Implementation best practices: Migrating to the cloud

It seems like everyone in health IT is flying into the cloud. Cloud computing has many pluses and a few minuses. And a great many healthcare CIOs are making the judgment that the cloud is where their data and/or applications should be.

Here, four experts in healthcare cloud computing offer healthcare CIOs and other executives comprehensive advice and helpful tips for implementing cloud computing technology at provider organizations. These are best practices for cloud implementation.

Decision criteria

When moving applications to the cloud, it is important to develop a decision criteria, said Ryan Oliver, a research director at KLAS.

“The majority of organizations we speak with are doing more in the cloud or considering moving more to the cloud,” Oliver reported. “Cost and security are usually the first considerations mentioned, but it’s important to maintain a disciplined approach to decisions that also includes considerations for scalability, integrations, governance, operational readiness to manage multiple cloud vendors, impact on staff and total cost of ownership.”

“All possible access methods and configurations must be vetted.”

Ryan Oliver, KLAS

Once the decision is made, most implementation projects share some common best practices: delineate roles clearly between all stakeholders to create a written project plan, over-communicate throughout the project, have a single in-house point of contact, and test extensively before putting a system into production, he added.

On another note, network compatibility and load testing are critical, according to the “KLAS Cloud ERP Decision Insights Report.”

“It might be tempting to skimp on this testing with cloud solutions, but bandwidth requirements can be substantial, and a network load test is critical to ensure that the production product will run at acceptable speeds,” according to the report.

“One CIO reported that his ERP system ran perfectly in the test environment but became unusable in production. In this case, the network infrastructure had to be upgraded before the ERP product could run at an acceptable speed, adding unanticipated cost and time to the implementation project.”

Hybrid cloud

Dave Nesvisky, executive director of healthcare at NetApp, a vendor of hardware, data storage, cloud storage and virtualization technology, said that one best practice is leveraging a hybrid cloud environment.

“When you are considering implementing a cloud technology, don’t lock yourself into one environment, embrace a hybrid cloud strategy,” he insisted. “The majority of data held by healthcare institutions is still traditionally stored in data centers. However, in order to provide the level of service and agility required by the modern business, such as increased capabilities, scalability, performance and efficiencies, IT organizations are moving toward a hybrid cloud deployment model – a combination of private and public cloud resources.”

“Hybrid cloud enables organizations to draw on resources as needed, thus enabling greater elasticity and attractive economics.”

Dave Nesvisky, NetApp

This is becoming the new normal for enterprise IT organizations, and a best practice, he added.

“This type of cloud model offers a wide choice of application environments with a seemingly limitless pool for computing, networking and storage resources,” he said. “Hybrid cloud enables organizations to draw on resources as needed, thus enabling greater elasticity and attractive economics. As new applications are brought on line, new silos of infrastructure are avoided.”

Clinician input

In the old days of system deployment, provider organizations largely had to adjust their workflows around the new server-based system, said Scott McFarland, president of HealthBI, a vendor of a cloud-based platform that covers whole-person integrated care, member engagement, quality and risk management, and provider enablement.

Cloud deployments represent a refreshing opportunity for providers to have more flexibility and say in how the application will work for them, he contended.

“So with that, my first recommendation would be to bring clinician input to the conversation pre-deployment,” he advised. “And this goes beyond asking what data they want and need; it should include asking how and where they want to get that data. The idea is to help clinicians become consumers of data at points where they will make best use of it, whether it’s at the point of care or within a workflow that has a logical relationship with that data.”

For example, now clinicians are challenged with needing data insights to solve for social determinants of health. So an application that supplies or works with that data needs to get it to the clinician in an accessible, usable way.

What’s driving the move?

As with any significant endeavor, it’s always important to first be clear on the need that’s driving it, said Kumar Madurai, delivery manager and principal consultant, technology solutions, at consultancy CTG Health Solutions.

“Let’s say you have value-based care as a goal and are doing a lot of manual performance-based reporting,” he said. “Don’t think you need to replicate those processes in the cloud; instead, look to see what a cloud vendor may already offer here.

“My first recommendation would be to bring clinician input to the conversation pre-deployment.”

Scott McFarland, HealthBI

“You could then link your cloud strategy to the vendor’s, whether it’s for an EHR, ERP or practice management system,” he explained. “In regard to performance and quality reporting, some care coordination vendors are even beginning to offer multi-payer systems for reporting in the cloud.”

Another point: Most healthcare CIOs recognize at this point that the cloud environment is essential for where healthcare is headed, which is very data-driven, outcomes-based care, and from a patient experience perspective, highly digital, Madurai said.

“But some are hanging back because of a lingering belief that the cloud isn’t as secure as on-premises,” he explained. “I think the opposite is increasingly the case. Cloud vendors have become very sophisticated in their approach to privacy and security, although that should always be verified by checking for proof of third-party audits and rigorous credentials like HITrust certification.”

This leads to a Madurai recommended best practice when moving to the cloud: Create a “risk profile” for each application one plans to move.

“This should address who will need access to the app, how it will be accessed, what data from the app will be stored in the cloud and where, and what regulations need to be complied with,” he said. “For the latter, this can vary by state, and even country, with one well-known example being Europe’s GDPR requirements.”

Test endpoints

Oliver at KLAS offers another cloud computing implementation best practice: Test endpoints thoroughly.

“What browser configurations and versions will people be using, what security policies are needed, and what mobile devices will people use to access the product?” he asked. “All possible access methods and configurations must be vetted. One senior IT leader found that an outdated security policy was preventing certain Internet Explorer users from accessing their cloud ERP solution. This unexpected hurdle took several days to resolve.”

McFarland of HealthBI also has another best practice to offer: Confirm how easy it will be for the cloud application to interoperate with other systems and data sources.

“Healthcare is increasingly collaborative and focused on whole-person care, driven in part by the cloud, actually,” he said. “But some app vendors may make interoperability an expensive proposition. The good news is trends are pointing toward ‘learning health systems’ that already aggregate and connect different data sources, and not just from one facility, but from multiple providers, payers, HIEs and even community-based organizations.”

A migration strategy

Elsewhere in the cloud implementation process, healthcare organizations should have a migration strategy they can learn from, but not at the cost of downtime or worse, said Madurai of CTG Health Solutions.

“Don’t wait to move to the cloud until you have a big system switch such as to a cloud EHR or ERP,” he advised. “Prioritize which apps you can migrate first and afford to use as a test case to understand, for example, potential integration and data-sharing challenges.”

“Cloud vendors have become very sophisticated in their approach to privacy and security.”

Kumar Madurai, CTG Health Solutions

Nesvisky of NetApp added that healthcare organizations should embrace what he called “data fabric.”

“Data fabric, by definition, seamlessly connects different data management environments across flash, disk and the cloud as a cohesive and integrated whole,” he explained. “If you have an environment that lives on several different platforms – such as a hybrid cloud – it is also necessary to have a system to connect the data seamlessly.

“Unfortunately, today’s hybrid cloud approaches often result in locked-in data silos that make it difficult for organizations to extract value from their data,” he added. “To harness the power of the hybrid cloud and unlock its full potential, organizations need a way to seamlessly move and manage data across clouds.”

Twitter: @SiwickiHealthIT
Email the writer: [email protected]

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