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Understanding Healthcare Infrastructure-as-a-Service (IaaS)

As health IT infrastructure moves to the cloud, organizations looking to cut down costs will increasingly turn to healthcare Infrastructure-as-a-Service options.

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Healthcare Infrastructure-as-a-Service (IaaS), sometimes called Hardware-as-a-Service, is becoming more popular as organizations migrate parts of their infrastructure to the cloud. Infrastructure delivered as a service can significantly cut back on costs and give organizations access to the latest hardware without having to purchase, install, or maintain the tools in their own facility.

Unrestricted by the burdens of owning and managing their own hardware, organizations can consider adopting more robust tools than what their legacy infrastructure can support, such as artificial intelligence and virtualization. Scalability is critical as more data-intensive tools are added, and IaaS allows IT infrastructure to act as a moldable support system for these initiatives rather than a rigid set of restricted hardware.

IaaS can offer many advantages, but healthcare organizations need examine their budgets, the ability of their staff, and their long- and short-term infrastructure goals before implementing IaaS.

While IaaS can simplify many IT infrastructure processes, it’s more complex than other cloud service models. Organizations that are not prepared for a large and involved cloud undertaking may not be able to take full advantage of what IaaS has to offer. 

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What is Infrastructure-as-a-Service?

Gartner defines an IaaS solution as “a standardized, highly automated offering, where compute resources, complemented by storage and networking capabilities, are owned by a service provider and offered to the customer on demand.”

IaaS includes hardware and software components which give IT administrators more control over their cloud environment. IaaS resources include servers, storage, network, security, and operating system (OS) licensing.

IaaS essentially takes the physical deployment and on-site maintenance tasks out of IT infrastructure by using vendor servers in the place of on-premises servers. This cuts back on maintenance costs because the organization is not responsible for the hardware in the same way they would be if they purchased the hardware outright.

While many IaaS deployments utilize servers hosted off-site, organizations still have the option of deploying their IaaS environment on-premises. Organizations choosing to deploy a hosted private cloud IaaS solution have the option of bare-metal servers. Bare-metal servers are single tenant physical servers that are not shared with any of the cloud service providers’ other customers.

The biggest difference between IaaS and the two other most common forms of cloud computing, Software-as-a-Service (SaaS) and Platform-as-a-Service (PaaS), is how much control the organization has over the cloud environment compared to how much the vendor controls.

With SaaS deployments, an organization’s applications, data runtime, middleware, OS, virtualization, servers, storage, and network are all delivered as a service. PaaS deployments only require the organization to develop new applications and provide data - the rest of the infrastructure is delivered as a service, giving organizations more control over their environment than SaaS.  

With IaaS, organizations have the most options.  They are able to implement applications, data, runtime, middleware, and OS. The virtualization, servers, storage, and network are all provided as a service for IaaS.

With IaaS, the organization has access to user interfaces (UIs) and application programming interfaces (APIs). This gives IT administrators the ability to modify how applications handle and store data as well as how hardware is used.

Implementing IaaS solutions makes it easier for organizations to add additional cloud deployments onto their infrastructure smoothly. Many solution providers boast “vendor agnostic” virtual solutions that are built to be compatible with many different IaaS solutions so they can be used together in the same infrastructure environment.

Different IaaS solutions can be deployed together to build a custom cloud environment.

IaaS can be deployed in several different ways, so organizations need to identify what they need from their cloud environment and what their resources can support before deciding if IaaS meets their specific needs. 

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Benefits of IaaS in the healthcare environment

According to the Northwest Regional Telehealth Resource Center, IaaS is a solid option for organizations that are:

  • Facing the expense of a technology or hardware refresh  
  • Ready to implement EHR solutions that require complex environments
  • Short-staffed due to changing needs or loss of experienced IT professionals  
  • Desiring a disaster recovery environment outside their own region
  • Concerned about ePHI security or other compliance issues (HIPAA compliant providers)
  • Seeking a more predictable cost structure

Entities typically need to refresh their infrastructure hardware every three to five years, whether the servers are simply running out of space or the technology has become outdated. Refreshing hardware isn’t just about which server to purchase next. The process may also involve moving part of the organization’s infrastructure to the cloud.

The rent-for-service nature of IaaS gives organizations access to the latest servers without having to buy them outright or finding a place within their facility to store them.

Using IaaS for EHR implementation also has its advantages. IT teams don’t need to spend as much time troubleshooting their environment to support their EHR because the cloud service provider is responsible for maintaining the system. This allows IT teams to focus on the needs of their end users and other IT tasks.

Organizations also tend to experience less downtime with off-site hosting because there is a team dedicated solely to making sure data is protected and downtime is minimized, according to Wasabi CEO David Friend.

If a major public cloud service provider suffered a truly damaging data breach, its reputation would be damaged, and it would lose valuable customers. This makes it a high priority for many vendors to make sure customer data is as secure as possible.

“If you search ‘data loss from Amazon’ or ‘data loss from Google,’ you’re not going to find much,” said Friend. “But if you search for data breaches for any sort of private datacenter, like a hospital or a bank, many of them have had incidents of intrusion, data destruction, and malware.”

The natural scalability of the cloud is also beneficial as organizations continue to grow and collect more data. Many IaaS cloud service providers are also HIPAA compliant and willing to sign a business associate agreement.

According to Gartner, IaaS providers will most likely be specific about which parts of their solution have been assessed by a third-party organization and are FedRAMP approved.

The FedRAMP program is a government program that provides a standardized approach to security assessment, authorization, and continuous monitoring for cloud solutions and deployments.

Gartner added that these solutions are usually HIPAA compliant, but organizations still need to discuss their solution and implementation at length to ensure that all parts of the cloud environment are HIPAA compliant.

Hosted servers off-site also provide backup and disaster recovery options. Data is already protected from physical disasters at healthcare facilities such as fire or flood by being off site and server farms often have more safeguards against physical disasters and are built in areas where the risk of a natural disaster is lower.

Many IaaS vendors also have data recovery options included in the organization's IaaS deployment agreement. Implementing disaster recovery through a cloud service provider cuts down on staff maintenance and can reduce the amount of time it takes for organizations to get back up and running after a disaster or a cyberattack. Vendors can help organizations regularly test their disaster recovery environment to make sure that it always works. 

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What needs to be considered for a healthcare IaaS deployment?

Each health IT infrastructure is unique, so organizations need to consider their individual requirements as well as their capabilities when deciding how they want to deploy and maintain their cloud environments.

While IaaS saves money on hardware with its scalability, there can be other expenses involved with it, mainly concerning staff.

When organizations begin considering the future costs of scaling up, budget concerns come to the forefront of the decision-making process. This is where cloud technology typically has an edge over on-premise solutions.

Cloud services act as utilities, as far as payments are concerned, with organizations paying monthly or yearly fees based on what they are using. As organizations need more space, they scale up their cloud service requirements and increase payments accordingly. Organizations never have to pay for resources they aren’t using.

Entities need to have a skilled IT staff in order successfully deploy IaaS because it is more complex and customizable than other cloud service models. Organizations need to consider their current IT staff and how many more skilled staff members they can realistically bring on if needed.  

Building applications is also a benefit of IaaS, but organizations need to decide if they need the type of IT infrastructure control IaaS offers or if they could adopt a simpler cloud service model instead.

PaaS allows organizations to build custom applications, but IaaS takes that control a bit further by allowing developers to decide how much computing power is dedicated to each app and how each app runs on the infrastructure.

Organizations that aren’t interested in having that much control over the app development process may not fully benefit from IaaS and are better off adopting a PaaS or SaaS solution. Building applications on an IaaS deployment requires in-house developers or outsourcing app development. If that kind of freedom and flexibility isn’t needed in an organization, than IaaS may be more trouble than it’s worth.

Organizations that want to have more control over their cloud environment, desire more than just implementing a SaaS solution, and are looking to cut down on staff and hardware costs will benefit from IaaS solutions. Many healthcare organizations have already started the process of moving parts of their IT infrastructure into the cloud and will continue to do so over the next several years.

As IT infrastructures become more flexible, entities will require and more customizable and controlled cloud environment to grow in to. Given the right staff and budget, IaaS can support the infrastructure growth needed to support more advanced technology. 

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