22 Feb 2021

Multi-Cloud Technology in Healthcare

Every year, healthcare providers generate, process, and store increasingly large amounts of data. Most groups and healthcare systems cannot feasibly manage all this data using internal servers. In the last decade, providers have turned to cloud computing services, which allow another company (a “cloud vendor”) to store the provider’s data in “data centers”. Popular cloud vendors include Amazon Web Services, Google Cloud, and Microsoft Azure. Recent proposals in the healthcare space advocate for the adoption of “multi-cloud” computing, in which a provider uses services from multiple cloud vendors [1]. Although the benefits of multi-cloud build upon those of cloud computing, multi-cloud also amplifies the information security risks of cloud computing.  

Healthcare systems stand to benefit substantially from the adoption of multi-cloud. First, multi-cloud reduces reliance on any one cloud vendor. Some vendors might be too specialized or too small to accommodate all of a group’s needs. Conversely, larger vendors might not offer certain specialized services that would benefit customers in the healthcare industry. By combining services across cloud vendors, healthcare providers can tap into greater analytical capabilities than are otherwise possible [2]. Second, multi-cloud presents a way to mitigate risk. If a cloud vendor encounters an outage or falls victim to a cyberattack, providers can rely on their other vendors to continue operating [2][3].  

Additionally, multi-cloud allows for cost reduction. Providers can choose which vendors offer the best prices for a particular service, like secure storage or big data analysis [3]. Finally, multi-cloud reduces latency, the delay between a data transfer request and the actual transfer. If a data center is far from a provider’s office, the provider must wait for their data for some time, especially if the transfer request involves a large amount of data. With multi-cloud, providers can choose to store frequently used data at a nearby data center, while keeping other data elsewhere [3]. With these benefits, multi-cloud appears to be a sensible solution for the future of healthcare data.  

Despite the aforementioned benefits of multi-cloud, its adoption raises information security concerns. When overseeing multiple clouds, senior IT and cybersecurity leaders have increased responsibilities, increasing the likelihood that security threats will go unnoticed. If secure data is stored redundantly across multiple clouds—as part of a risk mitigation strategy—malicious actors have more opportunities to steal the data [3]. One solution is to encrypt data, making it unreadable to all except trusted parties, like medical staff or data analysts. However, a report from 2019 by Thales Group, a defense and security company, found that 100% of surveyed American healthcare providers “use sensitive data” in cloud computing and other contexts, but only 38% use data encryption to protect sensitive data [4]. Furthermore, encryption alone does not suffice. A literature review of 140 research papers found that malicious insiders—people trusted to read the encrypted data—pose the greatest security threat to multi-cloud in the healthcare space [5]. As a result, the adoption of multi-cloud demands next-level efforts in cybersecurity and information security, which will require healthcare systems to invest resources well beyond current levels.  

In the next few years, more healthcare systems will likely move their data and computing needs to multi-cloud architectures. At the same time, cloud vendors and academic researchers will continue to address the underlying technical challenges. For example, some researchers are examining mobile app integration with multi-cloud [6][7], while others are calling for additional research on multi-cloud security [8]. If its adoption is done carefully, multi-cloud computing will help advance the future of digital healthcare.  


[1] Siwicki B. The Forces Driving Healthcare to a Multi-Cloud Environment. Healthcare IT News. May 13, 2020. https://www.healthcareitnews.com/news/forces-driving-healthcare-multi-cloud-environment.  

[2] Next Up for Healthcare: ‘Multi-Cloud’. ClearDATA. https://www.cleardata.com/news/next-up-for-healthcare-multi-cloud/.  

[3] Donovan F. Pros, Cons, and Strategies for Implementing Healthcare Multicloud. HIT Infrastructure. March 22, 2019. https://hitinfrastructure.com/features/pros-cons-and-strategies-for-implementing-healthcare-multicloud.  

[4] 2019 Data Threat Report – Healthcare Edition. Thales Group. 2019. https://cpl.thalesgroup.com/healthcare-data-threat-report.  

[5] Ahmed A., et al. Malicious Insiders Attack in IoT Based Multi-Cloud e-Healthcare Environment: A Systematic Literature Review. Multimedia Tools and Applications 2018; 77. DOI:10.1007/s11042-017-5540-x.  

[6] Wu H., et al. Mobile Healthcare Systems with Multi-cloud Offloading. IEEE International Conference on Mobile Data Management 2013. DOI:10.1109/MDM.2013.92.  

[7] Al-Muhtadi J., et al. Cybersecurity and Privacy Issues for Socially Integrated Mobile Healthcare Applications Operating in a Multi-Cloud Environment. Health Informatics Journal 2019; 25: 2. DOI:10.1177/1460458217706184.  

[8] Ali Khan Khattak H., et al. Security Concerns of Cloud-Based Healthcare Systems: A Perspective of Moving from Single-Cloud to a Multi-Cloud Infrastructure. IEEE International Conference on E-Health Networking, Application & Services (HealthCom) 2015.  

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