Lessons learnt from implementing cloud technology during the COVID-19 pandemic and implications for the future of healthcare

Dr Kathrin Cresswell, PhD, Senior Lecturer, Director of Innovation, Usher Institute, The University of Edinburgh, UK

Professor Robin Williams, PhD, Professor of Social Research on Technology, and Director, Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, UK

Professor Aziz Sheikh, MD, Professor of Primary Care Research & Development and Director, Usher Institute, The University of Edinburgh, UK

Correspondence to: K Cresswell, Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK, email: kathrin.cresswell@ed.ac.uk, tel: 00447502154328

Funding: This work was funded by a Scottish Government Chief Scientist Research Grant. The views expressed are those of the authors. AS is supported by Health Data Research UK.

Declaration of interest: KC and RW have nothing to declare. AS reports grants from Health Data Research UK BREATHE Hub, outside the submitted work.

Contributors: KC, AS and RW conceived this paper. KC led the write-up.

Abstract

We draw on recent and ongoing work to explore how healthcare settings have used cloud technology during the COVID-19 pandemic and what implications this may have for the future of healthcare. In doing so, we discuss how COVID-19 has provided a common focus to bring various stakeholders together around shared needs; how political and regulatory contexts facilitated the implementation of cloud services; how challenges posed by the pandemic allowed healthcare organisations to develop new visions of healthcare delivery; and how physical/information infrastructures and sustainability are key for healthcare settings going forward. Cloud technology presents an important component of health information infrastructures promoting rapid deployment of data-driven innovation. It should therefore an essential component for the transformation of healthcare going forward in the medium- to long-term.

Introduction

COVID-19 has posed unprecedented challenges to the provision of healthcare internationally. However, it has also provided opportunities. We here seek to contribute to deliberations around digital transformation of healthcare by suggesting the need to focus on the opportunities offered by moving healthcare data onto the cloud, drawing on insights gained during the pandemic. This builds on the recent mandate given by President Biden to Erik Lander to chart a course for the next 75 years: “What can we learn from the pandemic about what is possible—or what ought to be possible—to address the widest range of needs related to our public health?”.¹

COVID-19 has significantly accelerated digital transformation in healthcare through the rapid adoption of platform technologies (especially for remote communication/consultation), and the exploitation of existing information infrastructures (e.g. using data in electronic health records (EHRs) to identify patients at risk for exacerbations).^2-4

The use of cloud technology has, catalysed by the pandemic, rapidly expanded. Cloud provides a fluid and dynamic digital infrastructure allowing agile implementation and scale up of health services.⁵ We here draw on ongoing work with major international cloud service providers and on work exploring the role of digital maturity in tackling challenges posed by the pandemic. This will, we hope, help to illustrate lessons learned associated with digital transformation in order pave the way for the future of healthcare.

Application and evolution of cloud technology during the pandemic

In the pandemic, cloud technology has facilitated large-scale analytics, but settings have mainly used existing cloud-based technologies (e.g. Microsoft Teams) with limited new cloud implementations. The following paragraphs will explore lessons learned from the development and application of cloud-based services.

Prioritisation and alignment of stakeholder needs

COVID-19 has provided a common focus to bring various stakeholders together around shared needs. This in turn, helped to overcome institutional inertia, which had impeded the adoption of digital solutions. For example, there have been calls over several decades for remote consultation, but relatively little progress (with the exceptions of a few health systems such as the Veterans Administration) hitherto.⁶ Cloud-based EHRs have enabled this move to remote consultation and therefore presented a viable solution and an important strategic asset for healthcare organisations going forward.

Macro contexts facilitating rapid real-world testing and application

Political and regulatory contexts were crucial in facilitating the implementation of cloud services during the pandemic, as data-driven innovation became a recognised strategic priority internationally.⁷ They removed external barriers to rapid cycles of testing and refinement of technologies. For example, the United Kingdom Coronavirus Emergency Bill allowed accelerated routes for bringing promising healthcare technologies to market, where the medical device regulator deemed this to be in the interest of public health. This pragmatic approach was characterised by a recognised need to finding ‘good-enough’ solutions in short timeframes, and implementing solutions with incomplete or partial functionality compared to eventually agreed requirements to address immediate challenges surrounding COVID-19. Cloud technologies can scale quickly and facilitate data-driven innovation, which is essential during rapidly changing circumstances and needs associated with COVID-19.

A new digital vision of care delivery

The challenges posed by the pandemic allowed healthcare organisations to develop new visions of healthcare delivery, in many cases facilitated by could technology. Organisations had to re-conceptualise how they delivered services through agile technological innovation and development at speed. For example, cloud technologies allowed working remotely and collaboratively across distributed teams, resulting in radical changes in organisational and cross-organisational working by bringing together previously disconnected settings (e.g. cloud based design tools such as Miro have increased operational effectiveness and remote working).

Physical and information infrastructures in healthcare organisations

Whilst settings with existing sophisticated information infrastructures tended to have more scope to exploit these, those with less advanced physical and information infrastructures found it more difficult to realise benefits associated with cloud-based technologies. Here, digital maturity has presented an enabler to act quickly, and rapidly deploy at scale during COVID-19. Similarly, strategically mature organisations were better able to cope and react to emerging challenges, as they had established digital leadership, skills and digital change processes already in place and could therefore respond quickly to the various challenges posed by the pandemic.

Sustaining and scaling changes in the medium- to long-term

There is now a need to sustain cloud-enabled digital transformation established during the pandemic, as healthcare transitions into the recovery phase and the ‘new normal’. Whilst organisations using cloud technology during the early stages of the crisis have focused on adaptation within existing cloud capability, medium- to longer-term developments need to involve creating new infrastructures/capability, and optimisation of operations across a wider range of care settings. These make the case for better infrastructures going forwards.

However, this will require long-term negotiations around how new technology is impacting on organisational functioning and work practices as new actionable data insights need to be effectively integrated with social settings of use. There is also a need to be mindful of rate limiting steps and barriers to realise benefits associated with cloud technology in healthcare. These include concerns around potential vulnerability to cybersecurity and privacy risks and uncontrolled releases due to fast deployment, fear of loss of control over data amongst healthcare providers, a perceived lack of interoperability and vendor lock-in of existing systems, and risks surrounding unintended use of analysis tools and data insights.

Conclusions

Cloud technology has helped to tackle immediate challenges posed by the pandemic. The experience highlights that it presents an important component of health information infrastructures promoting rapid deployment of data-driven innovation. It should therefore an essential component for the transformation of healthcare going forward in the medium- to long-term.

Although presenting significant potential benefits, cloud-based technologies require a degree of health information, strategic, and physical infrastructure that does not always exist in healthcare. Digitally immature organisations are therefore unlikely to realise the full benefits of cloud in the short-term. If this infrastructure is in place, cloud technology can bring significant benefits and should be strategically accelerated addressing President Biden’s mandate to re-imagine healthcare after the pandemic, notwithstanding careful negotiation of barriers to realise benefits.

References

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