Cloud Computing in Healthcare
Aysha Al-shahrani#1, Noha Alnabit*2
#
Computer Information Science Dept., Prince Sultan College for women
Ariyadh
3alnabit.nous@gmail.com
Abstract:
In the past few years , the usage of the technology
cloud computing has been amazingly increasing among verity
of areas , such as e-business, social networks , educations..etc.
That propagation is mainly due to valuable and outstanding
features that this technology offers . The healthcare industry is
continuously developing as well as the health data .
Therefore , the need for more storage to keep the data , smart
techniques to handle them and remotely access to them is
becoming more and more sufficient. Cloud computing give a
promising solution to the healthcare industry with it webbased recourse, the huge storage available and experts
maintenance .
Google Health and Microsoft Health Vault are to Prominent
systems that are example for cloud computing which are used
for healthcare purposes .Google Health outstands with its
easy-to use interface while In the other hand Microsoft had
focused more in details adding. For security aspect both
systems proved their capability of providing highly security
and privacy tools .
By improving some of the aspects in the health data privacy
and more efficient data back-up . Cloud Computing has a
promising future to be more and more adapted and
intergraded in the healthcare industries .
Cloud computing technology provide an almost excellence
solution to improve the healthcare industries by decreasing
the cost and increasing the usability and reliability
Keywords cloud computing ,healthcare , PHR ,Systems.
network and application interface. While the back-end of it is
a cloud itself which consist of the data canter, provision
manager, monitoring server, application server and
visualization component.
Cloud computing can be categorized into three type;
public, private and hybrid.
The private could computing is only available within the
borders of an organization. It has all the features of cloud
computing but it's managed locally by the enterprise hence it
requires an IT infrastructure. This type is the favorable
among for the application that requires high level of security.
Because of the complexity, usually only organization with
huge investment in their IT infrastructure have the ability to
go with the private cloud computing,
In the other hand, public cloud computing is available
beyond the borders of any organization. This type considered
to be the traditional type and what directly comes to mind
when thinking of cloud computing. The infrastructure is fully
managed and hosted by the provider. This feature makes the
public cloud computing favorable among small businesses
because it releases them from the infrastructure expanses. In
in this research, we will mostly focus on public cloud
computing.
The third type is the hybrid cloud computing which consist
on both public and private cloud computing. Organization that
adopts hybrid cloud computing use the private clouding for
their matters that requires high secrecy and security. And use
the public clouding for the application that needed less
security. (see figure 1)
I. INTRODUCTION
Cloud computing is an internet base computing. It is a
model of computing that provides on-demand sources as
services over the internet. The implementation details are
hidden from the consumer who only be concerned about the
output services. In the cloud computing instead of owning the
physical infrastructure, consumer rent usage from cloud
computing service providers. Therefore, consumer will avoid
the expenses associated with the physical infrastructure.
Could computing is mainly constructed by two significant
components: front-end and back-end, where the front-end is
the part views by the consumer which includes client's
Figure 1 Types of cloud computing
http://commons.wikimedia.org/wiki/File:Cloud_computing_
types.svg
Cloud computing is used in variety fields such as ebusiness, education, e-government and finally which we are
concerned about in this paper is Health Care.
II. CLOUD COMPUTING IN HEALTHCARE
The Health care industry is developing .and the current
technology it's using which is 10 years behind the latest
technology is no longer efficient and doesn’t fulfil the
demands. The system that HCI are using now is consist of
paper medical records , duplicated test results , no digitized
data and images and data portability is rare (see figure 2).
Also the patient and the other parties don’t have the fully
required knowledge regarding so many things such as health
care plan costs or other options available for them because of
the lack of transparency on the current system. All of these
traditional ways as simple as it seems, wastes a considerable
amount of the HCI resource . A study made by
PricewaterhouseCoopers Health Research Institute on 2009,
showed that $2.2 trillion the U.S. spends each year on health
care is wasted .The study pointed that HCI need to modernize
the technology to improve efficiencies.
With the developing of HCI, User are demanding to be able
to access the data remotely from anywhere (see figure 3 ),
more storage is needed to keep the massive increasing data
and more smart technique required to manage the data.
Figure 2The standard way for collecting and accessing
health data.
Figure 3 Chat that show the demands to centric access
information is increasing in young generation .
A. The Need for Clouded PHR System .
PHR systems (Personal Health Records ) that are integrated
with the cloud computing technology is the best available
solutions to fulfil these demands . The basic functions of this
integrated system is that patient can upload their medical
information either by typing it , import it from other sources
that provide feeds such as clinics and pharmacies or by
generating them from other devices such a ( Pedometer 1 ) .
After entering these data , the system will automatically
upload them to the cloud which then permit the user to access
his or her recodes remotely form anyplace . Another side
functions available to the user is search for medical
information , making appointment , connecting with doctors
and several other functions that almost stimulate hospital
environment .
From organizations point of view , health record generates
a large amount of data such as patient record and medical
researches . So the ability to organize and manage these large
data effectively is sufficient for hospitals , clinics , insurance
company and so on . These data requires massive size of
storage to keep them which has a high cost .In addition , these
huge amount of data need expertise to maintain them which
mean either import skilled employee , who usually have high
salary , or provide advanced training sessions to current
employee which mean more expenses and more loads on the
employee . When using cloud computing , only basic models
software will be used locally with less hardware , less
memory and budget processors , Since hardware weight is
1
Pedometer is a device that is used to detect the number of
step a person made by monitoring the hips movement.
removed to the cloud , this will significantly decreases the
expenditure that was required for locally storage for the data
and the burden of maintaining and managing them will be
reduced .
As we mentioned in cloud computing definition , user of
cloud computed system will only be concerns about the
service itself , in this case , entering and accessing the
data .Any other implementations and maintenance details will
be abstracted . this feature ease up the usage of the system so
no special advanced skill will be required .
Additional great benefit of cloud computing in health care
that it could help avoiding medical mistake resulting from
different result of tests and different reading. When patients
are visiting different doctors the all are going to have the same
shared result and will use the same application . this features
has two main benefits , it reduce the time and the of having to
repeat some test over and over again because of the different
applications or different reading of the results .
Another feature that cannot be neglected is the system
reliability on recovering from failure. When local system
crashes down these data won’t be harmed since It is in the
cloud and can be recovered at any time. Take the example of
hurricane Katrina that hit New Orleans, many medical records
were completely destroyed after the catastrophe. These
medical records would have been easily recovered if the
health organization there used cloud computing technology
3To assure that massage won't be altered or be
interfered, All the encryption and decryption happens in the
connectors behind the firewall of each host . This feature
allow the massage to meet the strict regulation of information
exchange .
4To allow more widespread, each connector is able to
communicate with different types of protocols used on the
sender or receiver application whether it was HER, EMR or
any software.
C. Doubts Surrounding It .
These features ( reduced cost, high usability and failure
recovery ) put the clouded PHR systems in the lead among
other systems because these aspects are what health
organization looking for in new technical solutions.
B. How Does it Work ?
There are many varied ways to implement cloud computing
on a health care system we will take a general example that
will illustrate the concept .(see figure 4 )
When a patient checks onto the hospital with already
known condition. As he checks in , a massage is sent to the
Electronic Medical Records (EMR) to record the date, time
and the center he checked from . When a doctor needs to see
the results for a certain test , the system informs the lab center
to send the required lab test that was generated previously .
Later when the doctor write a prescription to treat the
condition, the pharmacy gets informed to prepare it and record
the information of the case and the medicine on the system .
Also the insurance provider gets a summary of the patient
visits .
For the technical part , what happens inside the cloud is :
1First a router send a message to the appropriate
connecter , let say the lab center . Then confirm the delivery.
2While the message is being delivered , a copy of it is
stored till it's completely received by the destination.
Figure 4 Illustration for how the Hcloud works from
http://info.cloudprime.net/CloudprimeBlog/?Tag=HITECH%20Act%20Meaningful%20Use
Considering all these features that makes cloud computing
the best available solution , a question arises ; Why the health
industries is still considered as the slowest field in adopting
this new technology . Health industries faces some obstacles
when adopting this technology and probably the main reason
for that is the lack of trust between healthcare organizations
and the clouded system providers
One of the obstacles resulting from the trust issue is the
privacy. In some countries , Healthcare organizations must
follow certain rules and regulations through what’s known as
HIPPA ( Health Insurance Portability and Accountability )
which is a federal protections for personal health
information .In addition , Many consumers are worried that
insurance company might access their data without their
permission and use the information to select who will they
cover based upon current medical conditions to decide what
they may have or medical conditions that they could develop
later in life. They are also concern that government agencies
could get hold of the information and share it with third party
who will have effect on the them such as their work place .
Also the providing company may have to pass the data to a
third party which mean more exposure to the personal
information .
Another obstacle that sometime considered to be the main
reason behind this hesitation is security. Regarding the
sensitivity associated with medical records nature , cautions
are extremely high .Consumer are worried from malicious
hacks and security breaches that not just can’t break their
privacy but also could affect the accuracy of the data
which ,on the individual level, could directly harm their health
and, on the organization level, could affect the sincerity of
such organization .
Finally another drawback that hold HI from adopting this
technology is connection reliability. Accessing the data
completely rely on internet connection .So , in case the
connection is temporary lost, accessing the data will not be
possible . Also, there is the possibility that the provider's
server crashes down for any reason. An example for that is
what happened with Amazon.com cloud computing service on
13th of May 2010. A car crashed into utility pole near one of
the company's data centers causing the company's to crash
down for more than an hour. In another hand , the possibility
that the storage provider company shuts down completely
which mean the loss of all data contained in it .
D. Answer to the Doubts
Many of the doubts surroundings clouded healthcare
system either have solutions to solve them or have been
proven wrong.
For the problem of connectivity, a redundant internet
access can be used (wireless, fibre-optic etc. ) for shoring the
connection and providing plan B in case of connection failed .
To improve the security and privacy of the cloud
system ,certain features could be added or improve to level up
the security.
- Encryption: level of encryption can be added .
Encrypt is the process of transforming the original
information to another format so it won’t be
understood. Than return it to its original form when its
needed . Although adding more level of encryption
might increase the cost of the service but it is a
justified price considering the importance of security
and all the advantages that this technology offers . But
even without increasing the level of encryption, cloud
computing is usually the best solution for security
because in most of the time ,the security the cloud
service provide is much higher than these provided by
locally-housed resources because the service provider
are able to dedicate special high cost recourses for
this matter where regular user cannot offered them .
- Authentication: which is feature that require the user
to create a user name and password.
-
Authorization: this features allow the client to lists
the people who are authorized to access information
stored on the cloud system. Many corporations have
multiple levels of authorization..
Regarding cloud computing in health care , it should
always be noted that this technology is still in its earlier
stages . Many companies are devoting all their capital and
resources to improve it more and ,develop more feature and
cover all the important aspects such as the security matter .
E. Organizations that Adopted the Hcloud .
Example for organization's' systems that has adopted
the cloud computing concepts
1- Athenahealth in Watertown, MA has become the
fastest growing HIT to adopt cloud computing technology.
This adoption brought two advantages two the company :
a) Low upfront fees for IT infrastructure.
b)
Online, consistently updated database of insurance
payment rules.
Ease up information sharing among different and remote
health-care providers.
2- Caritas Christi hospital in Massachusetts . The CIO
Todd Rothenhaus realized that he could merge onto the
cloud server and serve his users much more cheaply than if
he outsourced each of his IT needs. And to avoid HIPPA ,
they adopted a private cloud so the will not be worried
about the privacy and the security and in the same time
provide their costumer with the cloud features such as
online accessing data .
3- Mount Sinai hospital in Toronto. They are adopting a
community cloud in conjunction with the government
which will allow them to share information among 14
hospitals on the area .
F. Prominent Systems .
This section we will discuss two systems that have taken
the lead on implementing the cloud computing concept in
healthcare technology and provide advanced features which
will enhance the future of healthcare industries adoption of
technology . These Two Systems are Microsoft Health Vault
and Google Health. (see Figure 3 &4 ).
Both MHV and GH are personal health record “PHR”
software that offer a full and accurate summary of health data
such as medical history , charts , scans..etc . They both are
initiated and accesses by individual who could be patient ,
doctors , employer or even insurance company .
Both companies state the same goal which is to create
web-based environment for individuals to create and store
personal health data , search for medical information and
doctors , make appointment , have online consult and other
services that create an online-hospital environment . Since
security and privacy is two major issue in healthcare
industries , both systems offer ultimate control over what to
store and who has access to it and provide security as these
offered in online banks so no information of yours will be
share without your explicit permission . Finally , both
companies offer record accessing for free .
As they are different companies that released them , there
are some differences between the two software . Considering
Usability GH offers easy-to-use interface and a cohesive tabs ,
bars and profiles . While in the other hand , MHV had a
draw-back because of the jargonised terms used and the and
the inconsistency between different. Yet MHV strengthen its
usability by allowing more details to be added than these in
GH .
more of B2C system where it focus on the consumer while
MHV is considering B2B environment by connecting 3rd
party who takes on the responsibility of developing
applications and signing up users and also and also by helping
hospitals organizing their data .
In short , nor GH , ,MHV is perfect yet . Each of them has
it flaws which could be viewed as one of the obstacles that
prevent many Healthcare systems from adopting this new
technology . But in general participants preferred Google
Health because of its ease of use which is which is a critical
PHR task.
G. Promising Future .
Health care industries will continue to grow, while
cloud computing will play as a major role in the
development process. As we notice there are many
amazing opportunities for this high technology to expand
health data and services. It is enabling new abilities for
health's members. Cloud systems build new ways for
managing the data and the infrastructure which keep this
data and provides new techniques to use data in better way.
To reach our goals without any barriers we have to use
some strategies to solve the problems which found in the
current structure such as privacy, security and connectivity.
These strategies must be well planned to guarantee the
users will get the best value from the system.
Hcloud can benefit from other areas that uses cloud
computing such as banking which is known by its strong
security system . By strengthen their security level they
are more likely to get the HIPPA approval which will
empower the reputation of the technology that will lead to
more organizations adopting this technology .
Figure 5Google Health Interface
III. CONCLUSION
In fact, Cloud computing is developing the health system
in term of collecting and managing all health data which make
it an efficient system. Also, this technology must support the
users demanding of simplicity to access and use their health
information, low expenses and availability anywhere. In
addition the user need to make sure that it provides high level
of security and privacy on their information. Also the large
amounts of data required huge storage environments to keep
these amounts.
Figure 6 Microsoft Health Vault Interface
IV. ACKNOWLEDGMENT
Another difference between the two system that GH is
WE WOULD LIKE TO THANK ALL THOSE WHO HELPED US TO
FINISH THIS RESEARCH INCLUDING DR.AMANY ALSHAWAI
SUPPORTED US AND GAVE US FEEDBACK THAT HELPED US
TO COMPLETE THIS PROJECT.
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