How to Migrate Legacy Healthcare Systems Without Relying on Managed Services

Moving legacy healthcare systems to the cloud is challenging, especially when avoiding managed services. In this context, "managed services" refers to pre-packaged solutions from cloud providers, such as serverless computing, managed databases, and cloud-native monitoring tools. While these services save time, they come with trade-offs—less control, vendor lock-in, and unpredictable costs.

To keep this cloud-agnostic, we’ll reference multiple platforms instead of focusing on a single vendor. Examples of managed services include relational database services, serverless computing, managed Kubernetes, and cloud monitoring solutions.

Some healthcare organizations avoid managed services due to:

• Regulatory Compliance?– Full control over infrastructure and data helps meet HIPAA, HITRUST, and local regulations.
• Security and Data Privacy?– Avoiding vendor lock-in ensures tighter access control.
• Custom Legacy Dependencies?– Some applications don’t function properly on managed services.
• Cost Control?– Managed services often introduce unexpected costs at scale.

For teams without deep cloud expertise, Professional Services (PS) partners can help. Unlike MSPs, PS teams provide guidance while keeping control in-house. This allows organizations to adopt cloud technologies at their own pace without relying on fully managed solutions.

This post covers strategies for migrating legacy healthcare workloads while maintaining control.

Migration Strategy Without Managed Services

1. Assess and Modernize Legacy Applications

Before migrating, analyze the existing architecture, dependencies, and security posture.

• Identify outdated libraries and update them.
• Find open-source alternatives to managed services.
• If possible, break monolithic applications into smaller, modular components.

2. Infrastructure as Code (IaC) with Terraform

Define and deploy infrastructure as code to maintain full control.

• Compute?– Use self-managed virtual machines with autoscaling instead of serverless platforms.
• Databases?– Deploy databases on VMs or Kubernetes instead of managed DB services.
• Storage?– Use self-hosted storage solutions instead of vendor-specific services.
• Networking?– Build secure virtual networks, subnets, and VPN access.

3. Self-Managed Compute and Orchestration

Alternatives to managed container services include:

• Self-Managed Kubernetes?– Deploy clusters manually or use lightweight distributions like K3s.
• VM-based Compute?– Run applications on compute instances with traditional service management tools.
• Container Orchestration?– Use open-source tools like Nomad or self-hosted Kubernetes clusters.

4. Database Management Without Fully Managed Services

• Deploy self-hosted PostgreSQL, MySQL, or similar databases with custom replication and backup strategies.
• Use Kubernetes operators for automated scaling and failover.
• Implement manual snapshots and multi-region replication for disaster recovery.

5. Security and Compliance

Without managed services, security is fully in your hands.

• Access Control?– Implement self-managed authentication and role-based access control (RBAC).
• Encryption?– Manage TLS certificates and encrypt databases with customer-controlled keys.
• Logging and Monitoring?– Deploy open-source observability stacks instead of cloud-managed monitoring services.

6. CI/CD Pipelines Without CSP-Specific DevOps Tools

Automate deployments using vendor-neutral DevOps tools.

• Use Jenkins, GitLab CI, or ArgoCD for automation.
• Set up custom artifact repositories instead of vendor-managed solutions.
• Leverage Terraform and Ansible for infrastructure management.

7. Data Migration and Synchronization

To migrate data while maintaining control:

• Use rsync or CSP-agnostic data transfer tools.
• Set up database replication scripts before cutover.
• Use Kafka or RabbitMQ for event-driven data synchronization.

Your Thoughts?

Moving legacy healthcare systems to the cloud while avoiding managed services is challenging, but with the right strategy, it’s possible. The key is balancing modernization with control—using Infrastructure as Code, open-source tools, and self-hosted solutions.

Thanks for reading! Your feedback on my last article was incredible, and it pushed me to keep writing. Are you working on a cloud migration? What challenges are you facing? Drop a comment below, and let’s discuss!