With the release of Windows 10, Microsoft is radically changing the way they think about the operating system. Instead of discrete OS releases every couple of years, Microsoft is encouraging the world to move toward continuous OS updates.

Unshackled from the traditional model, Microsoft will be able to push out relevant updates to ensure the latest in OS is always available to all consumers. This doesn't just include new features, but is going all the way to instant patches and fixes for vulnerabilities, and even drive adoption.  Microsoft calls this new model the 'Operating System as a Service'.

Windows 10 introduces a variety of new features. While some features like Windows Media Center, Windows 7 desktop gadgets and USB floppy drivers have been dropped, there is a considerable amount of innovative new features in the Windows 10 release that will be useful to healthcare users:

• Cortana. Microsoft's interactive voice assistant: First introduced in Windows 8.1 on mobile phones, Cortana is now available across devices using Windows 10. With its strong Bing powered backend and a programmable API, Cortana may become the tipping point to make speech and voice a mainstream input that could power myriad of use cases from physician notes in electronic medical records (EMR) to transcribing tele-consultations.
• Security with Windows Hello and Windows Passport. Windows 10 now supports the use of biometrics for authentication and authorization of users as an alternative to passwords. Windows Passport allows the same biometric login to be used for authentication at third party member sites which opt-in to participate in the program. Widespread acceptability of biometrics has the potential to eliminate issues such as shared passwords, forgotten/lost passwords, etc., effectively reducing the security threats as well as saving on significant amount of support calls. With authentication being a core requirement across all healthcare applications, devices and platforms including EMRs, practice management software (PMS), etc., Windows 10 could effectively change the way users authenticate with applications forever.
• A New Internet of Things Core. Windows 10 IoT Core SKU comes with a rich set of development tools and support for a wide range of devices including Raspberry PI. Combined with offerings such as Cortana and Cortana Analytics, it is now possible to envision Windows 10 based solutions for preventive care, remote monitoring and treating chronic conditions.
• Edge Browser. Windows 10 comes with a new and improved web browser called Edge. Apart from improvements such as reduced memory footprint, faster browsing speed, improved compatibility with sites designed for other browsers, improved scrolling and rendering, it comes with additional features like note-taking mode where one can doodle and highlight web page content. Edge can be used for web-based EMRs and other applications.
• Universal Windows Apps. Microsoft introduced Universal Windows Apps as an update to Windows 8.1. Microsoft aims to provide a way to build apps that are compatible across all Windows 10 devices. App developers can now target desktop, tablets and mobile users.

Other interesting features relevant to healthcare include multi-monitor support, performance improvements and enterprise data protection.

Key considerations for healthcare CIOs.
From a cost perspective, Microsoft has made the Windows 10 upgrade quite attractive. Needless to say, there will be a significant push from Microsoft over the next few quarters to get its enterprise customers to adopt Windows 10. And while we can expect strong adoption in other industries, large healthcare organizations are usually conservative when jumping onto the bandwagon to do a organization-wide OS upgrade.

It's important for healthcare CIOs to understand the new features Windows 10 brings to the table. However, for a successful enterprise-wide migration to Windows 10, they also need to take account into some important considerations:

1. Infrastructure compatibility: Hardware and driver compatibility remain key factors when considering an upgrade to Windows 10. While most vendors are still upgrading their drivers, it is quite uncommon to run into issues with compatibility and interoperability. A test lab should be setup so that hardware components, drivers, stability and interplay with some of the applications can be tested. At a bare minimum, the OS should be tested with:

• LAN/Wi-Fi settings - connecting, disconnecting, restore from sleep/hibernate, etc.
• Antivirus software, antimalware software
• Power settings
• Network proxy software
• Update and patch maintenance software

2. Application compatibility: The Windows App Compatibility Center lists the products that have been verified to support Windows 10. The free Windows 10 upgrade advisor from the Get Windows 10 app is the recommended approach to learn about known compatibility issues. A test lab setup with all the Line of Business apps is also recommended. The lab should comprise systems that will test all LOB apps as well as browser based apps such as portals (enterprise intranet, extranet, training/learning portal), webmail, ticketing systems, etc., on the new Edge browser.

3. Training: With any upgrade, there is always a learning curve. Structured training programs can help reduce the hit to productivity as employees understand and familiarize themselves with the new environment. The time and resources for training should be factored into the upgrade plan to transition with minimal loss of productivity. CIOs need to be well aware of the level of training (and corresponding downtime) that needs to be planned for:

• End users (including vendors/contractors)
• IT staff
• Desktop support staff
• Development team


4. IT process change management: If an enterprise has not done a review of their IT infrastructure processes, a new OS release should be used as a forcing function to review processes. IT staff will need to prepare for the new set of group policy objects and review the app compatibility list often. Key questions to be answered include:

• Will the current hardware be supported or will the new OS necessitate a hardware upgrade? What is the OEM's stand?
• Will any of the network connected equipment be impacted?
• Would medical devices be impacted?
• What is the upgrade downtime for staff equipment?
• How will the backups be impacted?

5. Vendor support: Vendor support continues to remain a key factor in a migration exercise. CIOs need to ensure that their vendors will extend comprehensive support if their apps don't work on the new OS.

6. Upgrade offer: Microsoft's free upgrade offer from qualified Windows 7 and Windows 8.1 will definitely have quite a few takers. But the upgrade to Windows 10 Pro is only free for one year and the enterprise upgrades are not included without a Software Assurance subscription in volume licensing. In addition, Microsoft support for Windows 7 has already ended and support for Windows 8.1 will end in January 2018.

In addition to the points listed above, CIOs also need to make sure any evaluation of Windows 10 by their IT departments will need to be done on representative hardware and software that will need to be setup in a separate staging environment. Following these considerations will ensure a smooth and optimal transition to Windows 10 across the enterprise.