This paper aims to provide an understanding of the model and exploring options available for complementing the technology and infrastructure needs of Healthcare organizations.

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Cloud Computing in Healthcare IT
About the Author This paper aims to provide an understanding of the model and exploring options
available for complementing the technology and infrastructure needs of Healthcare
Dr. Nitin Verma
Dr. Nitin Verma leads organizations.
the Health Insurance
Practice. He has 17+ What is Cloud Computing?
years of experience in Cloud Computing is a new buzz word that IT organizations are exploiting.
IT & Healthcare
Domain. A qualified What is this Cloud Computing? Is it going to drive my business the way I want?
M . B . B . S , M S
professional with experience on Does the term “Cloud” here refer to something which is ambiguous and unpredictable
Healthcare Product Development, like the mad clouds? Does the cloud mean Internet clouds?
Consulting, Regulatory Compliance,
Pre-Sales, Business Development and Then what is new in this cloud?
Pharmacy Benefit & Claims
Management. Having implemented Cloud Computing has been defined in many different ways by industry experts. I
several Hospital Information Systems thought of defining 'cloud' in the common man's language because at the end it is the
(Cerner-Millennium, Siemens common man's personal & protected health information that is going to reside in the
–Invision/Sorien, Lorenzo Clinical) in 'cloud'.
Singapore, Germany, Netherlands,
Spain and UK. He is a key architect My audiences are not only the CIOs and CTOs here. I am talking to my customer's
involved in design, development and customers, patients and physicians like me. In my understanding, the “Cloud
deployment of many solutions at the
Computing – is a “fruit salad” made for a group of families in a community. In
Health Management & Research
Institute (HMRI). this scenario no family has budget to afford all kind of fruits in desired
quantity to complete the dish. The more apples you take, more pennies you
shell out, less banana means less money to the vendor. A community
organization procures all the desired ingredients and prepares it. Each family
now can pick and choose the quantity and type of fruit needed in their salad
based on their appetite and budget; they pay based on what they consume and
not based on what they planned to consume. So it is like, a third party has a
required platform to launch the application and can provide the entire
necessary infrastructure including storage, security, hardware, software and
support.”
Inside the issue
Defining the Cloud ............................................................................................................................... ........ 2
Critical Attributes .......................................................................................................................................... 2
Discovering the Cloud (Deployment models in relation to healthcare) ............................................................ 3
Clouds Services in Healthcare ........................................................................................................................ 4
Applications of Cloud in Healthcare .............................................................................................................. 4
Challenges .................................................................................................................................................... 5
Key Benefits .................................................................................................................................................. 6
Conclusion .................................................................................................................................................... 6

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Defining the Cloud
As the cloud will continue to evolve and mature, the industry experts and the
competitive vendors of cloud related software, hardware and services will keep re-
defining cloud computing. The sole objective of this exercise will be to guide the
organizations including healthcare enterprises the way they analyze and evaluate the
new technologies and ROI and finally avail those services.
Cloud Computing is a technology from a service provider who offers all computing
resources like Infrastructure, Platform, software, and all the components that rely on
the internet to cater to the computing needs of the client. The definition of cloud
computing has been rather elusive.
A quick glimpse of definitions from Wikipedia and NIST in the public domain
suggests a unanimous way of thinking but not a consensual definition.
“Cloud computing is Internet-based computing, whereby shared resources,
software and information are provided to computers and other devices on-demand,
like the electricity grid.”
– Wikipedia
Cloud Computing is a
technology from a service “Cloud computing is a model for enabling convenient, on-demand network access to
provider who offers all a shared pool of configurable computing resources (e.g. networks, servers, storage,
applications and services) that can be rapidly provisioned and released with minimal
computing resources like
management effort or service provider interaction”.
Infrastructure, Platform, – NIST (National Institute of Standards & Technology)
software, and all the
components that rely on the Critical Attributes
As the clouds have started to move from the hype stage to the real adoption stage in
internet to cater to the mainstream, the NIST and Gartner have defined its attributes. Both of them have
computing needs of the client. done a fair deal of work of spreading the clouds in to adoption. For our purpose of
understanding, I will use the NIST's model as a meaningful departure point for better
understanding. Further to their efforts this framework can be dissected to analyze its
relevance and usefulness to the Healthcare organizations. The NIST has defined the
following five (5) attributes of the clouds explaining its nature and behavior.
On-Demand Self-Service: The on-demand self-service, as the name implies, is self-
explanatory that irrespective of how excellent the vendor's offerings are, it requires
user's intervention and ability to upload, schedule and manage its day to day
activities. The benefit of the self-service model for an organization from the user's
perspective is that it gives a sense of empowerment to the employees by virtue of
their involvement in cloud.
Rapid Elasticity: The rapid elasticity in cloud means that the increased computing
capability can be provisioned as and when required and at the same time capabilities
can be elastically and automatically withdrawn when no longer needed.
Resource Pooling: Resource pooling is the key to scale up an ICT economy at a much
lower cost as compared to the traditional infrastructure cost for the same magnitude
of services. The cloud provider's pooled resources are shared among multiple
consumers. These shared resources are a combination of physical and virtual
resources. The built-in intelligence of the system allows the distribution and
redistribution of resources as per the consumer's demands. A healthcare organization
working on the clouds does not need to worry about the bandwidth congestion, slow
application speed, and increased time to upload or view the patient's previous
Electronic Medical Record (EMR) during the busy working hours.
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When a cloud is there, “All is well”!!!
Measured Service: The measured service in the clouds refers to “pay-as-you-go”
based on your usage. This concept has more to deliver to the healthcare organizations
involved in extensive imaging studies and are early adopters of the clouds. The
outcome-based model “as a service” has begun to surface in the Radiology
departments. The consumers are being charged based on the money saved on film or
per study. Every click on the cloud would trigger chain of reactions involving &
utilizing multiple resources and thus getting charged for their use. Resource usage
can be monitored, controlled, and reported providing transparency for both the
provider and consumer of the utilized services. The healthcare organizations already
struggling with the regulatory compliance are once again pushed to the wall by the
American Recovery & Reinvestment Act (ARRA). They have to start using the
certified Electronic Health Records (EHR) technology if not using currently and
demonstrate its significant use. This is applicable to all, the large providers and small
physician practices catering to Medicare patients. Either use the EHR or get
penalized by reduced reimbursement for services to Medicare patients. Medicare is
already paying low “fee for service” in comparison to private health plans. The
healthcare providers are trapped between the regulatory compliance and the high
The most vital characteristic of
entry cost of hospital information systems. Now the providers have to make the
cloud computing is the fact decision if they wish to lose to regulations or take the beating from high cost of EHR
that it is network based, and solution providers. At last breather for all, the providers can explore multiple
accessible at anytime from deployment & services model from the cloud vendors ensuring the privacy and
anywhere, from any security of their data.
standardized platform (i.e. Broad Network Access: The most vital characteristic of cloud computing is the fact
desktop computers, mobile that it is network based, and accessible at anytime from anywhere, from any
devices, etc.). standardized platform (i.e. desktop computers, mobile devices, etc.). This translates
into the availability of the right information to the right people at the right time to
make use of golden hours and save lives.
Discovering the Cloud (Deployment models in relation to healthcare)
Though the NIST has defined four different types of clouds but for the sake of clarity,
the community and the Public clouds are considered as one.
Private Cloud: In private clouds, the computing infrastructure is dedicated to a
particular organization and not shared with other organizations. Either logically or
physically these clouds are isolated and cannot be accessed from outside. Private
clouds are more expensive but secure when compared to public clouds. This can be a
potential solution for the healthcare organizations looking at the criticality of the
privacy and security of the patient's confidential health information.
Public cloud: In public clouds, the clouds infrastructure is provided by a cloud
vendor. Public clouds are shared by many organizations at any point of time. When a
cloud is shared by many organizations, the separation among their users is only by the
credentials and that too is purely logical. These are cost effective solutions but the
users can have concerns around data security.
Hybrid Cloud: Hybrid clouds are a combination of public and private clouds. The
hybrid cloud remains a unique entity as (Public-Private) they are connected to each
other by vendor's proprietary technology. This is a potential solution to the high entry
cost of the clinical information systems for a healthcare organization.
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Clouds Services in Healthcare
In today's world, healthcare organizations are moving towards a virtual universe
where everything is virtual except patients. Several healthcare applications like
EMR/EHR, storage hungry giant PACS and Personal Health Records (PHR)
provided as a service is gaining popularity, trust and acceptance of the healthcare
community. IT capabilities in clouds are highly modularized and isolated so that they
can be offered and consumed independently of other capabilities.
Infrastructure as a Service (IaaS): Infrastructure as a Service (IaaS) is the first
pillar of the clouds service model. IaaS means delivery of computer infrastructure,
typically a platform virtualization environment. It has also been referred to as
Hardware as a Service (HaaS). It is a provision model in which an organization buys
the services of a third party vendor for the equipments required to support
operations, including storage, hardware, servers and networking components. The
service provider owns the equipment and is responsible for housing, running and
maintaining it.
Desktop virtualization is a critical aspect of the IaaS for the healthcare
organizations. The administrator can select a configuration of CPU, memory &
storage that is optimal for their application. The whole cloud infrastructure viz.
IT capabilities in clouds are servers, routers, hardware based load-balancing, firewalls, storage & other network
highly modularized and equipments are provided by the IaaS provider. It can have an enhanced security and
isolated so that they can be reduced provisioning and administrative cost attached with the desktop
management.
offered and consumed
independently of other Platform as a Service (PaaS): Platform as a Service (PaaS) is the second pillar of the
capabilities. clouds services model and is built on top of IaaS. PaaS provides the flexibility, security
and integrated development environment to an organization looking to develop or
deploy an application without the anxiety of entry cost in terms of required hardware,
software and development tools. Another revolutionary trend that PaaS is bringing
more effectively is the penetration of open source technologies into the healthcare IT.
Software as a Service (SaaS): Software as a Service (SaaS) is the backbone of cloud's
services model. In this model a complete application is offered to the client running
on the provider's infrastructure. The user does not have to worry about the
underlying infrastructure like bandwidth usages, servers, and storage and support
tools. A single instance of the application runs on the clouds catering to multiple
users. The consumers are also delighted as they don't have to worry about the upfront
cost and licensing investment.
Applications of Cloud in Healthcare
Though there are several areas in Healthcare IT where usability of the clouds can be
explored and evaluated, I have explored only few of those areas for our understanding
and discussion.
Healthcare Providers
PACS: The storage of images along with interoperability will reduce overall costs as
duplicate orders can be significantly reduced. A chain of hospitals would not need to
have an individual storage of images for each hospital; instead a central image hosting
can be created on the clouds. It will be accessible to all the authorized users thus
saving cost on the storage area and cost of the film as the hospitals can then go
paperless.
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EHR/EMR: As per ARRA act, providers getting reimbursed from Medicare have to
start using the certified EHR technology. Moving on to the clouds can be an option in
order to save the entry cost for the EHR/EMR. Multiple practices can use the same
application while their data will be separated by thin lines. The patient's confidential
health information can be kept on the private clouds while other transactional data
can be kept on the public clouds.
Public Health
Bio-terrorism Surveillance System: An outbreak is an imminent threat in the current
scenario. It can be bio-terrorism or an outbreak of communicable disease. The
information can be managed on public clouds and accessible to the general public.
The information can be effectively and efficiently disseminated to the public to
convey messages of national security and avoid panic.
Personal Health Records (PHR): Personal health records are already on the clouds.
Few years ago Microsoft and Google have launched these services on the clouds.
Healthcare Payers
Health Plans: Bigger health plan companies involved in Business Intelligence, Data
mining and predictive modeling for new plans or configuration can benefit from
The patient's confidential clouds. Instead of investing significantly in infrastructure for hosting these huge
databases, they can leverage the IaaS and save millions of dollars.
health information can be
kept on the private clouds Healthcare Life Sciences
while other transactional In Pharmaceutical analysis, where researches are expected to compare more than 5
data can be kept on the million samples which may take weeks to get the results unless company is willing to
spend substantial amount on IT investment. These huge databases can be kept on
public clouds.
clouds and exploited with other computing capabilities to get faster results.
Challenges
There are many challenges including administrative, regulatory, security, reliability
and availability with the clouds for the healthcare organizations. Data governance and
regulatory compliance have been discussed in this context.
Data Governance
Data governance deals with data collection, storage, its access, recovery and many
other related aspects. Healthcare organizations have tons of sensitive data that
requires defined security processes and monitoring. In the current scenario,
organizations have their own data centers and rely on their IT services to safeguard it.
Regulatory Compliances
The biggest challenge to the healthcare world is to comply with the regulatory
compliance status of the government. In many countries, the patient's Protected
Health Information (PHI) cannot be taken out of the country. Apart from this, the
patients themselves will be concerned about the security of their confidential
information.
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Key Benefits
The organizations need to align their scalability, strategy and expectations to the
clouds. The key benefits though can be seen as:
? of entry to start or expand with new applications, its storage and
Low cost
infrastructure
? and not by foreseen usage
Pay-per -use
? as and when required with faster run time and response time
Scalability
Conclusion
What the healthcare industry needs from clouds are centralization, collaboration and
virtualization. Through centralization, all the patient data needs to be at one place so
that the right information is available to the right care provider at the right time. The
collaboration needs to be at two levels, one at the clouds provider level to have
standards and secondly at the regulation level. Virtualization is going to be the key of
services in clouds. Nothing is physically visible to the consumer though they are able
to operate and perform at much better pace and at lower cost. Clouds have the
potential to transform many challenges of the Healthcare IT, if Healthcare can drive
the clouds instead of clouds telling the healthcare professionals what to do and what
not to do. There cannot be one deployment model or the service model that can cater
to Healthcare world. It has to be customized clouds.
Clouds have the potential to
transform many challenges The healthcare world has to make some harsh decisions and trade off between the
of the Healthcare IT, if cost/benefits and the associated risks. But if we don't get active now and keep waiting
for the clouds to mature before we put our applications and data, we will lag behind in
Healthcare can drive the this race and Clouds will lead healthcare again like any new technology, rather than
clouds instead of clouds Healthcare dictating to the clouds as to what it wants from them.
telling the healthcare
professionals what to do and
what not to do. For further information please write to rfi@mahindrasatyam.com
www.mahindrasatyam.com
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