Authors: Harshal Sawant Associate Vice President, CitiusTech Shradha Doshi, Head of Consulting- Provider Market, CitiusTech
The healthcare industry is one of the biggest and the most regulated industries and it has its unique requirements when it comes to data management, storage and safety. The recent pandemic has brought significant demand of various IT-dependent services and offerings, such as telehealth, interoperability, wearables, remote monitoring of patients, cybersecurity and with that the trend to embrace complete digitalization is also increasing.
Achieving end-to-end digital transformation primarily depends on cloud migration. According to Gartner, cloud investments are viewed as one of the top three investing priorities by more than a third of organizations. What is a cloud computing environment? The majority of definitions state something along the lines of "cloud migration is the process of moving data, assets, and IT processes to a cloud computing environment." But what advantages does this tactic offer healthcare organizations, specifically?
Cloud adoption results in increased operational efficiency and at the same time, a significant reduction in cost, ultimately providing better support and accessibility to the entire workforce. The cloud market in the healthcare space is growing at an exponential rate and is expected to reach more than USD 70B by 2027, increasing at a CAGR of more than 15% from 2022. COVID-19 has accelerated the use of Telehealth, e-Prescriptions, mHealth and other healthcare IT oriented services and these are acting as the driving force behind increased cloud adoption in the healthcare industry. Cloud migration also offers improved interoperability systems along with increased data security as well as adhering to various regulations and policies. This in turn helps in taking better real-time decisions and optimizes resource utilization enhancing the overall patient care experience.
Trends and Opportunities:
Cloud computing is one of the IT industry's fastest-growing sectors of the healthcare economy in the post-pandemic era, and new trends and developments are now being incorporated into the system. By 2024, most enterprises aspire to have $8 out of every $10 for IT hosting go toward the cloud, including private cloud, infrastructure as a service (IaaS), platform as a service (PaaS), and software as a service (SaaS). The increase in adoption of Software-as-a-Service (SaaS) cloud service, which had a market share of 63.7% in 2020, resulting in the increasing number of migration of providers and payors toward more SaaS healthcare computing services to manage the inpatient data, and Infrastructure-as-a-Service (IaaS) having 26.0% market share and holding the second largest position as a result of key market participants’ affinity to expand their market share in this segment, will eventually uplift data sharing and remote collaboration, which was not something easily doable before. The following trends are being used by many organizations in the cloud computing space:
- Payment Reforms: A huge cloud migration trend can be seen in case of the Financial Institutions to improve scalability and provide better customer experience. The healthcare industry also is going through a major payment reform as a part of the movement from the fee-for-service model to value-based care payment model, and with that, the likeliness of moving towards cloud from on-premises model is increasing as well.
- EMR on Cloud: Instead of having to manage individual on-premises data centers, organizations can now outsource backend responsibilities to third-party cloud providers and reallocate all their resources to higher-value activities. Since data storage and software deployment are managed remotely, cloud-based EMRs can be implemented and operated more economically. At the same time, users can access updated clinical data from multiple locations, which is a significant advantage.
- Security & PHI: Along with that, organizations can consolidate operations and distribute access to cloud services as needed, and this in turn increases enterprise efficiency. For healthcare industry, meeting data security needs and complying with HIPAA regulations are very important. Healthcare facilities covered by HIPAA are allowed to use cloud for storing and managing Electronic Protected Health Information (ePHI), and this is another reason for the organization’s increased interest in migrating to cloud.
- Application Modernization: Cloud migration trend can be to eliminate the end-of-life timelines for various applications. The organizations deal with critical hardware and software to meet the healthcare industry’s unique needs and these hardware and software usually come with various long-term contracts and strict licensing agreements. Cloud solves this issue as the companies pay for crucial cloud capabilities, where the latest technology updates are available at once.
- Others: Reduction of capital expenses due to a hardware refresh cycle by minimizing on-premises data center needs and shifting to a more elastic and operational model, integration of new technology into existing environments with minimal operational impact in a cost-effective way, and improvement of disaster recovery (DR) capabilities in a cost-effective manner with largescale, geographically dispersed data centers and availability zones can also be considered as other noticeable trends.
Cloud computing is currently used to run critical applications and extract information from hordes of unstructured data including physician and laboratory notes with the help of multiple machine learning capabilities like AI, MLP etc.
Providers now are able to have easy access to patient data from various sources with minimum need for complex security protocols, which in turn helps them provide their patients with quick and accurate medication, therapies and information. Cloud computing has huge potential for the improvement of various health-related functions like virtual care and telehealth, drug anti-theft and counterfeiting measures, inefficiencies of resources, data privacy, uniformity of medical records and medication adherence. Cloud capabilities also play a significant role in enhancing the healthcare delivery experience of the stakeholders.
A recent McKinsey report categorized the healthcare functions including payers and providers, into five main categories, that can be extensively benefitted by cloud computing. With the help of cloud computing, these five categories will help to design and deliver new patient-centered delivery models improving patient outcomes.
These categories are:
- Personalized experience,
- Medical management,
- Member acquisition,
- Value-based care and,
- Home health.
Real-Time Data Accessibility:
Cloud computing is integrating more data to drive better business decisions, control cost, and improve quality of care with the help of healthcare analytics. Some of the leading BI solutions are capitalizing on the accessibility of cloud-based data which are freed from EHR silos, and available reference points to improve the care delivery system.
Although Cloud implementation is extremely beneficial for the healthcare sector, it comes with certain challenges. The resource constraints sometimes become major pitfall for cloud adoption for most of the healthcare organizations. A recent survey among healthcare IT industry leaders found that 35% of the participants said their major challenge is staff turnover. 21% of healthcare IT leaders were found to be proficient in AI/ML and only 23% thought that they have a team with DevOps and automation proficiency. This in turn is slowing down the cloud migration journey of the overall healthcare sector. Privacy regulations and security compliances are also other important setbacks for the healthcare sector.
Choosing cloud based EHR/EMR implementation service over on-premises one makes it more scalable and flexible with less chances of runtime error, readily available vendor IT support and low upfront cost. But it makes the system susceptible to higher risk of data breach and provides limited options for customization, control and data management. Providers often face challenges regarding cost related issues around this, as it might come with certain hidden expenses and additional charges for customization, hardware upgradation, storage expansion, and other related issues. Transferring data to a new system is somewhat expensive as well.
Cap-Ex to Op-Ex Model: The organizations keep facing cost related challenges even after migration as well. The first month post-migration is expensive as it runs on operational expenditure model (OpEx Model), which is different than the traditionally followed capital expenditure model (CapEx Model). But this gets compensated over time in terms of increased ability to scaling and visibility of global markets and accelerated speed of innovation, and the overall expenditure lowers to a great extent.
Governance is another post-migration challenge if the organizations fail to execute pre-migration planning and assessment successfully. This can create employee confusion, which ultimately results in reduced productivity.
Cloud Application Programming Interfaces (Cloud APIs) enable cloud to the enterprise level and allow flawless communication and information transfer among the applications in cloud. But exploring operations instead of objects into the cloud API can be a mistake. Development of a single version of API that changes with each release of the SaaS application and never batching or throttling the results of query calls against your API can also make the situation tricky.
Cloud SLAs (Cloud Service-Level-Agreements) determine the levels of reliability, availability and responsiveness to systems and applications and specify the governance and penalties in case of service interruption. Analyzing the SLA performance from time to time and making sure the cloud service latency remains similar even after migration, can ensure a smooth cloud migration journey.
Pragmatic Approach & Best Practices
Hyperscalers in cloud migration:
Hyperscaler cloud service providers are the entities that consult, design, develop, build, manage, and orchestrate software, data, and applications provided by one or multiple hyperscalers. These are continuously evolving around their technology offerings and tailoring them as per the healthcare industry’s unique requirements. These hyperscalers are basically chosen based on their skills and capabilities to recognize various domain functions specific requirements and their solution offerings towards them. Hyperscalers are niche with the latest technology and security measures to support the operation in every way, but a proper cloud assessment and implementation protocol is needed to make the cloud migration journey successful.
Healthcare organizations need to use numerous applications that are both web and mobile friendly to ensure optimum patient engagement and at the same time taking care of data safety and security. Most of the hyperscalers’ platforms are complex and difficult to manage because of their lack of in-house technical skills to cater to the unique organization specific needs for the healthcare industry. This sometimes makes the consumer organizations more prone to security risks. Hyperscalers can be really prompt when protecting data and dealing with the overall threat of data breach, but the organizations should also take responsibility for their data while investing into a particular hyperscaler and ensure data safety with the help of certain liability clause to avoid indemnification issues.
Organizations are becoming more prone towards adopting multi-cloud as it reduces dependency on a single cloud provider, thereby reducing the chance of failure and it also helps in combining different cloud implementations as per their needs. A recent IBM survey revealed that around 85% of organizations were currently multi-cloud business models’ users, but an active multi-cloud strategy was in place for only 41%. This shows the hyperscalers’ lack of ability to guide their consumers in the right direction while adopting clouds and to customize their solution as per organization needs. Lack of customer awareness towards multi-clouds will also increase the chance of vendor lock-in and can reduce overall efficiency and security of the organization workflow.
Multi-cloud and Hybrid Cloud:
Most of the organizations are following a multi-cloud or hybrid cloud strategy while migrating to cloud. Multicloud is when an organization chooses to use a combination of two or more private or public clouds of the same types together as their cloud service providers to distribute their applications and services, and a Hybrid cloud model is when the combination of different clouds are of different types. There are certain benefits and challenges associated with both the types, but they are significantly beneficial rather than sticking to a single cloud for the entire migration journey.
Is there a need for multi-cloud?
While most of the organizations are moving towards cloud, sticking to a single cloud strategy can be very expensive with more chances of failure. Incorporating a multi-cloud strategy allows the organizations to figure out the perfect cloud options for as per their workloads. This helps in optimizing the expenditure and ensures return on investments.
With the help of a multi-cloud infrastructure, the organizations can support a hybrid cloud environment which will in turn allow a combination of security as well as cost savings at the same time. The workload can be distributed among private and public cloud networks, where the private cloud can be used to keep the most security-focused workloads and regular business data and apps can be in public cloud networks in a cost-effective manner.
Sometimes a delay can occur while retrieving the data from cloud due to data traffic. The chances for this can be reduced by using the multi-cloud infrastructure, as the datacenter nearest to the end-users can retrieve the requested data with minimum server skips. Multinational organizations can greatly benefit from this as they need to provide corporate data across various faraway locations while sustaining a unified end-user experience.
Vendor lock-in is another setback for the organizations while migrating to cloud since it is an expensive process. Adopting a multi-cloud strategy enables them to select platforms and vendors as per their needs, so that their workloads are not dependent on any individual cloud providers. Switching to different vendors becomes easier, and with the decreased vendor lock-in, customers are now free to cater to the ever-changing business needs for security, performance, and ROI. Using different cloud providers at the same time also decreases the risk of server breakdown and downtime.
Will the Journey Ever End?
Organizations recognize that the healthcare industry is growing at an unprecedented pace and the majority of the growth is driven by demand for quality healthcare and the latest technology adoption. With this growth, the healthcare sector is expected to generate huge volumes of data coming from varied sources. To respond to the demands of the customer and deliver better patient care, Healthcare organizations need to manage their data effectively. It can be said that there is a tremendous growth opportunity as very few organizations are fully utilizing the cloud infrastructure.
Despite the push towards adopting telehealth and other AI based technologies because of the recent pandemic, healthcare industry is still struggling with various issues of cloud adoption, such as finding the right hyperscalers, compliance constraints etc.
Cloud adoption is the future of every business including healthcare, and according to industry leaders as captured in a recent Citrix Survey, it is going to be fully embedded into the organizations by 2025. Therefore, even after taking into consideration all the pitfalls, challenges, and market trends, we can say that Cloud adoption is an essential requirement for healthcare organizations to meet present market demands. However, since different organizations are currently at a different stage of their migration journey and they are going at a different pace, predicting a typical timeline for everyone to come on the same page would be in reality an ambitious statement.
Where Our Expertise Lie?
CitiusTech has worked with numerous clients across the healthcare industry to evaluate their present situation, create their migration strategy with a clear return on investment, and assist them with putting the strategy and migration plans into action to meet their business objectives. With our expertise and accelerators, we examine the cloud world holistically and provide flexibility in locating the best alternatives for your company's size.
We collaborate with leaders from cloud service providers including Microsoft Azure, Amazon Web Services, Google Cloud Platform (GCP), and Snowflake. Setting up and monitoring cloud infrastructure as well as guaranteeing business continuity are handled by our team of trained professionals. To protect the patients' sensitive data and enhance their experience, CT also complies with best practices and industry standards including HIPAA, SOC2 etc.
CitiusTech has the experience, expertise, and technologies to achieve Cloud Migration requirements and find strategic value from Cloud migration.
We can share case studies where we overcame various cloud migration challenges for clients and created solutions that do more than just comply. Contact us to discuss your unique cloud migration goals and timeline.
CitiusTech is at ViVE from 26th March to 29th March, 2023!
Come meet us at ViVE#2023 to discuss the healthcare cloud migration trends and challenges.