From on-premises to cloud for healthcare

Healthcare organizations are increasingly turning to cloud infrastructure to modernize legacy systems, strengthen security and improve system-wide agility. But migrating from on-premises environments to the cloud isn’t simply a matter of lifting and shifting workloads. It should be a strategic, well-governed process that balances speed, compliance and operational continuity at every step.

Below are six critical steps to help your organization migrate with confidence and minimize risk throughout the transition.

1. Assess your current infrastructure and applications

Start with a comprehensive audit of your current environment. This includes physical infrastructure, application dependencies, network configurations and data governance frameworks. Key questions to ask:

• What are your mission-critical applications — such as EHRs, PACS or billing systems — that must remain highly available throughout the migration?
• Are any legacy apps tightly coupled to on-prem hardware or custom middleware?
• Where are data silos or manual processes slowing performance or introducing risk?

Some workloads may be candidates for rehosting, while others might require replatforming or even a full rebuild. Rackspace Technology helps organizations perform structured assessments to determine cloud readiness, migration complexity and expected ROI — so you can prioritize what to move, when and how.

2. Choose the right cloud provider

Public, private or hybrid? The right model depends on your organization’s use cases, risk posture and long-term digital strategy. For many healthcare systems, hybrid cloud offers the best of all worlds: cloud-scale flexibility for innovation workloads and cloud-adjacent private environments for sensitive systems that demand performance and control.

Selecting a migration partner with healthcare-specific capabilities is equally important. Rackspace Technology provides HITRUST CSF–certified solutions and managed services designed for HIPAA-regulated environments, including EMR hosting, data integration, backup and disaster recovery.

3. Perform a risk and compliance assessment

The migration of sensitive patient data must be secure and validated at every stage. Healthcare organizations should begin with a risk assessment that evaluates where vulnerabilities exist and how to address them before, during and after migration. This includes:

• Mapping regulatory exposure across workloads, including HIPAA, HITRUST and local healthcare laws
• Assessing data handling practices for storage, transmission and backup
• Reviewing identity and access management controls to reduce the risk of unauthorized access or data leakage

A well-scoped assessment provides the foundation for a compliant migration and helps prevent costly errors down the line.

4. Develop a validated data migration plan

A validated migration plan represents the opportunity to improve data quality, retire redundant assets and realign workloads with your future-state architecture. Establish clearly defined stages, milestones and rollback procedures to safeguard integrity at every step, and make validation a continuous process before, during and after the migration.

Incorporate automated data integrity checks, dependency mapping and performance benchmarks into each migration phase. In clinical environments, testing must go beyond functional validation to include patient safety impact assessments and audit readiness, especially when migrating EMR systems or other regulated workloads.

• Validate patient record integrity across systems: Confirm that clinical data fields, including encounter histories, allergies, medications and lab results retain accuracy and formatting throughout the migration process.
• Map interdependencies between EMR and ancillary systems: Identify how your EMR interacts with radiology (PACS), pharmacy, billing and scheduling systems to provide continuity of care.
• Simulate real-world clinical workflows: Run controlled tests with clinicians to verify that migrated data supports workflows like charting, order entry and results review without latency or error.
• Establish rollback protocols for patient safety: Define recovery points and failover mechanisms to restore previous EMR states rapidly in case of post-migration issues.

5. Formalize governance policies and operational processes

As your organization transitions to cloud-based operations, your responsibility to maintain control over sensitive data only grows. Formal governance policies are essential for protecting patient trust, reducing operational risk and enabling secure data sharing across modern healthcare environments.

Start by establishing clear, role-based rules for who can access, modify and share protected health information (PHI). Define storage requirements based on data classification and create incident response protocols that address both cloud-native and hybrid failure scenarios.

Cloud-based operations introduce new governance opportunities and new risks. Your policies must evolve to support dynamic workloads, elastic scaling and real-time data access. A modern operational model should include:

• Access and identity governance: Define and enforce least-privilege access across all accounts, using multifactor authentication (MFA) and integration with identity providers.
• Standardized backup and disaster recovery policies: Ensure regular testing of recovery procedures to meet RTO/RPO objectives for clinical systems and patient records.
• Audit and monitoring workflows: Set up automated logging and alerting for policy violations, user anomalies and resource misconfigurations.
• Configuration drift management: Schedule regular reviews of cloud assets to detect deviations from approved baselines and enforce compliance using infrastructure-as-code (IaC) templates.

6. Train teams for cloud fluency and policy alignment

Your cloud migration strategy is only as strong as your teams. Staff must be equipped to use new systems effectively while also following the processes that keep those systems secure and compliant.

Invest in training that goes beyond technical walkthroughs to reinforce secure usage, role-based responsibilities and policy alignment. Consider these training priorities:

• Role-specific education covering tools, workflows and data stewardship responsibilities
• Hands-on enablement for clinical and operational teams to build confidence with new cloud interfaces
• Simulated exercises for backup, recovery and incident response aligned to organizational protocols
• Ongoing refreshers tied to evolving compliance requirements, feature rollouts and threat landscapes

Cloud fluency doesn’t happen overnight,  but informed, empowered users are essential for long-term success. Training helps reduce the risk of misconfigurations and user error, which remain two of the leading causes of cloud-based breaches in healthcare environments.

Plan your migration with confidence

Migrating to the cloud is a transformative step for healthcare organizations. When done right, it can improve agility, resilience, efficiency and the ability to deliver more connected, patient-centered care. A structured migration process supported by healthcare-aligned partners helps reduce risk, protect sensitive data and create lasting value.

Learn how Rackspace Technology supports hybrid cloud migrations in healthcare here.