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Viewpoint

The Current Status and Promotional Strategies for Cloud Migrationof Hospital Information Systems in China: Strengths, Weaknesses,
Opportunities, and Threats Analysis
Jian Xu, MSc, MPH
Department of Health Policy, Beijing Municipal Health Big Data and Policy Research Center, Beijing, China

Corresponding Author:
Jian Xu, MSc, MPH
Department of Health Policy
Beijing Municipal Health Big Data and Policy Research Center
Building 1, Number 6 Daji Street
Tongzhou District
Beijing, 101160
China
Phone: 86 01055532146
Email: _xujian@163.com

Abstract
Background: In the 21st century, Chinese hospitals have witnessed innovative medical business models, such as online diagnosis
and treatment, cross-regional multidepartment consultation, and real-time sharing of medical test results, that surpass traditional
hospital information systems (HISs). The introduction of cloud computing provides an excellent opportunity for hospitals to
address these challenges. However, there is currently no comprehensive research assessing the cloud migration of HISs in China.
This lack may hinder the widespread adoption and secure implementation of cloud computing in hospitals.
Objective: The objective of this study is to comprehensively assess external and internal factors influencing the cloud migrationof HISs in China and propose promotional strategies.
Methods: Academic articles from January 1, 2007, to February 21, 2023, on the topic were searched in PubMed and HuiyiMddatabases, and relevant documents such as national policy documents, white papers, and survey reports were collected from
authoritative sources for analysis. A systematic assessment of factors influencing cloud migration of HISs in China was conductedby combining a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis and literature review methods. Then, various
promotional strategies based on different combinations of external and internal factors were proposed.
Results: After conducting a thorough search and review, this study included 94 academic articles and 37 relevant documents.
The analysis of these documents reveals the increasing application of and research on cloud computing in Chinese hospitals, andthat it has expanded to 22 disciplinary domains. However, more than half (n=49, 52%) of the documents primarily focused on
task-specific cloud-based systems in hospitals, while only 22% (n=21 articles) discussed integrated cloud platforms shared acrossthe entire hospital, medical alliance, or region. The SWOT analysis showed that cloud computing adoption in Chinese hospitals
benefits from policy support, capital investment, and social demand for new technology. However, it also faces threats like lossof digital sovereignty, supplier competition, cyber risks, and insufficient supervision. Factors driving cloud migration for HISs
include medical big data analytics and use, interdisciplinary collaboration, health-centered medical service provision, and successful
cases. Barriers include system complexity, security threats, lack of strategic planning and resource allocation, relevant personnel
shortages, and inadequate investment. This study proposes 4 promotional strategies: encouraging more hospitals to migrate,enhancing hospitals’ capabilities for migration, establishing a provincial-level unified medical hybrid multi-cloud platform,
strengthening legal frameworks, and providing robust technical support.
Conclusions: Cloud computing is an innovative technology that has gained significant attention from both the Chinese government
and the global community. In order to effectively support the rapid growth of a novel, health-centered medical industry, it isimperative for Chinese health authorities and hospitals to seize this opportunity by implementing comprehensive strategies aimed
at encouraging hospitals to migrate their HISs to the cloud.
(JMIR Med Inform 2024;12:e52080) doi: 10.2196/52080

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KEYWORDS
hospital information system; HIS; cloud computing; cloud migration; Strengths, Weaknesses, Opportunities, and Threats analysis

Introduction
In the 21st century, innovative business models have emergedin Chinese hospitals, such as online diagnosis and treatment,
cross-regional multidepartment consultation, real-time sharingof medical test results, and continuous public health surveillance.
However, most hospitals still rely on traditional hospital
information systems (HISs) designed for in-hospitalmanagement that are inadequate to support the development ofthese new business models [1]. Cloud computing has emerged
as a promising global information technology recognized as a
new infrastructure for future economic growth [2,3]. Since 2010,it has also been prioritized by the Chinese government as a“national strategic emerging industry” [4]. The adoption ofcloud computing technologies can significantly reduce hospitals’
costs associated with system construction and maintenance [5],expand medical services to partner institutions or patientsoutside the hospital [6], provide more secure network protection
than self-built data centers [7], and facilitate large-scalecollection and analysis of clinical data essential for scientificclinical decision-making [8]. Based on these advantages, there
has been a surge in China’s medical cloud service market andapplication research in recent years [9].
However, despite the increased attention given to cloudcomputing in various disciplinary domains such as disease
monitoring, health surveillance, and clinical diagnosis, there isa lack of research on the cloud migration of HISs. A
comprehensive review of the PubMed and HuiyiMd databases
only yielded 3 relevant studies: an Iranian study that identified
key driving factors for hospitals adopting cloud computing [10],a Greek study that proposed a method for migrating clinical andlaboratory data based on local hospital conditions [11], and an
American study that focused on essential considerations forchief financial officers before venturing into the cloud [12].
However, none of these studies have adequately addressed theaforementioned issue. Without conducting prior assessments,
hospitals may struggle to fully comprehend the external
environment, internal conditions, and potential opportunities
and risks, thus failing to ensure prudent decision-making.
Blindly following trends could pose significant threats to thesecurity, operational efficiency, and maintenance costs ofalready deployed cloud-based information systems and existing
hospital networks [13]. Therefore, this study aims tosystematically assess factors influencing the cloud migrationof HISs in China, identify associated challenges, and propose

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corresponding strategies for advancement. It can assist hospitals
in gaining a comprehensive understanding of this work whilesafely implementing their cloud-based medical services.
Additionally, it serves as a foundation for formulating policiesaligned with Chinese hospital informatization development in
the new era by health authorities while being referenced byother countries or regions facing similar challenges.

Methods
Information Sources
The primary data source for this study was obtained fromliterature databases to understand the practical applications ofcloud technology in Chinese hospitals. The articles publishedbetween January 1, 2007, and February 21, 2023, were selectedfrom MEDLINE (accessible through PubMed) and HuiyiMd(accessible through the Huiyi Medical Literature Express Service
System).
In order to overcome the inherent limitations of academic
articles, this study augmented a wealth of pertinent internal andexternal environmental information by extensively consulting
authoritative sources such as government agencies, industry
organizations, academic institutions, and market researchcompanies. These sources of information included national
policies, action plans, white papers, implementation guidelines,
survey reports, and statistical data from the past 10 years.

Search Strategies
The search strategy for PubMed: (((cloud [Title/Abstract]) OR(cloud-based [Title/Abstract])) AND (hospital [Title/Abstract])
AND (“2007/01/01” [Date-Publication]: “2023/02/21”[Date-Publication])). The search strategy for HuiyiMd: ([TI](cloud AND hospital) OR [AB] (cloud AND hospital) OR [MH](cloud AND hospital)) AND ([PY]>=2007). The search strategy
for authoritative sources involves entering the keywords“hospital” AND “cloud” in the search box on websites.

Inclusion and Exclusion Criteria
Based on specified inclusion and exclusion criteria (Textbox1), irrelevant articles or those covering the same topic from thesame institution were excluded. Subsequently, an Excel(Microsoft) spreadsheet (Multimedia Appendix 1) and areference list (Multimedia Appendix 2 [1,2,6,8,14-26]) weregenerated for literature review and Strengths, Weaknesses,
Opportunities, and Threats (SWOT) analysis.

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Textbox 1. Inclusion and exclusion criteria for literature review.
Inclusion criteria•

Article type: fully retrievable•

Language: English, Chinese•

Nationality of the first author: Chinese (including Hong Kong and Taiwan)•

Article topic: the research, development, and application of cloud technology in Chinese hospitals•

Publication date: from January 1, 2007, to February 21, 2023

Exclusion criteria•

Article type: nonretrievable•

Language: other languages•

Nationality of the first author: other countries•

Article topic: other topics•

Publication date: before January 1, 2007; after February 21, 2023

Information Extraction
The accessible articles were assessed based on the following
criteria: title, authors, first author, first author affiliation,
publication year, journal name, digital object identifier (DOI),
PubMed unique identifier (PMID), first author nationality,
abstract, and conclusion. Furthermore, the positive and negative
impacts, research methods, disciplinary domains, cloud service
models, and institutional affiliations were taken into accountfor further in-depth analysis purposes. The findings were
documented and statistically analyzed in Excel.

Analysis Methods
The SWOT analysis is a systematic assessment of strengths (S),weaknesses (W), opportunities (O), threats (T), and other factorsthat influence a specific topic, objectively describing the current
situation of an organization or enterprise and formulatingcorresponding strategies [14]. It is widely used in strategic
decision-making and competitor analysis within organizations
or businesses due to its ability to simplify complex problems

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into essential issues, enabling more focused problem-solving.
This study uses the SWOT method to assess the factors
impacting China’s cloud migration of HISs and proposespromotional strategies.

Results
Literature Review
Identification Process
The identification process in this study consists of four steps(Figure 1): (1) A total of 880 articles were retrieved from
PubMed and HuiyiMd databases. (2) The search results were
amalgamated, resulting in 460 deduplicated articles. (3)Screening the titles and abstracts eliminated 138 irrelevant
articles based on the exclusion criteria. (4) The full text of theremaining articles was meticulously examined against
predefined inclusion and exclusion criteria, resulting in a final
selection of 94 relevant articles.

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Figure 1. Flow diagram for the identification process.

Comprehensive Description of the Literature
Research and Application of Cloud Technology in Hospitals
Has Grown Rapidly and Continuously Expanded in
Disciplinary Domains
In terms of time line, there was a gradual step-like increase in
the number of articles starting in 2012 and reaching its peak at
20 articles in 2022. The compound annual growth rate (CAGR)

was approximately 35%, highlighting the escalating quantityof research into and application of cloud technology in hospitals,
as shown in Figure 2. The number of disciplines involved has
increased from 1 in 2012 to 10 in 2022, encompassing a totalof 22 domains. Specifically, research and application are
predominantly observed in the domains of disease monitoring,
health surveillance, clinical diagnosis and treatment, safe
medication tracking, and medical devices, constituting 51%(48/94) of the overall distribution.

Figure 2. Time distribution of disciplinary domains involved in academic articles.

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Implementation of Cloud Technology Can Yield Favorable
Outcomes for Hospitals to a Certain Extent
The analysis of 94 articles identified 3 categories and 9 researchmethods (Table 1). The “technology” category was the mostprevalent, with 47 (50%) articles focusing on information
systems, cloud platforms, and associated technologies. The“experience” category followed closely, with 40 (43%) articles,
primarily validating the performance of or applying cloud-based
information systems through empirical research, case-control
studies, experience sharing, and cohort studies. Finally, the“literature” category consisted of only 7 literature reviews on

this subject matter. The consistent findings of these studies
demonstrate the implementation of cloud technology in hospitals
can yield positive impact to some extent, such as enhancing
precision in management practices, expanding disease
monitoring capabilities, reducing workload for medical
personnel, and providing convenient and cost-effective healthcare services for patients. However, 5% (n=5) of the articles
also acknowledged certain negative impacts, such as
underdevelopment of digital methods in hospitals, cybersecurity
risks, and low satisfaction rates among physicians andcommunity pharmacists.

Table 1. The correlation between research methods used in academic articles and the institutional affiliations of their first authors.
Research methods

Hospitals, n (%)

Universities or colleges, n (%)

Associations or companies, n (%)

System research and development

13 (14)14 (15)

N/Aa

Cloud platform construction

5 (5)

5 (5)

N/A

Technical research

2 (2)

8 (9)

N/A

Empirical research

14 (15)

7 (7)

1 (1)

Case control study

11 (12)

2 (2)

N/A

Summary of experience

3 (3)

N/A

N/A

Cohort study

2 (2)

N/A

N/A

Retrospective study

4 (4)

2 (2)

N/A

Standard study

N/A

1 (1)

N/A

Technology

Experience

Literaturea

N/A: not applicable.

More Than Half of the Studies Focused on Task-Specific
Cloud-Based Systems, While Only 1 in 5 Addressed
Integrated Cloud Platforms
Out of the 94 articles analyzed, the majority (n=49, 52%)
focused on task-specific cloud-based systems in hospitals. In
contrast, only 21 (22%) articles discussed or developed
integrated cloud platforms for sharing within a region, medical
alliance, or hospital. Furthermore, as shown in Figure 3, 67%(n=33) of task-specific cloud-based systems were used in

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patient-related domains such as disease monitoring, healthsurveillance, clinical diagnosis and treatment, medical care, andmedical devices. A total of 15 regional cloud platforms (16%)
were commonly used for safe medication tracking, data storage,
and medical imaging. A total of 3 medical alliance cloud
platforms (3%) found use in disease treatment-related domains
such as disease monitoring, clinical diagnosis, and treatment
along with medical imaging. A total of 3 hospital cloud
platforms (3%) primarily originated from digital hospitals or
HIS upgrades.

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Figure 3. The cross-distribution of cloud service models and disciplinary domains covered in academic articles.

More Supplementary Materials Were Collected to Support
the SWOT Analysis for This Study
Because the literature review provided insufficient information
to support the analysis of internal and external factors for thisstudy, supplementary materials were collected, including
national policies, action plans, white papers, implementation
guidelines, research reports, and statistical reports from
authoritative websites, such as government agencies, industry
organizations, academic institutions, and market researchcompanies. In total, 37 supplementary documents were includedin the SWOT analysis: 4 policy papers, 11 industry reports, 15
academic articles, 2 dissertations, 2 official bulletins, and 3
news articles. All of them were recorded in an Excel file
(Multimedia Appendix 2).

SWOT Analysis
External Opportunities (O)Politics: Governments Worldwide Prioritize Cloud
Technology and Have Implemented Supportive Policies
The United States introduced the Cloud First policy [2] and the
CLOUD Act [15]. Similarly, the European Union aims for
digital sovereignty through initiatives like the Gaia-X
Association and the EU Cloud Computing Strategy [27]. China
also prioritized cloud computing as a “national strategic
emerging industry” in 2010 and implemented policies topromote its adoption by the government and businesses [28].
Consequently, China has rapidly developed in this field andranks among global leaders [29].
Economy: Both Nations and Enterprises Have Made
Substantial Capital Investments to Foster Its Development
According to Gartner’s data from 2011 to 2022, the market scale
increased from US $95.24 billion to US $491 billion with ahttps://medinform.jmir.org/2024/1/e52080

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CAGR exceeding 16% [30]. The global medical cloudcomputing market reached US $39.4 billion, with Asia-Pacificexhibiting the fastest growth rate at 22% per year; China andIndia are significant contributors to this expansion [9]. In China,
the market size has surged from less than US $270 million in2011 to US $66.91 billion in 2022, with a consistent CAGR
surpassing 40%, and will exceed US $150 billion by 2025 [30].
Social: Online Health Care Has Become a Norm in Modern
Life
According to the National Telemedicine and Connected
Healthcare Center of China, as of June 2021, there were 239
million users accessing health care services online and morethan 1600 internet-based hospitals in China [31]. Another survey
revealed that approximately 63% (n=465) of the surveyed
hospitals (738 hospitals across 30 provinces) used cloud services
to some extent in 2022 [32]. Moreover, the COVID-19 pandemic
has further fueled the demand for online health care services[6]. Consequently, these services have become as commonplacein our lives as online shopping.
Older Adult Care: The Older Adult Care Industry Urgently
Needs Advanced Technological Support
By the end of November 2020, China’s population of people
aged 60 years and older was 264,018,766, accounting for 19%of the total population, making it the country with both thelargest older population and the fastest-aging society worldwide[33]. Consequently, relying solely on their children, nursing
homes, or communities to provide older adult care services has
become increasingly impractical. Recognizing this challenge,
the National Health Commission of China issued a documentin October 2019 emphasizing the need to fully harness modern
technologies such as cloud computing, artificial intelligence(AI), and the Internet of Things to develop an intelligent service
model known as “Internet plus Healthy Aging” [34].
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External Threats (T)Internal Strengths (S)Market: Technological Monopolies Pose a Significant Threat
to the Digital Autonomy of Nations
A total of 81 (81%) of the Forbes Top 100 cloud computing
companies are American [35], and they possess significant
technological and capital advantages. They continuously expand
their global market share; they captured 60%-70% (JPY
¥1,725-¥2,012 billion [US $11.6-$13.6 million]) of the Japanesecloud market in 2020 [36] and 69% of the European cloudmarket in 2021 [37]. The passage of the Clarifying Lawful Useof Data Abroad Act (CLOUD Act) by the US Congress in March2018 caused European countries to feel threatened due to thepotential loss of digital sovereignty [15], which prompted themto initiate their “European cloud” project in 2020 [27]. Other
nations may face similar challenges.

Data: Hospitals Generate Substantial Volumes of Medical
Data on a Daily Basis
Hospitals are natural suppliers of big data. For instance, theChinese National Cloud-Based Telepathology System(CNCTPS) has collected 23,167 cases and served 9240 users
in 4 years (2016-2019), providing comprehensive details fromwhole-slide images to diagnostic reports [5]. Additionally,
medical big data can provide substantial value to both hospitals
and patients. For example, the aforementioned CNCTPS
application can save patients around US $300,000 per year [5].
Abundant electronic health and care records in the United
Kingdom’s NHS can reduce hospital operational costs byapproximately £5 billion (US $ 3.9 billion) annually and savepatient welfare expenses by roughly £4.6 billion (US $3.6
billion) [41]. Furthermore, traditional computing tools are unable
to handle the processing and analysis of such massive amountsof data—this is exactly where cloud computing technology
excels [18].

Competition: Fierce Competition May Lead to Uncertain
Levels of Service Quality
In November 2021, 5 bidders for a public cloud service projectin Shijiazhuang City, China, submitted bids of CNY ¥0, sparking
concerns among stakeholders [38]. The intense competition
may lead to unpredictable service performance issues for users,
such as limiting hospitals’ access to better pricing and a wider
range of choices by restricting the interoperability and portabilityof HISs or causing sudden disruptions in cloud-based medical
services after winning the bid, which poses significant risks topatient safety [16].
Security: Hospitals Express Apprehensions Regarding
Diverse Cyber-Attacks Targeting Cloud Infrastructure
Security is the primary challenge for cloud-based systems due
to various cyberattacks faced by current cloud environments,
especially in the health care sector where sensitive data such as
personal privacy, health records, diagnostics, and treatments
are stored [13]. Even prominent cloud providers like Azure(Microsoft), Docker Hub (Docker), and Everis (NTT DATA)
have experienced malicious intrusions [30], while both theUnited Kingdom’s National Health Service (NHS) in 2017 andIreland’s Department of Health information system in 2021
were both targeted and resulted in a complete paralysis [39,40].
Legislation: The Lack of Precise Legislation Hinders the
Efficient Implementation and Enforcement of Regulatory
MeasuresTo support the implementation of the “Cloud Normal” and“Internet Plus” strategies, the Chinese government has enacted
laws, regulations, and management measures. However, there
are limited directly applicable legal provisions for cloud
migration of HISs. Imperfect laws and regulations, insufficient
safety standards, unclear legal liabilities, and the absence of adamage assessment mechanism hinder the proper developmentof cloud services. As a result, doctors and patients may
encounter challenges in protecting their rights during disputes[17].

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Business: The Provision of Comprehensive Medical Services
Necessitates Extensive Interdisciplinary Collaboration
Medical services are complex and innovative, requiring
synchronization of knowledge, technology, experience, andresources from diverse disciplines. Cloud computing provides
extensive connectivity, offering robust support for these tasks,
including interdisciplinary expert consultations, collaborative
surgeries, and integrating medicine and care [19]. The Huashan
Hospital, affiliated with Fudan University, uses a medical
consortium cloud platform where experts from higher-level
hospitals offer diagnostic advice to lower-level hospitals for
subsequent care and daily treatment, ensuring positive outcomesfor patients with epilepsy [42].
Application: Multiple Cloud Technology Applications Have
Been Effectively Implemented Across Various Medical
Domains
As shown in Figure 2, cloud technology is receiving increasingly
extensive research and application in the medical field, and evensome regional or medical alliances have constructed their own
medical cloud platforms to store health data, share medical
images, and facilitate collaboration. Furthermore, a national
survey conducted in 2022 also confirmed these findings by
revealing that out of the 738 surveyed hospitals, 63% (n=465)
partially used cloud services across nearly 20 different medical
business scenarios [32]. These effective practices can serve as
valuable references and support for other hospitals yet to
implement such initiatives.
Demand: The Provision of Health-Centered Medical Services
Necessitates Advanced Technological Support
The transition from disease-centered to health-centered hospitaldevelopment in the new era has rendered traditional HISs
increasingly inadequate as they were previously designed solely
for managing information within hospitals. Cloud computing
can significantly expand hospitals’ medical services beyond
their physical premises, enabling online chronic disease
management, individual life-cycle health surveillance, andremote diagnosis for patients in remote areas. This enhancement
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empowers hospitals to provide health-centered medical services[20]. The findings of this study also strongly support this notion.
As depicted in Figure 3, cloud technology has been extensively
used in closely associated domains with patients, encompassing
disease monitoring, health surveillance, clinical diagnosis andtreatment, and safe medication tracking.

Internal Weaknesses (W)System: The Complexity of HISs Poses Challenges for
Hospitals When Migrating Them to the Cloud
The HISs are the most complex organizational information
management systems developed by various contractors indiverse environments, covering a wide range of business
functions and user groups [21], as depicted in Figure 3, with
only 94 articles included but spanning across 22 distinct
disciplinary domains as well. Therefore, the cloud migration of
HISs presents significant challenges, particularly for thosesystems abandoned by development companies due toinsolvency or insufficient technical support. Nevertheless, if
there existed an all-encompassing and authoritative medical
cloud platform enabling hospitals to tailor services based on
their specific requirements, it would undoubtedly expedite theoverall migration process.
Security: The Security of Existing Hospital Networks Still
Faces Numerous Risks
Currently, most HISs still operate in self-constructed networks
instead of using cloud-based solutions, which poses information
security challenges due to insufficient infrastructure,
overreliance on a single protective measure, incomplete
regulatory frameworks, and potential vulnerabilities fromprivilege abuse [22]. For example, the 2019-2020 China Hospital
Informatization Survey Report revealed that around 28%(n=282) of surveyed hospitals experienced unplanned coresystem failures lasting more than 30 minutes [43]. To effectively
address these concerns, proficient IT teams like reputable cloudvendors or organizations equipped with advanced technologies
such as cloud computing should collaborate rather than solely
rely on in-house hospital IT capabilities.
Plan: Strategic Planning and Resource Allocation in
Hospitals Exhibit Certain Deficiencies
According to Figure 3, more than half of the research articles
focused on hospital-specific systems for various tasks. Thesesystems still adhered to traditional information system designs,
had limited scalability and functionality, and operated
independently. As a result, there were significant challenges in
effectively using cloud computing’s computing capabilities,
storage capacity, and integrated analysis to generate valuable
information supporting government scientific decision-making.
The survey results from China’s National Health Commission
also confirmed this point as many internet hospitals were notfully developed yet and encountered diverse issues [44].
Moreover, only 14% (n=101) of hospitals had migrated theircore business operations to the cloud with a mere 13% (n=100)
planning to do so in the next 3-5 years [32]. Therefore, it is
crucial for hospitals to reorganize and integrate their operations
and resources before incorporating their HISs into the cloud inhttps://medinform.jmir.org/2024/1/e52080

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Xuorder to meet the demands of cloud capabilities and new healthcare models.
Personnel: The Allocation of Information Personnel Is
Inadequate and Lacks Specialization Levels
With the increasing integration of cloud computing, AI, androbotics, hospitals urgently require highly skilled IT
professionals to effectively implement these new technologies[23]. However, a national survey in 2021 revealed that the
average number of information department personnel in 9376
secondary and tertiary hospitals was only 6. Most of these
personnel held undergraduate or junior college computer degrees
and possessed limited interdisciplinary expertise. This falls
significantly below national standards [24], particularly for
hospitals below grade 2 or in economically underdeveloped
areas [45].
Investment: Primary Hospitals Lack Sufficient Investment
in Information Technology and Cloud Services
According to a 2020 survey by the National Health Commissionof China, most primary hospitals allocated less than 1% of theirbudgets to HIS development, facing challenges such as unstable
funding and support [25]. A nationwide survey conducted in
2022 revealed that only 53% of the surveyed 738 hospitals had
expenses related to public cloud services in the previous 2 years,
with 54% spending less than US $14,000. Particularly forprimary hospitals, establishing a cloud service system is evenmore financially challenging [32]. Clearly, these primary
hospitals require more reliable financial guarantees for thesmooth operation of their HISs and cloud services.

Discussion
Principal Findings
Extensive literature review and systematic SWOT analysis
indicate that cloud computing is increasingly being applied innearly 22 discipline domains in Chinese hospitals; it plays acrucial role in monitoring patient-related diseases, healthsurveillance, clinical diagnosis and treatment, and safe
medication tracking. However, more than half of the research
and applications are limited to cloud-based systems for specifichospital tasks, which fail to fully leverage the robust integrated
analytical capabilities of cloud computing due to limited datascale and functionality that could otherwise generate valuable
information supporting hospital or government decision-making
processes. Additionally, challenges such as market sovereignty
disputes, intense industry competition, network attacks,
inadequate regulation, and hospitals’ internal weaknesses likecomplexity of HISs, insufficient resource integration, and limited
manpower and investment, hinder widespread adoption of cloudtechnology among most hospitals that exhibit a relatively weak
willingness to migrate their core operations to the cloud within
the next 3-5 years. Nevertheless, cloud computing is widely
recognized as a novel infrastructure driving global economic
growth. Integrating cloud technology in hospitals can enhance
medical service quality, foster interdisciplinary collaboration
and remote consultations, and promote coordinated development
within regional health care economies. Consequently, it isimperative for hospitals and health authorities to pay special
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attention to this matter and actively implement diverse strategies
to facilitate its advancement. Based on the aforementioned
research findings, this study proposes a set of promotionalXustrategies for collective deliberation among peers. The overall
framework depicting these proposed strategies is illustrated in
Figure 4, which will be further elucidated in subsequent sections.

Figure 4. SWOT analysis and response strategies diagram for cloud migration of HISs. HIS: hospital information system; SWOT: Strengths, Weaknesses,
Opportunities, and Threats.

Implementing Multiple Initiatives to Encourage More
Hospitals to Migrate Their HISs to the Cloud
The primary objective of this strategy is to address the issue of“whether or not to adopt cloud technology.” Based on theoutcomes of the SWOT analysis, despite the pressing need forcloud technology to enhance health-centered medical service
delivery today, hospitals remain cautious about its
implementation due to external threats and internal weaknesses.
Furthermore, providing cloud-based medical services hasbrought about a significant transformation within the medical
industry that exceeds traditional independent operations andself-financing models used by hospitals. Therefore, governments
should make greater efforts by implementing more active
measures such as policy guidance, training planning,demonstration projects, or provision of cloud vouchers, in orderto encourage more hospitals to securely migrate their HISs onto
the cloud and meet demands for innovative medical services inthis modern era.

Enhancing Hospitals’ Overall Capability for Cloud
Migration of HISs
The strategy aims to address the issue of “what preparations arenecessary.” As previously mentioned, cloud migration of HISs
is a highly intricate system engineering project that requires
hospitals to be fully prepared for its successful implementation.
These preparations encompass various aspects including, but
not limited to the following. First, human resources: hospitals
should enhance employees’ medical information literacy andhttps://medinform.jmir.org/2024/1/e52080

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application skills through comprehensive training programs,
specialized lectures, or successful case studies. Second, material
resources: hospitals should redesign and integrate existing
systems and resources based on future development, existing
foundations, and expert recommendations in order to optimize
the use of cloud resources for acquiring more valuable
information. Third, financial resources: hospitals requirelong-term financial investment planning to support the provisionof cloud-based medical services. Moreover, health authorities
should acknowledge that primary hospitals serve as both
frontline institutions addressing medical needs and significant
sources of authentic data. Therefore, moderate increases ininvestment in HIS construction of primary hospitals arenecessary to ensure a continuous input of firsthand authentic
data. Fourth, tools: a hospital that has robust IT capabilities canleverage free cloud migration consultation and tools provided
by major cloud providers such as Alibaba, Tencent, Google,
Microsoft, and Amazon Web Services, which can expedite theprocess of migrating information systems. However, it should
be noted that the cloud services used (eg, computing and storage)
may incur charges.

Establishing a Provincial-Level Unified Medical
Hybrid Multi-Cloud Platform
The strategy aims to address the issue of “how to implementchanges efficiently.” In response to numerous complex internaland external situations, this study proposes a coping strategy:
establishing a unified medical hybrid multi-cloud platform ineach province or municipality.
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JMIR MEDICAL INFORMATICSFirst, the hybrid multi-cloud platform highly aligns with hospital
operations. Hospitals require private clouds for storing sensitiveand core data, nonpublic community clouds for internal
consultations and other collaborations, public clouds forproviding more extensive medical services to the public, andadopting a “multi-cloud” strategy to reduce risks such as vendor
lock-in or declining service quality.
Second, a medical cloud platform at the provincial or municipal
level can achieve maintainable security and more highly
effective cloud migration. In comparison to hospitals, healthauthorities at this level possess stronger technological expertise,
greater manpower resources, maintainable financial support,
and relevant assets for constructing comprehensive platforms
while effectively mitigating internal and external risks.
Moreover, this approach can also foster overall advancements
in cloud migration and system function quality of hospitals(particularly primary ones), as well as minimize redundantconstruction and maintenance expenses.
Last but most importantly, the scale of data possessed by one
or several individual hospitals is insufficient to constitute true
big data, limiting the opportunities for leveraging cloudcomputing’s powerful intelligent analysis capabilities inuncovering hidden objective laws that can support the
government to make scientific decisions. Considering factors
such as data scale, cloud computing capabilities, and government
economic support capacity, a provincial or municipal regional
medical cloud platform is a more suitable choice.

Enhancing Legal Framework and Technical Support
for Cloud-Based HISs
The primary goal of this strategy is to address the issue of “howto create a supportive environment.” As an ancient Chinese
proverb states, “A single log cannot support a crumblingbuilding,” indicating that relying solely on a provincial-level
medical cloud platform is still insufficient to counter all external
threats and internal risks faced by hospitals. Therefore, it
requires a more proactive role from the government, whichstrengthens cooperation with relevant departments andenterprises to build a more robust and secure supporting
environment for medical cloud platforms. Specifically, 2 aspectsof support are necessary. First, credible legal support: although
the Chinese government has been improving laws regarding
cybersecurity, personal information protection, and data security,
its support for cloud-based medical services remains inadequate.
For example, in resolving disputes related to cloud medical
services, health authorities still rely on laws such as the
Physician Practice Law and Regulations on Prevention and
Handling of Medical Disputes in China. However, theseregulations have not explicitly defined the status andresponsibilities of all parties involved in cloud-based medical
services, which poses challenges in terms of judgments andXupenalties [26]. Therefore, it is essential to further refine relevant
legislation and update existing regulations regarding doctors’
practice rights, insurance responsibility, and reimbursement for
medical insurance, ensuring doctors and patients can confidently
participate in cloud-based medical services. Second, holistic
technical support: as indicated by SWOT analysis results,
hospitals often lack professionals with deep knowledge ofcutting-edge technologies like cloud computing, AI, and big
data. Therefore, establishing an organization like a medical
cloud technology association becomes necessary. This
organization should consist of experts from various relevant
fields, including IT, communication, engineering, cryptography,
medicine, and more. Their responsibilities would include
devising unified long-term plans and action plans, standardizing
contracts between hospitals and cloud service providers,reviewing hospitals’ cloud migration plans and contracts, andconducting regular evaluations of the construction and operationof cloud-based HISs.

Conclusions
In conclusion, cloud computing is prioritized by the Chinese
government as a “national strategic emerging industry.” Despite
encountering numerous challenges, the cloud migration of HISs
in China exemplifies a prevailing development trend. Therefore,
hospitals should adopt an open mindset and focus on enhancing
their capabilities to develop medical services based on the cloud.
Health authorities should also use more effective strategies toincentivize hospitals to migrate their HISs safely to the cloud,thereby fostering the flourishing growth of a novel
health-centered medical industry.
The main contribution of this study is a comprehensive literature
review and systematic SWOT analysis on the current status ofcloud migration of HISs in China, and corresponding strategies
for different combinations of internal and external influencing
factors. It can help hospitals gain a clearer understanding of theoverall situation while having more specific goals and methods
when planning and implementing related work. Moreover, it
can serve as a foundation for health authorities to develop
policies aligned with the development of hospital informatizationin the new era, as well as provide references for other countries
or regions facing similar challenges.
There are 2 limitations in this study: first, not all personnel from
hospitals contribute to writing papers, thus limiting thecomprehensiveness of literature information; second, the SWOT
analysis method assumes a distinction between internal andexternal factors, as well as a differentiation between strengths
and weaknesses, overlooking the interrelated effects among
influencing factors. To supplement and improve these aspects,
more empirical investigation data are needed, along with a more
rigorous analysis of the interactions among influencing factors.
This will be the focus of my future research.

Data Availability
The data sets generated and analyzed during this study are not publicly available but are available from the corresponding author
on reasonable request.

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Xu

Conflicts of Interest
None declared.

Multimedia Appendix 1
Academic paper database.
[XLSX File (Microsoft Excel File), 50 KB-Multimedia Appendix 1]

Multimedia Appendix 2
Supplementary database.
[XLSX File (Microsoft Excel File), 13 KB-Multimedia Appendix 2]

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Abbreviations
AI: artificial intelligence
CAGR: compound annual growth rate
CLOUD Act: Clarifying Lawful Use of Data Abroad Act
CNCTPS: Chinese National Cloud-Based Telepathology System
DOI: digital object identifier
HIS: hospital information system
NHS: National Health Service
PMID: PubMed unique identifier
SWOT: Strengths, Weaknesses, Opportunities, and Threats

Edited by C Lovis; submitted 22.08.23; peer-reviewed by T Khodaveisi, M Platt, C Xie; comments to author 07.10.23; revised version
received 30.11.23; accepted 02.12.23; published 05.02.24
Please cite as:
Xu J
The Current Status and Promotional Strategies for Cloud Migration of Hospital Information Systems in China: Strengths, Weaknesses,
Opportunities, and Threats Analysis
JMIR Med Inform 2024;12:e52080
URL: https://medinform.jmir.org/2024/1/e52080
doi: 10.2196/52080
PMID:©Jian Xu. Originally published in JMIR Medical Informatics (https://medinform.jmir.org), 05.02.2024. This is an open-accessarticle distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR
Medical Informatics, is properly cited. The complete bibliographic information, a link to the original publication on
https://medinform.jmir.org/, as well as this copyright and license information must be included.

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