I'd put every webservice in a physical server in a basement somewhere and be done with it.One of the benefits of working in healthcare is that if it's not on-premesis, it's a non-starter for many organizations.
My company's paranoia of cloud services has paid off several times in terms of security in the last few years, even if the cost in dollars was higher. At this very moment, a vendor is going through a ransomware attack and its SaaS service unavailable. Our locally-hosted version is unaffected.
We only rent other people's computers (cough "cloud" cough) when there is absolutely no alternative, including doing without. On the other hand, it's locked me out of a number of programs and services I'd like to use.
Still, startups have to learn that if you're serious about being in enterprise, having a locally hosted option opens doors. Very lucrative doors.