## 4 Drivers and Challenges for Cloud Based HIS
### IT Operational Excellence and DevOps
DevOps enhances and speeds up the software development lifecycle through: continuous integration (CI), which includes the planning and source code version control; continuous delivery (CD) of ready-to-release builds/deployment to production; continuous testing; observability through continuous logging; infrastructure monitoring and tracing; and application performance monitoring. Figure 2[54] summarizes the integration between application development and operations, which is the core concept behind DevOps. Easy and fast provisioning of application resources is a key advantage of cloud computing coupled with DevOps [9,28]. The usage of both of Infrastructure as Code (IaC) [51] and containerization techniques [49,55] provide agility in provisioning and managing new applications and features, as well as infrastructure needed to host any IS. They also enable quick deployment and scaling of applications. By introduction of DevOps and containers, the continuous integration and continuous delivery of the system, efficiency, and success is more likely [9]. This is extremely beneficial for HIS. Since an HIS implements quite a number of features and functionality, it is ideal to divide those into smaller subsystems, which can be implemented using the concept of microservices [10]. Cloud HIS exist [35,40], and HIS implementation and design frameworks can be inferred from these implementations. However, a more focused approach for designing and implementing a framework for HIS using DevOps and microservices architecture is needed [56,57]. More empirical studies in the HIS context can be conducted to measure software lifecycle Key Performance Indicators (KPIs) of HIS implementations using DevOps. The KPIs may include delivery times, compliance with requirements, performance, availability, and scalability. KPIs of a microservices architected HIS implementation may be compared to the traditional implementations. Additionally, reimplementation and refactoring of already implemented traditional HIS systems would be a welcomed experiment to measure and identify success factors of traditional vs. microservices architecture. Lastly, complexities in design and operations phases of systems along with skillset and experience needed for successful implementation and operation of HIS need to be identified. Complexities in designing cloud architectures especially in a situation like multi-cloud tenancy and hybrid cloud configurations can be daunting. That coupled with lack of skilled personnel in the market can make the adoption journey more difficult both in terms of startup and ongoing operations. Most cloud providers provide consultants for startup, however, the continuance of operations needs in-house personnel for cost effectiveness. Though the number of personnel required to support the operation of the cloud infrastructure is less than that of a traditional data center, the upskilling of existing personnel and hiring new ones can still be challenging. There is still a lack of skilled personnel in the market in both these areas. IT operational excellence and DevOps factors were primarily identified by interviewees with technical background (3,6,7,8,9,12). In addition, many key speeches in AWS Reinvent, Kubecon, and Cloud Native conferences reinforced the concepts. The CPO in a hospitality cloud hosted SaaS provider (3), and an advisory board member of hybrid cloud healthcare SaaS provider (6) outlined the improvements in agility and stability of their services after offloading many operations to cloud providers so that engineering teams could get more focused in implementing business features. This was also mentioned by the Director of design and architecture (7). The person outlined that the improvements achieved in the engineering process by using out-of-the-box SaaS and PaaS solutions offered by the cloud providers. The person elaborated on the automatic scaling and the  
Figure 2: DevOps Methodology components.