Cloud Migrations Helps Health Systems Reduce Technical Debt
“If you get to two-plus years of technical debt, even in one area, you typically will not have the money to catch up,” warns Hotchkiss. “You will not have the people to do the work. You will have other projects to complete, and you will put yourself at the back of the field in a race that you’re going to have trouble winning.”
When an application is moved to the cloud, the cloud provider — whether it’s Amazon Web Services (AWS), Microsoft Azure, Google Cloud or another company — owns the maintenance and upkeep costs. The job of the hospital is simply to patch and maintain the applications on the cloud versus maintaining the infrastructure to support these applications. Given recent supply chain issues, some hospitals may be forced to move certain applications to the cloud simply due to the cost of maintaining on-premises centers.
“Part of going to the cloud is distributing my eggs in more baskets to where maybe I’m more capable of handling what I have on-prem because I’ve delegated some of my responsibilities of technical debt for infrastructure to a cloud provider,” says Hotchkiss of the medical college’s hybrid infrastructure.
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The Journey From On-Prem to Hybrid Infrastructure
The decision to move to the cloud involves many people and, typically, months of planning: “Decisions of this magnitude, it’s never just one simple indicator,” says Lancaster, who has ushered Children’s Mercy along in its cloud journey.
The first step is having those conversations with senior leaders. For Lancaster, these questions included whether existing data centers could be converted to clinical care areas, if certain solutions would yield higher efficiencies and allow the organization to get more value from the technology, or if data could be more easily leveraged by AI.
Hotchkiss analyzes each application and determines whether it’s “cloud-appropriate.” Just because something can be moved to the cloud, it doesn’t mean it should. Hotchkiss needed to identify whether a move to the cloud made the most financial sense.
“The cloud is not necessarily a cost-reduction strategy. It’s a value-obtainment strategy,” says Lancaster. “It might cost more than you pay today, but you get more value from your technology.”
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This moment of analysis also allows IT teams to decide if there are opportunities to change, enhance or even sunset existing systems and applications. Lancaster cautions against simply “lifting and shifting.” For him, the goal is re-engineering the applications to ensure they’re taking advantage of all that the cloud provider has to offer, such as automation and AI capabilities.
Children’s Mercy also partners with both AWS and Microsoft for two reasons: Some applications only work in one cloud provider, and leveraging contracts with both providers gives Lancaster negotiating power.
Lancaster also believes that staff buy-in creates a successful transition: “You can’t cross a 10-foot chasm with two 5-foot jumps. Realize that the staff who got you to where you are with your technical debt needs to be the staff who gets you out of your technical debt.”
Staff often assume the worst — job replacement — but Lancaster encourages other healthcare organizations to get staff excited, listen to their feedback and help them upskill for the hospital’s benefit.
