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True North ITG CEO and CISO Matt Murren started us off in part-one with understanding the general challenges for healthcare moving to the cloud. In part-two, we examined the advantages and disadvantages of using cloud for EHR (electronic health records).

In part-three, we answer questions on the minds of healthcare IT directors who are now planning – if not already implementing – a move to the cloud.



The burning question is whether you’ve decided – or are still on the fence – on deploying cloud.

Once answered, your next logical question is how your health organization should deploy cloud.

Is there a right mix of cloud or an optimal/best mix for your organization?

How do you address that question?

Defining Your Healthcare Cloud Computing Goals

Matt Murren:

This is a question that we get from an IT director or a CIO. My typical answer is: “What are your business and organization’s objectives and what are you trying to achieve?

Prioritizing Compliance, Security or Cost?

They’re often looking for a technical answer, but like most things in IT, it’s an operational business function. You really need to have a good grasp on what you’re trying to accomplish, let’s say: compliance, security, better back-ups and data-protection, cost-standings or transferring a three-year CAPEX (capital expenditure) investment into a monthly expense.

There many different drivers and when we talk to our directors or CEOs, we really have to understand that first because that tells you how you roll the transition plan and what services align with whatever the organization is trying to achieve. If the problem is end-of-life hardware on a critical application, then that’s different than our first priority of protecting on-site data.

It really depends. It’s very rare we see someone that just says, “Hey, move it all.”

It usually starts with let’s protect our data and virtualize our servers (in the event of hardware failure). Once we we complete those servers, then the plan translates into moving some critical systems and, in general, proceeding from there.

Prioritizing What You’ll Move to the Cloud


That’s actually an excellent segue into the different objectives of healthcare organizations.

Perhaps you have to treat each healthcare organization on a case-by-case basis.

But with that in mind – and with healthcare IT administrators wondering for themselves – which systems do you think should be on-prem and which ones should be moved to the cloud? And why?

Is there a smart way to prioritize the systems that you should start moving to cloud first? Or is there even a sequence of steps that you’d recommend, such as starting with protecting data and inserting redundancy?

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Matt Murren:

Again, it comes down to the prioritization of what’s on-hand and taking inventory of what constitutes the organization’s IT data systems.

Determine What You Can Move to the Cloud

From there, you can mark down the list and determine if it’s possible – yes or no – to move this service to the cloud and identify the targets.

So we can move email, file services and core applications, but we may not be able to move things like the proprietary tax system because it runs on proprietary hardware that can’t be virtualized. It may be the same for some other legacy systems.

Once you start with that list, then you start understanding your prioritization. That’ll tell you whether something stays on-premise or if it moves to the cloud. From that list, you’d ask: ‘what is the priority based on the business objective?’

Read More about Setting Your Healthcare IT Goals Before Moving to the Cloud:


Interesting. So that’s another segue into the next section: now that you understand you want to move to the cloud and that you’ve got a good grasp on your current systems, what would you – at a high level and then more specifically –  need to do in order to be ready to start deploying cloud?

We have a couple of things you’ve discussed earlier: it seems that you would want to begin by listing each of the systems you have currently running. Perhaps some are already in cloud, such as a Software-as-a-Service (SaaS)-based solution, but many are still on-prem,

I imagine you’re starting by listing these items, after which, there’d be a logical second step.

Could you list the steps that you recommend an administrator keep in mind and help someone get through that process, especially when it seems like a very daunting task and they can’t seem to wrap their heads around it?

How to Reduce Your Healthcare IT Costs

Matt Murren:

So I’ve touched on a few of these but the first is the annual IT roadmap.

Survey Your Potential Cloud Computing Needs

Second, it’s as simple as a Excel spreadsheet outlining how your system works.

Build a Strong Understanding of Your On-Premise System

In fact, HIPAA requires that you have a criticality matrix for your critical systems to find what systems have patient electronic health records (EHR) on them. This is very similar. The difference is not only the criticality but a good understanding of what systems connect to each other and what platform they run on, such as operating systems.

Prioritize Out-of-Warranty On-Premise Hardware

It’s pretty much an inventory of both servers and services that identify what you have. From there, a lot of organizations will insert a column stating the end-of-life date. So if you look at this map and say: ‘Okay, well we bought this hardware four years ago. The warranty expired. So it’s definitely end of life.’ That would probably have a higher priority, right?

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Convert Sunk Capital Expenditure into Manageable Operating Costs

The other factor is your CAPEX vs. operating expenses. You’d have to look into how much an on-premise service or set of services cost your organization. That would include labor, power, annual warranty, software maintenance – such as patching – and anything else requiring care for that system.

With that clarity, you’ll be able to gauge whether it’s worthwhile to buy a new server every three or four years at $100,000. Perhaps you can convert that CAPEX into an operating expense where a vendor manages certain components.

Identify the Actual Cost of On-Premise vs. Cloud

You also look into the offset on labor, power and anything else you’re spending on in your local data-center. Most people overlook the fact of having your own UPS and redundant power system comes with a cost for maintaining those. You know, there’s a cost for cooling, maintaining physical security systems – like badging – and costly inputs.

So all of those inputs need to be in the total cost view when you’re talking about calculating that capital expense as well as monthly operating expense.

When an IT director looks at the cloud and says, “well, we can do this cheaper on-prem,” I typically see they’re missing five or more components of cost because those costs are transparent. For instance, facilities may manage five of those components, such as power cooling. These people may not have ever seen a power bill.

So we try and tease those out when we’re doing our mapping so they really understand the total cost of each server, service, or platform that they’re assessing in the cloud.


Those are key insights. I think you’ve outlined a lot of things that IT managers have to now keep in mind, especially details – such as power costs – that they may not have kept in mind before.

In part-four, Matt will discuss the apparent disadvantages of cloud computing in healthcare and how healthcare organizations can overcome those in their migration to the cloud.

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Interested in seeing how you can effectively deploy the insights discussed in part-three to design the optimal cloud deployment plan for your healthcare organization? Contact us today.