Cloud HSM Migration Basics

We’re 6-person healthtech SaaS, mostly devs, no real security hire yet. We’ve used cloud secrets and basic KMS so far, but now hospital networks are all asking about Cloud HSM migration and Cryptographic key lifecycle managment. Key gen, custody, rotation, RBAC, audit trails, break-glass etc. Every. Single. Time. So I want to know: when is managed HSM enough, and when do we call real specialists? Feels fine in MVP, then suddenly auditors rip it apart. Any