Are There Some Industries Where Service Computing May Not Work?
J Med Net Res. 2011 Jul-Sep; 13(3): e67.
Opportunities and Challenges of Cloud Calculating to Meliorate Health Care Services
Monitoring Editor: Gunther Eysenbach
Alex Mu-Hsing Kuo, PhD 
ane
1School of Health Informatics, University of Victoria, Victoria, BC, Canada
Alex Mu-Hsing Kuo, School of Wellness Information Science, University of Victoria, PO Box 3050 STN CSC, Victoria, BC, V8W 3P5, Canada, Phone: 1 250 4724300, Fax: ane 250 4724751, Email: ac.civu@ouka.
Alex Mu-Hsing Kuo
1School of Health Information Science, University of Victoria, Victoria, BC, Canada
Received 2011 Jun 10; Revisions requested 2011 Jul two; Revised 2011 Aug 10; Accepted 2011 Aug 25.
Abstract
Cloud calculating is a new way of delivering calculating resources and services. Many managers and experts believe that it can meliorate health care services, benefit health care research, and change the face up of health information technology. However, equally with any innovation, cloud computing should be rigorously evaluated before its widespread adoption. This paper discusses the concept and its current place in health care, and uses iv aspects (management, technology, security, and legal) to evaluate the opportunities and challenges of this calculating model. Strategic planning that could be used by a wellness organization to make up one's mind its direction, strategy, and resource allotment when it has decided to drift from traditional to deject-based health services is also discussed.
Keywords: Health care, electronic wellness tape, deject computing, bioinformatics, quality improvement
Introduction
Deject calculating refers to an on-demand, self-service Internet infrastructure that enables the user to access calculating resource anytime from anywhere [1]. Information technology is a new model of delivering calculating resource, not a new technology. Examples of commonly used non-health intendance applications include Microsoft Hotmail and Google Docs, while some meliorate known applications in health care include Microsoft HealthVault and Google Wellness platform (recently discontinued [ii]). However, compared with conventional calculating, this model provides 3 new advantages: massive computing resource available on demand, elimination of an up-front commitment by users, and payment for use on a brusque-term footing equally needed [3]. Several manufactures, forums, and blogs have reported its applications in industry, business, transportation, education, and national security [4-seven].
Health care, as with whatsoever other service operation, requires continuous and systematic innovation in guild to remain toll effective, efficient, and timely, and to provide loftier-quality services. Many managers and experts predict that cloud computing can meliorate health intendance services, benefit health care enquiry, and change the face of it (Information technology) [viii-13]. For instance, Schweitzer [10], Haughton [11], and Kabachinski [12] believe that cloud computing tin can reduce electronic health tape (EHR) startup expenses, such as hardware, software, networking, personnel, and licensing fees, and therefore will encourage its adoption. Inquiry by Rosenthal et al shows that the biomedical informatics community, especially consortiums that share data and applications, can take advantage of the new computing paradigm [xiii]. Equally indicated in the paper by Anderson et al, data-handling issues, complication, and expensive or unavailable computational solutions to research problems are major bug in biomedical research information management and assay [xiv]. Several computer science innovations have demonstrated that cloud computing has the potential to overcome these difficulties [15-21].
Despite the many benefits associated with cloud computing applications for health care, there are also several direction, technology, security, and legal bug to be addressed. The aim of this newspaper is to discuss the concept of cloud calculating, its electric current applications in health care, the challenges and opportunities, and how to implement strategic planning when the organization has decided to motility to the new model of service.
Deject Calculating: A New Economic Computing Model
Cloud computing is still a developing paradigm, and its definition, attributes, and characteristics will evolve over time. Vaquero et al studied more than 20 definitions and tried to extract a consensus definition also equally a minimum definition containing the essential characteristics. Based on the study, they defined cloud computing as follows [22]:
Clouds are a large pool of easily usable and accessible virtualized resources (such every bit hardware, development platforms and/or services). These resources can be dynamically re-configured to adjust to a variable load (scale), allowing also for an optimum resources utilization. This puddle of resources is typically exploited by a pay-per-apply model in which guarantees are offered by the Infrastructure Provider by means of customizedService-Level Agreements.
From a service point of view, deject calculating includes 3 archetypal models: software, platform, and infrastructure [1,23-25].
(1) Software as a service (SaaS): The applications (eg, EHRs) are hosted by a cloud service provider and made available to customers over a network, typically the Internet.
(two) Platform as a service (PaaS): The development tools (eg, operation systems) are hosted in the deject and accessed through a browser. With PaaS, developers can build Web applications without installing any tools on their calculator, and then deploy those applications without any specialized administrative skills.
(three) Infrastructure as a service (IaaS): The cloud user outsources the equipment used to support operations, including storage, hardware, servers, and networking components. The provider owns the equipment and is responsible for housing, running, and maintaining it. The user typically pays on a per-employ basis.
To deploy cloud computing, the The states National Institute of Standards and Technology (NIST) listed four models (meet Figure 1) [1,26]:
The deject computing deployment models.
(i) Public cloud: A cloud service provider makes resources (applications and storage) bachelor to the full general public over the Net on a pay-as-you-go basis. For example, the Amazon Rubberband Compute Deject (EC2) allows users to rent virtual computers on which to run their own applications. EC2 runs inside Amazon's network infrastructure and data centers and allows customers to pay only for what they use with no minimum fee.
(ii) Private deject: A cloud infrastructure is operated solely for a single organization. In other words, the proprietary network or the data eye supplies hosted services to a sure group of people. For example, Microsoft Azure enables customers to build the foundation for a private cloud infrastructure using Windows Server and Organisation Middle family of products with the Dynamic Information Center Toolkit.
(3) Community cloud: The deject infrastructure is shared by several organizations with mutual concerns (eg, mission, security requirements, policy, and compliance considerations). For example, the Google GovCloud provides the Los Angeles City Quango with a segregated data surround to store its applications and information that are accessible just to the urban center'southward agencies.
(iv) Hybrid cloud: The cloud infrastructure comprises two or more clouds (private, public, or community). In this infrastructure, an arrangement provides and manages some resources within its own information center and has others provided externally. For example, IBM collaborates with Juniper Networks to provide a hybrid deject infrastructure to enterprises to seamlessly extend their private clouds to remote servers in a secure public deject [27].
Condition and Adoption of Cloud Computing in Health Intendance
Many previous studies reported the potential benefits of deject calculating and proposed different models or frameworks in an try to ameliorate health intendance service [28-35]. Among them, Rolim et al proposed a deject-based organization to automate the process of collecting patients' vital data via a network of sensors connected to legacy medical devices, and to deliver the information to a medical centre's "deject" for storage, processing, and distribution. The main benefits of the system are that it provides users with 7-days-a-week, real-time information collecting, eliminates manual collection piece of work and the possibility of typing errors, and eases the deployment process [36]. Nkosi and Mekuria described a deject calculating protocol management arrangement that provides multimedia sensor signal processing and security as a service to mobile devices. The organisation has relieved mobile devices from executing heavier multimedia and security algorithms in delivering mobile health services. This will improve the utilization of the ubiquitous mobile device for societal services and promote health service delivery to marginalized rural communities [37]. Rao et al reported a pervasive cloud initiative called Dhatri, which leveraged the power of cloud computing and wireless technologies to enable physicians to access patient health information at anytime from anywhere [38]. Koufi et al described a cloud-based prototype emergency medical system for the Greek National Health Service integrating the emergency organization with personal wellness tape systems to provide physicians with easy and firsthand access to patient data from anywhere and via about whatever computing device while containing costs [39].
Numerous of articles and resources also reported the successful application of cloud computing in bioinformatics research [fifteen-21,twoscore,41]. For example, Avila-Garcia et al proposed a framework based on the cloud computing concept for colorectal cancer imaging analysis and enquiry for clinical use [18]. Bateman and Woods used Amazon'due south EC2 service with 100 nodes to assemble a total man genome with 140 one thousand thousand individual reads requiring alignment using a sequence search and alignment by hashing (SSAHA) algorithm [19]. Kudtarkar et al as well used Amazon's EC2 to compute orthologous relationships for 245,323 genome-to-genome comparisons. The computation took simply over 200 hours and cost US $eight,000, approximately 40% less than expected [20]. Memom et al applied cloud computing to evaluate the bear on of Chiliad-quadruplexes on Affymetrix arrays [21]. The Laboratory for Personalized Medicine of the Center for Biomedical Informatics at Harvard Medical Schoolhouse took the benefits of cloud computing to develop genetic testing models that managed to manipulate enormous amounts of data in record time [41].
Too academic researchers, many globe-class software companies accept heavily invested in the deject, extending their new offerings for medical records services, such as Microsoft'due south HealthVault, Oracle's Exalogic Elastic Cloud, and Amazon Web Services (AWS), promising an explosion in the storage of personal health information online. Also, the use of health cloud computing is reported worldwide. For case, the AWS plays host to a collection of health care It offerings, such as Salt Lake Urban center-based Spearstone'south health care data storage application, and DiskAgent uses Amazon Uncomplicated Storage Service (Amazon S3) as its scalable storage infrastructure [42].
The American Occupational Network is improving patient intendance by digitizing health records and updating its clinical processes using cloud-based software from IBM Business organization Partners MedTrak Systems. The visitor at present tin can provide faster and more authentic billing to individuals and insurance companies, shortening the average fourth dimension to create a bill from vii days to less than 24 hours, and reducing medical transcription costs by 80% [43].
The The states Department of Health & Human Services' Office of the National Coordinator for Health It recently chose Apprehending Solutions' cloud-based customer relationship direction and project management system for the selection and implementation of EHR systems across the U.s.a.. The software enables regional extension centers to manage interactions with medical providers related to the option and implementation of an EHR system [44].
Telstra and the Royal Australian College of Full general Practitioners announced the signing of an agreement to piece of work together to build an eHealth cloud. Telstra is one of the leading telecommunications providers in Australia; the Higher is the largest general do representative trunk in Australia with more than than twenty,000 members and over 7000 in its National Rural Faculty. The eHealth cloud will host health intendance applications including clinical software, decision-support tools for diagnosis and direction, intendance plans, referral tools, prescriptions, training, and other authoritative and clinical services [45].
In Europe, a consortium including IBM, Sirrix AG security technologies, Portuguese energy and solution providers Energias de Portugal and EFACEC, San Raffaele Hospital (Italian republic), and several European academic and corporate research organizations contracted Trustworthy Clouds—a patient-centered home health care service—to remotely monitor, diagnose, and assistance patients exterior of a infirmary setting. The consummate lifecycle, from prescription to delivery to intake to reimbursement, volition be stored in the deject and will exist attainable to patients, doctors, and pharmacy staff [46].
Wellness Cloud Computing Opportunities and Challenges
Recent research indicates that 75% of chief information officers reported that they will need and apply deject calculating in the virtually future [47,48]. The forecast, conducted by Mark Beccue, suggested that the number of people subscribing to mobile cloud applications will rise from 71 1000000 to nearly a billion by 2014 [49]. In health sectors, many organizations, managers, and experts believe that the deject computing approach tin can besides improve services and benefit inquiry [8-13]. In addition, a study by the European Network and Information Security Agency (ENISA) stated that this new computing model is set to come across massive global investment in many sectors, including health care [50]. The study also estimated that, by 2013, Usa $44 billion will be spent worldwide on cloud computing, potentially providing huge benefits to health care.
Every bit with any innovation, cloud computing should exist rigorously evaluated earlier its widespread adoption. Few research papers have systematically studied the touch of cloud computing on health care IT in terms of its opportunities and challenges. This report reviews the literature and evaluates the opportunities and challenges from the viewpoint of management, applied science, security, and legality (meet Table 1).
Table 1
Deject computing opportunity and claiming summary
| Aspects | Opportunities | Challenges |
| Management | Lower cost of new Information technologya infrastructure | Lack of trust by health care professionals |
| Computing resources available on demand | Organizational inertia | |
| Payment of use on a short-term basis as needed | Loss of governance | |
| Uncertain provider'due south compliance | ||
| Technology | Reduction of Information technologya maintenance burdens | Resources burnout issues |
| Scalability and flexibility of infrastructure | Unpredictable performance | |
| Advantage for green computing | Data lock-in | |
| Information transfer bottlenecks | ||
| Bugs in large-scale distributed cloud systems | ||
| Security | More resource available for data protection | Separation failure |
| Replication of information in multiple locations increasing information security | Public management interface issues | |
| Dynamically scaled defensive resources strengthening resilience | Poor encryption key management | |
| Privilege corruption | ||
| Legal | Provider's commitments to protect customer's data and privacy | Information jurisdiction bug |
| Development of guidelines and technologies to enable the construction of trusted platforms by not-for-profit organizations | Privacy issues | |
| Fostering of regulations past authorities for data and privacy protection |
Management Aspect
Opportunity
The principle reward of cloud computing is its low cost. For case, Amazon charges just US $0.1 per hour for ane.0-GHz × 86 educational activity set compages "slices" of EC2. Amazon S3 charges U.s. $0.12 to $0.15 per gigabyte-month, with additional bandwidth charges of US $0.ten to $0.15 per gigabyte to motion data into and out of AWS over the Internet [51]. An organization can easily get a cost-effective and on-premise Information technology solution through cloud computing without the need to purchase or evaluate hardware or software, or to rent internal It staff to maintain and service in-house infrastructure [20,41,51]. The result is that the organization can focus on disquisitional tasks without having to incur additional costs with regard to IT staffing and training.
Also, the deject computing approach speeds deployment while maintaining vital flexibility (ie, rapid elasticity and ubiquitous access to health resources). This capability ways that, as demand changes, hospitals and other health care providers do non need to adjust their infrastructures to conform the changes.
Challenges
The main challenges include lack of trust in information security and privacy by users, organizational inertia, loss of governance, and uncertain provider's compliance.
Trust is at the centre of the resistance that many customers have to the cloud [52]. Concerns arise when their sensitive data and mission-critical applications movement to a cloud calculating prototype where providers cannot guarantee the effectiveness of their security and privacy controls [53].
Cultural resistance (ie, organizational inertia) to share data and change traditional means of working is a common management challenge to adopting deject computing.
In some cases, a service level agreement may not offer a commitment to let the customer to audit its data. The loss of data governance could have a severe impact on a deject user'due south strategy and therefore on the capacity to meet its mission and goals.
Finally, if a provider cannot meet the requisite compliance norms (eg, applicative laws, regulations, standards, contracts, or policy changes), then a client'south investment may be at risk. In some cases, sure customer services (eg, credit card transactions) cannot be used [54].
Technology Aspect
Opportunity
Smaller hospitals, medical practices, and laboratories typically practice non have internal It staff to maintain and service in-firm infrastructure for mission-critical applications such as EHRs. Therefore, eliminating the new infrastructure toll and the IT maintenance burdens tin can remove many obstacles to EHR adoption [10,55]. For bigger wellness organizations, placing data storage or Information technology application needs in the hands of a cloud provider substantially shifts the IT management burden to a third-party provider. From an It management's signal of view, cloud computing can increase the scalability, flexibility, and toll effectiveness of infrastructure.
As well, deject computing has advantages for then-chosen greenish computing—the more than efficient employ of reckoner resources to help the environment and promote free energy saving. Usage of ready-fabricated computing resource tailored to an organization's needs certainly helps it to reduce electricity expenses. While information technology saves on electricity, it as well saves on resources required to cool off computers and other components. This reduces the emission of unsafe materials into the environs [56].
Challenges
Several technical challenges related to the employ of cloud calculating include resources exhaustion, unpredictability of performance, data lock-in, information transfer bottlenecks, and bugs in large-scale distributed cloud systems.
Low cost and calculating resources bachelor on demand are two key features of cloud computing. However, the market is becoming crowded with large providers. Because of high competition, many cloud providers overcommit computing resource (eg, key processing unit [CPU] allocation, storage space, applications) to attract customers. In order to maintain the profit, they cut corners in the value-delivery system. For case, they may limit access to the deject resources, or utilise out-of-appointment hardware or software or deploy older CPU technology. Unfortunately, most cloud customers are unable to govern the virtual compages, and the providers usually exercise not let an inspect by the customers. The result is variable leading to unpredictable performance in the service [57]. This departure between the customer'southward expectation and what the provider can actually deliver presents a major technical challenge for the deject customer to provide high-quality service to its own users.
Data lock-in is too an important challenge. In some cases, cloud users may accept to move data or services to some other provider or dorsum to an in-house IT environment because the provider ceases business or service operations. For instance, Google decided to discontinue its Google Wellness service on Jan 1, 2012. Users accept a year to download their health information [2]. Unfortunately, well-nigh cloud infrastructures provide very little adequacy on information, awarding, and service interoperability [51]. This makes information technology difficult for a client to drift from one provider to another, or move data and services back to an in-house IT environs.
Some cloud users (eg, biomedical inquiry laboratories) may need to frequently upload to or download very large amounts of data from the deject. Application users may find that there is a data transfer bottleneck because of concrete networking bandwidth limitation. Some other specific technical chance is that of bugs in large-scale distributed cloud systems. When compared with in-firm IT systems, the errors in these very large distributed infrastructures are more difficult to debug [51].
Security Aspect
Opportunity
Perhaps the strongest resistance to the adoption of cloud computing in wellness It centers relates to data security [58]. Nevertheless, compared with locally housed data, this model is not necessarily less secure. In some cases, it typically improves security because deject providers (eg, Microsoft, Google, Amazon) are able to devote huge resource to solving security bug that many customers cannot afford, in contrast to the destruction of many medical records and legal documents in the Japan 9.0 magnitude earthquake or the New Orleans Hurricane Katrina disaster.
All kinds of security measures, such as in hardware, software, human resources, and direction costs, are cheaper when implemented on a large scale. Almost deject providers replicate users' data in multiple locations. This increases data redundancy and independence from system failure and provides a level of disaster recovery. In addition, a cloud provider always has the ability to dynamically reallocate security resources for filtering, traffic shaping, or encryption in order to increase support for defensive measures (eg, against distributed denial-of-service attacks). The ability to dynamically scale defensive resources on demand has obvious advantages for resilience [54].
Challenges
There are many data security risks in the use of IT, such as hacker attacks, network breaks, natural disasters, separation failure, public management interface, poor encryption key management, and privilege abuse. Specific risks to deject computing are separation failure, public management interface, poor encryption key management, and privilege abuse.
Cloud calculating is usually attainable to many different customers. If the provider fails to dissever the resource, it could cause very serious security risks. For example, a customer requests to delete data stored in the virtual infrastructure; as with most operating systems, this may non result in true erasing of the data immediately. The data are still stored on the disk but are just non available [54]. In the multiple tenancies environment, hardware resources are reused by other customers. In this case, a tertiary party could have access to some other client's "deleted" data. This presents a college take a chance to the cloud customers than with dedicated hardware.
The public direction interface is deject computing's other Achilles' heel. Every bit indicated in the ENISA's cloud computing risk summary [54]:
The customer management interfaces of public deject providers are Internet accessible and mediate admission to larger sets of resources (than traditional hosting providers) and therefore pose an increased risk especially when combined with remote access and Web browser vulnerabilities
Strong encryption with key direction is 1 of the core mechanisms that deject computing systems use to guard confronting information loss and theft. All the same, a poor cardinal management procedure may crusade loss of encryption keys, disclosure of secret keys or passwords to malicious parties, or unauthorized utilise for authentication.
Lastly, as cloud use increases, employees may increasingly get targets for criminal organizations. If the malicious insider is a organisation administrator, and so he or she could use his or her privileges to steal critical data.
Legal Aspect
Opportunity
Data and privacy protection are essential to edifice the customer trust needed for deject computing to accomplish its full potential. If the providers adopt ameliorate and clearer policies and practices, users would exist better able to assess the related risks they face. Fortunately, many chief providers have commitments to develop best policies and practices to protect customers' data and privacy [59-61]. Besides providers' commitments to this protection, some organizations, such as the Cloud Security Alliance, have developed a comprehensive guide to deal with security and privacy issues [62]. The Trusted Computing Group (http://www.trustedcomputinggroup.org/), a not-for-profit arrangement, suggests a set of hardware and software technologies to enable the structure of trusted platforms. Governments as well play a critical role past fostering widespread agreement regulations for both users and providers [63-66].
Challenges
The use of cloud computing presents many legal issues such as contract law, intellectual holding rights, data jurisdiction, and privacy [67-71]. Among them, information jurisdiction and privacy issues are major concerns.
In the cloud, physical storages could be widely distributed across multiple jurisdictions, each of which may accept unlike laws regarding data security, privacy, usage, and intellectual property [lxx,71]. For instance, the Usa Health Insurance Portability and Accountability Act (HIPAA) [63] restricts companies from disclosing personal health data to nonaffiliated third parties, and the Uniting and Strengthening America by Providing Advisable Tools Required to Intercept and Obstruct Terrorism (PATRIOT) Human activity [72] gives the The states government the correct to demand information if it declares weather every bit being an emergency or necessary to homeland security. Similarly, the Canadian Personal Information Protection and Electronic Documents Act (PIPEDA) [64] limits the powers of organizations to collect, apply, or disclose personal data in the course of commercial activities. Notwithstanding, a provider may, without discover to a user, motility the user's data from jurisdiction to jurisdiction. Data in the cloud may take more ane legal location at the same time, with differing legal consequences.
Cloud computing is a shared resource and multitenancy environment for capacity, storage, and network. The privacy risk of this type of environment includes the failure of mechanisms for separating storage, retentivity, routing, and even reputation between dissimilar tenants of the shared infrastructure. The centralized storage and shared tenancy of physical storage space means the cloud users are at college chance of disclosure of their sensitive data (eg, wellness records) to unwanted parties [54].
Poor alienation notification is also an of import privacy event [73]. For instance, the PIPEDA proposed a new requirement for organizations to report fabric data breaches to the Privacy Commissioner of Canada and to notify individuals where there is a risk of harm [64]. Unfortunately, the breach notification does not actually protect a customer's privacy. A recent survey shows that consumers who have received data breach notifications within the by year are at a much greater risk for fraud than the typical consumer [74].
Deject Calculating Strategic Planning
When a health arrangement considers moving its service into the cloud, information technology needs strategic planning to examine the new model's benefits and risks, assess its capabilities to accomplish the goal, and identify strategies designed for its implementation. Several references are bachelor for establishing a cloud strategic program. For example, Marks and Lozano [75] describe the cloud computing adoption life cycle method involving nine stages to assistance users brainstorm a cloud projection. These are proof of concept/pilot projection, strategy and roadmap, modeling and architecture, implementation planning, implementation, expansion, integration, collaboration, and maturity.
The Project Management Institute, a not-for-profit membership association for the project management profession, published a white newspaper on deject computing that can be used every bit a reference for any cloud project manager. The paper provides 8 fundamental steps for implementing cloud computing, as well equally 2 case studies that support the method [76].
Stanoevska-Slabeva et al [77] also provide practical guidelines for moving traditional IT infrastructure toward clouds: initial analysis of need and readiness for cloud computing, strategic decision to introduce cloud computing, airplane pilot implementation, internal interconnection, inclusion of external resources, and continuous monitoring and evaluation.
The US Federal Health It Strategic Plan [78], released in June 2008, tin also be used for large government bodies to implement health deject projects. The Programme charged the Role of the National Coordinator for Health Information Technology with a leadership part for the development and nationwide implementation of an interoperable health It infrastructure to improve the quality and efficiency of health intendance. The strategic plan has ii goals: patient-focused health care and population wellness, with 4 objectives under each goal. The objectives for both goals are privacy and security, interoperability, adoption, and collaborative governance. The Plan for achieving each goal is detailed through 43 strategies that describe the work needed to attain each objective. Each strategy is associated with a milestone against which progress tin can be assessed and a gear up of illustrative deportment to implement each strategy.
Besides the in a higher place-discussed strategic planning methods, this paper, based on a report [79], proposes a health care cloud computing strategic planning (HCiiSP) model that can be used past a health arrangement to determine its direction, strategy, and resource allocation to migrate from traditional health services to cloud-based services. The model includes 4 stages: identification, evaluation, activeness, and follow-upward (see Effigy two).
Health care cloud computing strategic planning (HCtwoSP) model (SWOT = strengths, weaknesses, opportunities, and threats; VOC = vocalism of customer).
Stage 1: Identification
In this HCtwoSP model, the showtime phase is to analyze the current status of the health organization's service procedure and identify the central objective of service comeback past hearing the voice of the customer or the patients. The root causes analysis method can be applied to analyze the problems of the current service process. A typical hierarchy of causes would exist expressed as follows [80]:
Problem #one: The procedure of patient access to, or discharge from, hospital is besides long. Why? At that place is also much unnecessary (duplicate) charting. Why? The paper-based charting arrangement is inefficient. Why? At that place is lack of automated information systems such as EHR/EMR. Why? Information technology involves a lot of upwardly-front IT investments and maintenance.
The objective identification and its telescopic must be clarified and so as to serve the end users (patients) more efficiently and effectively. In addition, the strategic planning team has to define health care service quality indicators and explain their purpose as well as the use of each indicator. This stage of the model provides the strategic planning squad with a well-defined scope for the service problem being faced.
Stage ii: Evaluation
The second phase of the model is to evaluate the opportunities and challenges of adopting cloud computing. ENISA [54], the Cloud Security Alliance [62], and NIST [53] accept developed comprehensive guides to evaluate the benefits and risks of adopting cloud calculating. A potential user can also utilize a strengths, weaknesses, opportunities, and threats (SWOT) assay to evaluate the feasibility of the deject-based approach [81].
Furthermore, the user needs to assess methods to handle the identified issues. Many references are available for this purpose (encounter Tabular array 2 [51,53,62,71,82,83]). For example, Armbrust et al [51] report ten major obstacles for cloud computing. Each obstacle is paired with opportunities (solutions), ranging from straightforward production evolution to major research projects. Buyya and Ranjan [82] discuss several deject-federated direction problems, such as data transfer bottlenecks, shared logging, and federation of distributed clusters. They also provide further references to handle the discussed problems. In addition, Kuo et al [83] advise an XML-based mediator to conquer information lock-in bug.
Table ii
Potential solutions to the cloud computing challenges
| Challenges | Resources | Solution Summary |
| Management and technical issues | Armbrust et al [51] | Ten solutions to handle technical, policy, and business issues |
| Buyya and Ranjan [82] | Further references to handle cloud-federated direction issues | |
| Kuo et al [83] | XML-based mediator to handle information lock-in (interoperability) bug | |
| Security and legal issues | Cloud Security Alliance [62] | Solutions to handle cloud governance and operation issues (12 domains) |
| NISTa guidelines [53] | Precaution recommendations to deal with security and privacy issues | |
| Ward and Sipior [71] | Five strategies for treatment information jurisdiction issues |
The Cloud Security Brotherhood [62] describes 12 domains of concerns for deject computing. The domains are divided into 2 broad categories: governance and operations. Solution recommendations are likewise provided for each domain. The NIST Guidelines on Security and Privacy in Public Cloud Computing [53] names many key cloud security and privacy issues and the respective precaution recommendations for organizations to follow when planning or initiating a public deject service outsourcing arrangement. Ward and Sipior [71] focus on jurisdiction issues. They recommend five strategies for cloud customers to deal with jurisdiction bug.
Phase 3: Action
After evaluating the new computing model, the organisation will exist able to make up one's mind whether to adopt the service or non. If the answer is yep, it needs to depict upwardly an implementation plan. This paper proposes a 5-step plan every bit follows.
Step 1: Determine the Cloud Service and Deployment Model
Every bit discussed above, deject computing can refer to several different service types (SaaS, PaaS, and IaaS) and different deployment models (private, public, customs, and hybrid deject). Each service type or deployment model has its own benefits and risks [55]. Therefore, the key considerations in contracting for different types of services or deployment models should be different.
Step two: Compare Different Deject Providers
Choosing a proper cloud provider is the near important office of the implementation program. Different providers may offer different service models, pricing schemes, audit procedures, and privacy and security policies. The organization has to compare unlike offerings. As well, it needs to evaluate the provider's reputation and performance before it signs a contract.
Stride iii: Obtain Assurance From Selected Deject Provider
The organization needs assurances that the selected provider volition provide quality of service and follow sound privacy, security, and legal practices and regulations. The quality-of-service assurances include on-need access, pay-per-utilize, rapid-elasticity, on-time troubleshooting support, and operational transparency [54]. The privacy and security assurances encompass information confidentiality, integrity, availability, authenticity, authorization, and nonrepudiation. As well, the provider must assure that the data, including all of its backups, are stored only in geographic locations permitted by contract, service level agreement, and regulation.
Pace iv: Consider Time to come Information Migration
The arrangement may have to move data and services to another provider or back to an in-business firm Information technology environment considering the provider ceases business or service operations (eg, the recent discontinuation of Google Health [2]), has an unacceptable subtract in service quality, or has a contract dispute. Data portability must be considered upward front equally office of the plan [84].
Step 5: Outset a Airplane pilot Implementation
Many previous strategic planning methods suggest that an organization with no previous cloud experience first with a pilot implementation [75,77]. The airplane pilot should be suitable for providing proof of the advantages of cloud computing for the system.
Stage 4: Follow-up
The concluding stage is to deploy the deject computing infrastructure and develop a follow-upwards plan. The plan indicates when to measure and how to mensurate the service improvements. Reasonable targets are established beforehand, and the results of the new services are measured against the specified targets or performance indicators to assess the magnitude of the improvement [80]. If the new service condition is not satisfied, the health organization needs to review what facts influence the objective achievement. If the main crusade of unsatisfied service condition is from the cloud provider, the organization volition consult and hash out with the provider to meliorate service or may consider moving data and services to another provider or back to its in-business firm IT environment.
Discussion and Conclusion
Deject calculating is a new model of computing that promises to provide more flexibility, less expense, and more efficiency in It services to end users. Information technology offers potential opportunities for improving EHR adoption, health care services, and enquiry. However, as discussed in a higher place, there are still many challenges to fostering the new model in health care. Possibly the strongest resistance to the adoption of cloud computing in health It centers concerns data security and legal issues. Fortunately, many main providers (eg, Microsoft, Google, Amazon) have commitments to develop best policies and practices to secure customer'south data and privacy [59-61]. Some not-for-profit organizations, such as the Cloud Security Alliance and the Trusted Computing Group, take developed comprehensive guidelines, and hardware and software technologies to enable the construction of trustworthy cloud applications. Governments also foster regulations (eg, HIPAA [63] and PIPEDA [64]) to protect deject users' data security and privacy. In addition, most legal issues involved in cloud calculating usually can be resolved through contract evaluation or negotiations [10,54].
When a health organization considers moving its service into the cloud, information technology needs strategic planning to examine ecology factors such equally staffing, budget, technologies, organizational culture, and regime regulations that may affect it, assess its capabilities to reach the goal, and place strategies designed to motility forward. This newspaper provides useful strategic planning references for potential users to offset deject projects. Too a new model called HCtwoSP is proposed that could be applied by a wellness arrangement to determine its direction, strategy, and resource allocation to move to the cloud paradigm. The model includes 4 stages: identification, evaluation, action, and follow-up. At the kickoff stage, the organization analyzes the electric current status of the service procedure and identifies the fundamental service objective. Stage 2 is to evaluate the opportunities and challenges of adopting cloud calculating. By using the SWOT assay, the organization can determine the internal strength and weakness factors every bit well every bit the external opportunity and threat factors of adopting the new model. Some potential solutions to handle cloud issues have been likewise provided. Then, in phase 3, the organisation draws up a cloud calculating implementation plan. The writer suggests that this should include at to the lowest degree the post-obit: determine the cloud service and deployment model, compare unlike cloud providers, obtain balls from the selected cloud provider, consider future information migration, and start a pilot implementation. The last stage is to deploy the cloud computing infrastructure and develop a follow-upwards plan to measure out the wellness care service improvements.
As the Chief Executive Officeholder of a deject It company commented [85]:
If you woke up this morning and read in The Wall Street Journal that, say, Overstock.com has stopped using UPS and FedEx and the U.South. mail, and had bought fleets of trucks and started leasing airport hubs and delivering products themselves, y'all would say they were out of their minds. Why is that much more insane than a health intendance company spending $2 billion a year on (traditional) data engineering?
Deject computing presents a compelling opportunity for consumers of Information technology and producers of information services [86,87]. Gartner Enquiry likewise found that cloud computing ranked as the peak technical priority of chief information officers in 2011 [88]. However, adopting deject computing is a complex process involving many factors. It needs rigorous evaluation before introducing the new computing model to an organization. This paper focuses on 4 aspects of evaluation and strategic planning, which will assist health organizations in determining whether (or how) to migrate from traditional to cloud-based wellness services.
Acknowledgments
The paper has benefited greatly from the reviewers' insightful comments and suggestions. The author would like to give thanks Professor Francis Lau and Mr George Fraser for proofreading the manuscript.
Abbreviations
| Amazon S3 | Amazon Simple Storage Service |
| AWS | Amazon Spider web Services |
| CPU | central processing unit |
| EC2 | Elastic Compute Cloud |
| EHR | electronic wellness record |
| ENISA | European Network and Data Security Agency |
| HC2SP | health intendance cloud computing strategic planning |
| HIPAA | Health Insurance Portability and Accountability Act |
| IaaS | infrastructure as a service |
| IT | information technology |
| NIST | National Institute of Standards and Technology |
| PaaS | platform as a service |
| PATRIOT | Uniting and Strengthening America by Providing Advisable Tools Required to Intercept and Obstruct Terrorism |
| PIPEDA | Personal Information Protection and Electronic Documents Human activity |
| SaaS | software as a service |
| SSAHA | sequence search and alignment by hashing |
| SWOT | strengths, weaknesses, opportunities, and threats |
Footnotes
Conflicts of Involvement:
None declared
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