Few digital transformations come with stakes as high as those found in healthcare, where successful IT decisions impact both patient safety and operational efficiency. The recent Windows 11 migration undertaken by Vanderbilt University Medical Center (VUMC) offers an invaluable case study for healthcare organizations weighing similar upgrades. Through a candid look at VUMC’s journey, benefits realized, stumbling blocks, and emerging opportunities—including the potential for artificial intelligence integration—this article explores what others in the healthcare sector can learn from a major system-wide OS upgrade in a high-stakes environment.
The technology landscape is ever-evolving, and healthcare IT teams must balance innovation with the realities of tight budgets, regulatory scrutiny, and the imperative to minimize risk. For VUMC, the shift to Windows 11 was not simply a matter of keeping up with Microsoft’s OS lifecycle; it became a cornerstone of their broader digital transformation roadmap. As Curtis Arnold, a technical leader at VUMC, put it: “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.”
Microsoft’s latest operating system brings with it a host of benefits—some visible, others more structural. Notably, Windows 11 enforces stringent hardware requirements, compelling organizations to modernize aging infrastructure. Healthcare apps, particularly electronic health record (EHR) platforms like Epic, are notoriously resource-intensive and require robust hardware for optimal usability and security. By forcing an upgrade, Windows 11 ensures organizations like VUMC have the computing power needed not just for today’s needs, but for the next major app update cycle.
Arnold emphasized the importance of forward planning: “We want to make sure that our application owners are thinking about these things... if they can budget that into their software and software updates, it will be a smoother transition.” With Windows 11 migration, VUMC pressed application owners to proactively consider OS compliance as part of overall software management—an approach likely to pay dividends long-term.
Automation was a critical factor. For an organization the size of VUMC, with tens of thousands of endpoints, manual upgrades would have been untenable. Yet even with automation, success hinged on close collaboration between IT, application owners, and clinical stakeholders.
By the end of 2024, VUMC reported that 99% of its 10,000 clinical workstations had been transitioned—a remarkable achievement in a sector where system downtime can have severe consequences. The plan is to fully complete the transition by the time Microsoft ends regular Windows 10 support, minimizing expenses for extended security licenses.
The promise of Copilot—ranging from drafting clinical notes to automating administrative tasks—is significant. However, VUMC’s cautious approach is telling. Dr. Kumah-Crystal emphasizes the need to “learn early about the tools that we can take advantage of, but also determine when it’s right to try to scale them.” While Microsoft’s AI offerings hold promise, Dr. Kumah-Crystal stresses a phased rollout: “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.”
Keeping the underlying infrastructure modern and flexible is key: “Laying the groundwork by having the newest systems and architecture in place is going to get us there eventually.”
Healthcare organizations must maintain pressure on vendors to complete certification testing well ahead of end-of-life milestones, or risk being forced to maintain expensive, vulnerable legacy environments.
However, the process is ongoing, not static. OS support lifecycles, hardware capabilities, application certifications, and regulatory frameworks will continue to evolve. The notable strength of VUMC’s approach is its adaptability: rather than making one giant leap, the organization engineered a series of measured, collaborative steps. The risk, as ever, is in complacency and underestimating the true cost and complexity of lagging behind the technology curve.
For healthcare organizations yet to embark on or complete their Windows 11 migration, VUMC’s journey offers not just a roadmap, but a blueprint for building a continuously modernized environment—one in which innovation, security, and patient care can all thrive.
Source: HealthTech Magazine Lessons Learned from VUMC’s Windows 11 Migration
The technology landscape is ever-evolving, and healthcare IT teams must balance innovation with the realities of tight budgets, regulatory scrutiny, and the imperative to minimize risk. For VUMC, the shift to Windows 11 was not simply a matter of keeping up with Microsoft’s OS lifecycle; it became a cornerstone of their broader digital transformation roadmap. As Curtis Arnold, a technical leader at VUMC, put it: “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.”Microsoft’s latest operating system brings with it a host of benefits—some visible, others more structural. Notably, Windows 11 enforces stringent hardware requirements, compelling organizations to modernize aging infrastructure. Healthcare apps, particularly electronic health record (EHR) platforms like Epic, are notoriously resource-intensive and require robust hardware for optimal usability and security. By forcing an upgrade, Windows 11 ensures organizations like VUMC have the computing power needed not just for today’s needs, but for the next major app update cycle.
The Challenges of Healthcare OS Upgrades
Upgrading operating systems in healthcare is a far cry from simply pushing a button. Long-lifecycle applications, regulatory compliance, and the labyrinthine nature of hospital IT environments demand careful planning. Many hospital workstations host specialty software—sometimes custom-written or reliant on obsolete code—that must be certified for both functionality and security under a new OS. If one application is not yet Windows 11-certified, that device may be stuck on the older platform, leaving gaps in standardization and security coverage.Arnold emphasized the importance of forward planning: “We want to make sure that our application owners are thinking about these things... if they can budget that into their software and software updates, it will be a smoother transition.” With Windows 11 migration, VUMC pressed application owners to proactively consider OS compliance as part of overall software management—an approach likely to pay dividends long-term.
Rolling Out the Migration: VUMC’s Strategy in Practice
Early Adoption: Phased Approach and Automation
VUMC began preparing for Windows 11 in April 2022 by ensuring all newly purchased devices shipped with the new OS preinstalled—a proactive move that prevented IT staff from having to retrofit older systems immediately. By September 2024, VUMC began automating a large-scale push to bring 92% of its administrative devices and workstations onto Windows 11.Automation was a critical factor. For an organization the size of VUMC, with tens of thousands of endpoints, manual upgrades would have been untenable. Yet even with automation, success hinged on close collaboration between IT, application owners, and clinical stakeholders.
Managing Exceptions and Legacy Devices
Despite best efforts, not all devices were eligible for upgrade. Approximately 5% lacked the required processor, storage, or other hardware capabilities to support Windows 11. An additional 3% represented exceptions due to unqualified apps or custom needs. VUMC established a policy to begin replacing non-compliant hardware starting in July, prioritizing devices essential to patient care and critical business operations.By the end of 2024, VUMC reported that 99% of its 10,000 clinical workstations had been transitioned—a remarkable achievement in a sector where system downtime can have severe consequences. The plan is to fully complete the transition by the time Microsoft ends regular Windows 10 support, minimizing expenses for extended security licenses.
Centralized Application Management and Its Ripple Effects
One of the most significant process improvements was VUMC’s move toward centralized application management. Previously, different departments might independently purchase or update software, leading to waste and inconsistency. Central management enables several key advantages:- Cost Savings: Bulk licensing and volume discounts become feasible when application procurement is consolidated.
- Vulnerability Management: IT can systematically track which applications are up to date and patched—crucial for defending against escalating cyber threats targeting healthcare.
- Regulatory Compliance: Standardized upgrade paths streamline audit processes and reduce the complexity of maintaining HIPAA and other regulatory requirements.
The Next Wave: Windows 11 and Artificial Intelligence
With the technical foundations set by Windows 11, VUMC is now eyeing more advanced innovations. Dr. Yaa Kumah-Crystal, the health system’s clinical director of health IT, notes particular excitement about Microsoft Copilot and other AI-powered features. Already, small cohorts are piloting tools to assess their benefit and safety in daily clinical workflows.The promise of Copilot—ranging from drafting clinical notes to automating administrative tasks—is significant. However, VUMC’s cautious approach is telling. Dr. Kumah-Crystal emphasizes the need to “learn early about the tools that we can take advantage of, but also determine when it’s right to try to scale them.” While Microsoft’s AI offerings hold promise, Dr. Kumah-Crystal stresses a phased rollout: “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.”
Keeping the underlying infrastructure modern and flexible is key: “Laying the groundwork by having the newest systems and architecture in place is going to get us there eventually.”
Strengths and High-Value Takeaways from the VUMC Experience
Proactive Alignment with Vendor Roadmaps
VUMC wisely embedded the Windows 11 migration into its long-term digital transformation strategy. This forward-thinking approach minimized disruptions and ensured a seamless compliance process when Windows 10 approached end-of-life. By prioritizing new hardware shipments and aligning procurement cycles, VUMC ensured minimal productivity loss and achieved compliance faster than many peers.Standardized Processes and Documentation
Healthcare environments are infamous for their patchworked IT systems and informal shadow IT. By formalizing procurement and software management, VUMC not only reduced costs but also improved its security posture, making regulatory audits much less daunting.Broad Stakeholder Engagement
VUMC’s IT leadership succeeded in pulling application owners, clinicians, and administrators into the migration process. By making application owners responsible for OS compatibility planning, IT leaders fostered a culture of collective ownership—a must for any organization facing multi-year upgrade cycles.Early AI Readiness
VUMC’s embrace of Windows 11 gives it an edge in evaluating and potentially adopting generative AI for both administrative and clinical uses. Even as tools like Microsoft Copilot remain early in their lifecycle, the organization is positioned to take advantage of breakthroughs when they are fully ready for sector-wide deployment.Risks, Roadblocks, and Unresolved Issues
Legacy Applications and Certification Lag
The 1,200 devices in the exception category at VUMC highlight a thorny challenge for many healthcare IT teams. Many clinical and operational applications are slow to receive Windows 11 certification, leaving critical endpoints on aging operating systems that may become security liabilities.Healthcare organizations must maintain pressure on vendors to complete certification testing well ahead of end-of-life milestones, or risk being forced to maintain expensive, vulnerable legacy environments.
Hardware Requirements and Budget Constraints
Windows 11’s higher hardware bar has a double-edged effect. While it ensures future readiness, it can force the early retirement of otherwise serviceable endpoints. For organizations with slim IT budgets, the requirement to upgrade or replace large fleets of devices adds significant expense. VUMC’s tiered approach—phasing in hardware replacements and leveraging volume purchasing—demonstrates best practice, but not all organizations will have the same negotiating leverage.The Cost of Extended Support
Despite best efforts, some devices will always lag behind. For these outliers, Microsoft’s extended support is available—but at a significant cost. VUMC’s strategy to minimize this expense by completing the migration before support ends is solid, but IT leaders elsewhere must budget for the possibility of paying premium prices for security updates on a shrinking number of legacy machines.Early-Stage AI Integration
The appetite for AI integration is high, but tangible benefits in healthcare remain largely unproven—especially at scale and within the boundaries of HIPAA, GDPR, and other data privacy frameworks. VUMC’s incremental, data-driven approach is prudent. However, organizations should expect that meaningful ROI from AI deployment in clinical environments may still be several years away.Practical Steps for Healthcare IT Teams Planning Their Own Migration
1. Start Early, and Leverage Natural Hardware Refresh Cycles
Schedule OS upgrades in alignment with the natural cadence of device refreshes. Consider the purchase of devices with extended support cycles and ensure they ship with the newest OS to reduce technical debt.2. Foster a Whole-Organization Mindset
Pull stakeholders from every business unit—including compliance, clinical, and administrative teams—into the planning process. Make sure application owners understand and budget for ongoing OS compatibility, not just feature development.3. Centralize Software Management
Set policies that empower IT leaders to oversee and standardize software acquisition, deployment, and lifecycle management. This will pay off in lower costs, easier patching, and improved audit outcomes.4. Plan for Exceptions and Track Certification
Maintain a live inventory of unqualified hardware and uncertified apps. Develop upgrade or retirement plans for every outlier, and communicate regularly with vendors about certification roadmaps.5. Minimize Time on Unsupported OS Versions
Transition devices well ahead of vendor end-of-support milestones to minimize exposure and budgetary surprises linked to extended support.6. Stay Curious but Cautious About AI
Designate “innovation sandboxes” or pilot programs for emerging features like Microsoft Copilot. Collect data, analyze value, and scale only when benefits are proven and compliance assured.Final Analysis: Modernization Is a Moving Target
The story of VUMC’s Windows 11 migration is less about technology for its own sake and more about thoughtful, intentional design of a resilient, modern healthcare IT ecosystem. By weaving platform upgrades into a broader strategy, VUMC has set itself up for success—today and in the AI-powered future that is fast approaching.However, the process is ongoing, not static. OS support lifecycles, hardware capabilities, application certifications, and regulatory frameworks will continue to evolve. The notable strength of VUMC’s approach is its adaptability: rather than making one giant leap, the organization engineered a series of measured, collaborative steps. The risk, as ever, is in complacency and underestimating the true cost and complexity of lagging behind the technology curve.
For healthcare organizations yet to embark on or complete their Windows 11 migration, VUMC’s journey offers not just a roadmap, but a blueprint for building a continuously modernized environment—one in which innovation, security, and patient care can all thrive.
Source: HealthTech Magazine Lessons Learned from VUMC’s Windows 11 Migration