Many small and mid-size care organizations still have a server closet: a rack or a few boxes holding file shares, a local application or a phone system component. These machines age, require power and cooling, need patching and backup, and sometimes fail at inconvenient times. At the same time, moving everything to the cloud is not automatically cheaper or simpler.
This guide helps administrators think through the decision without technical jargon.
On-premises: servers owned by your organization and located in your building.
Cloud: services running in a provider's data centers, such as Microsoft Azure or Amazon Web Services, or software delivered as a subscription, such as hosted EHR and Microsoft 365.
Hybrid: a mix, with some systems local and others in the cloud.
Most organizations land on hybrid at least for a while.
An on-site server depends on your power, cooling, internet, hardware and staff. Large cloud providers offer redundant infrastructure that a single facility rarely matches. But the cloud depends on your internet connection, so a cut line can leave staff without access. If you move to the cloud, plan for connectivity redundancy.
On-premises costs include hardware purchase every several years, software licenses, electricity, cooling, backup systems, and the time to maintain them. Cloud costs are typically monthly subscriptions that scale with usage. The cloud may reduce large capital purchases, but monthly costs can add up and may be harder to predict if usage grows. Compare total cost over five years, including labor and downtime, not just the sticker price.
HIPAA does not prohibit cloud use, and HHS has published guidance on cloud computing, but it requires a business associate agreement with the provider and appropriate safeguards. Security is a shared responsibility: the provider secures the underlying infrastructure while you remain responsible for configuration, access control, accounts and data. Misconfigured cloud storage is a well-known source of exposure.
On-premises systems put everything in your hands, including patching, physical security and monitoring.
Some older clinical or business applications were designed for local servers and may perform poorly or not at all in the cloud. Ask software vendors what they support. Applications that move large files, such as imaging, may need extra bandwidth.
Running servers well requires skills in patching, backups, monitoring and recovery. If you do not have in-house staff for that, either the cloud or a managed service provider can fill the gap.
A tornado, fire or flood that damages your building can take local servers with it. Cloud-hosted data and cloud backups survive site disasters. If you stay on-premises, keep tested offsite copies.
On-premises gives you direct control. Cloud services depend on the provider's pricing, features and policies. Understand how to export your data and what leaving would involve.
For each server or application, note its purpose, age, vendor, who uses it and how critical it is.
Common candidates for cloud include email, file storage, phones, backup and many business applications. Some may already have subscription alternatives.
Certain equipment, such as devices that must communicate on a local network, or software that lacks a cloud option, may need to remain on-site for now.
Compare staying put, a hybrid and a full move. Include hardware refresh, licensing, connectivity upgrades, backup, support and migration.
If you move to cloud services, confirm bandwidth and backup connectivity. If you stay local, evaluate cooling, backup power and physical security of the room.
Move one workload at a time, starting with lower-risk systems such as file storage or email. Test, learn and then proceed.
Servers older than their warranty or running unsupported operating systems
Frequent unplanned outages
Backups that have not been tested
The server closet doubles as a storage room
Only one person knows how it works
There is no universal right answer, and the best approach is the one that fits your size, budget and risk tolerance. UnityCare IT helps healthcare organizations evaluate on-premises, cloud and hybrid options and plan migrations without disrupting care. If you are facing a server refresh, talk with us before you buy new hardware.
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Existing customers: support@unitycareit.com
Address: UnityCare Technologies, 2524 N Broadway Ste 554, PMB 947974, Edmond, Oklahoma 73034-4172