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Health Care Cloud Hosting: Reconciling Multiple Views

One of the age old debates that exist between health care CIOs is: To Cloud or Not to Cloud.  It’s a debate that never seems to end and has strong opinions on both sides.  Since both sides have strong opinions, I’m sure that the debate will continue on for many years to come.  Quite frankly, there are some really good arguments for both in house and cloud hosting in health care.  However, there’s been a real evolution around the discussion of cloud hosting solutions in health care with many health care CIOs reluctantly giving into cloud.

You can see this evolution in a few experiences.  The first experience starts off with an older female hospital CIO at a hospital CIO focus group.  During the discussion the facilitator asked the group for their view and approach to cloud hosting in health care.  This hospital CIO somewhat angrily replied, “Yeah, we have cloud hosting in our organization, but we don’t like it.”  She then went on to describe how they had cloud systems in their organization because some of the solutions they needed were only available as cloud based solutions.  Otherwise, she would have certainly been hosting them in house.

It was very clear that this hospital CIO was not a fan of the cloud, but had been forced into using and understanding how to make the cloud work for her organization.  If she had her druthers, you can be sure she would have hosted everything on site with nothing in the cloud.

In a starkly contrasting experience, at the same hospital CIO event, we come across a younger hospital CIO working in a rural hospital environment.  This rural hospital CIO flatly stated that cloud hosting was the only reasonable way forward for his organization.  He noted that finding and keeping talented people was extremely challenging in the rural environment.  Plus, his budget for staff was such that he could only afford to hire one tech staff to support all of his systems.  That’s a recipe for disaster if and when that system administrator gets sick or goes on vacation.

While these rural challenges were somewhat unique, this hospital CIO also suggested that hardware and hosting had largely become a commodity service.  Hosting the hardware, creating a data center, setting up the network infrastructure, etc were no longer a strategic advantage for their organization.  In fact, it had become such a commodity that it was a strategic advantage for them to put all of their systems in the cloud and not try and host the systems themselves.

The contrasting views of these two hospital CIOs is eye opening.  It illustrates the continuum of perspectives and opinions that exist when it comes to cloud hosting in health care.  However, even the most ardent supporters of keeping all of health care’s servers in house are reluctantly incorporating cloud hosting into their future health IT plans.  This trend is likely to continue, but the slow pace of change will likely continue for a while to come.

The problem for many health care CIOs is fear of the cloud.  There is a real fear by many CIOs that the cloud is unsafe and less secure than something they host onsite with their own technical staff.  For some reason, we all feel like something is safer if we can see it, feel it, touch it, and hold it.  In many parts of life, that is true.  However, in the world of health care IT, that’s rarely the case.

In fact, I recently heard a hospital CIO state multiple times to a room full of other hospital CIOs that “The cloud is more secure.”  He stated this as an unequivocal fact and in an exasperated tone that illustrated how tired he was of health care CIOs trying to argue that in house was somehow safer than hosting in the cloud.

While there are certainly edge cases, it is really hard to disagree with this hospital CIO.  The reality for most health care organizations is that they don’t have the money and scale needed to implement and invest in the types of sophisticated security that’s needed to keep your systems secure in this extremely challenging environment.  A health care organization’s resources are more limited than a cloud provider who spreads their security investment across multiple organizations.  Plus, cloud hosting providers realize that their business is dead if they are breached, so they have to make extra efforts to ensure the future of their business is secure.  While a breach is an ugly black eye on a health care organization, their business will still survive a breach.

Even though we see a move towards more cloud hosting in health care, this is not something that is going to change overnight.  Many health care organizations have big investments in data centers, servers, and storage and so it doesn’t make sense to move everything to the cloud immediately.  However, it is important that every organization have a well thought out Cloud Assessment & Migration Planning process.  This will help your organization more appropriately evaluate which applications you should move to the cloud and which applications should remain in house.  A good plan will make this a numbers driven, data decision as opposed to an emotional decision based on personal preferences.

As we look into the future, it’s hard to see any scenario that doesn’t include a large portion of health care being hosted in the cloud.  This will likely to be even truer as genomic medicine, personal health devices, and other health sensors become an integral part of our health system.  However, we shouldn’t be surprised if the shift to the cloud takes longer to happen than many would expect.

What’s your view on cloud hosting in health care?  Do you see it as inevitable?  Are you afraid of the consequences of the move to the cloud?  Are you excited by the opportunities that cloud hosting provides?


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