Debbie Cancilla, Grady Health System's senior vice president and CIO. A few years ago, one of the largest public hospitals in the U.S. had a big problem and it was hampering the way it was getting work done.

The problem, though, wasn't with the health care staff. The problem was email, which had become a nightmare for the doctors, nurses and administrators at Grady Health System , a 1,000-bed hospital in Atlanta that also runs seven neighborhood clinics, along with an infectious disease clinic.

Most companies or organizations experience occasional email downtime. However, at Grady, email was an ongoing headache for the hospital's users, as well as for Debbie Cancilla, the hospital's senior vice president and CIO.

Cancilla told Computerworld the IT staff was fighting an email outage about once a week.

In 2008, the hospital went through some major changes. Grady went from being a public entity to a private, nonprofit hospital. After making the switch, the hospital received funding that enabled it to update its technology.

2008 was also the year that Cancilla was hired. She and her team assessed the hospital's technology and quickly decided that the network needed to be rebuilt. Fixing the email system, which was running Novell GroupWise, was the top priority.

"The issues with email were in the forefront of everyone's mind," said Cancilla. "The servers weren't stable. The filters weren't working correctly. We had configuration problems ... We had constant down time. This was almost a weekly occurrence. We didn't have the depth or experience for this. And people have an expectation that email is a given and stable and it works. And it just didn't in this environment."

She added that no matter how hard her team members worked, they never felt the problems were corrected appropriately. With just one person dedicated to handling email, it was a problem that never went away.

The email problem was so bad that users at the hospital started expecting the system to crash. It was part of their routine.

"I think users were incredibly frustrated," Cancilla said. "For almost 10 years, this organization had no funding, so they'd learned to live with what they had. It was almost embarrassing from a leadership perspective that people had become satisfied with things not working the way they're supposed to."

Maybe even worse was the financial toll it was taking on the hospital.

Cancilla said on a high-level, the annual cost to manage the hospital's email system was about $150,000. However, if she added in all the costs associated with addressing problems and downtime, that number jumped to $200,000. That meant the cost of handling email problems was a quarter of the hospital's overall email expenditure.

With more than 12,000 computer connections in the hospital, its clinics and its affiliated medical schools, and not nearly the in-house expertise needed to run an efficient email system, Cancilla decided to look for her answer in the cloud .

Grady Health System in Atlanta updated its network and email system with Microsoft Exchange Online.

The hospital turned to Microsoft and its Exchange Online email service to do it.

"That was a very clear decision," she said. "We were rebuilding the whole infrastructure. We were trying to keep the lights on with all the old stuff. We ... didn't have the depth of experience within our own ship to be good at this. Email upgrades and conversions are not easy, and you need an engineer who's experienced or you just run into a litany of problems. We knew we needed to align our resources."

However, as a health care provider responsible for holding sensitive patient information, Cancilla said Grady needed to make sure that its emails would be safe and secure in the cloud.

"It was absolutely one of our considerations," she added. "We had to make sure we had security , and we had to know how things would be secured in the cloud. We also had to make sure that we'd be compliant with some of the e-discovery regulations going forward."

Cancilla said she figured the hospital's email would be safer and more stable in the cloud than it would be having the hosptial IT staff trying to do it on their own.

"There are certain things in your home that you'd be willing to tackle on your own," she noted. "You'd paint a room but replacing plumbing or electric, you might not have the experience to do. This is what Microsoft does. This is what they do for a living. They have a much greater depth of knowledge and experience. It's like calling a contractor."

Cancilla said she considered two other companies, though couldn't say which ones, before deciding to go with Microsoft. She said Grady chose Microsoft because the software maker had experience working with them and the company was eager and responsive about the project.

Grady Health began its migration by going from department to department in the summer of 2010. The whole move, which went smoothly, took six to seven months.

"Groupwise was retired," said Cancilla. "Unfortunately, we were too busy trying to bring up the new system or we would have had a party."

Though she wouldn't say what the hospital is paying Microsoft per seat, she did say it is spending a "fraction" of the $200,000 that was spent on email annually before. Cancilla also noted that with the move to the cloud, Grady has avoided more than $100,000 in one-time capital expenses related to hardware, such as storage and servers.

She's also expecting additional savings in annual operating expenses, including engineers and maintenance contracts.

So how's their downtime now?

Cancilla said there has been one service disruption, which lasted a few hours, about three months ago. It stemmed from an issue with Microsoft's hosted services.

"No, I'm not concerned yet," she said. "Over the years, you kind of learn to watch for patterns or trends before you get too excited."

And with only one hiccup and an absence of the old weekly email disruptions, Cancilla is happy with the choice she made.

"We clearly are saving every day because we don't have the expenses associated with our old instability," she said. "When you've got instability, you've got engineers trying to find the break in the system. You have the frustration for the end users. There's a savings right there. And it's one more area that we really shouldn't be spending a lot of time supporting. We need to focus our attentions on areas that align with business."

Sharon Gaudin covers the Internet and Web 2.0, emerging technologies, and desktop and laptop chips for Computerworld. Follow Sharon on Twitter at @sgaudin or subscribe to Sharon's RSS feed . Her e-mail address is [email protected] .

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