May 9, 2019

(Managed) Cloud Everywhere

I can see my close associates and friends’ eyes rolling now. “There you go again.” I’ve hardly hidden my fervor for cloud in all its incarnations, architectures, and applications over lo these many years. It’s not because the technology deserves deification – it most certainly does not. It’s because in a career of 30+ years trying to help hospitals get the IT platform right, one enduring conclusion is that the IT platform as it has existed in one form or another since the 1970s has got to go. Liking cats doesn’t make me a veterinarian. Enjoying airplane rides doesn’t make me a pilot. Having a keen interest in the application of technical infrastructure to the healthcare industry does not make me (or anyone) an IT guru. Healthcare organizations are, with a few exceptions, not IT organizations. This is not an indictment, just a reality. For 30 years bright engineers, product managers, and researchers across multiple facets of the technology industry have solved one or two engineering problems at a time and embodied them in technical infrastructure software, hardware, and utilities. A thriving ecosystem stacking, assembling, and arranging these parts like legos and competing with each other to see who could make the best stack arose. It has been an invigorating and necessary revolution. As Bran Stark says to a repentant Theon Greyjoy in “The Long Night” (Season 8, Ep. 3 of Game of Thrones) “Everything you did brought you where you are now, where you belong,”. Take heart, technophiles. Yeah, it was a bumpy ride, but you were laying the foundation for the future.

What cloud means to me as I write this is the evolving industrial-cultural shift to make IT extra-organizational, liquid, resilient, and secure. Restaurants already organically understand that customer experience means everything. The Yelp review starts with how welcoming the web site is, and continues through parking, queuing, seating, atmosphere, ordering, eating, the bathroom break, the (maybe) dessert, and the settle-up. Hospitals are just starting to get this. The trade press calls it consumerization and several other made-up words. Pragmatists view it as the blessed end of a cycle where healthcare went from excessively introverted and self-involved and has slowly been forced back to focusing on the patient and the patient experience. In their defense, US hospitals kind of had to serve their rainmaking physicians and specialists first to survive the opening rounds of US healthcare consolidation. Supply-side economics is a harsh reality of how healthcare is provided almost everywhere. Nations can choose between the roughly-equal-for-all rationing misery of socialized healthcare; the chaos of a completely open public & private market; or some hybrid. Hey wait, don’t look away. I’m not going there. But perhaps we could all agree, relative to demand, no matter what the system of allocating healthcare services, we are collectively managing scarcity.

Let that sink in. Then ask yourselves if hospitals should be developing skill sets in client device maintenance, networking, cybersecurity, data protection, operating systems, hypervisors, systems availability, and storage management. Wow, it got quiet in here. As one of my former colleagues often quoted (hi Adam!), “why buy a cow when milk is cheap?” Why indeed? The cow itself consumes excessive resources and leaves “treats” in the yard. Remind you of your data center? As another of my former colleagues was fond of pointing out (Wassup, Carrick?), hospitals have been sending laundry out of house for over 100 years. Why do they do IT? Because software. Ahhh yes. But that’s changing. Big-time. Industry leaders like MEDITECH are going cloud-platform-native, and while that could take more than a couple of years, managed IaaS platforms in Edge, Private, and Public Cloud are emerging to fill the transitional gap. Early adopters are starting to realize the benefits of a renewed focus on serving patients, clinicians, and administrators instead of staring at arrays of relentlessly needy hardware and trying to figure out over morning coffee why the last set of backups failed.

This is where the concept of cloud migration gets muddled for some. When you build your environment in a public cloud, you work within the strengths (massive scale, geo coverage, easy provisioning) and weaknesses (fixed platform offerings, Ingress/egress fees, limited networking, and security choices that don’t easily map to on-premise precedents) of that environment. Exhaustive catalogs of infrastructure and microservices are longer than the menu at The Cheesecake Factory. And then you realize: it doesn’t come with people. Hence the parenthetical (Managed) in the title of this article. For the “haves” in the healthcare IT business – the big IDNs, the corporate for-profits, the large academic medical centers – this is no big deal. They have massive, professional IT teams that will drop their hardware biases over time and figure out how to build their legos in the cloud. For those who don’t have the scale, staff, or budget in IT to absorb and manage this swap out, managed services providers who specialize in both cloud technology and healthcare IT services like CloudWave, are here to fill the gap. We are approaching a moment where we can classify and categorize all your workloads, get them on the right platform – Edge/On-Premise; Private Cloud; Public Cloud – and manage them as if they were all still running in your building. You lose the burden of infrastructure and architecture management and gain back time to craft the patient and clinician user experience. Seems like a viable trade.

Jim Fitzgerald is EVP of Strategy and a founder of CloudWave (www.gocloudwave.com) His opinions are his own. Summer is coming!