Microsoft on Thursday announced a new Office 365 benefit, offering enterprise-sized nonprofit customers free additional Office 365 F1 seats for their volunteers.
The new Office 365 benefit enables nonprofit customers who have Enterprise Agreements with Microsoft to receive 10 free Office 365 F1 seats for their volunteers per licensed Microsoft 365 E3 or E5 seat. Office 365 F1 includes applications for email, calendars, team collaboration, messaging, intranet, file storage and sharing. Nonprofits with 250 or more users in their organization are eligible for the Enterprise Agreement. The offer starts Jan. 1, according to the company.
Microsoft Cloud Solution Providers will be able to offer the Volunteer Use Benefit to customers directly via the Cloud Solution Provider Channel in spring 2020, according to the company.
This is not the first time Microsoft has donated or provided services for free. Some of their collaboration software programs, such as Exchange, OneDrive, SharePoint and Teams, are available to qualified nonprofits. “But it does mark a significant expansion of access for nonprofits who already pay for Office 365. Keep in mind that Microsoft has long had steep discounts for students and educators, as well,” said Nicole France, principal analyst and vice president at Constellation Research.
The recent move is motivated by several factors, she said. “One is certainly ‘keeping up with the Joneses’ or Salesforces, as the case may be, in terms of publicizing and extending support for the nonprofit sector,” France said.
Another factor has to do with the way Microsoft wants to be perceived by current and potential employees, especially millennials, France said. “We know that this demographic group in particular — an increasingly important one, in terms of recruiting and retention — is strongly motivated by an employer’s mission in the world, not just its commercial business. I suspect this is a significant part of the rationale for giving the nonprofit sector some additional love and attention.”
Lastly, she said, the offering addresses the pressing need for nonprofits to provide appropriate tools to their large numbers of volunteers.
One of the largest nonprofit health systems in the U.S. created headlines when it was revealed that it was sharing patient data with Google — under codename Project Nightingale.
Ascension, a Catholic health system based in St. Louis, partnered with Google to transition the health system’s infrastructure to the Google Cloud Platform, to use the Google G Suite productivity and collaboration tools, and to explore the tech giant’s artificial intelligence and machine learning applications. By doing so, it is giving Google access to patient data, which the search giant can use to inform its own products.
The partnership appears to be technically and legally sound, according to experts. After news broke, Ascension released a statement saying the partnership is HIPAA-compliant and a business associate agreement, a contract required by the federal government that spells out each party’s responsibility for protected health information, is in place. Yet reports from The Wall Street Journal and The Guardian about the possible improper transfer of 50 million patients’ data has resulted in an Office for Civil Rights inquiry into the Google-Ascension partnership.
Legality aside, the resounding reaction to the partnership speaks to a lack of transparency in healthcare. Organizations should see the response as both an example of what not to do, as well as a call to make patients more aware of how they’re using health data, especially as consumer companies known for collecting and using data for profit become their partners.
Partnership breeds legal, ethical concerns
Forrester Research senior analyst Jeff Becker said Google entered into a similar strategic partnership with Mayo Clinic in September, and the coverage was largely positive.
According to a Mayo Clinic news release, the nonprofit academic medical center based in Rochester, Minn., selected Google Cloud to be “the cornerstone of its digital transformation,” and the clinic would use “advanced cloud computing, data analytics, machine learning and artificial intelligence” to improve healthcare delivery.
But Ascension wasn’t as forthcoming with its Google partnership. It was Google that announced its work with Ascension during a quarterly earnings call in July, and Ascension didn’t issue a news release about the partnership until after the news broke.
“There should have been a public-facing announcement of the partnership,” Becker said. “This was a PR failure. Secrecy creates distrust.”
Matthew Fisher, partner at Mirick O’Connell Attorneys at Law and chairman of its health law group, said the outcry over the Google-Ascension partnership was surprising. For years, tech companies have been trying to get access to patient data to help healthcare organizations and, at the same time, develop or refine their existing products, he said.
“I get the sense that just because it was Google that was announced to have been a partner, that’s what drove a lot of the attention,” he said. “Everyone knows Google mostly for purposes outside of healthcare, which leads to the concern of does Google understand the regulatory obligations and restrictions that come to bear by entering the healthcare space?”
Ascension’s statement in response to the situation said the partnership with Google is covered by a business associate agreement — a distinction Fisher said is “absolutely required” before any protected health information can be shared with Google. Parties in a business associate agreement are obligated by federal regulation to comply with the applicable portions of HIPAA, such as its security and privacy rules.
A business associate relationship allows identifiable patient information to be shared and used by Google only under specified circumstances. It is the legal basis for keeping patient data segregated and restricting Google from freely using that data. According to Ascension, the health system’s clinical data is housed within an Ascension-owned virtual private space in Google Cloud, and Google isn’t allowed to use the data for marketing or research.
“Our data will always be separate from Google’s consumer data, and it will never be used by Google for purposes such as targeting consumers for advertising,” the statement said.
But health IT and information security expert Kate Borten believes business associate agreements and the HIPAA privacy rule they adhere to don’t go far enough to ensure patient privacy rights, especially when companies like Google get involved. The HIPAA privacy rule doesn’t require healthcare organizations to disclose to patients who they’re sharing patient data with.
“The privacy rule says as long as you have this business associate contract — and business associates are defined by HIPAA very broadly — then the healthcare provider organization or insurer doesn’t have to tell the plan members or the patients about all these business associates who now have access to your data,” she said.
Chilmark Research senior analyst Jody Ranck said much of the alarm over the Google-Ascension partnership may be misplaced, but it speaks to a growing concern about companies like Google entering healthcare.
Since the Office for Civil Rights is looking into the partnership, Ranck said there is still a question of whether the partnership fully complies with the law. But the bigger question has to do with privacy and security concerns around collecting and using patient data, as well as companies like Google using patient data to train AI algorithms and the potential biases it could create.
Jody RanckSenior analyst, Chilmark Research
Ranck believes consumer trust in tech companies is declining, especially as data privacy concerns get more play.
“Now that they know everything you purchase and they can listen in to that Alexa sitting beside your bed at night, and now they’re going to get access to health data … what’s a consumer to do? Where’s their power to control their destiny when algorithms are being used to assign you as a high-, medium-, or low-risk individual, as creditworthy?” Ranck said. “All of this starts to feel like a bit of an algorithmic iron cage.”
A call for more transparency
Healthcare organizations and big tech partnerships with the likes of Google, Amazon, Apple and Microsoft are growing. Like other industries, healthcare organizations are looking to modernize their infrastructure and take advantage of state of the art storage, security, data analytics tools and emerging tech like artificial intelligence.
But for healthcare organizations, partnerships like these have an added complexity — truly sensitive data. Forrester’s Becker said the mistake in the Google-Ascension partnership was the lack of transparency. There was no press release early on announcing the partnership, laying out what information is being shared, how the information will be used, and what outcome improvements the healthcare organization hopes to achieve.
“There should also be assurance that the partnership falls within HIPAA and that data will not be used for advertising or other commercial activities unrelated to the healthcare ambitions stated,” he said.
Fisher believes the Google-Ascension partnership raises questions about what the legal, moral and ethical aspects of these relationships are. While Ascension and Google may have been legally in the right, Fisher believes it’s important to recognize that privacy expectations are shifting, which calls for better consumer education, as well as more transparency around where and how data is being used.
Although he believes it would be “unduly burdensome” to require a healthcare organization to name every organization it shares data with, Fisher said better education on how HIPAA operates and what it allows when it comes to data sharing, as well as explaining how patient data will be protected when shared with a company like Google, could go a long way in helping patients understand what’s happening with their data.
“If you’re going to be contracting with one of these big-name companies that everyone has generalized concerns about with how they utilize data, you need to be ahead of the game,” Fisher said. “Even if you’re doing everything right from a legal standpoint, there’s still going to be a PR side to it. That’s really the practical reality of doing business. You want to be taking as many measures as you can to avoid the public backlash and having to be on the defensive by having the relationship found out and reported upon or discussed without trying to drive that discussion.”
One of the greatest challenges to running a successful nonprofit organization has always been that donors look at nonprofits’ stewardship of funds as a primary way to assess impact. While there is no doubt that nonprofits must use donor funds responsibly, tracking to see if a nonprofit maintains the highest possible ratio of spending on programs-to spending on overhead is a poor proxy for understanding how effective a nonprofit truly is. In fact, the imperative to limit overhead has forced many organizations to underinvest in efforts to improve efficiency. Ironically, this has long prevented nonprofits from utilizing innovative digital technologies that could help them be more efficient and effective.
Now more than ever, cloud-based technology can have a transformative effect on how nonprofit organizations increase impact and reduce costs. The same technologies that give for-profit businesses insights about customers and markets, create operational efficiencies and speed up innovation can also help nonprofits target donors and raise funds more strategically, design and deliver programming more efficiently, and connect field teams with headquarters more effectively. This means smart investments in digital tools are essential to every nonprofit’s ability to make progress toward its mission.
The good news is that a major shift is underway. As part of our work at Microsoft Tech for Social Impact to understand how nonprofits can use technology to drive progress and demonstrate impact, we recently surveyed 2,200 donors, volunteers and funding decision-makers to learn how they decide which organizations to support, what their expectations are for efficiency and effectiveness, and how they feel about funding technology infrastructure at the nonprofits they support.
The results, which we published recently in the white paper “Beyond overhead: Donor expectations for driving impact with technology,” make clear that people donate to organizations they trust and that donors are increasingly looking at data beyond the ratio of program spending to overhead spending to measure impact. We also found that those who support nonprofits now overwhelmingly recognize the critical role technology plays in driving impact and delivering value. Nearly four out of five supporters (which includes both donors and volunteers) and more than nine out of 10 funding decision-makers told us they support directing donations to improve technology at a nonprofit. An overwhelming majority — 85 percent of supporters and 95 percent of funding decision-makers — are more likely to contribute to organizations that can show that they are using technology to improve how it runs programs.
At the same time, the survey found that most people expect organizations to use donations more efficiently and to advance the causes they work for more effectively than in the past. Among supporters, for example, 79 percent believe nonprofits should be better at maximizing funding than they were 10 years ago. Just over 80 percent of funding decision-makers believe nonprofits should be more effective at achieving their goals and advancing the causes they work for now than in the past.
To give you a better sense of what potential donors are looking for as they consider where to target their nonprofit contributions and how much they weigh technology into their thinking, we have developed a tool using Power BI so you can look at the data in greater detail. Within the tool, you can see how people responded to questions about overall effectiveness and efficiency, the importance of technology as a driver of success, how likely they are to support organizations that use technology to demonstrate impact, and their willingness to fund technology improvements at the nonprofits they support.
To make the tool as useful as possible for your organization, you can sort the data by supporters and funding decision-makers, and you can explore how responses varied by region. As you move through the data, you will see how these critical groups of supporters and funders think about these important questions in the region where your organization operates:
The ultimate goal of this survey was to get a clearer picture of what motivates people to contribute to an organization and how technology can help nonprofits meet supporters’ expectations. Overall, I believe our research provides some important insights that can help any organization be more successful. Fundamentally, we found that people donate to organizations that are perceived to be trustworthy, and that trust is achieved though operational transparency and effective communications. More than ever before, donors recognize that using data to measure and demonstrate impact is the foundation for trust.
Nuffield Health, the United Kingdom’s largest nonprofit healthcare company, didn’t spend less on networking when it switched its 31 hospitals and 158 fitness centers and medical clinics to SD-WAN. In fact, the overall cost increased by 20%.
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“It wasn’t a savings,” said Dan Morgan, the IT operations director at Nuffield, based in Epsom, U.K. “We were spending slightly more than we were spending before, but we’re getting far more for it.”
The return from the SD-WAN deployment is not measured in reducing current costs. Instead, the technology is about the future.
In 2015, Nuffield decided to embrace cloud-based software to eliminate one of two data centers over time. Applications chosen by the company included Microsoft’s Office 365, SharePoint, Skype for Business and Teams.
Other products included TrakCare, an electronic medical record system from InterSystems Corp., and GymManager, a system developed by Sharptec for running sports facilities. Nuffield operates more than two dozen gyms with medical centers that provide rehab for injuries, weight control and health assessments.
Going online for software meant the single 30 Mbps MPLS link at each of Nuffield’s facilities was no longer adequate. Instead, the company wanted two 100 Mbps internet broadband links at each site — a more than sixfold increase in bandwidth.
“As soon as you start looking at that in an MPLS world, you’re then looking at double the cost, and probably triple the cost,” Morgan said.
The network overhaul demanded new technology for routing traffic, so Nuffield chose Silver Peak’s SD-WAN. In general, the product creates a virtual overlay that abstracts the underlying private or public WAN connections, such as MPLS, broadband, fiber, wireless or Long Term Evolution. Network operators manage the traffic through the software console that comes with the system’s central controller.
Installing the SD-WAN appliance was easy enough for Nuffield to have one running on the LANs of each of the 189 sites within four months, Morgan said. Speed was essential because Nuffield wanted to switch facilities to broadband before its MPLS contracts expired.
The most significant problem was the installation of the optical fiber that would carry the broadband. If the cable wasn’t available at a facility, then Nuffield had to get approval from government regulators and landowners to have it installed. At the health facility in Cardiff, Wales, for example, Nuffield had to get permission from four farmers to dig up their fields to lay fiber to the center.
At another site, Nuffield lost the MPLS service before the broadband connection was up. So, a non-technical project manager stuffed the SD-WAN appliance and two 4G dongles in a knapsack and flew to the rural location.
Once connected to the LAN, the appliance re-established the internet connection after downloading the preset configurations from the controller. Nuffield’s LANs use mostly Cisco Catalyst switches.
“The site was up and running over a pair of 4G dongles and ran like that quite happily for a good couple of weeks until the new link was ready to get plugged in,” Morgan said.
Lessons learned from the SD-WAN deployment
In hindsight, Morgan would have preferred six more months with the MPLS links. That way, he could have set up each SD-WAN appliance with those connections and change to the new ones when they were ready.
Another gotcha for Morgan was failing to have a full understanding of how each device communicates with the network, especially hardware that hospitals might use for years. Examples include magnetic resonance imaging (MRI) equipment and computed tomography (CT) scanners used to diagnose tumors.
“You end up having to retrospectively fix it, rather than accounting for it in the migration piece,” Morgan said.
Now that the SD-WAN deployment is done, Nuffield is working on migrating all its hospitals and gym-based medical centers to the online TrakCare EMR system. Also, the nonprofit will gradually consolidate on-premises applications in one data center. Nuffield plans to finish both projects within four years.
Nuffield will run its business operations on the broadband connections. The SD-WAN appliances will also have a 1 Gbps link available for the multi-gigabit size files CT scanners, MRIs and X-ray machines create.
Nuffield will store and access those files through its private data center, which is a less expensive option than using a public cloud provider, such as Microsoft Azure, Morgan said.
“With cloud hosting platforms, such as Azure, you have to be careful of the data volumes that are going in and out to keep an eye on your costs,” Morgan said. “At the moment, things like Azure are still quite expensive to host that sort of environment.”
So, while SD-WAN didn’t cut Nuffield’s networking cost, it is providing a more substantial bang for the buck.