North Alabama Bone & Joint Clinic Client Story

Ten Provider Practice Saves 30% by Moving to the Cloud

North Alabama Bone & Joint Clinic (NABJC) avoided a large, capital investment and saved about 30% of their overall IT budget by moving their IT infrastructure to a cloud platform with Netgain. In addition, the practice is enjoying the benefits of cloud such as world-class security, single point of contact, unparalleled availability, and a true IT partnership that is built on trust and proven results.

Tammy Highfield, Administrator of NABJC, along with her IT Manager, Tina McKelvey, spearheaded the cloud initiative within the practice. Their providers couldn’t be more pleased with the migration process and the benefits they’re seeing in their new environment.



  • Challenge: Facing large capital investment.

All of NABJC’s physical infrastructure was hosted within the walls of their clinic. From servers and switches to firewalls and desktop computers, it was located on-premise and managed remotely by an IT vendor.

With the equipment reaching its end of life, the practice was faced with a significant investment in new servers, storage, networking, and other infrastructure.

Their IT vendor had proposed a $125,000 infrastructure upgrade, which did not include the Microsoft license they’d need to operate the equipment and newest version of the EMR solution. The required licensing would have added $50,000 to the investment as well as an additional $8,500 for a Citrix renewal.

  • Challenge: Multiple IT vendors to manage.

With a complex infrastructure and only one full-time IT person on staff, NABJC was juggling multiple vendors who each had a role in managing their IT environment. They had a vendor who managed networking, another vendor who managed support issues, and yet another vendor who provided infrastructure support.

Each of their vendors had their own specific specialty however, when issues arose there was often finger-pointing or deferring responsibility to another vendor. They spent time running interference between vendors to determine where the issue originated and who was responsible for fixing it.

  • Challenge: Moving physical offices.

After 28 years in their original practice location, NABJC was moving to a new office building. Moving locations is no small feat for practices, especially when it comes to technology. They felt that when they moved their physical practice, they wanted their IT infrastructure, VOIP phone systems, networking environment, and telecom services to be as current and up-to-date as their new location.

  • Challenge: Outdated Centricity PM & EMR

Another driving force to upgrade their infrastructure was that their Centricity software needed to be upgraded to meet 2015 CERHRT requirements. The Centricity upgrade would require more robust servers that were running newer Microsoft Operating Systems than they had in place.

  • Challenge: Unreliable access

The providers at NABJC often see patients at specialty centers or affiliate hospitals. While they had access to their data via a Citrix login, the connection was unreliable and often faulty. The inability to consistently connect and access patient data from outside locations tested the provider’s patience and caused frustration for the providers and their patients.

  • Challenge: Unsupported Microsoft Operating Systems

Most of the practice’s servers were running on a soon-to-be-unsupported version of Microsoft’s Operating System. Further, the necessary Centricity upgrade would require the newest version of Microsoft’s Operating System.

Facing many challenges and multiple capital investments, NABJC started evaluating their options. They worked with each of their IT vendors to determine what needed to be done in their respective areas. From a network re-configuration to an infrastructure investment, the proposals were significant, and, with multiple vendors, the recommended environment still seemed incohesive from a strategy stand-point.

During her career in healthcare, Tammy had worked with Mike Sweeney, Netgain’s Director of Business Development. Knowing his role at Netgain, Tammy reached out to engage Mike in the planning process and determine if the cloud would be a good fit for the practice. Turns out, it was.



The move to the cloud was a phased approach for NABJC due to the complexity of their environment and unique needs. Working with specific dates driven by the physical office move, Netgain proposed a roadmap that would ensure each of NABJC’s challenges were evaluated, addressed, and resolved at the right time in the process.


  • Managed services

During the discovery and evaluation process, Netgain provided Managed Services for NABJC. This step in the process allowed Netgain to get a more comprehensive understanding of the practice, their challenges, and their desired outcomes. Managed Services also allowed for Netgain to provide immediate, temporary relief of some of the practice’s pain points, until the issues could be fully resolved in the cloud.

The full takeover of the environment from the previous IT provider resulted in a more stable environment for the migration to the cloud.

  • Physical move preparation and procurement

To adequately prepare for the practice’s move to their new Medical Office Building, Netgain needed to do design and planning work long before the actual move took place. Netgain’s engineers dutifully planned for the new location well ahead of time so the practice could order and configure the necessary equipment to have on-deck for the move.


  • Azure Cloud Solution

After stabilizing the environment, gaining a deep understanding of how users used the system, and where the system was being accessed from, Netgain designed a cloud solution in Microsoft’s Azure Data Center that would position the practice for short-term, and long-term, success.

All of NABJC’s applications, servers, and storage were migrated to the cloud, accessible from any computer via Remote Desktop Protocol (RDP) so they’re able to reliably access any and all of their applications from any location.

Netgain’s partnership with Azure ensures built-in redundancy, advanced encryption, identity and access management, and is arguably the most secure cloud platform in the world.


  • On-site support for office move

The last phase of the migration process was the physical move to NABJC’s new Medical Office Building. Netgain provided Engineers on-site to move existing equipment that would be utilized at the new practice location. The new equipment that Netgain had procured earlier in the process was then installed, configured, tested, and deployed at the new location.

Netgain worked with the NABJC team to ensure the move to the new location was seamless from a technology standpoint, and it was, according to Tammy and her providers.



The Netgain roadmap was detailed, complex, and timely. “The migration to the cloud was one of the easiest transitions that I’ve been involved in, and I’ve been at the practice over 18 years,” Tammy says. “We’re better positioned for the ever-changing future of technology, and long-term, we’re certainly saving money and getting a better service.”

Financial savings

Perhaps the greatest benefit NABJC is experiencing is the cost savings of moving to Netgain’s cloud. They faced a $125,000 infrastructure expense, a $50,000 Microsoft licensing expense, Citrix License renewal of $8,500 and a monthly management fee from their existing IT provider. After conducting the cost analysis, NABJC found that they would save more than $100,000 over the course of their three-year Netgain agreement.

“The value and additional services that Netgain provides as part of their cloud platform cannot be compared to what we would have gotten if we had built out the infrastructure internally,” Tammy says. “Netgain provides more than just a platform, they provide a comprehensive IT solution that addresses all of our IT needs.”

Adding to the cost savings, Netgain replaced the existing MPLS phone and dedicated internet circuits and implemented a new, 120 unit internet based VOIP solution. Along with Mike Jones at Trace Advisors, Netgain doubled NABJC’s bandwidth to all locations and provided direct dedicated access with redundant circuits for access to the Azure data center, promoting almost zero downtime for the clinic. This reconfiguration of their connectivity and phone solutions resulted in a savings of $4,500 per month for the practice.

Long-term partnership

One of Tammy’s most important objectives in this process was engaging with a partner that valued the importance of long-term relationships like NABJC does.

“We’ve seen other practices choose partners based on the lowest cost or the quickest solution. We wanted a partner that would be with our practice for the long-term and provide a quality solution we could depend on,” Tammy says. “We found that partner in Netgain.”

Unparalleled security

Security is always top-of-mind for Tammy and her providers. During the migration process, it was clear to Tammy that Netgain takes security as seriously as their practice does. Netgain’s innate attention to security and partnership with Microsoft, who spends over one billion dollars per year on security, shows the level of commitment Tammy and her providers desired.

Peace of mind

Tammy knew Netgain’s reputation for expertise in the healthcare industry when she first talked to Mike. Partnering with a vendor who has experience working with practices of the same size, specialty, complexity, and EHR provider gave Tammy the peace of mind and confidence she wanted in her cloud initiative.

“I don’t lose sleep anymore thinking about IT,” Tammy says. “I rarely even have to think about IT anymore – I know Netgain has it covered.”

One partner to manage

“We wanted one partner to manage – a one-stop-shop that could provide the level of service and support that our practice needed,” Tammy says. “We don’t have to go from vendor to vendor trying to figure out whose issue it is – we just call Netgain and they do that for us.”

Increased CEHRT reimbursements

With the Centricity upgrade and Microsoft Operating System upgrades powered by the cloud, NABJC will have the tools and reporting they need to ensure they’re maximizing their Federal reimbursements.

More time, new focus

Since the migration to the cloud, Tammy and Tina have been able to turn their attention to projects that improve patient care and move the practice to the next level.

“Because of the quality of service and support that Netgain provides, we have been able to move on to other initiatives,” Tammy says. “I haven’t even given IT a thought since we deployed, and Tina is spending significantly less time on IT.”

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Quote “The migration to the cloud was one of the easiest transitions that I’ve been involved in, and I’ve been at the practice over 18 years. We’re better positioned for the ever-changing future of technology, and long-term, we’re certainly saving money and getting a better service.”

-Tammy Highfield, NABJC’s Administrator