bit, too, about some of the other things I’d brought up, the financials. You know, everybody, at the end of the day, right, if we don’t have any margin, we can’t have a mission in healthcare, right? And so we have to be very cost-conscious.

And so, one of the things we hear a lot with cloud, or customers that are, you know, considering cloud or things like that, is that, you know, cloud’s more expensive. It’s more expensive than you think it’s gonna be, and it’s always gonna be, you know, there’s always this overrunage, and that you gotta just, you know, anticipate it to be a lot more expensive, and I’m curious, you guys have, you know, moved some pretty large and considerable workloads, in your environment. Kind of curious your experience, your perspective on kind of the financial side of it.

Allen Coleman: I think there’s… I think there’s a couple of things there. One of them is if you do what the lift and shift model, which… I’ll put my little asterisk up there. Depending on the use case, that might make the most sense.

But I think in a lot of cases, if we’re saying what we used to run with a data center on-prem, the compute power, if we take that and we put it straight into the cloud, on paper. Is it more than likely going to be more expensive? Probably.

But if you start tuning appropriately. and start saying, you know, how much compute power? Was I over-prescribed on my compute power when I had it on-prem?

Maybe. And you have better tools where you can scale that appropriately. And then secondly of all, do you actually need this running?

Do you need all the resources running, 7 by 24? And if you scale down and scale up appropriately, then I think you can make the financials work. With each system.

Now that, Curtis, as you well know, I’m broad brushing.

Curtis Hendrick: Yeah.

Allen Coleman: And, each particular system and use case needs to be looked at, which is analysis piece of it. And I’ll get to what I think your other part of your question was, is that this is part of the journey of being able to say, what is… why do you want to go to the cloud? And being able to say, what is the impact?

What’s the benefit to the business? And going and selling that to your senior leadership team, and getting buy-in from them, and then working through the process in order to budget appropriately in order for you to start moving workflows To the cloud, with some type of return on investment. And in, Dr.

Jeff Verranti, who leads our department, likes to talk about return on health, along with return on investment, to make sure that we’re impacting the business in the direction that we need to go. I do think that’s important to be able to do it. I will say this right here, and we touched on it when we were talking about just technology in general earlier.

is I’m still in that hybrid mindset, that I do think that there are certain things, especially in the healthcare industry. where you need close proximity and things that are local to that particular site in order to handle that compute power and that technology. And then I think there’s other things that are more appropriate in the cloud.

And you just need to be able to look at how you’re doing it. From both a technology, how you’re impacting what you’re doing as far as providing research or patient care. And then being able to work it out financially, and things will work well.

Curtis Hendrick: Alright, let me ask you one more follow-up pointed question with that. You know, you guys just migrated your Epic DR environment. You have a considerable workload running in there.

I know you did a lot of analysis beforehand. Did it cost as much as you planned? Were you close?

Was it way over or way under?

Allen Coleman: It… I think we were on target, of what… what we thought we were going to spend. We were spending. But this is where, and this goes back to the tipping point that you asked earlier.

Bringing in a partner, making sure that you bring in a partner in order to do the analysis, and making sure that you have your FinOps, which is one of my other colleagues that runs this part of it, set up appropriately. I think is key in order to do that. So I do think that we were on target.

There was no surprises there from our financial, perspective.

Curtis Hendrick: Awesome, excellent. Well, I know that’s probably encouraging for folks that maybe are in the analysis phase, kind of saying, you know, how good are these projections, kind of thing, right? So, you know, why don’t we end on that kind of topic, right?

For your colleagues that are out there that, let’s say, are in the analysis phase, that they’re in the discovery phase, they’re trying to figure out, is this something they should do? Is there value out of it? Is it going to cost more than it actually costs?

Is it really as elastic or as good as people say it is? And, you know, how much of that’s fluff out there? As someone who’s on that journey, has got a lot of that journey behind you, too.

What advice do you have for them? What words of wisdom do you have for anybody that’s a colleague considering this?

Allen Coleman: You know, what I would say is, I think you need to socialize it up and down the chain of your senior leadership team that’s running IT and across your business and clinical stakeholders. to understand, you know, where are their heads at, or what do they think about this, which will give you some type of inkling about what kind of facts do I need to bring to the table if I feel like this is a viable option. Down, at my particular level, at the senior director level.

I think that you need to find some appropriate partners, which I have three. One that runs infrastructure, another that runs the architecture and cloud team, and the third that runs partnerships, along with FinOps, and I think you need to bring that team together, and hopefully you have a good relationship, which the four of us do. Where we can challenge one another, but we’re looking at the situation from different points of view.

in order for us to get better. I think that is a key, to our success, is that I have some of my colleagues that don’t view the same things the way that I view them, and that is a benefit, and we should look at that as a benefit. And then third, being able to start, being able to look at a particular project that says, can we actually take this to the cloud.

And not necessarily call something catastrophic to be able to happen, and see how it plays out. So… To sum it up, Curtis, I would recommend people to get a partner, get alignment at senior leadership level, get alignment at their particular level. Understand your financials in order to do it, and then pick something that is able to start and then do the analysis and go there.

If you sit there and just mull over it, mull over it, mull over it, mull over it, and never start, then all of a sudden you’re gonna wake up one day and be a couple years down the road and decide, you know, we should have started, Two years ago.

Curtis Hendrick: I love one of the things you shared, kind of in the spirit of that, too, is… In our experience, as we’ve helped a lot of organizations through this, going through a large transformation and journey like this will amplify any cracks that exist within an organization, whether they be political tensions, they believe… they be disagreements between senior leaders or things like that, and it’s just so important to get the right buy-in, get the right partnership, right? Have the right business case, have the right analysis. With, you know, there’s a level of confidence behind where there’s kind of a proven track record of analysis.

To be able to make a decision, but, you know, knowing that, we do, we do get to kind of experience a considerable amount of any cracks that exist in an IT organization. when we go through a big transformation, and it’s something to be known… to be known on the front end, and for the, you know, the project sponsor to be aware of, and to be able to help mitigate through the actual journey. So, that’s a great point.

I don’t know, that kind of resonated with me quite a bit, so…

Allen Coleman: I mean, Curtis, you know, to your point there, and you and I have talked about this before, if technology is one of the fastest things that when you try to go and automate something, will bring bad business workflow to the top. It will expose it in a heartbeat. And that’s where you gotta have the emotional intelligence, the resiliency, the good relationships, and collaboration with others in order to work out that and saying, you know, we’re gonna work on this business workflow.

And allow the technology to enable us to be better.

Curtis Hendrick: Absolutely. You don’t want to do worse things faster. Exactly.

Very good. Awesome. Well, thank you, Alan.

I appreciate you joining us here today. Larry, back to you.

Larry Kaiser: Yeah, these are my favorite kind of conversations, because something like, you know, when a guest comes back and gives actionable advice for our listeners to be able to take away and learn from these. So, Alan, thank you very much. Very informative, very educational, and I’m sure our listeners appreciate that.

That does conclude our conversation. Any last thoughts or comments from either one of you before we sign off?

Curtis Hendrick: Well, I just…

Allen Coleman: I just wanted to say thank you, and it was a pleasure being able to do that, and I hope your listeners out there, they are able to, have great success in their cloud journey, like Duke is doing with theirs.

Curtis Hendrick: And I’ll share that if you ever get an opportunity to talk to Alan or his team, or pick their brain on how they do things, you’ll be better for it. So, would absolutely encourage you guys to listen to what he has to say. He’s done a phenomenal job there.

Larry Kaiser: Awesome, I totally agree with that. Alan, Curtis, thank you. To our listeners, thanks for tuning in to this episode of Visionary Voices, powered by Optum Healthcare IT.

And remember that the future of healthcare IT starts with your vision. We’ll catch you next time.