Innovation and changeCloud ComputingThink Cloud First? Or think first and then Cloud?

Think Cloud First? Or think first and then Cloud?

Rather than thinking Cloud First, should healthcare providers think first and then make an informed cloud choice based on their individual needs?

Darren Turner, General Manager at Carelink, discusses the drivers for cloud in healthcare, why the sector has been slow to migrate to date and how the new Health and Social Care Network (HSCN) could be a catalyst for driving adoption as multi-agency collaboration develops.

More importantly, Darren highlights that clouds come in different shapes and sizes – from private to public cloud and hybrid and specialist cloud – and one size doesn’t fit all. He makes the case that rather than thinking Cloud First, healthcare providers should think first and then make an informed cloud choice based on their individual needs.

The Government’s Cloud First policy states that when procuring new or existing services, public sector organisations should consider and fully evaluate potential cloud solutions before considering other options. We know that the driver for this is more efficient use of computing resources, through higher utilisation and flexible provisioning. And, alignment with this policy and the perceived cost savings associated with cloud are the primary motivators for public sector organisations to adopt the technology. This is particularly true in the healthcare sector.

With an estimated funding gap of £30bn expected by 2020, there is immense pressure on the NHS to increase efficiency while simultaneously cutting costs.


But how much could cloud migration save?

Figures of 35% cost savings are quoted, based on a comparison between on-premise, self-managed, platform with a public cloud platform with outsourced management. But further examination shows that the bulk of the savings are associated with outsourcing the management – a compelling argument for a managed service platform but not necessarily the best measure of cloud versus on-premise solutions.

While it’s difficult to quantify savings without comparing like for like, if we consider hardware resilience, resource scalability and the removal of the need for life cycle management, along with the wider benefit of higher, more efficient resource utilisation, the benefits of cloud become clearer.

But, most importantly, investment in virtual technologies is not just about saving money or boosting technical performance in a healthcare setting. The end goal of all digital initiatives in the NHS should be about delivering improved quality of service and better patient outcomes by accelerating the way the sector uses, stores and shares information.


Healthcare still in the clouds

Most recent figures available from G-Cloud (up to December 2016) suggest that less than a quarter of technology spend in healthcare was cloud related. So why has healthcare has been slower than many other sectors to embrace and migrate to cloud?

This is partly due to perceived security risks, particularly when it comes to public cloud providers, and complexity and constraints around location and sharing of Patient Identifiable Data (PID).

I also think there is a lack of trust in cloud performance and resilience, as well as concerns around physical location of hardware. Added to this, there is a shortage of the right skills, willingness to embrace the necessary cultural shift and the budget to cover the cost of migration.

However, what we’re finding when it comes to trust is that comfort levels increase with the amount of information that is available about the platform. Because these details tend to be more readily available when we’re talking about private and specialist cloud solutions versus public cloud, healthcare providers are more willing to explore these options.


Clouds come in different shapes and sizes

When we think cloud we tend to think about hyper-scale public cloud providers – indeed, the Cloud First policy is primarily directed at these suppliers. But it’s important to remember that clouds come in different shapes and sizes and one size doesn’t fit all, especially when it comes to the varying needs and requirements of health and social care organisations.

In addition to public cloud providers like Amazon Web Services (AWS) and Azure there are private clouds, with dedicated physical server hosting in UK data centres, as well as specialist cloud platforms powered by the likes of UKCloud. Specialist cloud providers combine some of the benefits of hyper-scale public cloud providers with the advantage of delivering secure, government assured infrastructure.


Should we really be thinking Cloud First?

Perhaps it’s the Cloud First diktat that presents the biggest hurdle. Despite these obligations, I’d argue that healthcare providers shouldn’t start from the basis that everything must go in the cloud or that public cloud is the only option. Instead, they should work with a trusted and technology agnostic supplier to identify the best solution or combination for their organisation’s specific needs.

At Carelink, we advocate Cloud First only where appropriate. I certainly wouldn’t encourage healthcare providers to simply push everything onto the public cloud without first assessing and critiquing the various options.

We know that most healthcare providers don’t want to go 100% cloud and that, in many cases, they are cautious or hesitant about cloud. There is still a strong desire to physically see where data is held and there will always be a need for more assured solutions, in terms of security and performance.

Cost and pressure to meet policy requirements will continue to drive adoption of virtual technologies, but I don’t foresee a day when everything is running on public cloud even in the longer term.


What’s the best approach?

While there are no hard and fast rules, we find a common approach amongst healthcare providers is to keep sensitive data or PID on our CCSP or a private cloud in our UK data centre or with UKCloud. Anything else can go on the public cloud.

Many healthcare providers favour a hybrid architecture, where hardware servers hosting legacy or resource hungry applications are mixed with virtual machines running less intensive services on the cloud.

With a hybrid approach, organisations can realise the efficiencies of virtualisation, through increased utilisation of compute resources, while being able to more closely control the availability of those resources across the estate.

For larger estates, particularly those with high storage volumes, the cost of a private cloud platform can compare favourably to the cost of a hyper-scale public cloud. Healthcare providers should, therefore, work with their network and infrastructure supplier to explore this cost comparison to ensure they get the best value for their money.

Whether opting for private or public cloud, multi-cloud or a hybrid solution, when it comes to entrusting a supplier with an incredibly valuable and irreplaceable asset – data – healthcare providers need to be sure it’s secure. Buyers should seek accredited suppliers with a proven track record in providing secure solutions and protecting mission critical environments, ideally in a healthcare environment.


Cloud supporting joined up health and social care

With the roll out of the Health and Social Care Network (HSCN), the data network for health and social organisations that replaces N3, cloud services are being made easier to provision.

Health and social care organisations will increasingly be able to access a full range of HSCN compliant network connectivity and cloud services from one supplier, effectively a one stop shop, which simplifies the supplier and procurement environment. With assurance that HSCN obligations and standards have been met, this will likely drive greater adoption of cloud services in the sector.

Ready access to HSCN compliant cloud services helps simplify the process and provides assurance for healthcare procurement. Indeed, we’re seeing the likes of UKCloud, as well as hyper-scale cloud providers, setting up healthcare divisions and actively seeking suppliers to deliver HSCN connectivity.

Furthermore, HSCN could actually be the catalyst for driving cloud adoption as multi-agency collaboration develops. We can expect to see cloud services become an increasingly important feature in delivering more joined-up health and social care, enabling distinct organisations to operate together in a seamless way and in doing so, providing better care to the patients they serve.

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