## 7 Conclusions and Future Research  
The research suggests that the health care industry has made improvements toward integrating their HIS locally. However, several HIS issues still need to be addressed. The IT infrastructure and the HIS are there, but optimal utilization of the system for better management of patient care is suspect. There is dissatisfaction with the current patient records systems especially in areas like interface, time taken to input data, and others. Cloud-based HIS may alleviate some of the aforementioned issues. Other benefits may include redesigned financial performance and cost procedures to provide more real time processing. Users, managers, and employees may be unaware and more skeptical of the value-added potential of the cloud-based HIS due to the privacy and security concerns, and issues related to lack of control. Communication may be the key here, and concerted effort is necessary between DevOps and top management to communicate and educate end-users and to help them become aware of the value-added potential of the cloud-based HIS. Enhanced IT operational excellence can be demonstrated through DevOps by introducing new features frequently. Along with this communication, it is essential to provide additional training to managers, doctors, and employees on the cloud-based HIS to utilize its new features and benefits. The model presented is based on a rigorous research and has face validity, content validity, and nomological validity. The model can be used by managers and decision makers to guide their adoption decisions for cloud-computing for HIS. Each of the dimensions outlined can be critically evaluated before the adoption decision. Each of the challenges and drivers may themselves be developed into a multiple item scale to allow for more comprehensive evaluation. The HIS area poses some unique challenges due to the sensitive nature of the information stored and its mission's critical nature. This mission's critical nature is an important consideration since it may lead to loss of lives in some cases. The cloud computing model is well proven with service providers like Netflix using it full scale to deliver its services. The booming trend of cloud computing adoption in different industries in recent years is driven by the cost, operation, and security benefits that these services provide. Benefits to the healthcare sector should be no exception but the required regulations and facilitators may need to take place in order to modernize HIS implementation in a reliable and secure fashion. It is time that HIS transitioned to a cloud computing model, and this may be enabled with some further research in the topics outline in this research. There are other trends and developments that may aid the acceleration of adoption of cloud computing for HIS. Security as mentioned is an important consideration for the EHR repository. Blockchain and smart contracts may provide a solution. Blockchain technology solutions have been used to address several issues, such as security, data privacy, authentication, interoperability, inaccessibility, and stored patient or provider data, in various fields of the healthcare application sector [68]. Several challenges in the use of blockchain though still persist. These include block sizes and block propagation [69], scalability [70], query latency and performance [71], amongst others. Several designs and frameworks have been proposed for blockchain-based EHR [72,73]; the implementations in mainstream HIS used by healthcare organizations have been somewhat limited. Several solutions have been proposed for the challenges posed by blockchain technology [69, 70, 71]. In addition, the solutions and frameworks come with stream use of blockchain with and within HIS and will be facilitated by cloud computing given that blockchain by nature as a distributed computing technology is better implemented using cloud technologies. Another trend likely to drive the adoption of cloud computing for HIS is the use of wearables and Internet of Things (IoT) sensors and devices.