One of the central statements of the “Cloud Computing in German Hospitals” study recently carried out by HIMSS on behalf of Nuance Communications is that one in two hospitals in Germany already uses a public cloud solution for administration and/or clinical records. “As far as I know, this is the first study on the use of cloud technology in German hospitals and the first HIMSS study on this topic”, says its author, Frank Fritzsche, Research and Advisory Services Manager, HIMSS. “We noticed great interest in the topic and a high level of willingness to take part in the survey. The proportion of those who already use the cloud today exceeded my personal expectations”, Fritzsche reveals.

Patient portals from the public cloud are very popular

More than a third of the respondents (38%) stated that public cloud solutions are currently a “high” or even “critical” priority. This assessment was independent from the hospitals’ self-assessment of their digital maturity, which was also covered in the survey. Public cloud solutions are currently used most frequently by the respondents for image storage (PACS) and administrative software such as Microsoft Office 365. Around 80% of the study participants can imagine obtaining at least one process or service from the public cloud, while 30% can imagine running even three to four processes or services in this manner. Patient and referrer portals are most frequently mentioned as a service that respondents would outsource to the public cloud, followed by administrative solutions, office software, and archiving. A third of all study participants can envision using speech recognition and electronic case files from a public cloud.

Public cloud scores higher than on-premise solutions

The study also examined which criteria are decisive for a hospital to operate a solution on-site or to obtain it from the public cloud. Furthermore, it turns out that the respondents, on average, rate public cloud solutions as more advantageous than on-premise solutions. According to the study, both technical-functions, and contractual-economic aspects speak in favour of the public cloud. In particular, this concerns the scalability of IT capacity and performance; regular patches, updates and release management by the provider; savings in hardware and software investments; device, time and location-independent access to the IT solution; as well as lower IT administration efforts. “Hospitals are exposed to a provider market in many areas of IT. This makes it difficult for hospitals to introduce innovations quickly or to adapt their IT infrastructure. Public cloud services give hospitals more flexibility in this regard. For example, a software subscription can be extended or cancelled more flexibly without having any major impact on the technical infrastructure on-site”, says Martin Eberhart, General Manager, Healthcare DACH & EE, Nuance Communications. “Since public cloud services are provided as a software subscription (SaaS), there is no need for high purchase investments and the focus of digitalisation is shifting from infrastructure to the processes”.

Hospitals particularly value aspects related to security concerns about on-premise services: protection of patient data from unauthorised access; reduction of security risks; the complete and reliable deletion of data if required; GDPR compliance, but also the option of adapting IT solutions to the individual needs of a facility. “If cloud providers respond to the subjectively perceived security concerns”, Fritzsche expects, “then these fears could also be dispelled”. Eberhart adds: “Of course, cloud providers must provide legally compliant services. As a provider, we see it as our duty to create more trust and transparency with information on all aspects of the cloud in the healthcare sector. To this end, Nuance Communications set up an online ‘trust centre’ in Germany a month ago”.

Cloud driving digitalisation push

The 2019 Annual European eHealth Survey from HIMSS Analytics showed that the German health organisations surveyed would rank the digital maturity of their respective institution lower than that seen in other countries. The increasing spread of cloud computing could help hospitals in Germany to close this gap. This, however, would depend on having sufficient financial resources. The increase in the IT budget of hospitals in the next two to three years forecasted 67% of those surveyed will play an important role in this development. It remains to be seen to what extent these funds will be adequate for reducing the investment backlog of past years.

The recently passed Hospital Future Act (KHZG), which explicitly lists the use of cloud computing as a way of digitalising processes, will also be helpful here. Germany’s federal government is investing €4.3 billion for “a better digital infrastructure” in the nation’s hospitals.

Moreover, the move towards cloud computing will also help compensate for the shortage of IT specialists. “The public cloud gives hospital IT more time to focus on the control and digitalisation of processes in the hospital. After all, the core business of a hospital is to provide the highest standard care for its patients. Establishing and maintaining the most comprehensive IT possible to be operated on-site is not necessarily part of this”, Eberhart explains.

Furthermore, the study shows that there is not only a general need to catch up, but also that there are major differences in terms of digital maturity between a few pioneers and numerous latecomers. On the positive side, however, the use of electronic case files is widespread (72%) and many hospitals are investing more heavily in mobility (41%).

The cloud to be used in the majority of German hospitals in the medium term

“I see great potential in cloud technology”, emphasises Fritzsche. “The study has shown that the use of the cloud will increase in the future and will drive digitalisation as a whole”. According to the study, the demand for public cloud services will grow rather moderately in the next year or two, while a stronger increase can be expected in three to five years as the public cloud reaches the majority of German hospitals.

“This study demonstrates how German hospitals are beginning to make use of cloud services. We should expect adoption to accelerate quickly over the next few years. The new Hospital Future Act [Krankenhauszukunftsgesetz] highlights the opportunity for cloud solutions to support digital transformation and designates it as an area for priority funding.”, said Tim Kelsey, Senior Vice President, Analytics International, HIMSS.

Study background

The representative study, which was supported by the HIMSS DA-CH community partner Nuance Communications, examines the importance of cloud computing in German hospitals as well as the factors influencing its use. The investigation is based on secondary research as well as on a nationwide survey that was carried out between 24 June -28 August 2020. As part of a quantitative online survey, the opinions of 76 hospital decision-makers were obtained, which were then validated by means of a qualitative telephone survey of eight C-level managers. The sample reflects a balanced mix of managers in administrative, clinical, and technical areas of the hospitals as well as the various providers and all federal states.