Cloud Computing applications for eHealth Óscar Barba Manzano, Héctor Martín GarcíaAbstract— Cloud Computing solves some Cloud Computing is structured as anproblems of traditional computing but it also architecture with layers. It can be thought as acarries some risks in safety and privacy. Its use in collection of services and each layer tries toeHealth can be pretty useful in order to have offer one of the services. We can found theselower integration costs, optimizing resources andmaking a widely medical system. Some solutions layers:of Cloud Computing applications for eHealth are - SaaS (Software as a Service): It is the upperDACAR, Practice Fusion and Athenahealth. layer of the stack and it allows users to run applications from the cloud.Keywords— Cloud Computing, eHealth, DACAR, - PaaS (Platform as a Service): This layer isPractice Fusion, Athenahealth. in charge of implementing the security systems. I. INTRODUCTION It provides an operative system for the applications which are implemented on the In the last few years, new technologies have cloud.been appeared and developed so the concept - IaaS (Infrastructure as a Service): It offersCloud Computing has emerged. computation resources and storage as a service. Cloud Computing is the use of computing The aim of this layer is similar to the PaaS but itresources which are delivered as a service over a is referred to the hardware.network and has become a significant - Virtualization: It is not a layer indeed, buttechnology trend nowadays so there are many the data virtualization in really important inapplications that are based on it. order that the other layers work properly. Healthcare can be one of them and the use of -dSaaS (data Storage as a Service): It is theCloud Computing can bring some benefits not lower layer of the stack and it is formed by theonly for patients but also for hospitals and servers of the network. It provides the storagehealthcare institutions. Reducing costs is really used by the client and the bandwidth requiredimportant nowadays with the actual situation of for the storage.economic crisis; the quality of the attention can In Fig. 1 we can see the stack organizationalso be increased due to the possibility of and how the different layers require from thecollaboration between doctors and hospitals lower layer to provide its service. It can be readusing Cloud Computing networks. also in . This article contains a brief summary of howCloud Computing works, how it can be used in ApplicationeHealth system with the benefits and risks and SaaSsome solutions of this application. Platform II. BACKGROUND PaaS A. Cloud Computing Infrastructure First of all, we are going to see what Cloud IaaSComputing is and which its features are. Cloud Computing is a model for enablingwidely configurable computing resources over a Virtualizationnetwork, usually the Internet. The maindifference between other computer paradigmsand this one is that Cloud Computing might Servers and Storage dSaaSoffer infinite power and capacity. As it is said in  it grows as the solution forsome problems related with traditional ways ofcomputing, which are mainly three, the storage, Fig. 1. Layered architecture of Cloud Computing (extractedthe bandwidth and the security. form )
In order to understand how Cloud Computing number of electronic fields stored in theirworks we are going to pay attention to Fig. 2, systems is increasing, so moving them to thewhere we can observe the typical structure of a cloud seems to be a good idea. On the otherCloud Computing network. It consists of servers hand, despite the fact that there are somewhere clients connect to use the applications, benefits to moving to a cloud system, there aredisks arrays in order to provide storage and a also some risks that have to be taken intocontrol/metadata path that makes all the system account because they are related with thework properly. All of the elements are privacy and the safety of the net.connected between themselves and to the Taking a look to the benefits, the mostclients, mainly by an Internet connection. important one is the benefit of the cloud for the Quality of Service of the patient. With Cloud Computing, collaboration between doctors and hospitals is made easier. In addition, costs for the organizations are widely reduced by adopting the cloud model. This model made the organization pay for what they use. Nevertheless, observing the risks, the first one which comes to mind is security. Healthcare documents contain very valuable information about patients and privacy should be respected. This challenge can cause the distrust of the population. Lots of companies are working on this issue, as we can see in . III. CLOUD COMPUTINGFig. 2. The architecture of Cloud Computing (extracted from SOLUTIONS FOR E-HEALTH) A. Data Capture and Auto Identification Reference Project [DACAR] B. Cloud Computing in e-Health This project was funded in October 2009 by the Technology Strategy Board (TSB). The aim Once we have seen the features of Cloud of this project was create a highly secure, “inComputing and before studying different the cloud” infrastructure for storage andsolutions which involve the use of it we are viewing of healthcare data.going to show the reasons why it is used in e- Cloud Systems are divided into threeHealth, a term that defines the healthcare data categories: Public Clouds, private Clouds andexchanging through the Internet. hybrid Clouds . Looking for guaranteeing the By using Cloud Computing many problems data privacy, DACAR uses a private Cloud forin healthcare can be solved, such as integration data storage and a hybrid Cloud for hostingcosts, optimizing resources and ushering in new service instances.era innovations, as it is said in . With the technological improvement,hospitals and other healthcare organizations the Fig. 3. Work flow (extracted from [ENLACE 8])
The eHealth service is developed in DACARin five steps, as we can see in Fig. 3 . First of C. Athenahealthall, users has to be identified by an username Athenahealth  is a company which isand a password. Immediately after, the client trying to extend the world of Cloud Computingsoftware forwards this information to the to the health services. Because of that, they haveresponsible Single Point of Contact (SPoC) with developed four platforms: athenaClinicals,the service request. Then the SPoC checks it and athenaCollector, athenaComunicator anddecide if the user is able to use the service athenaCoordinator.required. If it is allowed, the SPoC creates a First of all, we are going to studyService Ticket; however, if it is not permitted, it athenaClinicals. It is a web-based HER designedsends a message with the reason of the error. to overcome the limits of a traditional HER. It isThe last step is the use of the service by the a pay-for-Performance program, so the costsuser. related to the use of it will be less than those Another issue related to this project was the who would be if a traditional system were used.secure integration of smart devices related to the It is based in the Patient Centered Medicalhealth care. Home (PCMH) model in order to reduce the DACAR uses Radio Frequence Identification time to focus on patients care without reducing(RFID) for data capture. RFID is used not only the quality of the assistance.for data storage but also for gathering AtheneaCollector is a tool that tries to helpinformation from the environment. doctors with the billing operations; it maintains B. Practice Fusion the hospital joined to medical providers. In It was awarded the most valued Electronic order to make administrative tasks easier,Health Record (EHR) in Customer Satisfaction athenahealth has developed a tool calledin 2011. Practice Fusion provides a free, web- athenaComunicator; it will advertise you if youbased HER system to primary care physicians have an appointment scheduled.. Here is where we find the first thing thatsurprises to us. A health feature which has no Finally, athenaCoordinator is a cloud-basedcosts at all, it includes some advertisements in care coordinator. It is really useful not only forthe program which not interfere with the big hospitals, because they have to manage a lotworkflow. However, a paid advertisements-free of works involving a lot of doctors and peopleversion is available if it is required. working for the hospital, but also for medical Secondly, we can use it without the necessity practices in sending patients to differentof using our own computer, it is web-based, and hospitals depending on their necessities.so it is directly available by using a computerwith internet connection. The security of the IV. METHODOLOGYconnection is ensured with Fortune 500-level First at all we have been searchinginfrastructure guaranteeing constant availability. information about Cloud Computing in order to The users’ privacy data is a crucial issue. The understand what it is it, how it works and whatdata centers of the organization have biometric benefits and risks bring its use.security, data back-ups, redundant power Afterwards we have been looking forsupplies, continuous surveillance systems and different solutions of Cloud Computing inso on. eHealth in Technical articles and websites, then It includes the possibility of schedule the after collecting the information and analyze it,visits to the doctor, and its calendar will we decided to show 3 examples and how themadvertise us if we have an appointment with a work.doctor. Other interesting feature included is the Finally we made and scheme with all thee-Prescribing . It includes not only these two information chosen and started to write thisfeatures but also medical charting, referral article.letters and so on.
V. CONCLUSION, RESULTS AND DISCUSSION Cloud Computing has a lot of benefits in notonly solving problems related with storage andbandwidth but also in eHealth solutions, forinstance in integration costs and optimizingresources. That is why it is becoming to be asignificant technology trend nowadays.However, it carries also some risks mainly insafety and privacy terms. Lots of companies arecurrently trying to fix these problems and whenwe gets over them, there will not be any distrustfrom the population to its use in eHealth widely.Using Cloud Computing collaboration betweendoctors and hospitals is easier and has a lowercost. Apart from work in improving security, it isvery important the proposing and use ofcommon standards in these platforms in order toits use widely so any hospital can share data andthe implementation of a global eHealth systemthat could pretty useful for the patients. VI. GREETINGS We would like to express our gratitude to theteacher of this subject Isabel de la Torre Díezfor all the amount of information that she hasgiven to us; to Joaquín Guerra de la Cortebecause he informed us about the subject inorder to enroll it; and also to Inés MarbánBolaños for helping us with the writing. VII. REFERENCES I.de la Torre-Díez, F. J. Díaz-Pernas, G.Fernández, M.Antón-Rodríguez, M.Martínez-Zarzuela, D.González-Ortega, D. Boto-Giralda, “Analysis of the benefits and constraints for theimplementation of Cloud Computing over an EHRs system”. B. Furht, “Handbook of Cloud Computing” Chapter 1. 2010. F. G. Lejiang Guo, X. T. Li Chen, “The Building of Cloud Computing Environment for E-Health” in 2010 International Conference on E-Health Networking, Digital Ecosystems and Technologies. Sanjay P. Ahuja, Sindhu Mani1 & Jesus Zambrano, “A Survey of the State of Cloud Computing in Healthcare” in 2012. Sthepen Allen, “Cloud Computing and Health Care Security” in 2011. Alan Bennett, “Data Capture and Auto Identification Reference Project [DACAR]” in 2010. L. Fan, W. Buchanan, C. Th¨ummler,O. Lo, A. Khedim, O. Uthmani, A. Lawson, D.Bell, “DACAR Platform for eHealth Services Cloud” in 2011. Practice fusion “http://www.practicefusion.com”. The Center for Improving Medication Management “Clinician’s Guide to e-Prescribing” in 2011. Athenahealth “www.athenahealth.com”.