Positives outweigh concerns as shift to the cloud continues

More healthcare organizations are looking to cloud strategies to achieve efficiencies, with IT executives aiming to make wise choices.

Healthcare organizations are engaging in an inexorable shift to the cloud – past reticence to surrender control of key patient and business information has given way to strategic moves to take advantage of the cloud’s benefits.

More organizations are looking to move more of their operations to the cloud, but still wrestle with data security concerns and worries about sufficient uptime.

Data tells the story
A 2018 survey by HIMSS Analytics predicted that the majority of electronic medical records would be cloud-hosted at the beginning of this decade, and that prediction appears to be borne out in other barometers of cloud use within the healthcare industry.

According to an online survey conducted last July by the College of Healthcare Information Management Executives (CHIME), 82 percent of health IT executives said their organizations are relying on the cloud in some way. Nearly 10 percent said they are “all in” on the public cloud, while 60 percent are migrating to the cloud by adopting a hybrid approach, with part of their data in the cloud and part still maintained on premise.

The global market for healthcare cloud computing is predicted to grow at a rate of 18.7 percent, hitting a projected $76.8 billion by 2026, predicts a study by ResearchandMarkets.com.

A HIMSS Analytics’ survey in 2018 found that 37 percent of respondents said their rationale for moving to the cloud includes supporting disaster recovery; 25 percent said the cloud lowers current IT maintenance costs; another 25 percent said it reduces dependence on on-site IT staff or expertise; and 13 percent use the cloud because of the benefits of always-available apps or services.

The financial industry’s shift to the cloud provides an indication of the potential growth path for cloud computing in healthcare. A 2021 survey of IT professionals worldwide in that sector found the “vast majority” of them are using some form of public cloud, with those in the U.S. leading the way. They cite resiliency, improved staff productivity and increased regulatory compliance as key reasons for cloud migration.

Cloud awareness grows
Tim Brown, chief business information officer at Infor, a cloud software provider, says discussion of cloud migration in healthcare is moving to how best to shift electronic health records and enterprise resource planning systems to off-site clouds. “Those are the two large systems used to support the environment today,” Brown said. “Most providers are in some spot of deploying one or both into the cloud.”

Brown says he is seeing the evolution to the cloud play out much quicker in the finance sector than in the healthcare sector, but some in healthcare are moving ahead. “Clinical systems like Epic and Cerner are starting a swing in momentum for taking what’s in the data system and migrating it into the cloud,” he says. “The key component to make that happen is to enable the connectivity with the interfaces. It’s a complex environment. Healthcare is like a mini-city; it provides everything from care delivery to nutrition, so you need a flow in applications.”

Brown recently helped lead a roundtable on cloud migration with CHIME. “We asked [CIOs] where they are now with cloud migration and where they expect to be in three years. They all had different answers,” he says. Mainly, they indicated that they are trying to figure out what’s right for them, with budget constraints a factor. Executives who recently spent a huge amount on servers want to get some of the lifecycle out of that purchase first, he says.

Others have already migrated. A few years ago, talk of the cloud was “the buzz” with the C-suite, but now it is moving past just talk. Brown says. IT departments are starting to plan how to make it happen. The consistent message from all of them is, “we don’t want to be in the data center business.” They also all “truly see the cloud as the future.”

Challenges and benefits
Brown says the journey to the cloud needs to be looked at as an evolution. CIOs can’t just snap their fingers and move all their applications at once. “It’s too big of a lift. They are taking a look at their application lifecycles and asking, ‘Is it cloud-enabled?’ They are looking for what is viable to move; and not taking what they have in their data center and moving it to the cloud,” he says.

Scalability will be one of the main benefits when everything becomes cloud-based, Brown says. There will be the ability to scale quickly and flexibly with the cloud. “Think in terms of size and scale. If an organization is going through shifts and changes, it will be able to grow very quickly,” he says. “Today it is constrained by the data server. In the cloud, it can grow and shrink the cloud usage as needed. This will be particularly helpful with mergers and acquisitions. It will save money and not require investing in a big server, particularly if you only need the larger server for a period of time.”

There are challenges to cloud migration, Brown notes. For starters, “there are just so many competing projects, and only so much time and money to work on given projects. When you start to bring the cloud into the picture, there are changes to roles and responsibilities. Organizations are just beginning to figure out how to manage that cloud environment or other service-based organizations; it’s a bit of a learning curve.”

There doesn’t seem to be a struggle to get leadership to buy into using the cloud. “It’s not a real hard sell,” Brown says. “On the other hand, the people in the organization itself might have concerns or be resistant. It could be based on a security incident they read in the media or a type of outage that impacted other organizations, and it makes them pause and question their decision. But overall, organizations do pretty good due diligence.”

Different types of cloud approaches
Scott MacLean, senior vice president and CIO of Medstar Health, says most of Medstar’s applications — an delivery system with more than 120 entities and 10 hospitals — have been in the cloud for more than four years. Many of Medstar’s applications are in Software as a Service (SaaS) clouds.

MacLean still has enterprise resource planning (ERP) on premise, although in a co-located data center in Northern Virginia. “So, it's not really the cloud, but it's almost like a private cloud that we're leasing — not far away,” he says.

MacLean says when talking to other healthcare system executives about migrating to the cloud, many are doing the same thing. “There are things that you can put in Azure or AWS, no problem. There are things that are Software as a Service, no problem; and then they're just things that don't work [in the cloud] yet,” he says. “There are just some things that need to be on premise. And usually that's because of a latency issue.

"Things that are in this category are generally clinical engineering, biomedical devices and some telephony components need to be on premise, depending on the solution.” When it comes to the cloud, “I think everyone's wrestling with it,” MacLean says. “And it really depends on the size and complexity of the applications you have for your organization.”

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