Cloud Computing In Healthcare: Benefits, Opportunities, And Implementation

Business problems and Opportunities

Health care delivery continues to evolve with the changing political, economic and technological scene. Healthcare is being guided by a consumer-driven principle and framework.  Health systems therefore are finding ways to achieve greater efficiency, seamless care, reduced costs and reliable, predictable outcomes. New partnerships are being set up in the health care systems to address trends that impact negatively on the health care delivery while implementing the positive strategies, (Armbrust et al 2010). Computers are at the centre of the human lives playing very big roles such as productivity, entertainment, creativity and health has not been left far much behind. The integration of information technology and health care in the administrative, clinical, research and teaching aspects require the adoption of cloud computing. the practice of medicine however, has remained very conserved to the use of traditional manual practices with little or extremely cautious use of technology, (Buyya, Yeo and Venugopal 2008). Use of cloud computing therefore, must provide a clear vision of the benefits more so concerning patient safety in improved efficiency and effective care while reducing the cost of treatment. The top ranked trend in health care delivery to watch out for in 2018 would therefore be cloud computing.

Cloud computing is the future of medicine, as a business and health care provider. This is so because:

Priorities in the practice of medical care are changing to increase the quality of care and cut down the costs. The cost of care has been increasing over the years while patients feel less satisfied with the outcome. Practices will have to find ways to increase the work output from medical staff and generate more workflows, (Buyya, Yeo and Venugopal 2008). This is where cloud computing comes into play in integration of systems such as hospitals and accountable care organizations to increase more remote medical care with the use of technology and facilitation from community health care workers.

Access to medical care has become a competitive strategy. Millennials have an increased throughput to deliver on their life goals and career opportunities and therefore demand easily accessible quality healthcare. Cloud computing and the integration of technology such as wearables and mobile phones will shift the scope of practice from a hospital or office-based system to a more urgent medical care delivery system through telephones, teleconferencing and health mobile applications.

Medical practice is shifting to a fee-for-service and accountability scheme and therefore will push the medical professionals and stakeholders to implement strategies such as technology like cloud computing integrated with peripheral sensors and devices in preventable medicine targeting causative agents such as lifestyles and diet other than management.  

Project Stakeholders

Artificial intelligence is slowly taking course in the practice of medicine and therefore the use of cloud computing and servers will increase the output and outcome pf aspects such as deep learning in providing storage facilities, platforms for development and testing and user interfaces for controlling the humanoid robotics or machines used, (Armbrust et al 2010).

Government structures and policies have supported the healthcare system as holding companies for long but are now shifting to being operating companies. The use cloud computing will enhance the integration of medical systems and hospitals to increase the quality of service delivered while also monitoring the physicians to reduce burn out while increasing incentives to those actively participating in health care to provide overall success of the system.

With the implementation of cloud computing, the following pain points are being solved:

Replacement and complementation of the out-dated healthcare practices with digital options.

 Utilization of data integration and e-health records.

Adoption of new medical practice strategies such as accountable care organization for lower costs and more quality care.

Provision of easily accessible healthcare care on personal computers and mobile devices to patients to reduce admissions and re-admissions.  

Patients: are the direct beneficiaries of the project implementation to utilize cloud computing in provision of quality health care to them.

Project team: a team of 12 individuals comprising of computer experts, Information Technology administrators and accounts experts.

Government: forms the framework in determining the success and implementation of the cloud computing. Additionally, is a sponsor of the project.

Healthcare professionals. The doctors, nurses and paramedics will be integrated into the cloud computing framework and are therefore key players.

Executives. Primarily are a project sponsor together with the government.  Include the top leadership of the health facilities and health care organizations.

Stakeholder communication mapping.
Stakeholder	Power.	Priorities.	Mode of communication
Executives.	Project sponsor	Reduce cost of medical practice Achieve patient satisfaction Generate more revenue.	Boardroom meeting.
Government.	Project sponsor.	Quality service provision Better utilization of taxes.	Boardroom meeting.
Patients.	Clients.	Ease of access of medical care Reduced costs of care. Value based payment and fee-for-service.
Medical professionals.	Stuff.	Increase workflow. Increase incentives. Reduce physician burn out.	Boardroom. Notice board.

This project seeks to address the wide aspects of medical practice in integration of cloud computing into practice. The project focuses on integration of the hospitals as a system covered under one umbrella of cloud-based service with centralized functions such as storage of medical services, communication between medical stuff from the remote community worker to the consultant officer through a single network framework and the provision of data analysis to determine and improve the clinical decision making process of the physicians and artificial intelligence.

The project addresses to cover the following areas or at least allow room for future improvements.

A connected healthcare across multiple providers spanning across public and private facilities with a centralized cloud based system with electronic patient records.

Stakeholder Map

Big data analysis and cloud-based genomics for providing functions such as analysis of medical data such as diagnosis, prevalence, incidences, treatments, costs and effectiveness.

Telemedicine, to open up the scarce and remote areas through online health care consultations for example in providing new mothers with resources for breastfeeding, whining and taking care of post-partum medical needs, (Buyya, Yeo and Venugopal 2008).

Internet of everything enabled and diagnostic support medicine, in integration of wearable devices and monitoring systems to provide vital sign data, diet and lifestyle practices to assist in preventable medical care, diagnosis and cognitive features of deep learning for the artificial intelligence.  

Medical care application development to ensure continuous patient care through greater productivity in mobile applications such as dosage reminders, diet, lifestyle and exercise guides and physician applications.

Backup services for the database and enable recovery.

This project is justified because the current state of medical practice has not full adopted cloud computing and is not utilizing is for the benefits of cost reduction and quality care provision in the following instances, (Buyya, Yeo and Venugopal 2008).  

1. Segregated healthcare delivery system reduces the accessibility of medical services by the patients since they have to visit specific service providers to obtain their records or start the whole process of medical history taking and examination instead of a continuous care.
2. The current system does not allow efficient remote consultation and telemedicine unless the service is offered by very few accountable care organizations where the clients are charged through the nose to be cured and be offered primary physicians assigned to them.
3. The current state of traditional medical record keeping is in a sorry state with the file keeping method the most used. Even though some facilities have adopted electronic keeping, they utilize on premise systems and therefore the data management cost is very expensive in form of data protection, upgrades and maintenance, scalability and installation.

According to (Calheiros et al 2011), Health information systems and electronic data records. Healthcare delivery facilities have adopted on premise IT configuration to enable the management of patients’ records in electronic form integrating services from the different departments such as pharmacy, laboratory, clinical practice, billing and finances and administration, (Armbrust et al 2010). Due to fears of data protection, most facilities have not gone online into provision of connected healthcare since the input costs to install such on premise systems is very expensive.

Mobile devices are used in the provision of eHealth services through mobile applications meant for the service providers such as Epocrates to consumer mobile applications and websites such as WebMD and fitness tools like Nike+ fuel band.

Health insurance portability and accountability act compliant email services allow doctors and patients to communicate and enable functions such as refill prescriptions, test results and check-in appointments, (Buyya et al 2009). Through secure texting messages, information such as texts and pictures about patients are shared among medical specialists such as radiographers and surgeons to help improve diagnosis and management.

Development of patient monitoring devices installed in mobile phones such as Samsung’s health application that monitors the patients’ mobility and other wearable devices for glucose, blood pressure and weight testing that are used to generate user data and store in their mobile phones, (Zhang, Cheng  and Boutaba  2010).

Scope of Project

A requirement analysis called the business strategy, context and process. The model involved setting an i*goal model for strategizing the cloud computing framework, Jackson context diagrams for the context and the role-activity-diagrams.

The total cost of ownership determined according to the Gartner’s definition.

themes	Description.	RE techniques.
strategy	Implementation of cloud computing to increase quality and efficiency of healthcare. Cut cost of service delivery. Increase revenue generation	I*Goal model.
context	Outpatient management Inpatient operations Patient follow-ups.	Jackson context diagrams.
process	Admissions Testing and imaging Administration Surgeries Prescriptions Patient education Billing and finances.	Role activity diagrams.

Health information system and eHealth records.

Desktop computers, core i3 intel processor.

Uninterrupted power supply units.

Trained personnel.

Networking routers and gateways.

Health connect and remote access.

Trained personnel.

Mobile devices, iPad devices.

Cloud computing.

Cloud-based service provider

Database management service provider.

Internet service provider.

Back-up service provider.

Must-have.	Nice-to-have.
Desktop computers.	Uninterrupted power supply.
Networking system.	Power back-up generator.
IPad mobile devices.
Cloud-based service provision.
Database service provision.
Internet provision.
Back-up service provision.
Trained personnel.
Trained stuff
Network administrator.

A single organization registration number for the eTendering process regardless of the commodities to be applied for supply.

The eTender registration should be up-to-date inclusive of the time, contact details and name of the organization.  

The tender should be submitted in the right Procurement Area for your supply.

The tender questionnaire should be answered fully and accurately of the organization’s circumstances.

All the necessary attachments such as uploads should be included in the tender application forms.

Guarantee of the Budget Availability certificate for the goods and services to be delivered.

Submission of the tender request from in time, before deadline.

The two main evaluation processes employed are impact and process evaluation.

Process evaluation involved seeking to understand the delivery of the cloud computing solution in health care, (Zhang, Cheng  and Boutaba  2010). Through seeking the questions relating to the delivery, we continue to understand how best the project can be improved to increase the quality and efficiency of health care delivery and reduce the cost of production. Independent evaluation teams will interview the different stakeholders in the surveys.

Impact evaluations basing on the positive or negative difference that the cloud computing solution in health care would have made. The outcomes of the solution are measured against the objectives and scope of the project, (Nurmi et al 2009). This evaluation process answers the questions on what difference cloud computing will impact to delivery of health services and the outcomes of the new technology in health care. Impact evaluation assesses the changes that occurred after cloud computing is adopted into the practice of medicine, (Armbrust et al 2010). To account for the utilization of resources, impact evaluations are performed to determine the benefits of the project and help in the decision making process about resource allocation for future projects.

The solution evaluation using the impact evaluation criteria aids in the settling on the Platform as a Service model from Amazon web services in a hybrid architecture of the cloud computing.

Impact evaluation assesses the observed outcomes of cloud computing in the field of medicine. These outcomes are compared against the objectives and scope of the project.

Impact evaluations account for the resource utilization and therefore for the success of the project. A report from impact evaluation forms the basis of allocating resources in the subsequent projects in the field of medicine and other fields such as finance, commerce and education, (Zhang, Cheng  and Boutaba  2010).

In science-based projects such as cloud computing in health care, impact evaluation is of choice because the benefits in terms of productivity could occur many years after project funding has been rewarded.

Impacts are compared against the outcome that would have happened in the absence of cloud computing(counterfactual) and this would form a more accurate evaluation.

The weighted criteria to arrive on the Platform as a Service in a hybrid architecture from the Amazon web service as the best solution was based on the following function.

 Amazon web services.

Is a sub company of Amazon.  Amazon web service that offers subscription clouding services on demand to individuals, companies or government institutions, (Foster et al 2008).  Amazon web services offers services such as big data computations through amazon elastic compute cloud and amazon lambda serverless computing, networking, storage and content delivery, contact centre through amazon connect, database, mobile services, analytics, application services and other functions such as code writing, running and debugging.  

Microsoft azure.

It was initially called windows azure, a cloud computing service provider founded by Microsoft. Its role is in building, running, testing and management of services and applications, (Buyya et al 2009). Microsoft azure offers services such as computational through virtual machines, applications and websites, mobile services, data management, storage services, media services and messaging. Running on Microsoft azure operating system, that manages the storage, computational and allocation of resources functions of the data centres.

IBM cloud computing.

Offers public, private and hybrid models of cloud computing services such as software as a service, infrastructure as a service and platform as a service for businesses. IBM cloud computing services allows a pay-as-you-go pricing, (Armbrust et al 2009). The private cloud is owned by the client and the client controls the security firewall by their own IT staff.

Oracle cloud.

It is offered by oracle corporation, a cloud computing provider for analytics, network, applications and storage services through Oracle managed data centres. Oracle provides IaaS, PaaS, SaaS and data as a service. These services are purchased for the building, integration and storage functions. Oracle, apart from the usual functions, also provides load balancing, Ravello, FastConnect and edge services.

Google cloud platform.

This is a cloud based service provided by google. It uses the same infrastructure that provides the services of google search and YouTube. Google cloud platform offers services such as app engine, BigQuerry, BigTable, cloud data store and compute engine. Google offers a free trial service to its customers, (Armbrust et al 2009).

vcloud.

Offered by the Online Virtual Hosting and VMware. They offer virtualization and cloud services and infrastructure.  This loud services offers flexible and lower cost storage, networking, disaster recovery and computing analytics.  VMware however does not provide hosting service but only cloud computing.

Vendor.	IaaS.	PaaS.	SaaS.	Storage.
Amazon	Elastic cloud compute	Amazon web services, with many computing services.	Amazon web service.	Simple storage service.
Google	Not available	Google App engine with python, Java and Go support.	Google aps.	Google cloud storage.
IBM	Smartcloud enterprise	Smartcloud application services.	SaaS products.	Smartcloud enterprise object storage.
vCloud.	VMware vSphere.	VMware vfabric	n/a	n/a
Oracle.	Oracle cloud infrastructure	Oracle cloud platform	Oracle cloud applications	Oracle data cloud.

Amazon web services.

Amazon web services offers many web based services and always upgrades. Amazon offers a very deep and broad platform with infrastructure, development platform, data storage and software services.

The amazon web services include:

Compute services such as amazon elastic cloud compute with virtual servers, scalable on demand capacity compute servers, storage, developer tools, mobile services and network and content delivery.

Amazon web services offers cloud management services and tools such as cloud watch, auto scaling and systems manager.

 Amazon web service provides a customer engagement support framework and service such as amazon connect, pinpoint and simple email services that allow customer communications such as customer care.

The cloud service also additionally provides business productivity services such as Alexa, amazon Chime that allows easy conducting of meetings, video calling and chats on the online platform. The Chime service can allow personal interaction between physicians and patients and hence offer ease access to medical care anytime, anywhere, (Armbrust et al 2010).

The amazon web service allows for connection of peripheral devices such as internet of things to be connected to the amazon web service IoT core. Therefore, it is easier to connect devise such as sensors, blood pressure machines, home system monitors and other wearables.

The amazon’s SageMaker can be used for machine learning that can be utilized in the design, adoption and implementation of artificial intelligence and deep learning of machines.

Therefore, amazon web service is engineered to provide cloud based computing services that meet the most demanding user or client needs such as security, compliancy, different architectures of the cloud that are private, public and hybrid which all of them are scalable, (Armbrust et al 2009).

Pain point.	Benefits.
Health information system and eHealth records.	Simple storage services.
Generate and increase workflows	Software as a service services.
Artificial intelligence	Platform as a service and SageMaker.
Ease of access and remote consultation.	Amazon’s connect, Alexa and Chime.
Wearables and data collection.	Amazon’s web service IoT core.
Billings, finance and physicians’ supervision.	Amazon’s management service such as systems manager.
Data security and protection.	IaaS services such as AWS Direct Connect and Amazon Inspector.

Software as a service:

SaaS is the primary cloud computing utility that gives the user an interface to interact with the cloud based services from anywhere at any time provided that there is accessible internet connection. Software as a service services are managed by the cloud-based service provider and do not require the consumer to manage or maintain or repair the system. Software as a service functions of the cloud include storage services.

Software as a service allows the consumer run programs without having to install the software on their computers or mobile devices.

A software for service cloud design allows the hospital or health facilities run with a small IT department because all the technical problems are sorted out by the provider’s technical stuff.

The software as a service allows the following;

1. Health management and electronic records on the cloud. The cloud service is accessed via a web browser like page that provides the medical stuff with an interface to input data such as patient’s history in the form of biodata, chief complain, history of presenting illness, past surgical and medical history, a social history and review of systems.
2. Software as a service allows the health facility to integrate services and programs such MEDIGATE and allow input of patient of data that aids in the final clinical judgement on the diagnosis and management of the diseases.
3. The storage function of the software as a service model of the cloud computing provision allow for online data storage on the large amounts of data collected in the facility or generated by the numerous sensors such as blood pressure machines, weighing scales, oximetry scales and motility trackers.
4. The SaaS allow an interface for the patients to access online medical services such as on the mobile application installed on their phones or the mobile devices’ web browser. Such functions include dosage reminders, patient education data, diet recommendations, lifestyle guides and a chat platform for teleconferencing.

A software as a service model of cloud computing is good for a health facility because of the aspects outlined and additionally is not a onetime purchase package but allows time-to-time subscription.

Platform as a service.

PaaS allows the client more control on the cloud based service to design, develop and run applications. The client has the capability to control the applications unlike in the SaaS model that only allows interaction with the apps, (Buyya et al 2009).  The platform as a service model of cloud computing includes a software development kit and allows development languages such as python and java. The client can, using their own employed developers or outsourced contracted developers, to design and code for programs and mobile applications that would increase the service delivery.

The following are aspects of the healthcare solution to choosing a platform as a service model:

1. Development of third party custom applications for android, iOS and blackberry platform s to be used by the patients after installation on the mobile devices to allow ease of access of medical health care from their remote locations, (Armbrust et al 2009).  Such mobile applications would include dosage reminder applications, lifestyle guides, diet guides and messaging and internet applications that allow log in through a portal to access the cloud based data such as test results and next physician bookings.  
2. Utilization of platform as a service utility such as Amazon’s SageMaker to design and develop and engineer deep learning algorithms that allow artificial intelligence programs and robots to be used in medicine in fields such as radiology and pathology.
3. The platform as a service offers the health facility an online platform for the creation, analysis and design of 3D medical components and technologies such as organ 3D design and printing, advertisements and educational animations.

In reference to (Jackson et al 2010), Infrastructure as-a-service gives the customer the most control over the cloud resources. This infrastructure comprises of the accumulation of equipment and programming that empowers the five fundamental qualities of distributed computing. These attributes are:

On-request self-service

Pooling of resources

Wide access to the network

Quick and high flexibility

Ability to measure the quality and quantity of service

Infrastructure is made up of both the physical machines like servers, and reflection layers like virtual machines.

The solution for cloud computing in healthcare is the platform as a service model. This is because, even though each one of these cloud service models offers a different layer of accessibility and functions, for a health facility or ministry of health with a hybrid architecture of cloud services the PaaS model offered all the required functionality, (Hayes 2008). While some facilities such as accountable care organizations can absolutely get by with just SaaS, it’s imperative not to settle on a choice in light of cost over the amount of services provided. IaaS model solution will be costlier than PaaS or SaaS models, however in the event that the need is there for a healthcare delivery organization to control cloud security and capacity with its own huge employee base of IT administrators, then IaaS would have been the model of choice, (Buyya et al 2009).

The critical path:

The critical path is used to generate the longest time that the project can take. It is used to generate the possible resource stress points for the project.

The Gantts chart project schedule is:

Task	June	July	August	September	October
1st to 15th	16th to 30th
Cloud computing in healthcare.	From beginning to completion.
Recruitment of personnel and the team project.
1.1 application
1.2. interviews
1.3. appointment
Collection of requirements
2.1. advertisement of tenders
2.2. selection of companies
2.3. delivery of equipment.
Platform as a service design, core configuration.
1.1. MEDIGATE design.
1.2. Custom apps design, code and run.
1.3. Core configuration
Testing and deployment.
4.1. stuff education
4.2. stuff testing
4.3  client testing and evaluation
4.4. launch.

stakeholder

Stage.	Role.
Business Sponsor	Tendering	Financing
Project/Program Manager	Completion.	Supervision.
Government Project Officer	Completion	Inspection.
System Developer or System Maintainer	Tendering Configuration. testing	Designing and algorithms coding and deployment
Quality Assurance Manager	Testing	Quality assurance.
Configuration Management Manager	Configuration.	Deployment and testing.
Security Officer	Completion.	Security.
Database Administrator	Configuration. Testing Completion	Database management Back up. Repair and maintenance
Site Implementation Representative	Completion.	Deployment
IV&V Representative	Completion.	Competency and testing.

Ownership; the government and the health facility are the owner of the data and information contained in the server’s storage system and cloud components.

Access to data: the government and the health facility can access and retrieve the data at their own will.  Client has the right to access the data, retrieve the data at any time or in case of emergency. The government and the health facility has the sole discrete to deny or allow access to any individual’s request to access the data on the cloud service, (Varia  2010).

In the event of contract termination, the data will be retrieved with immediate effect and the data on the servers done away with. The data retrieved will be in XML format and the client be allowed the right to audit the servers and ensure no client data is still available after contract termination.

According to (Fusaro et al 2011),In the event of data breaches and unauthorized access, the cloud based service provider shall notify the client immediately and provide a full report of the incident clearly illustrating the nature, type of data compromised, the involved individual and correction efforts to prevent future breaches. The cloud service provider will be responsible for the data breaches and therefore take responsibility of all the fines and legal implications that result due to lose of private patient data.

The client’s rights to audit and inspect:

1. The client has every right to review and audit the system provided by the cloud provider in terms of security and use exploitation tools to test the vulnerability of the security set up.
2. The client has the right to contract a 3^rdparty firm to do an audit of the cloud in their own time basis and schedules.

• The client, if so wishes, has the right to view the infrastructure and security protocols in written formats.

1. The client has the right to audit the performance of the cloud provider as well as inspect the service quality statistics.

Outsourced services, the client MUST inform the client, the government and the health facility, of any outside sources of functions and the provider thus remains solely responsible for all the functions despite the outsourced functions.   

The client, that is the government and the health facility, can terminate the contract of service provision at will without facing any penalties of fines. However, the cloud service provider will have to give a 90 day before termination of service, (Newcombe et al 2015).

In case of that unfortunate event that the provider is going out business, the provider has to give an at least 30-day period to the client before service discontinuation

Conclusion.

The project is expected to solve the pain points in health care provision.

The expected benefits are:

Reduced cost of health care delivery and increased revenue generation of the health facility.

The government will observe a more accurate and efficient utilization of the tax payers’ money in improving the provision of health care.

The patients will easily access medical care with more guarantee to quality and efficient health care made possible by allocation of primary physicians and allow remote medical access through teleconferencing, video callings and chats.

Cloud computing will improve administrative functions of the facility and the government through the responsible ministry via increasing the throughput of the executives and the leadership.

To foresee a successful project, a buy-in culture is established from all the levels of the organization including volunteers and internal resources, barriers need to be directly faced and challenged and the benefits of the design and co-creation should be celebrated in an all-round manner

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