Amazon Web Services and Microsoft’s Azure topped the new Gartner Magic Quadrant — while Google and IBM did not make the coveted leaders’ corner.

With other analyst houses, including IDC and HIMSS Analytics, predicting that healthcare entities will increasingly turn to cloud services as data-intensive trends such as population health and precision medicine come to the fore, Amazon, Google, IBM and Microsoft are widely considered to be the big four of IaaS.

This Magic Quadrant is particular to infrastructure-as-a-service offerings. Gartner describes those as hosted on-demand compute resources as well as storage and networking that hospitals and other customers can use for development and testing, running apps in production environments, batch and high-performance computing, and disaster recovery.

[Also: Cloud computing will change the nature of hospital IT shops]

So why did Amazon and Microsoft beat rivals Google and IBM?

Amazon “continues to be the thought leader and the reference point for all competitors, with an accelerating pace of innovation on top of an already rich portfolio of services,” Gartner analysts wrote, adding that AWS is the most mature service in the lot and has the deepest technical chops.

Gartner also offered reasons to be cautious about each vendor and for Amazon that is the reality that its portfolio of cloud services is so extensive it demands a certain degree of expertise and familiarity just to implement the services. Another issue to look out for is Amazon’s complicated pricing structure and limited service level agreements.

Microsoft’s Azure, meanwhile, is what Gartner dubbed a broad and capable platform, on top of which the software giant is quickly adding innovative new features and functionalities, rather than following what competitors do. The analysts also noted that Microsoft’s recent work with partners and its embrace of Linux and other open source technologies marks “a vital and positive strategic shift.”

Among the cons are issues that customers have reported with documentation, tech support and training. The analysts also cautioned hospitals to consider Azure’s incomplete functionality and unclear guidance about which service to use for specific purposes.

Whereas Amazon and Microsoft are in the top quadrant, Google and IBM, along with Alibaba Cloud and Oracle, landed in the so-called visionaries box, meaning their ideas are solid but they do not execute as well as the leaders.

Google ranked “a distant third” in terms of marketshare, according to Gartner. But its strengths include bringing innovative in-house technologies to market, its Customer Reliability Engineering program, the company’s continuing push to be more open, such as its open source Kubernetes cluster management software.

The “deep discounts and exceptionally flexible contracts,” which Gartner said Google uses to lure customers from Amazon and Microsoft, are also among Google’s strengths.

That said, Google’s historical focus on cloud-native apps and DevOpps have resulted in features and services that are not as broad as those of Amazon and Microsoft for enterprise customers. Google recently began building out its partner ecosystem, adding more capabilities and inking partnership, Gartner noted, though it will take time for those to manifest in the open market.

[Also: Buyers Guide to cloud computing]

Coming in at fourth place, IBM is currently preparing its Next-Generation Infrastructure (NGI), however, and Gartner predicted that “is likely to help IBM evolve beyond its current status as a hosting-scale provider, making it more viable for IBM to match the cost economics of the market leaders.”

Big Blue has other strengths today that hospitals considering IaaS should know about, including its data center outsourcing business, developer ecosystem and its SoftLayer architecture.

The tech stalwart’s cons include a lack of significant improvements to the SoftLayer architecture since IBM acquired it in 2013, a disjointed cloud that does not include low-latency network context or unified security, Gartner said, and the fact that IBM has not yet committed to a delivery date for NGI.

Gartner’s Magic Quadrant also ranks eight niche players: Century Link, Fujitsu, Interoute, Joyent, NTT Communications, Rackspace, Skytap and Virtustream.

Twitter: SullyHIT
Email the writer: tom.sullivan@himssmedia.com

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