Should healthcare IT shoot for the cloud?

To wit, IT consulting and contract services remain well entrenched and acceptable as standard operating procedure in the healthcare IT realm. In fact, software-as-a-service (SaaS), more commonly referred to as “cloud computing,” is no exception.

In the April 2015 edition of Health Management Technology, healthcare IT executives discussed the virtues of adopting and implementing virtualization within provider organizations, independent of cloud computing or in tandem. All expressed bullishness for both virtualization and cloud computing, which when intertwined can make IT networking more efficient.

For this issue, our experts delve deeper into the benefits and tradeoffs of moving to the cloud.

“If you’re hosting hardware, you almost certainly should invest in virtualization,” says Chris Schremser, Chief Technology Officer, ZirMed. “I can think of very few instances where that investment would not be worthwhile, but I suppose if you have loads of excess capacity and don’t mind paying for it, virtualization might not be for you.”

Opting to pursue cloud computing, however, need not be an overwhelming project.

“A good place to start is to separate your mission-critical IT needs and applications from non-mission-critical, Schremser advises. “You might want to start by hosting those non-critical workloads on someone else’s infrastructure – aka the cloud. Again, this helps contain costs and frees up additional virtual, and potentially physical, space that you can use to accommodate increased demand or future growth.”

More organizations may be doing just that, according to David Ting, Chief Technology Officer and Founder, Imprivata. Quoting from his company’s 2014 Desktop Virtualization Trends in Healthcare report, Ting says that 41 percent of healthcare organizations expect to be using cloud computing over the next 24 months.

“For healthcare organizations, cloud computing reduces the need to invest capital on new IT assets and infrastructure, and offloads the maintenance, management and upkeep to a service provider,” says Calvin Hsu, Vice President, Product Marketing, Desktop and Apps, Citrix. “As a result, doctors, nurses and clinicians can focus on patient care, instead of technology. Healthcare IT organizations can focus on strategic application and data management, rather than hardware maintenance.

From an operational perspective, cloud computing and the software-as-a-service model offer compelling benefits.”

But Hsu urges caution before deciding to take the plunge.

“At the same time, it’s critical to make sure the right security and management measures are in place to comply with HIPAA requirements and provide healthcare staff with constant, reliable access to the information tools and resources they need to serve patients,” he says. “Some cloud service providers specialize in the unique requirements of the healthcare industry.”

Jeremy Molnar, Vice President, Services, CynergisTek concurs.

“Adopting cloud technologies requires really understanding the purpose and any associated risks,” Molnar says. “Most think of cloud as data storage, so the type of data stored determines whether this is an acceptable solution or not. In terms of Infrastructure as a Service (IaaS), PaaS (Platform as a Service), or DaaS (Data as a Service), you’re really looking to transfer the risks and management of IT functions to the cloud provider. This allows an organization to slim down its own IT staff or to at least let them focus on internal tasks that are much more important. I have not seen huge adoption rates of cloud technologies largely due to lack of understanding and overstatement of the risks involved.”

Much depends upon the healthcare organization’s needs, culture, budget and the specific applications they use, says Chan Ghosh, Managing Director, Technology & Operation, Orion Health.

“If they are looking into using cloud-based applications, they need to be

comfortable that the security and accessibility of the systems is in keeping with their institutional standards,” Ghosh says. “If they are looking to run their own virtualized systems in-house, they need to be sure that is the best use of their capital and human resources.

“Today, many healthcare organizations are finding they have enough to do focusing on care and population health, and they want to outsource as much as they can,” Ghosh continues. “Others want to have clear control of all their systems and processes. There is a cost-benefit analysis to consider there, but also a cultural decision as well.”

While popular and trendy now, cloud computing isn’t new – clever branding just makes us think it is, according to Henri “Rik” Primo, Director, Strategic Relationships, SYNGO, Siemens Healthcare.

“Cloud computing is actually as old as the beginning of IT in the mainframe computer era,” Primo says. “The mainframe was running all the applications centrally and was located in the hospital’s data center. End-users interacted with the applications on the mainframe through terminals, which, in fact, were the first ‘thin clients’ since terminals had no internal application software, only a keyboard and a card reader or display, and connected to the mainframe over a network.”

Primo adds that virtualization allows smaller hospitals to build their own private cloud to run their applications, such as billing, electronic medical records, PACS, email, registration and ordering. According to Primo, these facilities will have to scale the number of servers in the virtualized environment appropriately in order to provide the required computing horsepower to run the applications with the required performance, or they might contract with a cloud-based vendor to manage these applications through their datacenters.

“In any industry, including healthcare, companies should adopt a ‘virtual first’ policy, meaning everything runs on virtual unless there’s a technical reason why it can’t,” says Doug Hazelman, Vice President, Product Strategy, Veeam Software. “When considering cloud, private cloud and automation are the best first steps, especially in healthcare. It’s important to understand any rules and regulations certain data may be under, as it may prevent some healthcare organizations from being able to utilize a true public cloud.”

Taking the plunge

Hsu identifies three key factors to determine whether to invest in cloud computing, virtualization or both in some hybrid fashion.

First is the age of the organization. “Older, more established organizations will have significant legacy systems and applications that may make moving to cloud impractical, or at least a lengthy process,” Hsu says. “Newer organizations may want to start including cloud to position themselves better for growth and change, as well as acquire IT skills from the service provider that otherwise would take significant effort to ramp.”

Second is regulatory compliance. “Some organizations may not feel comfortable with grasping all the considerations of regulatory compliance in the cloud, and opt to keep everything on premises with virtualization helping to drive efficiency and flexibility,” he continues. “For these types of organizations, new forms of hybrid cloud management are emerging for application delivery, where data and applications can be kept securely on premises, but the management service is provided from the cloud. This new form of hybrid holds a lot of promise for healthcare organizations that want the benefits of virtual app delivery, but lack the IT resources to implement it themselves.”

Third is the financial model. “Some organizations are more inclined to leverage [capital expenditures] for IT purchases, particularly if their IT environment is [seeing] steady, predictable growth,” he says. “In some areas, the IT requirements might be more volatile, in which case an [operating expense] cloud model helps them react better to the changing needs of the organization.”

Deciding to pursue cloud computing and data virtualization should hinge on business information rather than the underlying IT hardware and software involved, according to Suresh Chandrasekaran, Senior Vice President, Denodo Technologies. As a result, the abstraction, flexibility and cost savings realized from this reduction in data replication can be achieved regardless of whether the healthcare organization adopts cloud computing or hardware virtualization.

“The only real consideration is where to locate the data virtualization software itself,” Chandrasekaran says. “Put simply, it is better co-located where most of the data already resides, either on-premise or in the cloud.”

A healthcare organization should take an inventory of its hardware resources, including servers, storage, applications and networks, he suggests. Determine what applications, resources and capabilities must remain on-premise and dedicated given factors such as data security, control, customizability, network latency and real-time needs, and scale and performance requirements too. Then the facility should compare this with the available skills and resources to manage IT infrastructures and cost.

“For example, a healthcare organization may decide that while some key analytics and operational systems containing patient and clinical records must remain in-house, most other non-core IT functions and applications such as HR and procurement can move to the cloud or SaaS platforms,” he says. “This also depends on the size of the organization, their unique business strategy and customer needs. In most cases, we can assume that cloud computing resources are being virtualized and the benefits reflected in the costs indirectly.

“Next, the decision would be to determine whether the virtualization benefits for those in-house applications and resources would still be meaningful, and if operations and skills can be centralized,” he adds.

Both cloud computing and virtualization can work together, Chandrasekaran insists. “For example, data virtualization often includes cloud computing resources as either sources or consumers and can be deployed on cloud or virtualized server environments,” he says. “And cloud computing architectures primarily use virtualization techniques to maximize the efficiency of resources.”