The question of whether hospital IT should move to the cloud or not is no longer an issue these days. It has already moved there, and will expand even faster in the future. Far more important is the question of which functionalities are operated "as-a-service" and to what extent. Answers to this question are presently being discussed intensively in the German Association of Hospital IT Managers (KH-IT). There is consensus that cloud solutions will be indispensable in the future to compensate for the shortage of skilled personnel.
Whether it is better to run an IT service from the cloud or on-premise depends first of all on the expectations of the users: how much flexibility and individuality are necessary and appropriate for IT to have a positive impact on providing care? "There are services that have already been in the cloud for a long time, but most users may not even be aware of this. For example, many hospitals use so-called "infrastructure-as-a-service" models for operating printers. Another example of a typical cloud service is the operation of the e-mail server as a so-called platform-as-a-service. With these applications, it is not noticeable in practice that we no longer run them locally," explains Lars Forchheim, Vice Chairman of KH-IT. Other solutions which these days are typically already being operated via the cloud and unnoticed by the users, are the Citrix backend and the end-point protection. In view of today's security risks, the latter can only run in the cloud to provide fast and widespread protection. These examples illustrate how the cloud has long been a part of everyday operations in modern hospital IT structures.
Attractiveness is a question of motivation
The extent to which it will also find its way into medical functional software depends on a variety of factors. One factor depends on how "hardware-loyal" IT departments and their management are. If a department defines its primary area of responsibility through the operation of hardware and software, then cloud solutions represent an encroachment on their field of competence. For other departments, however, they are very tempting, as the KH-IT spokesperson reports: "Cloud solutions are attractive with their promise of a stable, readily available environment, with standardization and documentation of operations. In other words, by relieving the workload. The cloud makes it easier for IT departments to stay abreast of the latest technology. Furthermore, cloud providers, whose business model is based on the data and information security of numerous customers, have a completely different focus on the topic. That makes using the cloud attractive."
The decisive factor is also the direction in which a hospital is heading from an economic and strategic point of view: if the signs point to growth and expansion, cloud services that can be flexibly added are economically interesting, also because a higher degree of standardization is then presumably desirable. If it is foreseeable that a house will stagnate in terms of size, then the financial burden of cloud services is often higher than the acquisition of an on-premise solution.
In focus: memory and computing power
Cloud services are also an interesting option when considerable memory space and/or computing power are required. The former is the case with classical archiving, including backups. The latter occurs in radiology whenever image data have to be transmitted and processed with considerable effort. For example, to incorporate AI applications into the diagnostic process. Here, it is far more efficient for hospitals to transmit images to a software via DICOM Send and receive the results back via the same route. Also, because not all images go to the same AI for the same issue. Another example for a useful application in the cloud in radiology is the evaluation of metadata for dose monitoring. "We believe that core systems such as PACS, which require a high degree of customization to achieve their full potential, are currently well served locally on site. However, at the same time, it makes sense to extract individual tasks from the PACS and transfer them to the cloud. This applies in particular to all applications which require an exchange of data. After all, this is exactly what the cloud was developed for," says Lars Forchheim, explaining KH-IT's approach.
Overall, the representatives of the German hospital IT managers has a positive attitude coupled with great expectations toward cloud solutions and the current development momentum in this area. The reason being that to maintain the requirements for data and information protection, as well as for the up-to-dateness and availability of systems, IT departments are increasingly dependent on outsourcing services in view of the shortage of skilled personnel. Lars Forchheim concludes: "We simply no longer have the time and personnel resources in the departments to cover everything ourselves. The question of solutions in the cloud is therefore not a question of sensitivities or personal preferences, but one of security and quality."
"Cloud solutions are attractive with their promise of a stable, readily available environment, with standardization and documentation of operations. In other words, by relieving the workload."
Deputy Chairman of the KH-IT