Just some quick thoughts as I've worked as a systems analyst in healthcare maintaining and installing new applications:

* I'll echo G-Squared here: know what your vendors require and what is allowed by them to keep your support contract valid is important. Some systems that are FDA certified have very little flexibility in their configuration, especially when they interface with equipment that comes in direct contact with the patient.

* There are some good things out there in terms of cloud storage for healthcare, but not on the database side that I've seen. For instance there are some really cool medical imaging storage schemes where you have a local "cache" on SAN with copies replicated to the cloud for redundancy. Eventually over several years old images would be evicted, and would exist only on the cloud. The cloud provider could buy storage at a fraction of the cost that we could and pay the electricity bill to keep them spinning.

* At a previous position we were very resource constrained in terms of both money and manpower and one of our cost savings projects was to virtualize as much as possible. The reason was that a lot of vendors tended to trail far behind the current state of the art in terms of SQL Server and Windows OS. I remember looking at RFPs where they were still recommending SQL 2000 SP4, and SQL 2005 had been out for more then two years, and the vendor wasn't supporting anything newer yet. 😀 Since some of the hardware was approaching and exceeding 5 years of age we poured money into some beefy VM servers instead of replacing individual application servers. Also, some of the small apps that didn't have a heavy I/O load we hosted on a single SQL Server instance if the vendor would allow us to.

* Don't forget about your SAN/Disks: You might find that as part of your consolidation that a lot of data that was stored on local disk arrays need to migrated to a SAN. Then you see the price of the disks....

Hope this helps....