Cloud first can deliver enormous benefits for healthcare, which is why the government has set a cloud first policy for the NHS and the wider public sector. However, frontline organisations can perceive security, cost and vendor issues as barriers to adopting this approach. Matthew Chase, chief technology officer at Fujitsu, explains how these can be overcome.
In simple terms, ‘cloud first’ means considering cloud-based technology solutions before considering others; and that includes building or deploying in the cloud instead of building or deploying in an on-premises data centre and then trying to lift and shift to the cloud.
There are many reasons for adopting this approach. The big one is that you do not need a traditional server infrastructure. You just run what you need, which is very, very cost effective.
Also, if you are working in the cloud, you no longer have to maintain the hardware and, if you use managed services, you no longer have to patch the software. Which means staff can focus on higher value work, such as business change and innovation.
We find that people look at cloud because of cost but they pursue it because of innovation. If it doesn’t work, you can shut it down, if it does work, you can scale it up. In addition, cloud has a big contribution to make to the carbon neutral agenda. The UK is committed to becoming carbon neutral by 2050 and the NHS wants to get there by 2040.
If the NHS is going to meet its target, it needs to embrace cloud computing, both to remove wasteful excess capacity and to secure services from companies, like Amazon Web Services (AWS), that are committed to using renewable energy sources to power their infrastructure.
Addressing perceptions of security issues
The UK government is urging public services to go cloud first, and we are expecting NHSX to underline that message in its cloud strategy this autumn. We are already seeing arms-length bodies adopt cloud first for approaches for new developments.
Yet individual trusts and integrated care systems can still encounter challenges to cloud first. One of the issues that is often raised is security. Understandably, healthcare organisations want to be sure that an innovation is secure and that it is going to benefit patients, rather than harm them before they roll it out.
With more than a million active customers in the UK embracing the cloud, including government departments managing critical national infrastructure, through to banks and airlines; it’s hard to say the security case has not been made.
Also, because we are talking about putting code on code when we talk about deploying or developing systems in the cloud, a cloud first approach makes that deployment or development faster and more predictable.
Fujitsu has been working with AWS to give NHS trusts the option of running the Epic electronic patient record in the cloud. One of the reasons that Epic and its customers are interested in that is that it would make every deployment and upgrade the same. It would make the process more predictable and more predictable processes tend to be safer processes.
Addressing the business case challenge
Another issue that is often raised is the business case. Going from on-premises infrastructure to the cloud means going from a CapEx model, in which you make a big capital investment upfront, to an OpEx model, in which you incur operating expenses over time.
If you are an NHS chief financial officer, that can look scary, because it can look unpredictable. However, there are ways to make costs more predictable and to put a cap on expenditure.
Also, whenever we start working with an organisation on cloud, we do a discovery piece. Often, chief financial officers and chief information officers don’t have a complete picture of all the systems in their data centres, and there will be opportunities to consolidate assets and switch things off: which saves money.
A final point is that moving to cloud is a journey. It is not something on which you just flick a switch. You can do something in the cloud, get comfortable with it, and then build on that initial investment.
Addressing clinical pain points
It’s also worth remembering that traditional infrastructure comes with its own issues. When we talk to medical professionals, they often complain about not being able to log-on in the morning, or about the time that it takes key systems to load.
That’s because these systems cannot scale. Cloud fixes that: it can scale up to meet demand on Monday morning and scale down on Friday night. Clinicians also complain about having to wait months for a new feature or an app that will help them in their practice.
Cloud fixes that: the scale and innovative services are ready and waiting for systems and innovations that will drive efficiency, quality, and transformation.
Opportunities for embracing cloud-first
There is a common misconception that moving to cloud first means moving systems out of a data centre. Some trusts might do that, if they have a data centre that is facing a major challenge, like flooding or overheating. For most trusts, the opportunity to start thinking cloud first is going to arise when they have a development project to run, or a new system to deploy, or a major system to replace.
We know the NHS faces a challenge when it comes to replacing systems, because some healthcare IT vendors are not yet ready to run their software in the cloud. However, we are seeing systems integrators, like Fujitsu, working with the big, hyperscale cloud providers to get vendors on board – while newer, smaller disruptors are thinking cloud first from the outset. Integrated care systems have a significant opportunity to lead the way on cloud first. ICSs are going to be setting up systems to support multi-provider, multi-site pathways for millions of people and it’s just not going to be possible to start by building a traditional infrastructure in a trust data centre.
Time to think smarter
We can all see that IT is becoming more complex and that IT departments are finding it harder to find the skills and capacity to do everything that is being asked of them. So, they need to start thinking about how they can hand off some of this work to platform providers and systems integrators; while taking advantage of the other benefits that cloud first delivers.
Cloud is not going away, cloud first is national policy, and other sectors are well ahead when it comes to leveraging those benefits. I used to work for a major NHS trust, and if I was still in my old job, the questions I would be asking myself are: ‘How can I accelerate that change?’ and: ‘How can I get the benefits for my organisation, earlier?’
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