Following on from our chat with Nick Roberts and Jason Jones from Rackspace Technology about the tangible benefits that can be delivered to the NHS through leveraging cloud, HTN caught up with the pair again to discuss the benefits of sovereign cloud services, the wider market, and how cloud impacts the healthcare workforce.
Nick is the Sovereign Services Lead for Rackspace Technology (including Healthcare, Cloud, proposition services and product), whilst Jason is the Global Customer Manager, Healthcare. Rackspace Technology delivers hybrid multicloud solutions across platform infrastructure, applications, data, and security; for healthcare in particular, Rackspace Technology offers secure UK-sovereign compliant healthcare cloud solutions and services designed to underpin and enable NHS organisations to deliver their digital transformation, with a focus on strategy, delivery and on-going management.
Cloud as a sovereign service
Firstly: what does it mean for cloud to be offered as a sovereign service, and what is the impact on healthcare organisations?
Digital sovereignty is “where everything end-to-end is delivered solely by UK resources, with all technology behind UK borders. That includes the tools we use, our people, and all our networks,” explained Nick. “That’s a key reason why the cloud and sovereign cloud in particular is of particular interest to our healthcare market here in the UK.”
When it comes to healthcare in particular, Nick acknowledged, a lot of emphasis is placed on the fact that digital solutions are handling sensitive patient information. “Between that and the increasing cyber and ransomware attacks we have been seeing, there has been a significant drive for sovereignty of services and of data; what Rackspace Technology calls its digital sovereignty.”
Touching on the relationship between this and the healthcare provider market, Nick reflected that some “large players in this market are not UK operators”, which means their software and solutions are “not necessarily designed to meet the UK market. I see this in some ways as a risk to our NHS. Organisations are buying services believing that they are buying fully UK-compliant solutions right off the shelf; but these solutions may not always be able to guarantee sovereignty of the data. If they cannot, that means that our sensitive patient or citizen-centric information is not going to be ring fenced and isolated purely in the UK – which is what Rackspace Technology’s cloud offers, through our digital sovereignty.”
EPR market
Expanding on thoughts around the EPR market in recent times, Nick reflected that – specifically in the UK – he has observed a “maturity in the market, where previously it was just the big multi and well-funded trusts that could afford a significant investment such as Epic or Cerner or any of the other big players. We are now starting to see trusts trying to purchase best of breed EPR solutions, and more and more we are seeing trusts group together to afford that.”
Nick also pointed out that there are lot of “technology refreshes” happening around EPR solutions and large-scale deployments at present, particularly among the larger trusts. This leads to other trusts “looking to piggyback off the back of those investments, as it can introduce economies of scale from their point of view – but it can also bring massive increases in risk if those systems aren’t quite right.”
On affordability, Nick noted that Rackspace Technology offers platforms and services to help make cloud-based EPRs more affordable and sustainable for its customers. Rackspace Technology, although independent of any electronic patient record and capable of working with any system or supplier, has seen particular success stories supporting the Epic EPR. On this, Nick commented that as part of its ethos Rackspace Technology looks to “leverage that specialism with Epic and make the most of it, so that we can bring additional benefits to our customers in this space”.
With regards to the market and the EPR workforce, Jason said that from his perspective, focusing on the Epic marketplace, there is “definitely a demand and a need for labour – the certified individuals who can deliver EPR capability across the NHS today. There’s a real labour shortage there, but it’s a key component of delivering the EPR in the right way. You need that expertise, and so it becomes very expensive as a result.”
This raises a number of questions, Jason continued, particularly how organisations can deliver the training required and how EPR delivery can be achieved at scale. On-premises solutions require NHS organisations to provide their own management resources; and migrating to cloud, especially for large healthcare organisations, brings with it a lot of work and necessary complexity.
Managing cloud
Building on the above point, Nick and Jason agreed that there is a tendency for people to think that “cloud is cloud”, although there is a “very different level of capability between a managed service cloud capability and general cloud”.
Ultimately, Jason pointed out, if a trust is managing its own cloud, it has to get a system integrator involved; there is a need to identify people with the right level of expertise to be responsible for the EPR capability and delivery.
There is risk involved here: Nick emphasised that organisations can “make some really bad decisions if a non-specialist is placed in a position where there really needs to be a specialist” and decides to try and do something that could have a serious impact on the wider organisation.
“Cloud was meant to be simple, and as it has matured, it has become more complex – probably more complex than the original systems it exists to replace,” he considered. “You have to consider day one decisions, but you also have to be thinking five or ten years into the future; about what you are going to need to do next. So I think this can lead to a sense of paralysis, almost – a sense of ‘why don’t we just stick to what we know?’ There’s naturally a fear of unintended consequences.”
However, this paralysis can be subverted if the right type of specialist knowledge is brought into the organisation to help them make the most of the benefits cloud can offer. This is the space in which Rackspace Technology sits, Nick explained.
“Rackspace Technology can help by bringing in our EPR specialists and our sovereign cloud specialist capability to deliver the platform – we’ve already invested in all the necessary infrastructure, from the technology underpinning the application stack to the specific cloud-based solutions that our customers require. So, you don’t have to start from scratch, looking to try and understand cloud in the first place and then trying to design something yourself. We can help you carve out what you need from it and help you deliver it swiftly, and this also means you will only be paying for what you are actually using.”
Tackling integration with cloud
On whether cloud has a role to play in tackling common challenges faced by NHS trusts such as interoperability, integration and APIs, Jason said: “Every organisation is connected to the internet already – cloud is just an extension of that capability, really. I don’t think that improving integration, for example, is necessarily about leveraging the cloud. It’s about better integrating medical devices into the ecosystem of data that they are generating.”
He raised the example of an infusion pump at a patient’s bedside. “You need to write better code at the bed to enable better, richer datasets from that pump which can then be leveraged further. Cloud can help you utilise that data – pull it from different sources, pull it together, locate specific things. Cloud isn’t necessarily solving your problem, because we still need better data integration at the device point; but it can help you once you have improved that foundational issue.”
Nick shared a perspective from the technology and infrastructure side of things. The cloud is “a standard environment built on enterprise-grade technologies, delivered and developed by enterprise-grade organisations,” he said. “Therefore, they are focused on enabling things like seamless API integration and standard API development. If you move everything to a smaller number of platforms, it means that you have fewer communication points between them, and it also likely means they have been developed by specialists. So, at a technology level, I think that it is natural that integrating the bits of technology gets better and a bit easier. You’ve got less to work with, and a higher level of expertise.”
It does ultimately come down to vendors improving integration from their side, Jason and Nick agreed. “We at Rackspace Technology , as part of the IT service provider market, can play our part here,” said Nick, “as other providers should too. It’s not a silver bullet; it’s not going to fix everything. But we can absolutely help to improve things.”
Looking to the future
Do Jason and Nick think that this space will accelerate when software systems utilised in healthcare organisations are true cloud services designed purposefully for the cloud, as opposed to being migrated across?
“Without question,” said Jason. “I think we will see cloud models take hold, and we will be able to deliver software as a service capability. But I want to stress the importance of the hybrid multicloud; because you are never going to get rid of a datacentre. There are datasets that need to sit on the ward floor, in order to be of most use to the people who use them. It’s important to bear that in mind.”
Nick noted that there will “always be an element of customisation” required within the NHS, that will necessitate unique infrastructure and customised coding in order to meet individual NHS requirements. “I think I can see a future where we can take around 80 percent of services from true cloud application service providers,” he reflected. “And the other 20 percent, as Jason says, will operate separately to meet specific NHS needs.”
Jason added that “we are seeing the start of that acceleration now”, reflecting on Rackspace’s own journey. “We have come a long way in the past two years and we have seen a lot of development in this space. Today, we are the largest third-party hosting provider of Epic globally. I believe that is due to ease of contract, ease of use, and ease of understanding. People know what they get when they buy our services, and that price remains consistent. Contractually, we are bound to deliver at a set price, and so NHS organisations know what to expect and they can plan ahead.”
Thank you to Jason and Nick for taking the time to join us and share their perspectives. To find out more about Rackspace Technology and their work with the NHS, please click here.
