Moving an entire health system’s technology infrastructure to a new operating system is much more than a technical upgrade—it is a high-stakes act of orchestration, balancing critical application compatibility, cybersecurity, and the medical mission of seamless patient care. Vanderbilt University Medical Center (VUMC), recognized for its scale and complexity, undertook just such an endeavor in its recent Windows 11 migration. Their experience, as detailed by Keith Arnold, a VUMC IT leader, is instructive not only for healthcare executives but also for IT professionals tasked with transformative change in regulated, mission-driven environments.
Successful OS migrations demand more than software deployment; they require organizational alignment. At VUMC, IT is structured into three distinct, interconnected organizations: central IT (handling infrastructure, application management, networks, ITSM, and service support), Vanderbilt enterprise cybersecurity (responsible for identity, firewall, and access management), and health IT (overseeing clinical app management, from expansive solutions like Epic to niche applications installed on only a handful of devices in specialized units).
This triune structure became foundational. Arnold emphasized that preparing for Windows 11 depended on substantive collaboration among all three groups. The technology path wasn’t linear—applications in healthcare often have unique regulatory and operational demands. For example, a single device running custom imaging software in the eye institute is mission-critical, even if it’s one of only ten such devices. “We worked with those teams to find the tools and the apps that were not certified,” Arnold recounted. The approach rejected a ‘big bang’ cutover; IT and app owners performed hands-on testing with Windows 11 devices before deploying upgrades widely. This step was both a quality control measure and a crucial confidence-building exercise, ensuring clinicians and operators were comfortable with the new environment.
This collaborative posture is crucial in highly regulated industries, such as healthcare, where application failure can be more than just disruptive; it can endanger lives and complicate compliance. VUMC’s insistence on ensuring application function before moving forward helped minimize the risk of outages or workflow disruptions—a critical concern for any health system, and a best practice for organizations in similarly regulated fields.
“We don’t want to put things in the landfill, so we use an external company,” Arnold noted. VUMC managed hardware reclaim but outsourced drive and component shredding to ensure that all sensitive data was irrecoverable. The vendor then recycled or reused components wherever possible, balancing HIPAA-anchored data privacy mandates with organizational sustainability. This aligns with healthcare’s growing emphasis on green IT practices and demonstrates the operationalization of values beyond technical requirements.
Central to this transformation is the standardization and modernization of processes. By building compliance into the upgrade routine—not as a one-off checklist but as a recurring theme—VUMC reinforced the importance for app owners to anticipate operating system lifecycles in their budgeting and development cycles. The result is not only smoother migration but also greater organizational resilience, as “keeping devices up and working at a higher percentage” becomes an operational metric.
Additionally, the move to Windows 11 unlocked advanced security features, especially when paired with the latest management tools in Microsoft Intune. With Intune on Windows 11, VUMC realized deeper endpoint control, streamlined patch management, and improved compliance tracking. This level of integration simply isn’t possible—or is only partially realized—with Windows 10.
This mirrors a growing trend in healthcare: risk-adaptive security. Rather than outright eliminating older systems, organizations create managed exceptions and tightly controlled perimeters. It’s a pragmatically cautious strategy, recognizing both operational necessity and present-day cyber threats.
This hardware recalibration is double-edged: on one hand, newer devices deliver performance and security benefits; on the other, healthcare organizations must manage operational budgets, especially in economic climates where device prices can be volatile. VUMC’s proactive refresh, fueled by the migration, positions it well to support future software requirements while supporting clinicians with performant, reliable technology.
Standardizing application management isn’t just about reducing licensing costs—though those savings can be considerable. It also streamlines vulnerability management and audit processes, closing cracks through which outdated or unsupported applications can become compliance or security risks. This centralized strategy represents a significant organizational shift for many institutions, but it’s one that directly addresses both security and operational efficiency.
Ultimately, the VUMC experience provides a roadmap for other institutions navigating similar transformations. Migrations executed with deliberation, collaboration, and care do more than keep systems current—they build the organizational muscle needed to adapt to continual change. For the healthcare sector, where technology is inseparable from mission, this is not just IT best practice—it is a mandate for safer, more resilient patient care.
In summary, the VUMC Windows 11 migration stands as a case study in strategic IT leadership, where discipline, cross-functional transparency, and relentless focus on both end-user needs and macro-level cybersecurity converge. It’s a reminder and a challenge: digital transformation is about people and processes, as much as platforms and devices—and each component demands equal, ongoing investment.
Source: EdTech Magazine Q&A: VUMC IT Leader on What It Takes to Migrate to Windows 11
Aligning Three Pillars: The VUMC IT Ecosystem
Successful OS migrations demand more than software deployment; they require organizational alignment. At VUMC, IT is structured into three distinct, interconnected organizations: central IT (handling infrastructure, application management, networks, ITSM, and service support), Vanderbilt enterprise cybersecurity (responsible for identity, firewall, and access management), and health IT (overseeing clinical app management, from expansive solutions like Epic to niche applications installed on only a handful of devices in specialized units).This triune structure became foundational. Arnold emphasized that preparing for Windows 11 depended on substantive collaboration among all three groups. The technology path wasn’t linear—applications in healthcare often have unique regulatory and operational demands. For example, a single device running custom imaging software in the eye institute is mission-critical, even if it’s one of only ten such devices. “We worked with those teams to find the tools and the apps that were not certified,” Arnold recounted. The approach rejected a ‘big bang’ cutover; IT and app owners performed hands-on testing with Windows 11 devices before deploying upgrades widely. This step was both a quality control measure and a crucial confidence-building exercise, ensuring clinicians and operators were comfortable with the new environment.
Application Compatibility: Testing, Not Forcing
Experience at VUMC validated a lesson familiar to many enterprise IT professionals but frequently overlooked during OS rollouts: business continuity depends on the granular details of software compatibility. “We gathered the data and worked with the app owners who were concerned to test the Windows 11 update or devices with them, rather than just forcing that update,” Arnold explained. This extensive data collection included engaging with every application group—clinical, organizational, or departmental—and mapping their ecosystem.This collaborative posture is crucial in highly regulated industries, such as healthcare, where application failure can be more than just disruptive; it can endanger lives and complicate compliance. VUMC’s insistence on ensuring application function before moving forward helped minimize the risk of outages or workflow disruptions—a critical concern for any health system, and a best practice for organizations in similarly regulated fields.
Responsible Device Disposal: Security Meets Sustainability
Operating system migrations inevitably uncover legacy hardware that doesn’t meet the minimum requirements of the new platform. Windows 11’s requirements, such as TPM 2.0 and Secure Boot, are well publicized, but in practice, hospitals run a heterogenous, often aged, array of devices. VUMC’s philosophy for decommissioning noncompatible equipment demonstrates a thoughtful intersection of environmental stewardship and rigorous information security.“We don’t want to put things in the landfill, so we use an external company,” Arnold noted. VUMC managed hardware reclaim but outsourced drive and component shredding to ensure that all sensitive data was irrecoverable. The vendor then recycled or reused components wherever possible, balancing HIPAA-anchored data privacy mandates with organizational sustainability. This aligns with healthcare’s growing emphasis on green IT practices and demonstrates the operationalization of values beyond technical requirements.
Digital Transformation: More than a Migration
For VUMC, the migration to Windows 11 wasn’t merely a technical refresh—it was a leap forward within a broader effort of digital transformation. “With Windows 11, we’re putting processes in place for now and for the future, because at some point, Windows 11 will go away, and we’ll have to do this all again,” Arnold reflected. This forward-looking philosophy stands in contrast to a “set it and forget it” approach, encouraging ongoing vigilance and planning among application owners.Central to this transformation is the standardization and modernization of processes. By building compliance into the upgrade routine—not as a one-off checklist but as a recurring theme—VUMC reinforced the importance for app owners to anticipate operating system lifecycles in their budgeting and development cycles. The result is not only smoother migration but also greater organizational resilience, as “keeping devices up and working at a higher percentage” becomes an operational metric.
Additionally, the move to Windows 11 unlocked advanced security features, especially when paired with the latest management tools in Microsoft Intune. With Intune on Windows 11, VUMC realized deeper endpoint control, streamlined patch management, and improved compliance tracking. This level of integration simply isn’t possible—or is only partially realized—with Windows 10.
Managing Legacy Systems: Securing the Unupgradeable
Despite diligent updating, Arnold acknowledged that some Windows 10 systems will remain in service for the foreseeable future, often due to legacy application constraints or specialized hardware dependencies. Here, VUMC’s cybersecurity strategy shines: such devices are segmented onto secure, isolated networks with no external access, significantly reducing their attack surface. “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 said.This mirrors a growing trend in healthcare: risk-adaptive security. Rather than outright eliminating older systems, organizations create managed exceptions and tightly controlled perimeters. It’s a pragmatically cautious strategy, recognizing both operational necessity and present-day cyber threats.
Hardware Refresh: Rethinking IT Investment
OS migrations are often the catalyst for hardware reviews. Windows 11, with its design for more modern hardware, prompted VUMC to re-examine aging fleets. “Windows 11 just takes a little bit more processing power, but so does every application update. This really helped drive us to get better processors and bigger hard drives—not only for Windows but also for all those other apps when they upgrade,” said Arnold.This hardware recalibration is double-edged: on one hand, newer devices deliver performance and security benefits; on the other, healthcare organizations must manage operational budgets, especially in economic climates where device prices can be volatile. VUMC’s proactive refresh, fueled by the migration, positions it well to support future software requirements while supporting clinicians with performant, reliable technology.
Standardized Application Management: Strength Through Centralization
VUMC’s migration surfaced a critical challenge for many complex organizations: decentralized software procurement and management. “I don’t have 15 different departments ordering the exact same software,” Arnold observed. “Now, I can get discounts associated with volume. I can also track and manage the vulnerabilities of specific applications to make sure they are getting the updates they need.”Standardizing application management isn’t just about reducing licensing costs—though those savings can be considerable. It also streamlines vulnerability management and audit processes, closing cracks through which outdated or unsupported applications can become compliance or security risks. This centralized strategy represents a significant organizational shift for many institutions, but it’s one that directly addresses both security and operational efficiency.
Lessons for the Broader IT Community
Arnold’s closing advice to other organizations: “Continue close coordination. 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.” This echoes the need for transparent, two-way dialogue, especially in stakeholder-heavy environments like hospitals, where technology serves as both an enabler and a constraint for care delivery.Pitfalls and Potential Risks
While VUMC’s process is an exemplar of maturity, several inherent risks bear consideration for any organization embarking on a similar path:- Application Certification Bottlenecks: Some vendors may be slow to validate their applications on new OS versions, creating operational bottlenecks or compelling organizations to delay upgrades. For mission-critical systems tied to vendor support matrices, this can introduce significant risk.
- Resource Constraints: Device and application testing, collaborative planning, and phased rollouts require sustained human capital. Organizations with lean IT teams may face delays or miss testing edge cases.
- Security Drift in Legacy Devices: While network segmentation is effective, legacy devices—even when isolated—present an ongoing security liability. Zero-day vulnerabilities or misconfigurations could expose sensitive data if segmentation fails.
- Disposal Chain Reliability: Using third-party partners for device disposal underscores the importance of rigorous vetting and contract management. Data breach risks persist if any step in the chain fails—a paramount concern in healthcare.
- Early or Late Adoption Dilemmas: Arnold acknowledged the tension between adopting new platforms too early (risking instability) or too late (increasing vulnerability and exceeding support windows). Striking the right balance is an operational art, not a science.
Strengths and Strategic Innovations
VUMC’s model highlights several best practices:- Interdepartmental Collaboration: Frequent, early engagement with application owners fostered trust and improved user satisfaction, reducing operational shocks at cutover.
- Iterative Testing: Phased, user-driven testing of Windows 11 on critical applications provided assurance before mass deployment.
- Holistic Security: Integrating cybersecurity from network to endpoint, including during device disposal, exemplified defense-in-depth.
- Process Standardization: Centralizing application procurement and management not only cut costs but enabled better vulnerability visibility.
- Sustainability and Stewardship: Recycling devices responsibly demonstrated alignment with green IT and regulatory best practices.
Looking Forward: Upgrading Mindsets, Not Just Machines
Arnold reflected on the inevitability of future migrations—Windows 12 is already on the horizon. “We don’t want to be a very early adopter whenever Windows 12 comes out, but it will be important for app owners to keep that in mind and have discussions with their vendors.” Baking OS lifecycle planning into procurement and software development discussions signals a maturing IT approach, one that prizes foresight over firefighting.Ultimately, the VUMC experience provides a roadmap for other institutions navigating similar transformations. Migrations executed with deliberation, collaboration, and care do more than keep systems current—they build the organizational muscle needed to adapt to continual change. For the healthcare sector, where technology is inseparable from mission, this is not just IT best practice—it is a mandate for safer, more resilient patient care.
In summary, the VUMC Windows 11 migration stands as a case study in strategic IT leadership, where discipline, cross-functional transparency, and relentless focus on both end-user needs and macro-level cybersecurity converge. It’s a reminder and a challenge: digital transformation is about people and processes, as much as platforms and devices—and each component demands equal, ongoing investment.
Source: EdTech Magazine Q&A: VUMC IT Leader on What It Takes to Migrate to Windows 11
