The journey to the cloud

The healthcare industry is now well into its digital transformation journey, having embraced new digital platforms in order to reduce costs while providing higher levels of service and engagement for all stakeholders, including providers, physicians, payers, and patients.

The cloud is becoming ever more critical within the transformation journey and whilst the healthcare sector started cautiously – migrating non-critical and back end services – it is swiftly learning that the benefits far outweigh any risks and is accelerating the shift of clinical applications and data to the cloud.

However, while the many benefits of cloud technology for healthcare organisations and, indeed, the wider ecosystem, are largely understood, the journey to the cloud is not without its roadblocks. As Cegedim Healthcare Solutions’ IT Director, Mike Collier and Primary Care Product Director, Tony Thorne discuss, suppliers play a significant role in realising the NHS’ Cloud First strategy – and transparency and openness are key to this transition.

Cloud First

The acceleration in digital transformation throughout the NHS during the past 12 months has challenged perceptions and addressed many legacy technology constraints. The use of the cloud, for example, enabled 111 calls in London to be handled by a team in Newcastle when London resources were overwhelmed; and anytime, anywhere access to shared patient records has been vital in supporting COVID-19 vaccination clinics.

Technology-enabled collaboration has driven essential change and, as Health Secretary Matt Hancock said recently, “This has been a difficult time for us all, but what we had found though is that the power of using the best available technology and developing new technology quickly had proved its worth – saving lives and keeping our health and care service standing at a time when it was under unbelievable strain like never before.”

Digitisation of services is now a priority, changing the way services are imagined and deployed. The NHS now has a ‘Cloud First’ strategy – which means digital services should move to the cloud (hosted in the UK) ‘unless there is a clear reason not to do so’. The goal is clear – public cloud services transform the speed with which new services can be deployed and ensure they can rapidly scale up in line with demand. They also provide the availability and accessibility required for the federated delivery of healthcare and community services that underpin the NHS strategy.

Extending the Ecosystem

The public cloud also provides the wider IT healthcare ecosystem with unprecedented access to data and services, which will be vital in enabling the innovation required to deliver safe, efficient and fit for 21st century needs. The sheer scale of the expertise and intelligence provided by the large public cloud providers is aiding the migration of existing solutions to the cloud and accelerating the speed with which new services and solutions are being developed.

Companies such as Amazon Web Services (AWS) provide an extraordinary array of services, tools, migration support and advice. The service includes nearly 200 tools that help software developers achieve innovation, for example, through leading machine learning and artificial intelligence tools. These tools can provide risk stratification within patient cohorts and support healthcare professionals with easy to consume diagnostic insight – all vital resources in an increasingly federated model that will reduce the reliance upon personal relationships between clinicians and patients. Combining the ability to manage huge amounts of data in the cloud with incredibly powerful analytic tools will provide clinicians with new, immediate insight that has the potential to transform patient outcomes.

Understanding Cloud Strategies

However, it is important to understand the journey to the cloud and the role that suppliers play within this. While NHSX guidance is clear that digital services should be delivered from the public cloud – there are caveats. For example, if service level characteristics, such as availability or recovery time objective (RTO) times, or cyber/ information governance cannot be met by the public cloud, an alternative model – such as a private cloud hosted by the supplier – is permitted. This is key because there will be challenges associated with a wholesale shift to the public cloud within a healthcare sector that relies upon vast quantities of diverse services and solutions, both recent and heritage.

In fact, many of these technologies are excellent. There would be no need for the wholesale replacement of all technology with brand new digital solutions designed from scratch for the public cloud – even if the budget was available.  It is also not viable to move all legacy applications into the public cloud – without the right migration model solutions become expensive and unproductive. The ‘pay as you go’ public cloud model does not fit with many legacy designs, such as traditional desktop applications which rely on local hardware and data storage.

All of these considerations place the onus on suppliers to take the right approach to ensure the NHS is using cost-effective and productive solutions. Indeed, this public cloud cost of delivery has been an issue for some suppliers: having announced a wholesale shift to the public cloud, the commercial reality has led to a rapid reversal of cloud strategy. This creates huge concerns for any NHS organisation: trust in suppliers is paramount at any time, but it is vital to have confidence that suppliers are 100% committed to a development roadmap during this rapid digital transformation.

Trusted Open Model

This is why it is important to understand how a supplier’s cloud strategy is being delivered. Does it require products to be reengineered? Will the use of public cloud technology incur additional costs? How will data privacy and cybersecurity protocols be assured? How will cloud strategies help drive innovation? It is this level of insight that is key to building confidence in cloud strategies.

A supplier’s cloud technology strategy should be strongly aligned to NHS aspirations and positioned around a clear vision for the future of Healthcare. It begins with a concept of placing tools in modern apps to enable healthcare professionals and patients to choose a device of their choice on which to use apps and access data; and extends to cover the adoption of internet first and public cloud technology alongside open standard APIs and the best cybersecurity layers.

Best practice would also suggest working closely with public cloud providers and NHS bodies to ensure products and applications are intelligently re-architected and re-engineered to deliver the optimal cloud model for each solution.

It is also essential to consider the fact that this push to the public cloud is just one part of the wider story of creating a patient-centric model that encompasses both health and care services. Interoperability is an essential part of the model, where open standards, such as the FHIR, developed by Health Level-7, are key.  Application Programming Interfaces (APIs) that use this standard ensure that health and care information can be shared between providers and systems.

This enables collaboration between healthcare professionals based on shared care records and overcomes many of the development constraints that have restricted innovation in the past. When suppliers open up their systems and data, everyone – from providers to clinicians and patients – benefits from accelerating digital transformation.

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Conclusion

The cloud offers an extraordinary array of benefits for NHS organisations, from an improved security posture to a level of systems availability – typically 99.999% – that would be impossible to achieve on-premise. From a strategic perspective, the combination of cloud and open standards is the foundation for an extraordinary digital transformation journey that will introduce new ways to deliver care.

Successful provision of federated services across health and community care is just the start. The use of the cloud and powerful analytics across population health data will unlock the next level of innovation – improving patient outcomes, reducing hospital admissions, and improving prevention strategies.  The true power of a digital NHS is as yet untapped – and a successful transition to the cloud is the next essential step in unleashing that potential.

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