At this very moment, there is one thing pretty much everyone in the healthcare industry understands intimately.
It’s pervasive. And it’s not limited to our overworked and underappreciated clinicians and caregivers. In healthcare IT, CIOs and CTOs and CISOs and their entire teams are also buried under constant pressure and noise. There has long been an industry-wide technology strain from trying to do more with limited budgets and legacy infrastructure in an increasingly digital age. That strain accelerated in 2020 with the pandemic — and it hasn’t let up.
We are all so very, very tired.
So it might seem counterintuitive to advise that now is the time to embrace a massive change to traditional healthcare IT operations by moving your Epic EHR to the public cloud.
But that is exactly what you should be doing. Here’s why.
Healthcare-Specific IT Challenges
Healthcare technology leaders want to be the people who enable the benefits of modern technology, deliver the best experience, empower clinicians, and modernize their organizations. But they spend far too much of their time worrying about ballooning costs and diesel fuel for backup generators and datacenter redundancy and ransomware attacks and all the obstacles to those benefits.
The public cloud takes away a lot of the noise.
Reluctance to adopt public cloud infrastructure in healthcare historically centers on connection limitations, single points of failure, or complexity in moving or managing workloads. Those were reasonable concerns in 2006 when AWS launched. But things have changed. You can’t go to the local Blockbuster to rent your movies anymore, either.
Moving the EHR to the cloud is a big leap, but it actually alleviates all those issues. And it ultimately lets IT teams shift focus to the things that matter: for example, building out your Epic environment so you can actually optimize your clinical workflow for better patient care and clinician user experience.
Getting Practical and Tactical
The EHR has become the de facto heart of hospital and health center IT. And among EHR vendors in the US, Epic still holds the largest market share. On the cloud front, AWS has long led the public cloud market and continues to grow its footprint.
To be blunt, Epic is arguably the most difficult workload to move out of a traditional environment and into a hosted environment like AWS quite simply because so many things are tied to it. A mid-size medical center will have over 500 interface connections to their Epic instance to manage. That theoretically translates to as many as 500 unique vendors to work with to move those connections. The effort involved is not insignificant.
But there is a path to do it, and in fact you can do it in a matter of months. Which means we’re talking about making an impact in the very next capital budgeting cycle. That’s plenty of practical motivation. On a more tactical level, consider what you get when you make the leap — to be blunt, the public cloud provides an affordable and near-limitless supply of storage and compute resources. And it enables long-term value creation that cannot be matched by the on-prem status quo. Three key healthcare-specific considerations that prove this out:
The Resiliency Challenge
Increasing business resiliency is the number one challenge facing every business leader right now — and the healthcare sector is no exception. Economic uncertainty means U.S. companies have started making pricing adjustments and managing exposure to input costs, while also taking action on operating expenses, according to a recent McKinsey Risk and Resilience analysis: “These short-term moves can help many companies. But they’re more like firefighting than putting in fire-resistant materials — and in a higher-for-longer environment, companies should also be thinking about more structural solutions that not only manage costs but also build resilience and can drive long-term value creation.”
When it comes to building structural resilience in IT, hospitals and health systems face the same market forces impacting all businesses, with the added weight of responsibilities that don’t worry Wall Street — like consistent critical care delivery even in the most inhospitable of circumstances. Disaster recovery (DR) management alone is a significant challenge with significant costs. I work with one medical center in New Orleans that must maintain six 3-megawatt generators to service DR capacity for the hospital. That backup requires half a million gallons of diesel fuel that goes stale and has to be tested and treated and flushed out every year at staggering cost.
Cloud use doesn’t prevent disaster, but it can significantly reduce its cost and complexity. Cloud providers invest heavily in reliability and achieve at least 99.9% uptime, and also offer disaster recovery services ranging from simple backup to complex strategies spanning multiple geographics.
As Tampa General Hospital CIO Scott Arnold recently explained in Becker’s Health IT, “We are making seismic transitions away from on-premise equipment to cloud environments to lower our risk profile with better resiliency and availability, especially given our proximity to sandy shores and hurricane probabilities. The transition to the cloud also supports recapturing hospital real estate — once used for a data center — and repurposing that space for clinical coordination or accretive use.”
The Scalability Challenge
The second healthcare IT consideration centers on scalability issues: Storage and compute resources are a perpetual challenge for healthcare IT because we generate tons of unstructured data. A sector like financial services tends to work with a lot of structured data (rows and columns of numbers) that is pretty efficient to move and store and doesn’t actually take up that much space, by comparison. Healthcare also works with plenty of structured data, but trades in a vast array of unstructured data (written notes, natural language dictations from physicians, discharge summaries, lab reports, images and imaging data with everything from MRI scans to scans of faxes and scanned consent forms, and on and on). All this stuff is unstructured data and it inherently takes up far more space than structured data. We are also a highly regulated industry where we can’t just delete old files just because we need more room, further complicated by when we can delete particular types of data according to various rules and requirements — seven to ten years in general.
And guess what we usually do to make it simpler? We just don’t delete anything.
Inexpensive and scalable cloud storage drastically reduces the costs associated with storage needs. And public cloud providers like AWS further reduce storage costs with tiered services like Amazon Glacier to make storing data that doesn’t need to be accessed often even cheaper.
Processing is another issue. The types of unstructured data that Epic stores, for example, is inherently more process intensive than what you find in databases and record retrieval systems for other industries. And anticipating the need for speedy access to it is inherently frustrated by the often acute, intermittent, and episodic nature of healthcare work. Nobody schedules a broken leg or a cardiac arrest, much less a pandemic.
Because of this, healthcare IT requires access to more processing power on demand. Which means that healthcare organizations traditionally have to invest in enormous server capacity even if they’re only going to need to utilize it around 10% of the time. And again, the public cloud addresses this conundrum. AWS offers the ability to pay only for what you need when you need it, and easily scale resources up or down through features like elastic provisioning of compute power and spot instances.
AWS issued a healthcare provider report this year containing “an analysis of 28 customer-specific business cases for healthcare providers around the world…both globally and operationally diverse, operating in six continents, with representation ranging from local providers with 300 beds to national organizations with more than 5M patients.” The findings forecast a combined cost saving of $208M from moving IT infrastructure to the public cloud (averaging just 44% of the forecast on-premises IT infrastructure cost) and representing a cost savings of $5,963 per bed over five years. That’s huge!
The Capability Challenge
The third consideration addresses capability — and it is incredibly straightforward. It is not unreasonable for people to wonder why they can seamlessly stream Netflix pretty much whenever and wherever they want among TVs and monitors and tablets and phones, but their doctor still needs to fax their prescription to the pharmacy.
There’s a pretty serious technological gulf when it comes to the healthcare sector in general. There is, however, a tremendous amount of artificial intelligence and business intelligence available via the public cloud marketplace, which can help bridge that gulf and provide access to a lot of tools for advancing healthcare practice.
The organizations that move their Epic workloads into AWS will become pioneers in leveraging their data to profound effect — like utilizing AI-powered decision-support systems and automated cybersecurity defenses or workload provisioning.
There’s so much financial intelligence, operational intelligence, and clinician intelligence embedded in healthcare data — but the level of processing and compute resources and expertise required to extract it is just so much easier to acquire and readily available from AWS and its partner networks than anything that could ever be accomplished in-house and on-prem.
Facing Down Fatigue
Today’s healthcare IT challenges practically scream for public cloud resources. It’s almost as if AWS was perfectly built to solve them (that and streaming movies, those two things).
It’s senseless to continue trying to meet today’s healthcare needs with yesterday’s infrastructure. Moving your Epic EHR to AWS won’t eliminate every IT problem. But it certainly eliminates a whole lot of problems that should no longer be taxing your time or energy. Relief is available. The tools are here. Use them.
— Austin Park is a seasoned healthcare technology executive and consultant. He is founder and CEO of Sapphire Health.