Banana yellow file folders, with patients’ names handwritten on stick-on labels, were de rigueur at the family physician I visited as a child all the way up until college.

Even now, some clinics still rely on paper documentation and a tedious filing system. In the wake of the 2017 WannaCry ransomware attack on Windows operating systems worldwide, significantly crippling the infrastructure of hospitals, two schools of thought have arisen:

1. To ensure the security and preservation of businesses, outdated technology must be addressed and fixed
2. Businesses must double-down on on-premise solutions in order to control access to sensitive data and prevent similar cyber attacks in the future.

Cloud infrastructure helps providers effectively deliver health services to their patients. In his latest column, Zack Busch, a G2 research analyst specializing in IT and cloud solutions, discussed the impact of cloud adoption in the health care industry, and specifically, provisioning. But the health care industry has so much more at stake than simply provisioning. Changes to the mode of provisioning directly impacts the modernization and evolution of the industry, both in terms of operations and technology offerings.

There are signs that the health care industry sees cloud computing as a big—and necessary—part of its future. In 2018, Healthcare IT News reported that 91% of hospital CIOs attribute cloud computing to “more agile, nimble products and services [powered by] the proliferation of healthcare data,” according to a survey by Black Book Research. CIOs recognize that they must scale their digital operations, regardless of whether that means changes to their roles, to be able to better “orchestra between services, IT systems and...business goals,” reports PR Newswire. A year later, CIO Review reported that by 2022, “the global healthcare cloud computing industry is anticipated to see a compound yearly growth rate of 11.6 percent and achieve a value of $35 billion.” Couple that with the January 2018 announcement from the National Health Service (NHS)—the largest health care provider in the United Kingdom—could begin utilizing cloud providers from the United States to store patient data, and it’s clear that cloud computing will continue to play a role in the health care industry. 

What does this mean? Cloud is hot. Cloud is nimble. Cloud is necessary.

In 2018, technological intelligence publication Information Age declared, “The cloud has the capacity to revolutionize healthcare, rendering it more efficient through a decentralised approach, and improving the patient experience by providing services comparable to those offered by internal IT organizations—yet at significantly lower costs.” 

While they are crucial to delivering quality patient care, the health care industry must look beyond the immediate, short-term benefits of going digital. These include everything from streamlining daily, routine tasks of medical care professionals; to facilitating the creation of a seamless patient experience before, during, and after appointments; to simplifying the aggregation of patients’ files. 

Longer term benefits include digital transformation methods like machine learning, which add to the positive changes to larger, more institutional processes (e.g. security and employee retention). This technology could enable tailored patient experiences, ensure adherence to security measures, reduce compliance risks, and lessen provider fatigue and burnout. By proactively adopting cloud infrastructure, hospitals, medical practices, clinics, and other health care organizations can ensure security, reduce capital expenditure, and work away from their desk with ease—extremely helpful in medicine. 

Impact of cloud hosting on medical industry

We see a clear impact of cloud hosting and infrastructure in the evolution of virtual medicine. In addition to the proliferation of electronic health records (EHRs), health care providers are reaping the benefits of digitized health records because they no longer need to store paper charts or participate in other methods of clunky data sharing processes. This freedom enables providers to administer health care services—both specialized and standardized—in all types of systems and facilities, extending the reach of care. 

Cloud-based solutions enable the storage, maintenance, and utilization of massive data sets like disease research, health insurance, and patient outcome tracking. Cloud hosting allows providers to administer “big city health care” in small cities or rural settings; no matter how remote or how small a medical practice is, it can still offer competitive medical services such as telemedicine and procedural or medical treatments dependent on thorough documentation and communication between primary and ancillary care providers. 

Moreso, cloud democratizes health care data access and maintenance. Imagine if the closest hospital was 25 miles away (or more) and a patient needed to check in with their doctor regarding their condition, medication adherence, or postoperative regimen. The patient could potentially spend hours in the car to reach a specialist or doctor—not optimal in times of emergency. With cloud computing, smaller clinics in rural settings can provide necessary kinds of primary and specialized care. Cloud computing offers remote physicians access to patient files stored securely in the cloud, and relieves some of the medical operations costs that cause productivity loss and threaten the livelihood of a rural practice.

Cloud-based solutions help eliminate the extraordinary capital expenditure involved with hosting large amounts of data. The CapEx that goes into buying and maintaining hardware or servers is often unrealistic for smaller health care practices and services. Cloud resources turn those outrageous costs into manageable, subscription-based expenses.

Common reservations about cloud hosting

Typically, health care facilities face a number of shared concerns that might hamper them from immediately updating legacy, on-premises systems to cloud systems. The health care industry had to overcome a variety hurdles during the 2014 EHR digitization mandate; the biggest one was, and still is, interoperability. Hospitals are full of legacy solutions and systems when it comes to storing and sharing patient data. On top of that, 2019 was the year when providers realized how important it was to prioritize patient care quality, accurate population health management, and reduction in costs. (If they didn’t, then their competitors would, and patients would follow word of mouth.) It makes sense that providers have similar hangups when it comes to switching from on-premise servers to SaaS, multi-cloud, or even hybrid cloud systems. Let’s dig into how to overcome those hangups:

Reservation 1: Interoperability

Will all of my health care systems’ configurations promote interoperability once I move to a cloud hosting model?  

CIO Review explains that “the primary challenge for organizations” once they implement cloud APIs is that “they are not standardized [because] cloud service suppliers use distinct [interfaces]. Interoperability is currently being performed on an ad hoc basis.” On the bright side, cloud-based systems, as a whole, are more adept at evolving based on need. Digital methods of storing and sharing information are much easier and more collaborative than manual methods. Additionally, major cloud providers including Amazon, Google, and Microsoft are investing in open-source technology to improve interoperability. Google launched their healthcare integration engine Health API and both Amazon Web Services and Microsoft have created storage and exchange services for the Fast Healthcare Interoperability Resources (FHIR) data standard, all in their efforts to ease the way data is consumed, analyzed, and shared. According to Fierce Healthcare, those three companies, alongside fellow giants Salesforce, Oracle, and IBM, recently renewed their pledge to support health care interoperability.   

Reservation 2: Security

Have major cloud providers signed Business Associate Agreements (BAA), those crucial partnerships between HIPAA covered entities that ensure the security of their data assets? How stringent are the cloud providers' security requirements when it comes to protected health information (PHI), specifically? 

Despite research and investment that providers like Amazon, Google, and IBM have poured into the health care space, Healthcare IT News revealed that those giants are still reluctant to enter into BAAs, which are vital to accessing and manipulating PHI under HIPAA regulations. However, they have taken strides to boost their technical infrastructure to “prove they have the wherewithal to handle PHI and other health data,” according to Healthcare IT News. 

Additionally, despite efforts of many organizations to update and modernize their legacy systems, many systems are ancient. It’s better to lean on experts to manage and store patient data; it would take years and significant amounts of money to get on-premises systems up to the same level of security and protection that cloud systems have proven they could handle across many other industries. 

Reservation 3: Burden of building environments

How can I build and manage a cloud system if I don’t have the expertise? 

Setting up cloud-based systems may seem cumbersome, since effective systems require configuration, framework and architecture standards, documentation, and compliance. Additionally, organizations must realize that no matter the level of support they receive from the cloud hosting vendor, they must still invest resources in IT security. Healthcare IT News puts it succinctly: “Sound security is a shared responsibility.” The cloud service provider can offer as many security parameters as possible, but it’s up to the health care provider to make sure that those parameters are correctly and appropriately configured. However, the idea that old systems are cheaper is a misconception; sure, they may not require a monthly subscription, but money is needed to update, fix, and maintain outdated systems. Any updates and fixes to security and infrastructure issues for cloud systems, along with any other support issues, are bundled into the monthly price. 

What are hybrid cloud systems?

Providers have other options besides strictly cloud-based systems. Cost savings aside, some practices and organizations may put more importance on the security of health care information, and may not be convinced about the benefits of a cloud-based server over on-premises solutions. 

That’s where hybrid cloud systems come in. Hybrid cloud is a model where software and services are delivered via a mix of on-premises, public, and private cloud systems. Providers can pick and choose which systems route through an on-premises data center and which are stored in the cloud. Hybrid cloud storage systems offer practices and hospitals the benefits of the cloud while also assuaging them of security concerns. 

Multi-cloud systems also exist; these systems split up the storage of data among separate cloud providers. The significant benefit of multi-cloud systems is that they don’t depend on any one system; if one system isn’t working properly, others can help mitigate that issue. If providers understand the benefits of cloud computing, and don’t want to go down the hybrid cloud route, they can look to multi-cloud computing systems that allow them to partner with several cloud providers, meaning they can leverage the best parts of differing cloud providers. Healthcare Global predicted, “Rather than thinking about multi-cloud as separate cloud providers for different applications, disaster recovery, or cloud provider diversity, 2019 will see a focus on a cohesive health care multi-cloud strategy around different public cloud services for the same application.” 

All in all, any health care or medical organization—hospitals, life sciences labs, or public health clinics—can (and should) turn to cloud-based systems and services. “Can” because cloud-based systems are inherently less expensive than on-premise servers. “Should” because cloud hosting provides organizations with flexibility, modernization, and the most bang for your buck, especially for practices, organizations, and hospitals already stretched too thin when it comes to staff, resources, and inventory. 

Final remarks

Of course, there are disadvantages to utilizing cloud when it comes to managing a practice or sharing patient data. There are benefits to leveraging secure, on-premises servers, one of which is the perception that they offer impenetrable security in the able hands of the practice’s IT administrator. 

Unless health care organizations ensure the underlying network infrastructure is secure based on their specific requirements, as well as invest enough in the physical and human resources to maintain that infrastructure, organizations won’t be able to realize all the benefits of cloud systems. However, the freedom and agility that cloud-based solutions give to health care providers—allowing them to address inefficiencies and close the gap between facility realities and patient experience—is the unmistakable benefit of turning to cloud.