The Rising Cost of Staying On-Premises

The Software Isn’t the Problem 

Most healthcare cloud migrations don’t begin because an application stopped working. Usually the opposite is true.  

The forms platform still supports patient intake. The document workflows still route information where it needs to go. The integrations still connect to the systems around them. Operational teams have built processes around the application over many years, and from a functional standpoint, it’s doing exactly what it was designed to do.  

That’s what makes these conversations interesting. Organizations are rarely evaluating these systems because they failed. They’re evaluating them because the environment around them has changed.  

Ten years ago, keeping these systems on-premises was the practical choice. The infrastructure was familiar, internal teams knew how to support it, and there were fewer hosted alternatives. Today the calculation looks different, not because the software changed, but because the responsibilities of maintaining the environment around it keep growing.  

The Cost of Ownership Looks Different Today 

What changed over the past decade isn’t a single trend. It’s the cumulative weight of several arriving at once.  

Cybersecurity expectations have risen sharply. Infrastructure continues to age. Vendors are concentrating innovation in hosted environments. And the expertise required to support legacy systems is getting harder to find and harder to replace.  

Individually, each is manageable. Together, they’re pushing many healthcare organizations to reevaluate decisions that made perfect sense years ago. The question is shifting from whether a system can stay on-premises to whether maintaining it internally is still the best use of resources, capital, and expertise.  

For many organizations, that reevaluation spans a broad category of operational applications often called EHR-adjacent software or third-party apps: the forms platforms, document workflows, and integration engines that stayed on-premises long after much of healthcare moved to the cloud.  

(Related: The Systems Around the EHR Are the Next Migration Wave) 

The Cybersecurity Burden Continues to Grow 

Cybersecurity is often where organizations feel this shift first.  

Maintaining an on-premises environment involves far more than keeping an application running. Teams own patching, monitoring, backup, disaster recovery, access controls, and a security checklist that keeps expanding. None of that goes away just because the application is stable.  

For many healthcare leaders, the question is no longer whether their teams can manage those responsibilities. It’s whether those responsibilities are the highest-value use of internal resources, or whether some of that burden is better shifted to a partner whose primary focus is maintaining and securing the environment.  

Infrastructure Competes With Every Other Priority 

Healthcare organizations have no shortage of places to invest: AI initiatives, analytics, patient experience, clinical technologies, workforce enablement.  

Every infrastructure refresh competes with those priorities. Servers still need replacing. Hardware still reaches end-of-life. Support contracts still come due. The issue isn’t that the investment lacks value, it’s that leaders have other places they’d rather put the money.  

The People to Run It Are Getting Harder to Find  

One of the most overlooked costs of maintaining a legacy environment has little to do with the technology itself. It’s finding and keeping the people to run it. 

The talent to run on-premises infrastructure is getting harder to hire and harder to retain. Many of the health systems we talk to don’t have enough people to keep up, and even the well-staffed ones are stretched thin. One CIO told us she considered herself fortunate to have three people on staff managing her servers and even then, updates and backups still fell behind schedule.  

The work doesn’t pause when the team is short-handed. Patching, monitoring, backups, and recovery all have to happen on schedule, and when they don’t, the risk compounds quietly until something forces the issue. 

There’s a knowledge dimension too: the few people who understand how the integrations work and why a workflow was built a certain way are also the hardest to replace when they retire or move on. So leaders are increasingly asking not just whether they can maintain an environment today, but whether they can realistically staff and sustain it five years from now. 

Waiting Has a Cost Too 

A common assumption in modernization planning is that delaying a decision reduces risk. Sometimes it does. But waiting rarely freezes the environment in place.  

Infrastructure keeps aging. Security expectations keep evolving. Staffing challenges keep growing. Institutional knowledge keeps walking out the door. And vendors keep investing in hosted environments and future capabilities. The systems may stay stable, but everything around them keeps moving.  

That’s why many organizations are evaluating migration differently. The question is no longer whether migration is necessary today, but whether waiting creates more value than preparing for what comes next.  

That preparation usually doesn’t start with migration. It starts with understanding which systems create the greatest operational burden, which are becoming hardest to support, and where modernization delivers the most value.  

(Related: A Cloud-Smart Framework for Prioritizing Healthcare IT Migrations) 

None of this means every organization should migrate tomorrow. But those waiting for the perfect time to evaluate their options often find the decision has become more urgent than expected. Increasingly, healthcare leaders are moving cloud migration out of the “someday” category and into current planning because modernization is easier to approach proactively than reactively.  

A Different Modernization Conversation 

This is ultimately why healthcare cloud migration conversations are changing.  

The conversation is no longer about fixing a broken system. It’s about whether continuing to own and maintain the infrastructure behind that system is still the right long-term decision. Once organizations start asking that question, they usually find it’s less about technology and more about timing.  

The systems still work today. The infrastructure may still be manageable today. The expertise may still be available today. The real question is whether those conditions will hold three, five, or seven years from now.  

And increasingly, that’s the question moving cloud migration from a future initiative to a current priority.  

Related Resources 

• The Systems Around the EHR Are the Next Migration Wave 
• Healthcare Cloud Migration Is More Predictable Than Most Organizations Think 
• Three Paths to the Cloud: How Health Systems Are Approaching EHR-Adjacent Software Today 

Download the Whitepaper 

This blog laid out why the cost of staying on-premises keeps rising. Our whitepaper, Off the Server, goes further: how health systems are weighing that cost, what makes these migrations harder than they look, and how to decide what moves first.  

If your organization is evaluating the future of its FormFast environment, the whitepaper also breaks down three cloud pathways designed to align with different operational goals: 

• PROTECT: Strengthen resiliency with FormFast Backup & Recovery 
• OFFLOAD: Reduce infrastructure burden with Fully Hosted FormFast 
• TRANSFORM: Modernize with Nova, Interlace Health’s SaaS platform 

Download Off the Server to see how health systems are approaching the move and how to sequence what comes first.