Who, What, When, Where and Why in the Cloud

The last time you made a difficult decision, chances are you engaged in some form of a process called the 5 W’s, or maybe the 5W’s and Sometimes How, or 5W+1H … maybe 6 W’s.

Right. So, what the process lacks in an agreed-upon name it makes up for with the logical consistency of directed, relevant questions: Who? What? When? Where? Why? How? It’s a process journalists often use consciously in writing articles, and it comes in handy for non-journalists when the goal is breaking down options and arriving at an optimal outcome.

You may have even used a 5W1H-like process yourself when considering whether to move your healthcare IT systems to the cloud. For those that haven’t made a final decision, let’s work through this together and see where it leads.

  • What are we looking for? Clouds can be public, private, a hybrid of the two or community oriented. The terminology lends itself to misperceptions. A public cloud is not open to the public and a private cloud may best be understood as a remote data center used by one organization. Still, they accomplish roughly the same task and the optimal approach will be determined by budget and objectives. 

    In deciding what kind of cloud to use (unless you build your own in house, of course) you’ll also want to consider the types of services you’re looking for. Basically, a cloud provides services related to infrastructure (IaaS: Amazon, Rackspace), platform (PaaS: Microsoft Azure, Salesforce), software (SaaS: Google Docs) or storage. Some or all may play in a part in an organizations IT stack. Organization size, level of control and HIPAA impact are just some of the considerations when deciding which cloud components to use. 

  • Who (Which?) is the best cloud-services provider for us? Evaluating cloud options specifically from a healthcare perspective, Healthcare IT News identifies 7 predominant providers, in no particular order. Receiving initial mention is Amazon Web Services, who was first to the party, is aggressive in terms of price and frequently releases updates. As mentioned, Amazon’s primary service is infrastructure. CDW Cloud Solutions, which may be familiar to many in healthcare, offers a menu with more choices, including migration planning, project scoping and support. The Healthcare IT News list also includes ClearDATA, Google Cloud Platform, IBM Cloud, Microsoft Azure and VMWare. 

    In this case, “best” is certainly a relative term as the optimal provider for you will depend on needs and costs, as it does with so many of the choices you make. Familiarize yourself with services and determine a budget, and one or another cloud partner will rise to the top.

  • When should we transition to the cloud? If you don’t have some cloud-based applications in use at your facility now, you’re in the minority. Deciding when to make the move is less about the cutting edge than it is about proper preparation. Do we have the right people and processes in place to make optimal use of the cloud? Is the management team united and stable? Is there a business strategy associated with the move? Are local infrastructure and providers like ISPs reliable? Do we have the budget for it?  And, of course, can we document a likely return on our investment?

  • Does where the data centers are located make a difference? No, not really. The important part is that applications and data are replicated in geographically distinct regions in the unlikely event a natural disaster were to impact one. 

    Referring again to the What? and Who? sections above, Where? will be determined by the technology stack and specific configuration that’s best for your organization. If you are you paying someone else for 24/7 support and monitoring, then location probably matters very little. 

  • Why are we thinking about doing this? It wasn’t long ago that this was the first question anyone asked. Increasingly, the why’s of moving to the cloud are becoming more compelling and less a question of if than when. Cloud systems scale rapidly and easily for less money than local data centers. Data replication and disaster recovery set up is a more straightforward process. Cloud providers offer pay-as-you-go subscriber models. 

    And data security—once considered a liability in local data centers before a rash of high-profile data breaches and ransomware incidents—is probably better with cloud systems. 

  • How do we move to the cloud? The easiest approach might be to go with a healthcare IT provider already in the cloud and take advantage of their experience and knowledge. Doing the project yourself? Figure out what you are moving to the cloud (Everything or just some applications and databases?), research providers and their cloud models, compare costs to make sure you’re saving money, and become very familiar with the provider you ultimately choose.  

    Also, pay attention to scalability. What happens if your organization grows significantly in size during the contract term? Make sure the provider you select provides documents containing their cloud solution specifications and design details and offers the tools and features required to maintain compliance with HIPAA and HITECH.  A clear and comprehensive migration plan will ensure that downtime and interruptions are kept to a minimum as you transition to a chosen cloud solution. 

    “Once you go with a particular vendor, you’d better be happy with that vendor because it’s [data] are going to stay there,” says Paul Butler, a director at Top Tier Consulting. 

If this trend endures, where is it likely headed and how will it change? Butler sees a future of huge, HIPAA-compliant and certified data centers for most hospitals with lingering onsite data facilities for very small hospitals.

Assuming Butler is correct, healthcare organizations with greater resources will be most able to reap the benefits of remote data centers. One challenge for healthcare more broadly will be much the same as it is now—ensuring that a rising healthcare tide lifts even those boats hanging by a financial thread in America’s rural areas. Achieving that task will require more will and focus than technological savvy.

Richard Sullivan is chief operations officer for Medsphere Systems Corporation, the solution provider for the OpenVista electronic health record.

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