Three Paths to the Cloud: How Health Systems Are Approaching EHR-Adjacent Software Today

The Conversation Has Changed 

For years, the infrastructure conversation was relatively straightforward. 

If a health system purchased software, it also owned the infrastructure required to run it. The organization bought the servers. Managed the backups. Applied the patches. Planned the upgrades. Maintained the disaster recovery environment. 

That was simply part of operating enterprise software. Today, the conversation looks very different. 

Not because health systems suddenly want different software. Because many are questioning whether they still want the responsibility that comes with running it. 

That distinction is driving a growing number of conversations around forms platforms, document workflows, patient intake systems, integration engines, and other EHR-adjacent applications. 

The question is no longer whether a hosted option exists. The question is how much operational responsibility the organization wants to keep. 

The Shift Isn’t About Technology 

Cloud migration is often framed as a technology decision when, in reality, it is increasingly an operational one. 

Most healthcare organizations are not evaluating hosted environments because their applications stopped working. They are reevaluating them because the environment around those applications has changed. 

Infrastructure is more expensive to maintain. Cybersecurity requirements continue to increase. The expertise required to support aging environments is harder to find and harder to replace. 

Meanwhile, vendors have invested heavily in hosted deployment models that reduce many of those responsibilities while accelerating access to new capabilities. 

As a result, organizations are finding themselves with more choices than they had a decade ago. Those choices generally fall into three categories. 

For Some Organizations, Staying On-Premises Still Makes Sense 

Despite the momentum around cloud adoption, remaining on-premises is not always the wrong decision. For some organizations, it may be the right decision. 

A health system navigating competing capital priorities, preparing for a broader infrastructure initiative, or working through staffing transitions may intentionally remain on-premises for a budget cycle or two. 

The decision works best when it is intentional. The risk is when staying on-premises stops being a choice and quietly becomes the default. 

Infrastructure continues to age whether organizations modernize or not. Staffing challenges continue to grow. Vendor roadmaps continue moving toward hosted environments. 

For many organizations, remaining on-premises buys time, but it rarely eliminates the need to eventually make a decision. 

Others Are Choosing to Offload Infrastructure Ownership 

Many healthcare organizations have reached a different conclusion. They no longer want to own the infrastructure supporting operational applications. 

That does not mean they want to replace the software. It means they want to stop managing the environment it runs on. 

This is one reason vendor-managed cloud environments continue gaining traction. The application remains familiar. The workflows remain familiar. Users continue working much as they always have. 

What changes is who manages the infrastructure. Monitoring, patching, backups, upgrades, disaster recovery, and infrastructure maintenance shift to the vendor. 

For IT teams facing resource constraints, that shift can be significant. Instead of maintaining infrastructure, teams can focus on cybersecurity, interoperability, analytics, optimization, and other strategic priorities. 

There is also an advantage that is easy to overlook. When the vendor hosting the environment is the same team that built the application, there is no gap between the people who understand the software and the people running the infrastructure beneath it. Updates, fixes, and new capabilities move directly, without coordination across multiple parties.  

Organizations also remain aligned with the vendor’s roadmap, where new capabilities, security enhancements, and AI-powered functionality increasingly arrive first. 

Some Organizations Prefer a Middle Ground 

A third group of organizations takes a different approach. Rather than moving directly into a vendor-managed environment, they choose to work with a third-party hosting provider. 

The appeal is understandable. Many health systems already maintain broader managed services relationships and want consistency across multiple applications. 

At first glance, the model can appear very similar to vendor hosting. The difference is accountability. 

In a vendor-managed environment, one organization typically manages both the application and the infrastructure supporting it. In a third-party hosting model, those responsibilities are split: the hosting provider owns the infrastructure, the vendor owns the application, and the health system owns the gap between them.  

That gap stays invisible until something breaks. When it does, the infrastructure provider and the application vendor can each point to the other, and the organization is left coordinating between them to find the resolution.  

For some organizations, that tradeoff is worth it for the consistency a single hosting relationship provides. For others, owning that gap is the reason they look to the vendor.  

The Real Decision Is About Ownership 

When healthcare organizations evaluate deployment models, conversations often focus on infrastructure, security, architecture, and cost. Those factors matter. 

But the deeper question is usually much simpler. 

• Who applies updates? 
• Who manages backups? 
• Who monitors performance? 
• Who is responsible when something breaks? 

The answers to those questions directly influence operational burden, staffing requirements, and long-term sustainability. 

That is why the most successful organizations are not asking which deployment model is best. They are asking which responsibilities they want to keep, and which ones they are ready to hand off.  

Download the Full Whitepaper 

This blog walked through the three paths. Off the Server goes further: how healthcare organizations are sequencing migrations, where the hidden complexity tends to live, and the operational and cost realities of owning infrastructure versus handing it off. 

Download Off the Server for the full picture.