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Hype surrounding cloud solutions for clinical IT has ramped up in the last two years, buoyed by user demand for more flexible data access and connectivity. However, global market adoption of cloud technology for clinical IT to date has been relatively slow, despite the increased marketing efforts of healthcare technology vendors and the growing presence of cloud technology platform vendors in healthcare, such as Microsoft (Azure) and Amazon (AWS).
So why is market penetration so low when cloud IT is big business in other sectors? And what are the key factors in cloud adoption for healthcare?
1. Each provider implementation is unique
No two clinical IT implementations are the same and no single software solution can address every provider’s needs. Scale, complexity of existing infrastructure, variety of user groups and interfaces and differing needs for mobility and connectivity all impact the effectiveness of clinical IT implementations. Therefore, the one-size-fits-all approach rarely works.
This complexity also impacts IT architecture selection: some provider organisations already own and maintain extensive IT data warehouses, so are unwilling to use third-party solutions when they can host their own private cloud. Others have complicated legacy networks of disparate clinical IT solutions across multiple locations, requiring flexile, multi-faceted cloud IT solutions. Smaller providers have limited resources for IT administration and so require full third-party managed service cloud solutions.
This variance of need makes it very difficult for providers and vendors alike. For providers, it is challenging to find case study examples of past implementations with similar profiles to learn from, especially as cloud IT is relatively new for healthcare. For vendors, it’s difficult to know which market segments and regions to target and which product lines to “cloud-enable”, without spending extensive time understanding the nuances of their customers’ unique needs, not to mention the dizzying amount of red-tape from local, regional, national and international regulations (see number 3).
2. Providers often misconceive cloud is less expensive
Whether fully hosted or hybrid architecture, it is rare for cloud IT implementations to be less expensive than on-premise solutions, though this is a common misconception amongst buyers.
Some cloud solutions are offered with a subscription-based managed service pricing model which can be misunderstood as less expensive relative to an up-front purchasing model. However, cloud solutions for clinical IT can be up to a third more expensive, depending of course on the unique needs of the provider. The complexity of most providers’ health networks and multi-faceted interfacing also adds significant financial risk to new implementations, for providers and vendors alike.
The relative infancy of cloud implementation also means there are few long-term case studies outlining the cost benefits of cloud for clinical IT. Vendors should be doing more to partner with early-adopters to better profile the wider benefits that cloud IT enables (mobile and remote access, workflow efficiency, reduction in IT administration). In doing so, providers will be able to better understand if a true return on investment (ROI) is possible.
3. Security and legislation is a moving target
Barely a day goes by without news headlines announcing the unsolicited release of sensitive patient health data, be it from malicious hacking or accidental release. Cybersecurity has therefore become a leading issue and challenge for healthcare providers, both to satisfy patients and adhere to the increasingly complex array of cybersecurity and compliance legislation. For larger providers with regional, national or international footprints, this is even more challenging, as each has its own “flavour” of regulation and each is evolving as legislators catch-up with new types of cyber threat.
This creates a challenging environment for selling cloud IT products, even if they are proven to be more secure than the provider’s current on-premise architecture. Large health providers are particularly sensitive to patient data security, as a major breach could be costly both from a financial and legal perspective, not to mention losing patient trust.
While many strategies exist to overcome these issues, vendors must fundamentally build customer-confidence in their adherence to the most up-to-date legislation and security protocols, provide certified examples and statistics on their cybersecurity record and be willing to work long-term with their customers on transitioning to cloud. Risk-averse providers are more willing to adopt cloud IT in a step-wise approach, such as off-loading second copy data and disaster recovery back-up in a hybrid cloud architecture as a first phase trial. Once the benefits from a financial, administration and security perspective have been proven, they will be more willing to expand cloud technology implementation.
4. Enterprise EMR is not an adoption precursor, but it helps
From a global perspective, adoption of cloud technology for clinical IT is relatively low compared to other industry sectors. It has however, been closely linked to markets where enterprise EMR implementation has been significant, such as the USA, the Nordics, the Netherlands and Singapore. There is no technical reason for this trend – cloud technology can in theory be deployed in any market with the necessary base infrastructure.
Instead, it is more to do with the impact made by digitalising core patient information with enterprise EMR. The mere existence of a basic centralised EMR spurs greater administrative and clinical focus on improving interoperability and connectivity of health data, both within network and intra-network. Moreover, EMR has commonly provided the initial interconnectivity of patient and data to drive momentum for implementation of value-based care models. As many of these models exploit and demand patient-payer-provider interconnectivity across a variety of access nodes, cloud technology adoption consequently increases.
5. Health data is the new currency
The value of health data is also changing, especially due to recent market development and focus on predictive analytics and artificial intelligence. While the question of who should “own” patient data is a complex and ethical one that far outstrips the remit of this piece, the increasing importance of patient data as a commodity to fuel new healthcare IT solutions, such as risk stratification analytics for phm or new care management workflows, is quickly becoming evident to provider, vendors and patients-alike.
Hybrid or hosted cloud technology solutions can be viewed by some providers as “losing control” or “ownership” of their data, despite the many contractual safeguards available. This view has also intensified with the advent of artificial intelligence, as providers also see the mid-term revenue potential of licensing use of their data to train machine learning algorithms.
While this is still a relatively new development, providers, healthtech vendors and cloud IT platform vendors are already acutely aware of the potential commercial gains to be made from pooling patient data, making adoption of cloud technology even more complicated.
New Service from Signify Research: Clinical Content Management IT – 2017
This and other issues will be explored in full in Signify Research’s upcoming intelligence service ‚ÄòClinical Content Management IT – World‘, with first delieverable due in April 2017. For further details please contact steve.holloway@signifyresearch.net