The Future of Healthcare in the Public Cloud

The Current Landscape of the Public Cloud in Healthcare

The pandemic forced healthcare organizations to accelerate their technological upgrades. According to a Google Cloud study conducted in conjunction with The Harris Poll, 45 percent of physicians said the COVID-19 pandemic accelerated the pace of their organization’s adoption of technology. In fact, more than 3 in 5 physicians (62 percent) said the pandemic forced their healthcare organization to make technology upgrades that normally would have taken years.

For example, 48 percent of physicians would like to have access to telehealth capabilities in the next five years. Before the pandemic, about half of physicians (53 percent) said their healthcare organization’s approach to the adoption of technology would best be described as “neutral” (that is, they would be willing to try new technology only if the product has been on the market for a while or others have tried and recommended it).

“To that end, a new U.S. regulation that takes effect this year not only makes it easier to improve the healthcare experience and quality of outcomes for patients, but also lays the groundwork for potential innovation that goes far beyond simple compliance,” says Joe Miles, managing director of cloud healthcare and life sciences at Google Cloud.

As part of the 21st Century Cures Act, the Office of the National Coordinator for Health Information Technology instituted a rule that patients must receive secure access to their electronic health information to use and share as they please. On Oct. 6, 2022, the definition of electronic health information will expand, and healthcare organizations must provide that information when requested by patients.

Likewise, the Centers for Medicare and Medicaid Services’ Interoperability and Patient Access Rule requires that healthcare organizations participating in federal exchanges share claims data with patients electronically.

“By requiring that healthcare organizations convert data into the Fast Healthcare Interoperability Resources (FHIR) standard, the regulations serve as a forcing function for health plans and providers to improve the quantity and quality of data they share with patients. The idea is to enable patients or members to make more informed decisions about healthcare plan purchases, treatments options and lifestyle choices,” says Miles. “In healthcare, one of the biggest challenges we’re seeing customers face is getting to the right information. This requires time and significant resources coupled with artificial intelligence and machine learning expertise. It also requires a fluency in speaking many healthcare data languages natively. Patients, machines and caregivers are generating vast amounts of medical data in many different languages — or in varying schemas and clinical terminologies. Further, that data is often spread across multiple electronic health records instances, inhibiting holistic insights. When data is available and translated, it is often stale by 36 hours or even a week, making it unreliable to draw potentially life-altering conclusions from.”

Healthcare organizations are addressing these challenges using the public cloud to collect various types of data, harmonize that data and derive valuable insights from it. Miles explains that the challenge now is broader: Organizations need to offer a level of scale, privacy and governance never seen before in healthcare and life sciences.

“The sheer volume of this data presents the biggest opportunity in healthcare and life sciences — to provide deeper insights, distribute them to the right people and then make better real-time decisions — all with the highest levels of security, compliance and respect for user privacy,” he says.

What’s in Store for the Future of the Public Cloud in Healthcare?

“The cloud is ultimately about helping you use speed to be reactive to your marketplace,” says Pete Johnson, field CTO for CDW’s digital velocity solutions team. “The cloud is a pattern, not a place, and that pattern is very tightly coupled to automation,”

For example, a traditional healthcare organization may have a queue of requests for some virtualized resources such as a virtual machine, but it may take four to six weeks for that to be created due to low headcount in the IT department. Healthcare organizations could repurpose 30 percent of that headcount with automation. Johnson explains that automating a VM lifecycle could turn off the virtual machine automatically when it’s not used in a set number of days to reduce maintenance burden.

For organizations looking to make their first steps into automation in the cloud, he recommends using infrastructure as code tools such as Terraform or Ansible.

“If you choose one of those tools, it automatically becomes cloud-agnostic and that includes your own private cloud,” says Johnson. “You can take some baby steps in trying to get some cloud patterns without even deploying anything in any of the big three clouds.”

Containerization and microsegmentation aren’t utilized as much as automation in healthcare due to many organizations preferring to customize commercial off-the-shelf products rather than create native applications. However, Johnson expects that the industry could come to adopt these techniques in the future to stay competitive.

“When we say the cloud is a pattern, not a place, it’s about enabling organizations to achieve that speed, regardless of whether you’re trying to spin up resources in one of the big three public clouds or your own private cloud,” says Johnson. “The real power of the cloud is how adaptive it is and how it can expand and contract to your needs.”

Ted Baker, senior business development manager for CDW’s digital velocity solutions team, explains that healthcare organizations can be held back by independent software vendors. Yet, as the desire for the security, flexibility and agility benefits of the cloud has grown, organizations have pushed to move applications to the cloud for competitive advantage. Many nonclinical applications are already running on the cloud. However, clinical applications always need to work and come with more risk when operating in the cloud.

Going back a decade ago, cloud providers gave healthcare organizations basic compute, storage, and network capabilities. Then they expanded to databases and queuing systems. Now, cloud applications are becoming more specific; for instance, using artificial intelligence to simplify call routing.

“The cloud has evolved a great deal over the past five to six years, and most organizations are now realizing they don’t want to be in the data center business any longer. The tools have matured, and the security’s actually better in the cloud,” says Baker. “Healthcare organizations are starting to realize that. Scalability and costs are also better in the cloud, and I think that’s created that shift.”

The cloud also is increasing the ability for consumers to have access to real-time health insights via cellphones, wearable devices and other technologies, says Miles. This helps patients manage their own health, which includes everything from glucose levels to payments for healthcare services.

In addition to expanding healthcare outside of a hospital’s four walls, the cloud is also enabling improved security.

“Cyber and ransomware attacks on critical institutions such as hospitals soared to record levels in 2021 and will only get more sophisticated in 2022,” says Miles. “Health systems need to be proactive in ensuring their tech stack can mitigate these risks. The cloud enables healthcare organizations to securely store, analyze and gain insights from health information, without having to worry about the underlying infrastructure.”

How Healthcare Can Prepare for the Future of Public Cloud

Interoperability and the use of data analytics, AI and machine learning are on the rise in healthcare. However, many healthcare organizations still run critical applications on legacy IT systems and haven’t updated the way they think about their IT infrastructure.

“Most healthcare organizations are used to spending capital dollars on all their projects. We call it the five-year death loop. Every five years, they buy a whole bunch of infrastructure, overpay for it, buy too much capacity and hope it lasts five years. A pain point right now is the shift from capital budget to operational budget,” says Baker.

Johnson elaborates, explaining that cloud developments are happening so quickly that if a healthcare organization has a five-year cloud plan, it will be obsolete in two years. He recommends organizations approach the cloud with an 18- to 36-month plan.

Organizations may be overwhelmed by the number of services available from the big three public cloud providers. Baker says that rather than focusing on the number of services, healthcare IT teams should pay attention to the functional needs and use cases of their organization to find the right fit.

“The cloud model encourages experimentation because you can go rent these resources by the hour, or by the usage model. It’s difficult for folks who are used to the capital model to get their head around the fact that it’s OK to try something and for it not to work, but to learn something and then try something else,” says Johnson. “The answer is going to be different for different organizations. If you fail with a capital expense, it’s super expensive, and the consequences are far reaching. If you fail with a VM that you’re spinning up on the free tier on AWS, there are no consequences to that other than your own time. It’s a very different mindset for folks to get used to given the model that they’re used to working with in the capital expense world.”

It’s also important for healthcare IT teams to remember that they can get help from professional services organizations during the migration. Their team will get upskilled during that process. Later, health IT teams can leverage managed services to offload lower-level functions such as backups and patching to maintain the environment.

“The past two years have been exhausting and have presented challenges that we could not have ever anticipated,” says Miles. “It’s the collective responsibility of the industry to help forge new paths and partnerships so that we’re prepared for when the next crisis hits. Technology will continue to play a huge role in this effort to conquer the challenges that lie ahead.”