## 5 Research Model and Issues for Additional Research  
Based on the review of the literature, this research proposes the cloud computing adoption model for HIS shown in Figure 3. Items that can measure the drivers and challenges were arrived at during the same process that was used to arrive at the dimensions and their associated drivers and challenges. The items presented here are preliminary and may need to be further refined when a survey is ready to be administered to a wider audience. To keep the length of the data collection to a reasonable length and given that industry professionals receive several surveys for completion, the initial proposal is to have one item measured on the 7-point Likert scale for each of the drivers and the challenges. These items are listed below:  
Construct: Financial performance and cost of cloud services:  
* Q1-1: Cloud computing services reduce the total cost of operations (TCO) for IT.
* Q1-2: Cloud pricing models provide flexibility in infrastructure deployment and cost savings.
* Q1-3: There may be hidden costs of cloud computing that the organization will need to manage.
* Q1-4: Cloud computing can lead to unmonitored on-demand usage, thus increasing costs.
* Q1-5: Service outages of cloud computing providers can lead to an undesirable financial impact.  
Construct, IT operational excellence and DevOps:  
* Q2-1: Offloading IT operations and refocusing on business is a primary benefit of cloud adoption.
* Q2-2: Automatic scaling of cloud infrastructure is a priority feature for an organization's infrastructure needs.
* Q2-3: Ready-to-use SaaS and PaaS of cloud providers is a feature that is attractive to the organization.
* Q2-4: DevOps and automation facilities of cloud providers will provide the agility needed by the organization's HIS.
* Q2-5: Containers and microservices architecture are the current or target roadmap for architecting application in the organization.
* Q2-6: Opensource alternatives for cloud management will help the organization avoid vendor lock-in and ease migration issues.  
Q2-7: Possible vendor lock-in of a cloud provider is a source of concern.
* Q2-8: Cloud architecture complexities in design and operation phases are a source of concern.
* Q2-9: Limited availability of skilled and experienced personnel is a source of concern. Construct: Security, governance, and compliance of cloud providers.
* Q3-1: Inheritance of security controls and benefits of cloud providers will alleviate security concerns in the organization.
* Q3-2: Obtaining and maintaining HIPAA and HITECH compliance can be done more cost-effectively and easily when using a cloud provider.
* Q3-3: Shared responsibility model for security is a source of concern for the organization.
* Q3-4: Shared security vulnerabilities with the cloud vendor are a source of concern for the organization.  
Construct: Cloud computing adoption for HIS
* Q4-1: The organization is ready to adopt a cloud-enabled/native HIS.  
During the process of arrival at the model, some research gaps were identified which have been discussed previously. These gaps pertain more to cloud computing in general but at the same time are also relevant in the context of cloud computing adoption for HIS. These provide an apt opportunity for researchers to further delve into issues that are pertinent to the adoption of cloud computing in HIS and may also apply to a more general case. Studies addressing these issues will aid managers to further  
Figure 3: Cloud computing adoption model for HIS.  
towards the adoption of cloud computing for HIS and in a more general case. These research opportunities are summarized in Table 2. These specific issues and opportunities can be taken up for study by other researchers in the field given that these are based on the experiences of a seasoned professional working in this area.