A Guide for CIOs and CISOs on Evaluating Azure, Google Cloud, and AWS

Clinical AI is now in full-scale production across the United States. CIOs and CISOs face increasing pressure to deploy, scale, and govern AI safely while leveraging existing cloud infrastructure.

Azure, Google Cloud, and AWS each offer different advantages and disadvantages, and no single platform stands out as ‘the best’. The best selection depends on the organization's current architecture, operational practices, and anticipated lifecycle of AI. A good way to start is by breaking down your strategy into a phased plan: near-term, mid-term, and long-term. This allows CIOs and CISOs to connect cloud choices to the evolving maturity of their AI goals over the next three to five years, making sure each stage is in line with the organization’s broader goals.

Why Cloud Choice Matters for Clinical AI

Which of these factors most threatens your AI rollout today? CIOs and CISOs evaluating clinical AI deployments typically weigh:

• Security and privacy requirements for PHI
• Compatibility with existing data systems and imaging workflows
• Compute needs for model inference and retraining
• Cost efficiency and scalability
• Support for the AI lifecycle, including validation, deployment, monitoring, drift detection, and auditability

Each cloud provider offers tools addressing these requirements; however, their ecosystems and operational models differ. These are critical in the decision-making process. For instance, consider a healthcare organization’s PHI. When choosing between providers, an executive might find a security nuance: Google Cloud offers advanced encryption that seamlessly integrates with its AI services, which might be more suitable for institutions requiring strong data protection. Meanwhile, Azure provides extensive identity management capabilities that can be a better fit for organizations with complex access needs.

Microsoft Azure: Enterprise Integration and Consistency

Strengths

• Identity and access management consistency for organizations invested in Microsoft technologies
• Strong ecosystem for hybrid deployments, beneficial for health systems with mixed on-prem and cloud infrastructures
• Native healthcare data services like FHIR and DICOM handling that align well with clinical systems

Potential Tradeoffs

• May present greater operational complexity for teams that prioritize streamlined developer workflows. This can lead to delays in model updates, potentially impacting the clinical accuracy of AI applications. Such delays can, in turn, affect patient outcomes by prolonging the time it takes to integrate the latest AI insights into clinical settings, potentially delaying critical improvements in patient care.
• Requires additional configuration to optimize AI-specific workloads compared to platforms designed with native AI tooling

Best Fit For…

Best suited for health systems with substantial Microsoft adoption, hybrid environments, or organizations that prioritize consistent enterprise controls.

Google Cloud: AI-Native and Interoperability-Driven

Strengths

• A modern architecture built for AI, including strong managed services for model training and inference
• FHIR-first data strategy, making it attractive for systems that prioritize interoperability and data unification
• Developer-friendly environment with intuitive workflows for MLOps and analytics

Potential Tradeoffs

• While Google Cloud has a smaller presence in healthcare than Azure and AWS, it offers a unique opportunity for strategic capability-building. CIOs and CISOs should consider what investments in internal skills or partnerships could offset this limitation, transforming it into an asset for innovation. Organizations should focus on building skills in AI-specialized services such as TensorFlow, Google AI Platform, and Kubernetes for container management. Establishing partnerships with vendors experienced in Google Cloud deployments can significantly ease transitions. Is the investment required worth the potential advantages Google provides in AI-native capabilities and interoperability? By weighing the effort against the strategic gains, organizations can turn this challenge into a proactive planning exercise.
• Certain services are tightly integrated, which can increase reliance on Google-native components.

Best Fit For…

Best suited for organizations pursuing cloud-native AI innovation, advanced analytics, or modernized imaging and data strategies.

AWS: Flexibility and Scale for Custom Architectures

Strengths

• The broadest set of cloud primitives, allowing highly tailored deployments
• Strong global footprint and scaling capabilities, ideal for large systems or multi-site inference workloads
• Longstanding integrations with healthcare vendors, EHRs, and medical imaging partners

Potential Tradeoffs

• Imposes a greater configuration burden, as teams are responsible for assembling more components independently. It is estimated that this assembly can increase engineering time by 20-30% compared to using native AI tooling available on other platforms. This extra effort may be justified for organizations seeking high flexibility, but it is essential to weigh the opportunity cost against potential logistical benefits. This consideration prompts decision-makers to rigorously evaluate how the investment in additional engineering resources compares with the customizability and scalability gains offered by AWS.
• System complexity may increase over time, particularly in the absence of robust architectural guardrails.

Best Fit For…

Best suited for health systems seeking deep customization, operating large distributed infrastructures, or those with significant existing AWS adoption.

What CIOs & CISOs Should Really Ask: Does Our Cloud Support the Full AI Lifecycle?

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Health systems often discover that while their cloud platform supports AI workloads, no single cloud natively provides everything required for safe clinical AI at scale. This can expose them to various risks, which can be categorized to accelerate strategic decision-making:

Operational Risk: This includes the lack of transparent oversight of model performance and unified audit trails, as well as the absence of governance frameworks that span vendors.

Regulatory Risk: Drift and bias monitoring, along with validation workflows and clinical safety checks, must be addressed to comply with stringent healthcare regulations and ensure clinical reliability.

Clinical Risk: Without seamless policy enforcement across imaging, EHR, and operational datasets or the ability to deploy AI from multiple vendors, patient outcomes might be compromised.

At this stage, platform selection becomes complex, and Ferrum Health has a critical role in addressing that. Deployed in hundreds of care centers nationwide, Ferrum's Governance Suite delivers robust performance and streamlines AI operations across cloud environments. This widespread adoption shows its essential role in navigating the complexities of AI deployment.

Where Ferrum Health Fits In: A Vendor-Neutral Layer on Top of Any Cloud

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Ferrum Health’s Clinical AI Governance Platform is designed to be cloud-agnostic, functioning seamlessly with Azure, Google Cloud, AWS, or any combination thereof.

This neutrality allows CIOs and CISOs to:

1. Avoid Cloud Lock-In for AI

Ferrum abstracts model deployment, monitoring, and governance, enabling teams to maintain consistent operations across diverse environments.

2. Normalize Data and Workflows Across Clouds

Ferrum standardizes and manages FHIR, DICOM, HL7, and operational datasets without necessitating cloud migration.

3. Establish Unified AI Governance

Ferrum provides lineage tracking, performance monitoring, and operational guardrails, independent of the underlying cloud platform.

4. Make Cloud Selection a Strategic Decision—Not a Constraint

Regardless of whether a system increases Microsoft investment, transitions to Google Cloud, or expands AWS infrastructure, AI operations remain stable.

5. Deploy Multiple AI Vendors with a Single Framework

While cloud providers do not unify models from different vendors, Ferrum does.

Rather than selecting a cloud platform solely for its AI governance features, health systems can choose the platform that best aligns with their existing architecture and future strategy, while relying on Ferrum for the AI operating layer.

So Which Cloud Is Best? The Truth Is: It Depends on Your Starting Point

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If your system is deeply invested in Microsoft → Azure, it may reduce integration friction.

If you are modernizing towards cloud-native AI workloads → Google offers powerful tooling.

If you need customizable, large-scale architectures → AWS is often the most flexible option.

Ferrum ensures that, regardless of the chosen cloud platform, health systems can safely deploy, monitor, and govern clinical AI.

Conclusion for CIOs and CISOs

The cloud you choose should align with your:

• Existing identity and security architecture
• Data strategy and interoperability roadmap
• Operational maturity
• Goals for AI adoption in the next 3–5 years

However, the ability to deploy, scale, and govern clinical AI should not be constrained by the choice of cloud platform. Ferrum Health delivers the governance, monitoring, and standardization layer required by health systems, independent of the underlying platform. This enables CIOs and CISOs to focus on strategy, security, and outcomes rather than cloud limitations.

Which governance gap will you address first to unlock safe AI? As you align your cloud choice with your strategic goals, consider the immediate steps you can take to strengthen AI governance and ensure the integrity and safety of clinical applications. Immediate action items could include assessing your current governance framework to identify gaps, piloting Ferrum Health's platform to experience its capabilities firsthand, and reviewing existing cloud contracts to understand their implications on AI governance. These steps will help move from strategy to execution effectively.

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