Moving is a very daunting task. The longer you live somewhere the more stuff you have to pack up into boxes and then unpack in your new place. And you’ve kept this stuff for so long that you’re attached to it and don’t want to get rid of anything. Moving your organization to a new system is just the same. All of your data and information is stored away in other systems and applications. And while those systems and applications may not be perfect, your staff have used them for so long that they’re used to them and might be resistant to change. Tragically, for both moving in our own lives and moving our organization’s practices, we can’t always keep everything and sometimes we have to migrate to something newer to gain new benefits. Since moving off old hardware inevitable, we have to ask ourselves how can we best migrate to the cloud and are there times we shouldn’t?
To answer that question, we reached out to our brilliant Healthcare IT Today Community. Here is their recommendations on what you need to consider when migrating existing healthcare systems and applications to the cloud.
Patty Hayward, General Manager, Health and Life Sciences at Talkdesk
Consumers expect convenient and connected service from healthcare, increasingly at the level they are getting from other industries. Organizations are not going to be able to deliver that service and keep up with expectations if they’re using legacy systems. Most leaders understand the need to move to the cloud – this isn’t a new trend in IT – but they must avoid transitioning their problems to the cloud along with the tech stack. On premise technology is often highly customized and built up over years in the same organization; adopting cloud systems, replicating your on-prem processes, and expecting magically better results is setting your project up for failure. Treat it as a catalyst for innovation, rather than a new place to do the same old thing.
Anthony Brooke, Chief Technology and Innovation Officer at DrFirst
Let’s talk less about the pros and cons of moving to the cloud and more about what we can free up by removing the limitation of infrastructure. Having led the shift to cloud-based tech for three organizations, I found it had a surprising effect on staff culture. Conversations shifted from “We can’t because…” to “Let’s give that a try.” And teams’ project timelines contracted from quarters to weeks. Less infrastructure to manage meant more time for teams to develop software that generates outcomes, rather than managing the hardware that it runs on. Think about what your team can achieve with 30% of their time freed up. Transitioning from “on premises” to the cloud certainly requires different skill sets, but the dividends offset the challenges with benefits for culture and agility.
Dave Mulligan, Executive Vice President of Technology at Carenet Health
Measure twice, cut once. For migrations, more attention should be paid to the legacy system than the future state cloud environment. A common error with cloud migrations is expecting an automatic benefit from the target solution while struggling with existing system deficiencies. In other words, don’t shift a problem to the cloud and expect it to be better. Instead, define the order of “lift and shift”, process and/or technology transformation, data mapping, and related conversions. The order of these priorities varies based on the needs of the business. Mapping a plan for key gaps in capabilities, defining a plan for process reengineering, followed by a controlled migration, as opposed to a flash cutover, is preferred. Adjustments to staff organization, skills, etc. should be identified prior to a migration.
Clay Posey, AVP, Technical Services at CereCore
We are taught that questions should not normally be answered with questions; however, in this instance the questions and comments are to help spur thoughts around some of the challenges that will need to be addressed.
While moving to a public cloud can offer improved scalability, enhanced accessibility, and potential cost savings, healthcare systems need to be cognizant of several potential challenges. Ensuring that HIPAA compliance is met by the cloud provider is top of mind. Along that same vein, confirming that data in motion and data at rest is encrypted should be confirmed. Healthcare systems should evaluate the systems that are under migration consideration. Are the applications able to take advantage of public cloud scalability and flexibility or will the migration just result in IAAS? If IAAS, has the healthcare system performed a financial analysis to verify that a migration to the cloud will have financial benefits?
Have the healthcare systems prepared their leadership about the real potential of having to cover costs of on-premise systems and cloud systems at the same time due to delays in the original cloud migration schedule? Has a plan been developed to cover these potential cost overruns? Healthcare systems should account for the time to migrate data to the cloud. Does the healthcare system already have tools to assist with the migration? How does the data migration affect the on-premise systems as data is being copied to the cloud? Is there enough network bandwidth? Have the healthcare systems built a rollback plan, if the migration fails for some reason?
Does the cloud technology meet the disk speed and disk presentation requirements of the systems that are migrating? Are there any regulatory concerns or patient notification concerns that need to be addressed with patient data being placed in a cloud environment?
Further, healthcare systems should investigate their interoperability and integrations. There are several “legacy” devices and systems inside of most healthcare systems that will have to be addressed and could require some form of development or more complex routing/security/interfacing than required when located on-premise. Have healthcare systems spoken to their 3rd party partners/vendors about any potential challenges with migrating systems to the cloud? Have the healthcare systems investigated their interoperability model and how that will function within the public cloud? What if any are the potential security concerns or new tools required?
Have healthcare systems invested in the proper toolsets to monitor and manage systems that have migrated to the cloud? Have employees received the proper training on cloud technologies and the toolsets? Have technical teams been empowered to be creative so that cloud technology opportunities are realized? Have DR and BCP plans been tested and updated to reflect the migration to the cloud?
Finally, healthcare systems should prepare for the change. In general, healthcare tends to be behind other verticals when it comes to technology adoption. Are healthcare systems prepared for the change to the cloud? Do they have the correct blend of skillsets to be successful? Is there leadership understanding regarding the differences, opportunities, and potential challenges between on-premise and cloud?
These questions should be answered by large scale migrations.
Tim Quigley, Chief Client Officer at CloudWave
The primary challenge in migrating existing healthcare systems to the cloud is that many legacy applications were not originally designed to run in cloud environments, particularly in public clouds. Trying to use the modern technology and newer functionalities that leading public clouds are built on is a constant issue.
The problem stems from the fact that many healthcare applications have not been re-engineered/rewritten to function seamlessly within these cloud infrastructures. Additionally, there is a risk of potential breakdown of critical functionalities within an application while incorporating legacy code into non-cloud-native software. As a result, trying to move healthcare applications to a cloud environment often proves challenging, leading to increased costs and unforeseen operational issues. Therefore, it is crucial for healthcare organizations to consider the complexity of their systems and have a comprehensive migration plan that accounts for their specific interdependencies and ensures minimal disruption to patient care.
One approach is to identify components that can be made multi-tenant while maintaining separate environments for those that require it. Healthcare organizations should strongly consider discussing hosting options directly with the software vendor rather than trying to move to the cloud with their internal resources or get help from a qualified third-party provider who has a comprehensive understanding of how the healthcare ecosystem operates. These providers bring valuable insights, having navigated the pitfalls associated with various vendors, and their expertise can significantly alleviate the complexities and challenges related to cloud migration.
Rich Amelio, Vice President, Healthcare IT Operations and Consulting at e4health
Similar to migrating data between applications in healthcare, the success of healthcare application cloud migrations is often driven by proper planning and governance. While there are significant advantages in cloud migrations, there are equally significant risks, including the overall cost, resource need and timeline. Healthcare organizations often underestimate the impact of a cloud migrations, more specifically as it relates to timeline and costs; strategic planning related to overall project as well as pre-planning can help improve the overall success of a cloud migration. In addition to planning, working to put proper governance in place to lead the effort while providing organizational leadership with visibility into progress is extremely important to organizational leadership.
Maxwell Lawson, Chief Information Officer at e4health
When weighing the pros and cons of moving to the cloud, organizations need to pay attention to their long-term goals, expected scale, and the evolving cost implications of cloud technologies. Cloud solutions can provide easier maintenance, allow for easy scalability, lower initial costs, and can help reduce an organizations security burden.
Over time though things like recurring large data transfers, special security requirements and unplanned price increases can tip the scale to the point that many organizations seek out a hybrid approach. Organizations must be careful not to lose the knowledge base they have grown via internal systems or become solely reliant on outside systems that may change the ways or costs to do business.
When evaluating the use of public, private, and multi-cloud scenarios, organizations must make sure they are paying attention to the level of regulatory compliance they are subject to, as well as their risk for tolerance, and their budget for security. Public cloud options have become common place as organizations have worked to reduce their operational cost and staffing but pose the highest threat to compliance regulations amongst the three categories.
For that reason, many health systems turn to private cloud or multi-cloud solutions but realize increased overhead costs either from a private cloud infrastructure, or from staff to work to keep the right balance in a multi-cloud environment. The trick is to focus on your data classifications in your various business units, and to pick the minimal selection of cloud solutions that fit your specific needs. Unfortunately, there isn’t a one-size fits all solution, and your needs are likely to continue to change, so building out a team that can evaluate your cloud strategy is crucial.
So many great suggestion on what to look out for! Thank you to everyone who took the time out of their day to submit their insights and thank you to everyone reading this article! We could not do this without your support. Let us know what you think people need to think about when migrating existing healthcare systems and applications to the cloud either in the comments down below or on social media. We’d love to hear from all of you!
