Challenges of Adopting the Cloud in Healthcare


By Lynn Gibson, CTO/VP, CHRISTUS Health

For more than a decade, marketing pitches have sold the ease of moving to the cloud. Cloud will save you money. Cloud will allow you be more agile. Cloud is more reliable. The truth is a mixture of those marketing sound bites for most industries. Deciding to move to the cloud is complicated even to those in information technology. It can be a great solution if you have a large amount of internally developed software. It is a great solution if you have limited funds for capital refresh. For those in healthcare, the opportunities are all there as well as some challenges that other businesses addressed some time ago.

Companies having a difficult time hiring server engineers or database administrators may think going to the cloud is an easy way to resolve a talent management issue

Having the money to make the changes is a challenge for many healthcare organizations. With horrible margins, most healthcare organizations struggle with priorities of capital investments. During difficult times, such as today with the pandemic, many healthcare systems struggle to have the ability to borrow money at affordable interest rates, let alone the cash flow to cover capital investments. Add that many healthcare organizations struggle to find right IT talent. The HR departments of healthcare organizations tend to compare salary rates in IT to other healthcare organizations’ healthcare IT departments. Yet, the large majority of positions in IT cross-industry boundaries where salaries are more competitive. Even larger healthcare systems struggle maintaining talent or having sufficient cash flow. The sound bites become very tempting to be a potential answer. However, making uninformed decisions on a marketing ploy can be costly.

Before an organization makes a decision to move to the cloud, there are some areas of concern to consider: technical, staffing, processes, and culture.

Technical:

The technical area is the easiest to identify and potentially address. Healthcare software seems to be mostly locked into two worlds. The modern software can run on a tablet, a laptop and can be easily accessible from anywhere. This software was written for the current virtual world and can, if not already, can be easily migrated to the Cloud. Then, the software written in the 1980s and 1990s which stays on a local physical server and written for operating systems that were prominent at the time. However, support stopped long ago or is minimal at best. The company either stopped supporting the development; was bought; or went out of business. Yet, you have a clinical or business team that loves the software or does not have the money to replace it. This software cannot be easily moved to the Cloud. Can the software be updated to move to the cloud? A software developer, if they can get access, will have to be able to evaluate the existing code. Can you convince your medical team to move to something new? Do you have the funds to purchase a replacement? If you cannot positively respond, then cloud will notbe the answer. If you can positively respond, then you are ready to address the next consideration. 

Staffing:

Staffing isoften an overlooked or simplified issue. Companies having a difficult time hiring server engineers or database administrators may think going to the cloud is an easy way to resolve a talent management issue. After all, those positions are tough to recruit into a small market or a highly competitive one. But cloud does not remove the demands on your network, it shifts the need from technical resources to the business. Your Cloud provider will become an essential partner and should not be treated as just another vendor to manage. Moving services to the cloud means contractual management costs will increase. How much of expertise exists internally to absorb this new responsibility? Does it exist or will it have to recruited? Experienced contract managers may become a significant cost. 

Processes:

With concept of contract management being introduced, the expectations of processes and service levels need to be considered. What is the tolerance of the clinical team when an outage occurs? Is it 15 minutes, 30 minutes or less than a minute? What is the process of identifying outages? Will you invest in a monitoring team or will the organization rely on the cloud vendor to communicate both planned and unplanned outages? When there is an outage, and there will be one, what is the expected return to production (RTP), and is it in the contract? Does the process of communicating outages identify expectations? What is the process for escalation if the SLA or the RTP is not met? Once an organization hands over the management of applications to a cloud management firm, service levels will be met only when contractually agreed. These are a sampling of questions that must be addressed by the leadership contemplating moving key services to a cloud operation. The answer to the questions will also determine the price of the contracted service.

Culture:

All of this now leads to the ultimate concern, which is culture. Does the organization embrace technology at the highest levels as an innovative tool or does it view technology as a utility? The difference becomes the use of the Cloud and the partner being chosen. Is the organization looking to leverage technology as part of its overall innovation plan or is it a utility? When an organization leverages technology, the world sees them as a trusted leader. Patients tend to come to them and contracting agencies seem to embrace them. Where does your organization fit in these challenges? Realize what makes sense for one organization is not necessarily the best solution for your organization.

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