Lessons Learned from VUMC’s Windows 11 Migration

The Benefits of Windows 11 for Healthcare Organizations

VUMC incorporated the Windows 11 migration initiative into its existing digital transformation roadmap. Arnold explains that the upgrade is an investment in the organization’s future.

“What VUMC is really trying to do is modernize and standardize where we can. With Windows 11, we’re putting processes in place for now and even in the future, because at some point Windows 11 will go away and we’ll have to do this all again,” he says. “We want to make sure that our application owners are thinking about these things, because they generally don’t. They don’t consider the compliance with a Microsoft OS on their device. However, if they can budget that into their software and software updates, it will be a smoother transition.”

The upgrade process helped VUMC keep up with the latest in hardware technology. Because Windows 11 has certain hardware requirements, the organization now has the processing power needed to accommodate future app versions, such as a major Epic update.

VUMC is also moving toward standardized application management so that different departments aren’t ordering the same software at different times. With new processes in place, Arnold is more likely to be able to get discounted pricing associated with volume, among other benefits.

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“I can also track and manage the vulnerabilities of specific applications to make sure they are getting the updates they need. Because a lot of times, an organization will pay for an app that they’ll use for 20 years without going to the next version,” he says. “However, if we centralize the management of those applications, then we can keep those applications managed and secure.”

As VUMC achieves stability following the upgrade process and further explores the new features offered by Windows 11, Dr. Yaa Kumah-Crystal, clinical director of health IT, associate professor of biomedical informatics and a pediatric endocrinologist at VUMC, expects the organization will begin exploring how to take advantage of Microsoft Copilot. The health system has already begun that exploration in small cohorts to determine which use cases should be introduced more broadly.

“The wider strategy will be to learn early about the tools that we can take advantage of, but also determine when it’s right to try to scale them,” she says. “Microsoft is doing a lot of interesting things, but from our testing we know it’s still very early and the road to getting to something that we will absolutely want to implement for everyone is still in progress. However, I definitely see it as something we would want to take advantage of, and laying the groundwork by having the newest systems and architecture in place is going to get us there eventually.”

How VUMC Approached the Windows 11 Migration Process

Beginning in April 2022, any new device being implemented at VUMC was shipped from the manufacturer with Windows 11 already installed. In September 2024, the organization started an automated push to update 92% of its administrative devices and workstations to the new OS. The remaining devices are either exceptions (3%) or they lack the processor, disk space or other requirements from Microsoft to qualify for Windows 11 (5%). Arnold explains that the organization will begin replacing devices in the latter category in July.

By the end of last year, 99% of the organization’s approximately 10,000 clinical workstations had been upgraded to Windows 11, and all of the devices are expected to be on the new OS within the next few months.

“Hopefully, by the time October comes around when Windows 10 standard support is no longer available, we’ll have as few devices as possible that we’ll need to buy Windows 10 extended support for,” says Arnold. “We know that we’re going to have a group of devices still on Windows 10, but we need to minimize that so that we can minimize the cost.”

Devices that are excluded from the migration project host an application that is not yet Windows 11-certified. Those devices will be upgraded as well once the application gets certified or is upgraded to a version that is certified. Arnold says that around 1,200 devices at VUMC currently fall into that exception category.

Arnold explains that the organization’s central IT team, enterprise cybersecurity team and health IT team all worked together to identify the applications that are not certified for Windows 11.

“We did extensive work across all the different app groups to verify and collect that data, and then to make sure that we did not force an upgrade,” he adds. “We did a lot, especially for our clinical workstations. The way that those are set up, every clinical workstation except for the 1% that have a special app on them are all built and managed the same, so a lot of work went into testing, deploying and managing those devices.”

The three teams are tracking non-certified applications by checking in with app owners and end users to verify the app’s current update timeline.

“As we get closer to the October deadline, we will go back and validate a plan to have all those devices placed with our cybersecurity team as an exception to remain on Windows 10 so that they can be formally tracked through our cybersecurity team as well as our IT team,” he adds. “Especially now, with cost and hours being spent, the fewer dollars I can spend on this means I can spend them somewhere else.”

Kumah-Crystal adds that the teams have ensured that even work-owned laptops that physicians can take home will get timely Windows updates pushed through. VUMC can enforce password updates to those devices as well.

“Fortunately, because Microsoft is an enterprise platform, they’ve thought about things like this to allow us to stay current,” she says.

DISCOVER: A how-to guide for migrating to Windows 11.

Takeaways for Other Health Systems on Windows 11 Migration

Arnold says VUMC likely won’t be an early adopter of Windows 12 when it’s released, but he thinks it’s important for the organization’s app owners to consider that eventuality when holding discussions with vendors rather than waiting to begin planning after a new OS is released.

As part of the organization’s digital transformation, it is focused on keeping devices up and running at a higher percentage. In addition to regular patching, pairing Microsoft Intune with Windows 11 helps the IT team monitor devices with new processes and tools compared to Windows 10 devices. As a result, the organization can identify issues quickly to prevent downtime.

VUMC also has a security plan in place for devices that will remain on Windows 10.

“We may have some Windows 10 machines around for years and years, but only because you don’t want to replace a million-dollar MRI machine just because it requires Windows 10. However, we do have security protocols in place to make sure that, if that’s the case, we put them on a secure network that doesn’t have outside access to reduce vulnerability. We lock down those types of networks and, again that’s why we bring our cybersecurity team in to consult on every exception and every device,” Arnold explains.

Arnold suggests that other healthcare organizations looking to begin a Windows 11 migration project employ close coordination between IT and end users.

“Make sure that instead of IT and cybersecurity coming in and saying, ‘Well, this is what we’re doing,’ they should be having those conversations and explaining the why to owners of both clinical and standard applications,” he says.

Kumah-Crystal emphasizes the importance of IT working with someone who works directly with end users to communicate changes or explain what’s happening with unsupported apps. This involves having a good system in place to identify app owners and to monitor applications and devices. This way, IT teams can ensure applications are still working post-migration, communicate that applications won’t be left unsupported, and monitor updates so that, in the future, the team knows when additional licensing is needed.

She explains that VUMC’s health IT team, which consists of analysts, builders and engineers, works with people in clinical director, associate chief medical information officer and CMIO roles to facilitate communication with end users.

“For things like the migration, they’ll get feedback about communication strategies and how we’re going to get information out to folks,” she says. “They’ll allow us to pilot things early or look at the interfaces early on to see if there are significant changes that someone might pick up on as they’re doing clinical work. We might need to communicate that. We’ve found it to be a successful way of getting ahead of the ball.”

Kumah-Crystal points out that one of the more noticeable changes from Windows 10 to 11 is the appearance and location of the search window on the task bar. The organization did work to keep the search bar in the same location for its clinical workstations but plans to use the new version for its virtual desktop infrastructure workspaces where Epic is run. VUMC communicated that change to ensure that staff are not surprised by the update.

“The good news is that, for Windows 11, it was a very uneventful upgrade overall. The best kind of upgrade is when you hear nothing about it,” she says.

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