March 6, 2018

2018 Healthcare Trends Part 5: The Real Cloud Comes to Healthcare

Travis Good, MD

Co-founder, CEO & Chief Privacy Officer

Information technology groups at healthcare organizations spend a colossal chunk of their time supporting and “optimizing” EHRs. And, with many of the largest EHR vendors, health system IT does it in-house using their own data centers. In addition to EHRs, hospital IT also has hundreds of smaller, often less essential technologies, that require care and feeding. Couple that with the needs to integrate applications and you quickly see why healthcare IT has such a huge backlog.

At the same time, a significant strategic priority for healthcare organizations is assessing the cloud, developing a cloud strategy, and implementing that strategy. Most organizations are at some stage in this process. Many are still pre-implementation of a cloud strategy. But, it’s coming. And the health IT backlog is not conducive to the massive amount of work required to start moving technology to the cloud.

What I mean by the cloud or the “real cloud” in my initial 2018 Healthcare Trends post, is not virtualization. What I mean is the public cloud and the public cloud providers Amazon, Microsoft, and Google. The public cloud is not Epic hosting in Verona, with a data center that is managed and operated by Epic, or Cerner hosting in Kansas City, with a data center that is managed and operated by Cerner; those are private clouds dedicated to a specific application and purpose. The public cloud is different.

The public cloud is a powerful public utility and a force that will transform healthcare, not just healthcare IT. It is almost infinitely scalable with a growing laundry list of services and features that can be activated and accessed on demand. And, with new security features, it is now finally ready for prime time, meaning only that it is ready for healthcare organizations to develop and implement cloud strategies. The public cloud will enable many things for healthcare organizations.

The public cloud will:

  1. Get healthcare organizations out of the data center and infrastructure business, allowing focus on providing care, better services, and better products (meds and devices)
  2. Massively improve disaster recovery, aiding in meeting compliance requirements
  3. Accelerate innovation, enabling faster response and adaptation to market changes
  4. Improve and ease access to health data both for providers and patients
  5. Enhance visibility into security and compliance
  6. Enable new partnerships and integrations.

Despite the scale and challenges of moving to the cloud, the cloud is coming to healthcare, and it’s coming faster than most people think. Look no further than HIMSS 2018 and the newly enlarged presence of major cloud providers Amazon Web Services (AWS), Google Cloud Platform (GCP), and Microsoft Azure. Healthcare on the cloud is strategic for every cloud provider. The challenge for these three behemoths is being in healthcare at the right time. These cloud providers are at HIMSS in 2018 because now is the right time, not because 2018 will be the year all healthcare organizations will move all their technology to the cloud; but, 2018 and 2019 will be the years most healthcare organizations start to implement a cloud strategy that will take years to execute. Microsoft, Amazon, and Google can’t miss those opportunities.

I was listening to a Software Engineering Daily podcast last week featuring one of the founders of Box. The podcast focused on how Box has embraced the public cloud and why they have chosen to leverage Kubernetes. It’s a fascinating listen. One of the takeaways that map to the cloud trend in health IT is around how moving to the cloud is never one and done, even if you only have one large, monolithic application (in the case of the podcast, the one application was Box).

Hybrid cloud for 3-5 more years

During the next 3-5 years, we’re going to see a hybrid approach to the cloud for health IT where there is a mix of cloud applications and ground-based, or on-premise applications. This necessitates a new integration strategy to ensure secure and reliable connectivity between cloud and existing ground applications, not just integration between legacy applications and new applications; ground applications are typically legacy applications. This hybrid cloud strategy also necessitates management of multiple forms of technology infrastructure, cloud, and ground or on-premise.

Legacy applications either killed off or re-architected for public cloud

As healthcare organizations implement and start to scale their cloud strategies, more ground-based applications will move to the public cloud. Some set of these legacy applications, likely the last to move to the cloud, will be migrated as they are currently architected; that, or they’ll be sunsetted and killed off before they are migrated. Many more of these legacy ground applications will be re-architected as a part of the migration process. The reason to re-architect legacy applications is to:

1) fully take advantage of the cloud (auto-scaling, auto-healing, redundancy, portability, etc.) and 2) prevent lock-in with a specific cloud provider.

While AWS, Azure, and GCP offer great cloud services and resources, healthcare organizations will want optionality and to avoid lock-in with cloud providers APIs and the specific flavor of services (containers, serverless, etc.). This re-architecture process will be a crucial part of the cloud strategy for healthcare organizations.

Public cloud requires new skillsets

The public cloud does require a unique skill set and should usher in a new paradigm (containers, security, serverless, DBaaS, etc.) for healthcare technologies. Hiring resources with the necessary skillsets are challenging to say the least. It’s challenging if you’re in Seattle or Boston. It’s nearly impossible if you’re in a rural location like many healthcare organizations. Access to the right skillsets to leverage public cloud will improve over time but health systems should, and likely will, leverage third parties that specialize in cloud computing; these third parties have matured along with the public cloud.

Security and compliance — a big challenge

One particularly outsized challenge associated with the cloud is security and compliance. The cloud has distinct advantages over the current, on-premise model but it also has the perceptive challenge of giving up the keys to the castle to a cloud provider. This perceptive challenge can and will be overcome, but it requires changes to the way healthcare organizations manage risk for their data and how they align that risk with liability from cloud providers acting as stewards of their data. Transparency, both legally in the form of BAAs and data processing agreements and technically in the form of security dashboards, have never been more critical.

In leveraging third parties, both cloud providers for infrastructure and cloud specialists for migration, security, and compliance, healthcare IT and healthcare compliance will transform themselves. What those groups look like in a post-cloud world is hard to say, but it’s clear they will have to change to embrace this brave new world. This will not happen overnight.

A lot of the above are impacts that will be felt long-term and not necessarily in 2018. But, as healthcare organizations begin their journey to the cloud, some starting that journey at HIMSS this year, they need to consider all of this. Cloud strategies should be all-encompassing but also should be revisited on some regular period as the pace of the cloud does not show any signs of slowing down.

I Invite you to also take a look at the first three trends we’ve already explored in this series: How cash-pay practices will grow in 2018, 6 predictions for a post-EHR world., and Clinicians as Developers And don’t forget to subscribe to the blog to the right to have the rest of the trends we’ll explore delivered right to your inbox.

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