> I don’t think public cloud vs self hosting makes a massive difference. Right now, I'm the CTO of a medium-sized healthcare company. We're building our own EM

> I don’t think public cloud vs self hosting makes a massive difference. Right now, I'm the CTO of a medium-sized healthcare company. We're building our own EMR to replace the one we're currently using ON TOP of building out some line-of-business integrations that can help modernize other parts of our office. Part of that is grabbing data from an FTP EDT source from an HIE, storing that, processing it and then reporting. Our EMR has a bulk data download that we roll throuhg each night, processing data, building reports, etc. These integrations also tie into existing apps we use like Microsoft Teams, Microsoft Forms, Power BI, etc. With the EMR we're building, I was able to pull on some help early on, set up all environments in Azure (dev, test, prod), all databases, background services (which we use A TON), blob storage, certificates, etc. I can count on one hand the number of times I've had to touch it since. Prior to me coming on, all our data was stored on a server we hosted ourselves. It was a simple shared drive that constantly needed to be patched and updated. Went down ALL the time. And became a nightmare to manage on top of the 20 other pieces of technology we needed to use to get by. You know what I did? Copied the entire share to OneDrive and shut down the server and I was done. Never had to think about it again. And it's versioned. That's another benefit of cloud infrasturcture. I'm a single dev at a healthcare company that has dozens of things going on all because I can rely on Azure's cloud infrastructure. And that's not even counting the additional healthcare services they offer like FHIR servers, deidentifications services, pulling out snomed, med, and diagnoses codes from history and physicals, etc. I couldn't come close to this if I was tasked to do it myself. And the problem is that healthcare changes constantly. So you need to be able to be nimble and fast. Being able to offload those sort of challenges has been super helpful in that regard. It's not a silver bullet. My biggest issues NOW are people related. Links in emails are the hands down the biggest attack vector I have to worry about (for better or for worse). As far as the coding complexity, while a totally different animal, is another huge challenge as you mentioned. And it's not just "how do I translate this to a billing code" it's being able to make sense of unstructured clinical documentation, being able to report on it and analyze it, and most importantly share it. An encounter with a patient could potentially have to collect upwards of 2000 data points that are changing based on the patient, the diagnoses, or what's happening the world (Covid for instance). It's an insanely challenging problem which it sounds like you have experience with.