Considerations as Healthcare Moves to the Cloud
The case for moving healthcare to the cloud is already strong. However, healthcare systems need to make big changes to their mind-sets and finances to ensure that new processes, governance, financing, and skills are aligned for the future.
Traditionally, CIOs and their teams look after server rooms. In the move to the cloud, the IT department will change from a team that physically manage boxes, wires, and air conditioning to a team that remotely provisions infrastructure. That change will take quite a bit of transitioning in skill and the structure of the team.
The cloud also changes how healthcare systems finance what they do. Before the cloud, in both the public and private sectors, most of the infrastructure that people bought was hardware using capital funds. By comparison, cloud computing is a revenue subscription service in which organizations actually purchase computing power.
The change to the cloud is not frictionless. Even though our C-level leadership understand why healthcare needs to move to the cloud, that move requires changes to how we finance the technology. While other industries are moving to the cloud, there is a bit of lag in healthcare as we deal with these changes that, while not insurmountable, have notable implications for our organizations and healthcare systems.
The Cloud Requires a New Mind-set
Using cloud computing is like managing the electricity in a house. You must think about when to turn the lights off as opposed to leaving them on all the time. To get the true financial benefits of the cloud, providers must profile their usage. That means understanding the clinicians’ and patients’ behaviors so that an organization knows when they need to make cloud services available and to what scale.
The real benefits of cloud computing are apparent only when organizations profile things correctly. For instance, it is a big task for a hospital or clinic to process and extract EHR data, but a technology team can look at that task and see that the functionality is needed for only a couple of hours overnight. For another example, more computing power may be needed at the end of every month because a lot of work happens around reports and other activity.
Cloud storage can also be cost effective for storing data, but providers have to be cognizant of the types of storage they need. Cloud providers offer different types of storage, like cold storage, so that it takes more time to actually recover say an image from the archive. If your organization uses that type of storage as well, that can be an added financial benefit.
CIOs can start to plan out these pieces and optimize the cloud environment. Good governance around provisioning and deprovisioning environments is key. Once that is done, the cloud can be cost effective; we found that to be the case in our region for almost all the solutions we will need to use in the future.
Perform Due Diligence
When I was a CIO, I made a very strong case to our board and regional leadership to invest in doing due diligence on our existing state and our suitability for moving to cloud. I secured enough funding to evaluate our top 50 systems to see what size and shape of infrastructure they would need. Once I evaluated those systems, I priced out our infrastructure’s existing profile and compared that cost, with contingency, to a profile within the cloud.
I recommend that all CIOs begin a significant move to the cloud with due diligence. Organizations may work with an existing partner who is moving to the cloud to give them some warranties around the price of the cloud contract for a system. But if a CIO is going to single-handedly warrant, manage, and underwrite a degree of the cloud infrastructure, then that CIO needs to make sure that he or she has absolutely looked at all aspects of hardware, software, support, and licensing.
Current Moves in the Market
More and more cloud providers are trying to actively engage the big health systems and imaging vendors to get them to adopt the cloud. In essence, the software creators, cloud providers, and hardware providers that deliver the cloud infrastructure are all pulling on the same end of the rope to get healthcare to move toward the cloud. And that effort is mutually beneficial.
While I am not seeing any major players moving holistically to the cloud, I am seeing some of the results of cloud provider’s efforts in recent news, such as Cerner’s collaboration with Amazon Web Services (AWS). I was also very interested to work with Microsoft Azure and Allscripts in the UK as part of their partnership. I am excited to see what comes out of these partnerships.
Creating Time and Space for Innovation
I have managed an awful lot of server rooms in my time as a CIO. I have inherited overheated server rooms in which air conditioning has been blocked by leaves. I have seen mice and rats in those rooms and fires in the machines more than once. Managing the infrastructure 24/7 left little energy for my team to make transformational changes and patient engagement changes on top of that infrastructure. The more distracting the infrastructure is, the less your team can make transformational changes.
Moving to the cloud removes a lot of those distractions. This means that IT teams have time to concentrate on designing new transformational models of care with modern technology. Cloud vendors have many distributed infrastructures that they can use to move data around. Should part of the infrastructure flood, the data can switch over. There may be a small interruption, but you don't have to get all your people out in the middle of the night to deal with whatever's happening. And for me, that utilization helps us make headspace for important innovations in the future.
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