Between cloud and on-premise servers for hospital software, there is no universal answer. The cloud reduces upfront investment and on-site maintenance but depends on the internet connection; an on-premise server stays accessible inside the facility without internet but requires hardware, a reliable power supply and skills to manage backups. The right choice depends on your connectivity, your budget and your technical resources.
Key takeaways
- The cloud suits well-connected facilities, especially those with several sites.
- An on-premise server suits facilities with unstable internet but backed-up power and a reliable technician.
- In both cases, power, backups and access control remain your responsibility.
- Before deciding, test your real connection and read the contract on hosting location and data return.
Cloud or on-premise server: what are we talking about?
With the cloud, the software and data are hosted in a remote data centre. The facility’s computers reach it over the internet, and the provider manages servers, updates and part of the backups.
With an on-premise server, a server computer is installed in the facility. Workstations connect to it through the internal network, and the facility, or its IT contractor, maintains it.
Example: with the cloud, a clinic in Accra and its branch in Tema view the same records over the internet. With an on-premise server, the two sites must be linked through secure remote access.
Cloud or on-premise server, criterion by criterion
| Criterion | Cloud | On-premise server |
|---|---|---|
| Upfront investment | Low: computers and connection | High: server, UPS, network, technical room |
| Running costs | Subscription and internet connection | Maintenance, electricity, hardware replacement |
| Internet dependency | High: no connection, no access | Low inside the facility |
| Power dependency | Computers and network equipment need backup power | Server, network and computers need backup power |
| Backups | Handled by the provider, to be specified in the contract | Organised by you, with an off-site copy |
| Updates | Done by the provider | Planned by the facility or its contractor |
| Several sites | Simple access from each site | Extra network configuration |
| Physical security | That of the data centre | That of your room: access, heat, dust, theft |
| Data location | Hosting country to be checked | Inside the facility |
The table shows that neither option is better in absolute terms. Each one shifts the risks: towards connectivity for the cloud, towards hardware and in-house skills for the on-premise server.
Questions to ask before choosing
- What is the real quality of your internet connection at peak hours? Measure it over several weeks.
- Can you subscribe to two connections from different providers?
- Is your power supply backed up by UPS units, a generator or solar panels?
- Who, in-house or at a contractor, can maintain a server and check backups?
- Do you have several sites to connect?
- Which rules apply to hosting your health data?
Example: a rural health centre in Sierra Leone with an unstable connection but a trusted technician may prefer an on-premise server. An urban clinic in Lagos with two connections and several branches will often find the cloud simpler to manage.
Planning for continuity in both cases
Neither option removes the risk of outages. Some solutions combine both approaches with a synchronised local copy: ask each vendor what they actually offer and how data entered during an outage is caught up.
In every case, write a backup paper procedure, decide who re-enters the data and test it. Our article on power and internet outages details this organisation. Example: a clinic that simulates an outage on a quiet day discovers that the backup forms are stored in a locked cupboard.
Health data: the legal framework to check
In Nigeria, the Nigeria Data Protection Act 2023 governs personal data, including health data, under the oversight of the Nigeria Data Protection Commission. In Ghana, the Data Protection Act 2012 (Act 843) applies, supervised by the Data Protection Commission. Before choosing hosting outside the country, check with the relevant authority what applies. Our guide to health data protection helps you prepare these questions.
Whatever the option, the facility remains responsible. The contract must state the hosting location, backup frequency, access arrangements and the return of data at the end of the contract. For internal measures, see our article on IT security in clinics.
MediFlow: points to examine during the demo
Whatever the hosting option, two measures remain essential to protect health data: role-based access and an audit trail of user actions. Ask every vendor, MediFlow included, how they implement them.
Come to the demo with your answers to the six questions above. Ask about hosting, backups and data return, and request that the answers be written into the contract.
Frequently asked questions
Is the cloud less secure than a server inside the facility?
Not necessarily. Security depends on the measures in place: access control, backups, updates and physical protection. A server sitting in an unlocked office with no off-site backup is more exposed than professional hosting under a clear contract, and the reverse is true with a vague contract.
What happens with online software when the internet goes down?
Without a connection, computers can no longer reach a remote server. Plan two connections from different providers, a backup paper procedure with re-entry, and ask the vendor how its software behaves during an outage.
Can we move from an on-premise server to the cloud later?
It is possible if the vendor offers both options and if your data can be exported and re-imported. Check this before signing, with the migration and data return conditions written into the contract.
Want to see how MediFlow fits your facility? Request a free demo.