Electronic Health Reporter

By Inga Shugalo, healthcare industry analyst, Itransition.

Following the wind of change, we find that healthcare is on the way to transferring most of its processes to the cloud. According to IDC, hospitals now tend to prefer keeping custom medical software from EHRs to AI and data analytics on cloud servers instead of in-house management.

With more providers investing in scalability and cost-efficiency of cloud solutions, the recent research forecasts the global healthcare cloud computing market to reach $35 billion by 2022 at 11.6 percent CAGR.

Currently, the cloudification develops in two complementary directions.

Some providers only test the waters going for a new cloud solution, for example, a mobile app to support chronic disease management. Others consider migrating their already existing architecture elements to the cloud to enable seamless synchronization between different system parts, create new team collaboration practices, or save time and money on the infrastructure maintenance.

Since cloud migration is a complex process requiring substantial planning and good timing, we’ve decided to cover the initial steps of a smooth transition to the cloud.

Assessing the infrastructure

First things first, there is a good chance you don’t need to migrate the full infrastructure and can better manage your investments by injecting them into strategic areas only. Start with considering your as-is situation and pinpointing the architecture components with the potential to impact the business evolution via new or improved services.

Additionally, take into account the possible technology and business constraints, upcoming updates, integration and compatibility requirements for the solutions, as well as the need for a substantial redesign before starting the cloud migration.

It can turn out that some big data archives that aren’t used frequently can stay on-premise, and some applications will serve providers better from the cloud due to increased robustness and security for the regular multi-user access.

In this case, an organization can choose to go for the hybrid environment, decreasing the load on in-house servers and adding up more flexibility to the picked system elements.

Self-check: What are our migration goals?

Answering this question, you will be able to determine the priority elements for migration to the cloud by determining the most pressing needs, such as everyday workflows, equipment management, or disaster recovery.

While thinking about the goals, review all parts of the infrastructure, including business and clinical applications, such as EHR, LIS, PACS, and RIS, assigning them to one of the following categories:

• First to be migrated
• Future migration projects
• Unable/unneeded to migrate

With such a clear prioritization, it will be easier to assemble a migration roadmap that will guide the project scope creation, design, and implementation processes.

Drafting a migration strategy

After your priorities are all set, it is time to create a migration strategy based on applications and data to be transferred to the cloud. You can either pick one of the approaches or mix and match them depending on particular infrastructure elements.

Lift and shift

With this approach, you practically transfer the application or data from the on-premise environment to the cloud without redesigning it, practically as is. Lifting and shifting process is fast, cost-effective, and can be achieved with the help of migration tools.

However, resource-demanding solutions (such as EHRs) aren’t the best candidates for using this approach due to possible performance and latency issues after the migration. Moreover, when transferring legacy apps in their initial state, providers can be unable to access such cloud-native benefits as autoscaling.

Replatforming

This approach allows optimizing the app or solution for the cloud without changing its core architecture. This way developers can reuse legacy languages, frameworks, and caches to tweak the software. For instance, replatforming can be used for migrating PHI databases to DaaS or fully managed platforms.

Partial and full refactoring

Refactoring means that an application or solution requires architecture changes to enable the cloud-native functionality or improved performance. The partial approach assumes that developers can leave the application core unaltered building extending features on top of it.

If you need to migrate the monolithic architecture to a serverless or service-oriented one, only full refactoring will do the trick. Indeed, this strategy will require more time and budget investments, but it makes sense to apply if you are planning to refactor the critical application in the IT infrastructure. The application stays the same but gets all cloud-native features, boosts in performance, new security layers – anything you’ll need. Still, there are more options to go for.

Repurchasing

This is the part where you decide that the legacy application is too outdated to try tweaking and tuning it. For example, your application for nursing staff doesn’t support the current workflows anymore, forcing the nurses to create complex workarounds to enter administered medications. In this case, healthcare organizations can decide to purchase a SaaS solution to replace the old system, for example, move their clinical CRM to the Salesforce or Microsoft Dynamics platform.

Retiring

Migration to the cloud means leaving outdated software behind. This is why we have a soft spot for this approach – it offers precisely that. If you did a good job assessing the current architecture, you have probably found some parts of the system that are no longer used. Particularly, it can be 10 to 20 percent of the system, consisting of various applications, archives, plugins, etc.

So just get rid of anything you found to be unsuitable for the new cloud-based clinical IT of yours.

Retiring the obsolete software allows you to optimize your resource allocation – cut on maintenance costs, reduce security concerns for outdated software, and engage the in-house IT specialists in other tasks.

Taking one step at a time

Healthcare is the area where bold treatment breakthroughs blend with more gradual and cautious innovations; that’s why we have cloggy legacy systems and continuous PHI security threats. Thankfully, we are standing at yet another milestone for the cautious but really important innovation – cloud computing. By transferring data and parts of the IT architecture to the cloud, providers can achieve flexibility, save on costs by transitioning to operational expense instead of a capital expense, and cut corners on the needed IT resources for on-premise maintenance.

By adopting a step-by-step approach to cloud migration, you can prioritize the applications and solutions, eliminate the obsolete system components, decide on the proper migration strategy, and gain all cloud benefits on the most advantageous terms.