A Study on Significance ofAdopting Cloud

Computing Paradigm in Healthcare Sector

Mervat Bamiah, Sarfraz Brohi, Suriayati Chuprat lamalul-lail Ab Manan

Universiti Teknologi Malaysia, Malaysia Mimos Berhad, Malaysia
abmervat3@live.utm.my jamalul.lail@mimos.my
nbsarfraz2@live.utm.my, suria@ic.utm.my

Abstract- Healthcare sector is information critical industry that supplying the required computing resources such as hardware
deals with human lives. Transforming from traditional paper­ and software installation, upgrades, maintenance, backup, data
based to Electronic Health Records (EHRs) was not efficient
storage, and security under the umbrella of SLAs. Moreover,
enough since EHRs require resources, integration, maintenance
this promising paradigm can support existing electronic
and high cost implementation. Cloud computing paradigm offers
healthcare and the future trend of implementing smart
flexible, cost effective, collaborative, multi-tenant infrastructure
healthcare systems which are able to sense and diagnose
which assists in transforming electronic healthcare to smart
healthcare that consists on the use of latest technologies such as complex medical situations. Smart healthcare systems are
smart mobiles, smart cards, robots, sensors and Tele-health predictive and have the capability to decide and to interact
systems via internet on pay-per-use basis for best medical with the environment. Also they can be energy independent
practices. Cloud computing red uces the cost of EHRs in terms of and networked. Healthcare professionals will benefit from the
ownership and IT maintenance, also it otTers sharing, integration integration of micro-sensors and micro-actuators in products
and management of EHRs as well as tracking patients and to better treat and take care of patients in the hospitals and at
diseases more efficiently and effectively. This review paper
homes which was not possible before [5]. The urgent need for
represents the significance and opportunities for implementing
pervasive and ubiquitous real-time access to patients' data
cloud computing in healthcare sector.
from anywhere and from any digital device is essential for
Keywords- Electronic Healthcare, Cloud Computing, Smart proper diagnosis and treatment procedure that leads to
Healthcare achieving high quality of medical services. This review paper
is organized as follows. Section-II discusses current healthcare
I. INTROD UCTION systems issues. Section-III presents emergence of cloud in
Cloud computing evolved as a new IT paradigm that healthcare. Section-IV defmes the role of cloud computing in
provides an agile method to deliver healthcare services in enabling smart healthcare. Section-V views cloud computing
smart way (reducing IT cost, C02 footprint and providing implementations in healthcare. Finally section-VI will present
computing services on demand). It is a business model that has cloud security issues.
inherited the benefit of other technologies such as distributed,
II. CURRENT HEALTHCARE SYSTEMS' ISSUES
pervasive, ubiquitous, utility computing and virtualization to
offer cost-effective and scalable IT services [1]. Cloud Healthcare systems mainly include personal and public
computing paradigm differs from other existing technologies healthcare services, teaching and research activities. Personal
such as Remote Hosting Options (RHO) which is data center healthcare services are offered at hospitals, homes and
space and infrastructure offered by several vendors that relevant organizations. Public healthcare services involve
guidelines for drugs, food and safety policies to maintain a
involves specification of the hardware and software required
healthy environment. Teaching and research activities are
to support the contracting health organization for a fixed
essential for prevention, detection, tracking and treatment of
period besides guaranteeing performance and availability.
diseases. Technology contributes in providing high quality of
Cloud computing includes all of these features beside Service
medical services for healthcare sector. IT solutions brought
Level Agreements (SLAs) which are aligned with healthcare
significant benefits to healthcare by solving issues of human
organizations needs and scalability [2]. Also cloud differs
errors and providing an agile way of accessing and processing
from Client-Server network topologies in terms of its ability to
large volume of patient's information besides saving papers
provide robustness and improved traffic congestion issues [3]. and storage space. The accelerating innovations of smart
Cloud is defmed by the National Institute of Standards and electronic devices have facilitated the dynamic nature of
Technology (NIST) as "a model for enabling convenient, on­ healthcare delivery. However, still there are several challenges
demand network access to a shared pool of configurable that are facing current electronic health care systems in terms
computing resources that can be rapidly provisioned and of cost, connectivity, client assistant and disaster recovery.
released with minimal management effort or service providers Canada Health Council second healthcare report in 2011 [6]
interaction" [4]. Cloud service providers are responsible for described the current need for connectivity to handle

Proceedings of 20121ntemational Conference on Cloud Computing, Technologies, Applications& Management

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 15 7741229: A Study on Significance of Adopting Cloud ComputingParadigm in Healthcare Sector

heterogeneous healthcare computing infrastructure. Successful selection of these cloud delivery and deployment service
healthcare interoperability will be dependent upon the ability models depends on clients' data sensitivity and management
to connect people, processes, data, policies and procedures. requirements [9]. Fig.1 [10] illustrates cloud computing
Due to the advent of agile IT infrastructure and the continuous operating environment as follows.
innovation of various smart electronic devices, concern of
interoperability between these systems and the existing
healthcare systems have been raised. Moreover, limited access
to patient-related information during decision making and the
ineffective communication among patients' care team
members also resulted in the occurrence of severe medical AppIlcatJon
Storage Netwotlls Repltcalton
SelVers
errors which decreased healthcare quality of services [6].
Recently new home-based applications for monitoring elderly Virtual Machines, Application Servers Email Apps
people and patients are being deployed with their specific Storage Servers Database Servers Web [X)cs, Onltne
load Balancers Sef'lers Development Games. CRM
electronic devices. For-example data produced by implantable
N etwotlls etc Ell'Ilfonmems etc SCM, etc
biomedical devices used for home healthcare monitoring must
Infrastructure as a SeMee Platform as a SeMee Software as a SeMee
be stored in healthcare organization's database. This stored
OaaS) (PaaS) (SaaS)
data should be available for healthcare professionals to
conduct instant and accurate interpretations of the patients'
condition while they are at home. The current technologies
such as distributed and grid computing are not sufficient
enough to handle the existing and new health care applications
in terms of dynamicity, scaling and low cost [7]. Healthcare Internet
sector contains huge amount of data that are increasing in its http https smtp, ftp
volume, velocity, and variety which creates two major
problems for healthcare organizations regarding to complexity
and increased IT expenditures. Managing and maintaining
these large datasets is vital to the success of these

�
organizations since their IT hardware and software needs
maintenance, monitoring and upgrading by skilled IT
personals. Furthermore, software cost, complexity, and
inflexibility issues of EHRs have raised the need for low cost Customerl Mobile UtJlrty Software e g Us r App's Deployed in
Thn Cftent
technology as service that frees healthcare organizations from End-tlser Deo.1ces Web-8rowsers Cloud
buying or managing the computing resources [8]. In addition,
healthcare organizations data resides on-premises which Figure I. Cloud Computing Architecture [10]
makes it under environmental and human threats all together.
Cloud computing is useful for healthcare sector since it
III. EMERGENCE OF CLOUD IN HEALTHCARE reduces complexity and enables efficient administration of

Cloud paradigm evolved as a utility computing that ERRs for improved care best practices, It facilitates the

provides functionality for managing data in distributed, collaboration between the systems in healthcare sectors.

ubiquitous and pervasive methods supporting several Electronic Medical Records (EMRs) are entered once in the

platforms, systems and applications at independent locations system but accessed from multiple places in order to retrieve

[7]. It encompasses of shared computing and services the required information by authorised professionals [11].

delivered over the internet. It has unique features including Cloud based architecture can gather data from multiple

on-demand self-service, ubiquitous network access, resource sources, integrate and analyze that data in real-time also it

pooling, rapid elasticity and pay-per-use pattern. It facilitates allows healthcare practitioners to remotely monitor patients

variety of service delivery and deployment models that offers ubiquitously and pervasively which will save transportation

diverse services such Software as a Service (SaaS), Platform cost, in-hospital cost besides considering patients comfort for

as a Service (PaaS) and Infrastructure as a Service (laaS). best practices. Cloud computing as a pay-per-use model

Within SaaS the latest standardize applications are offered, enables healthcare organizations to leverage the latest

while software engineering tools for healthcare developers are upgraded software while minimizing operating costs, covering

offered via PaaS. Virtualized infrastructures such as virtual only the essentials. It can reduce electronic health record start­

machines (VMs) are offered through IaaS. These services can up expenses, such as hardware, software, networking,

be obtained through several service deployment models personnel, and licensing purchasing cost [12-13], Cloud offers

including Private cloud which is operated for a single backup data redundancy and disaster recovery capabilities

organization with strong security features. Public cloud that is which are significant for healthcare organizations since it

available to the general public or industry group. Community replicates the data in various locations for more availability

cloud which is shared by a group of organizations that have and robustness [14]. Gartner stated that cloud service

the same interests and Hybrid cloud which combines the revenues are about to reach 148.8 billion USD by 2014,

features of one or more cloud deployment models. However, with large percentage from the healthcare sector [15],

Proceedings of 2012International Conference on Cloud Computing, Technologies, Applications& Management 66

 MervatBamiah, Sarfraz Brohi, Suriay ati Chuprat, Jamalul-lail Ab Manan

IV. ROLE OF CLOUD IN SMARTHEALTHCARE (AWS), for processing personal health information online [25].
One example of cloud computing implementation in healthcare
Not only cloud facilitates healthcare best practices also it
is "Biomedical Cloud" in form of community cloud. It could
opens the door for more innovations to take place, and for
be filled with data relevant to biology, medicine and health
smart healthcare to assist in reaching patients and old people in
care that would be accessible to individuals via any electronic
rural and urban places as well as people in difficult situations.
digital personal devices [26].
We are moving towards the era of next generation healthcare
that includes smart hospitals, smart homes, smart devices etc,
VI. CLOUD COMPUTING SECURITY ISSUES
which are interconnected, intelligent and context aware. For
Cloud computing consists of a variety of service delivery
example IBM [16] has launched Smarter Planet campaign
where ubiquitous, pervasive technologies and ecosystems of and deployment models with the chance of more advent of new
models according to the market and business needs. These
organizations are urged to work together in various industries
to solve technology issues. Transforming to smart healthcare existing cloud service models have their own security strengths
and limitations with no current standards. These models require
requires development of personalized management approaches
that addresses patients' requirements through empowering new security and trust mechanisms for each cloud deployment
and service delivery type. Choosing the right service model
them to take the responsibility of their own advanced health
informatics and enabling collaborative care through creative depends upon information sensitivity and clients' requirements.
For-instance, healthcare Software as a Service (SaaS) clients
utilization of technology [17]. Cloud computing paradigm can
assist smart healthcare in various fields such as improved requires more security and privacy mechanisms to trust cloud
computing, because they are outsourcing their data and
emergency support since cloud interoperable systems provides
an immediate access to patient's lab test results that allows the infrastructure to the cloud. Clients do not manage or control the
underlying cloud infrastructure including network, servers,
physicians to review those results immediately. In case of
public health, cloud computing enables smart healthcare OSs, storage, or even their individual applications capabilities
[27]. While having no control over the infrastructure, data and
systems to perform information tracking which supports
medical research and practices such as bio-surveillance, quick applications which results on clients lack of trust on adopting
cloud computing especially when they need high trust
response to disease, chemical or biological attacks and
improved monitoring of adverse drug effects [12]. mechanisms during exchange of messages and critical
information. In Platform as a Service (PaaS) and Infrastructure
V. IMPLEMENTATION OF CLOUD IN HEALTHCARE as a Service (laaS) securing the data are shared responsibility
between the CSPs and the clients. They require two levels of
Various research projects have been conducted on cloud
protection for security from CSPs side who provides basic
computing as an IT business solution to improve healthcare
security mechanisms such as end-to-end encryption,
services [17], [18-19]. For-example C. Rolim et al. [20] have
authentication, and authorization, as well as from the
proposed a cloud based system to automate the process of
healthcare client side that must define application dependent
collecting patients' vital data via network of sensors connected
access control policies, authenticity requirements, and so forth.
to electronic medical devices, in order to deliver the data to the
Fig. 2 [28] shows various protection measures that cloud
cloud storage, real-time processing and distribution. However,
service delivery models demands.
no further details were given on how the system ensures trust
establishment and privacy protection. U. Lang [21] described a
Searty, p<1my,DI ""I'!'\!lt protectkJo .... ures
cloud computing protocol management system which provides nr:ededar.�dDIJdsen1CeieYek
multimedia sensor signal processing and Security as a
Service (SCaaS) to mobile devices. This system has relieved Blnirtwlys.. lQI1"'".Web.6j>pfi,......
""""""'" """'ty, copyr1jjlt pIOO<tIOO
mobile devices from executing heavier multimedia and security
Dm "" protMIOn. conmon kJi fi�,
algorithms when delivering mobile healthcare services that dttlbos< """", I1lCI1� l\1CryptIoo.
would improve the utilization of ubiquitous mobiles and dtacolorq(watelTlllllrJj)
GotenmE!ir ns.k II1im2.Emf!I\t iU'Id [omrtmce,
expand it to rural communities. A pervasive cloud project Minlgon'flt � "'oe"" 1IIiIl.... lIt ..,l1Itual rmch ... (VMs),

called Dhatri [22], has leveraged cloud computing and wireless ""dl lllillllt """"

technologies to enable doctors to access patients' health

information anytime from anywhere. Koufi et al. [23] _ IDMPS,fi,.....,dta pro".OjklfomutlOO,
mIlDoS. (loS, DN!liK
implemented cloud computing emergency medical system
rrustod "","I", Hintwiro ... so ..... ilDT DlAIk.
prototype for the Greek National Health Service that integrated <Mt""';';''''''!'£1'''''''''''""
the emergency system with Personal Health Records (PHRs) to C""""'''''torli< IDMPS,host·"'oHir.",31s,n",1tpoofiroq
1IIiIl""
lIt ",, , ""'7PtIOO. 1Tl!!li"€
facilitate physicians with easy and immediate access to patient
data ubiquitously and pervasively in cost effective way.
IPS: Otrus""""""'''''!)''t011
Moreover E. Schweitzer [24] discussed the significance of RoT: iIDotof<Mt
DOo.\; Dl!tr1bu!d dollll of ......,
cloud computing paradigm in reducing ERRs start-up DNIIEC: Do!n>ll Namo Syuon SoaJIIy Extsillotll
QoS; Qwllty of ,.......
expenses. Some of the high reputable IT organizations have (.) (b)
also invested in cloud medical records services such as
Oracle's Exalogic Elastic cloud and Amazon Web Services Figure 2. Security Measurements of Cloud Models [28]

Proceedings of 20121ntemational Conference on Cloud Computing, Technologies, Applications& Management 67

 15 7741229: A Study on Significance of Adopting Cloud ComputingParadigm in Healthcare Sector

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