File Name: cloud computing networking and communication challenges .zip
The future is in the cloud.
Cloud computing is a new way of delivering computing resources and services. Many managers and experts believe that it can improve health care services, benefit health care research, and change the face of health information technology. However, as 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 4 aspects management, technology, security, and legal to evaluate the opportunities and challenges of this computing model.
Strategic planning that could be used by a health organization to determine its direction, strategy, and resource allocation when it has decided to migrate from traditional to cloud-based health services is also discussed.
Cloud computing refers to an on-demand, self-service Internet infrastructure that enables the user to access computing resources anytime from anywhere [ 1 ]. It is a new model of delivering computing resources, not a new technology. Examples of commonly used non-health care applications include Microsoft Hotmail and Google Docs, while some better known applications in health care include Microsoft HealthVault and Google Health platform recently discontinued [ 2 ].
However, compared with conventional computing, this model provides three new advantages: massive computing resources available on demand, elimination of an up-front commitment by users, and payment for use on a short-term basis as needed [ 3 ].
Several articles, forums, and blogs have reported its applications in industry, business, transportation, education, and national security [ 4 - 7 ]. Health care, as with any other service operation, requires continuous and systematic innovation in order to remain cost effective, efficient, and timely, and to provide high-quality services. Many managers and experts predict that cloud computing can improve health care services, benefit health care research, and change the face of information technology IT [ 8 - 13 ].
For example, Schweitzer [ 10 ], Haughton [ 11 ], and Kabachinski [ 12 ] believe that cloud computing can reduce electronic health record EHR startup expenses, such as hardware, software, networking, personnel, and licensing fees, and therefore will encourage its adoption.
Research 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 [ 13 ]. As indicated in the paper by Anderson et al, data-handling problems, complexity, and expensive or unavailable computational solutions to research problems are major issues in biomedical research data management and analysis [ 14 ].
Several informatics 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 management, technology, security, and legal issues to be addressed. The aim of this paper is to discuss the concept of cloud computing, its current applications in health care, the challenges and opportunities, and how to implement strategic planning when the organization has decided to move to the new model of service.
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 as well as a minimum definition containing the essential characteristics. Based on the study, they defined cloud computing as follows [ 22 ]:. These resources can be dynamically re-configured to adjust to a variable load scale , allowing also for an optimum resource utilization.
This pool of resources is typically exploited by a pay-per-use model in which guarantees are offered by the Infrastructure Provider by means of customizedService-Level Agreements. From a service point of view, cloud computing includes 3 archetypal models: software, platform, and infrastructure [ 1 , 23 - 25 ]. With PaaS, developers can build Web applications without installing any tools on their computer, and then deploy those applications without any specialized administrative skills.
The provider owns the equipment and is responsible for housing, running, and maintaining it. The user typically pays on a per-use basis.
For example, the Amazon Elastic Compute Cloud EC2 allows users to rent virtual computers on which to run their own applications. In other words, the proprietary network or the data center supplies hosted services to a certain group of people. For example, Microsoft Azure enables customers to build the foundation for a private cloud infrastructure using Windows Server and System Center family of products with the Dynamic Data Center Toolkit. In this infrastructure, an organization provides and manages some resources within its own data center and has others provided externally.
For example, IBM collaborates with Juniper Networks to provide a hybrid cloud infrastructure to enterprises to seamlessly extend their private clouds to remote servers in a secure public cloud [ 27 ].
Many previous studies reported the potential benefits of cloud computing and proposed different models or frameworks in an attempt to improve health care service [ 28 - 35 ]. The main benefits of the system are that it provides users with 7-days-a-week, real-time data collecting, eliminates manual collection work and the possibility of typing errors, and eases the deployment process [ 36 ].
Nkosi and Mekuria described a cloud computing protocol management system that provides multimedia sensor signal processing and security as a service to mobile devices.
The system 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 system with personal health record systems to provide physicians with easy and immediate access to patient data from anywhere and via almost any computing device while containing costs [ 39 ].
Numerous of articles and resources also reported the successful application of cloud computing in bioinformatics research [ 15 - 21 , 40 , 41 ]. For example, Avila-Garcia et al proposed a framework based on the cloud computing concept for colorectal cancer imaging analysis and research for clinical use [ 18 ].
Memom et al applied cloud computing to evaluate the impact of G-quadruplexes on Affymetrix arrays [ 21 ]. The Laboratory for Personalized Medicine of the Center for Biomedical Informatics at Harvard Medical School took the benefits of cloud computing to develop genetic testing models that managed to manipulate enormous amounts of data in record time [ 41 ].
Also, the use of health cloud computing is reported worldwide. The software enables regional extension centers to manage interactions with medical providers related to the selection and implementation of an EHR system [ 44 ]. Telstra and the Royal Australian College of General Practitioners announced the signing of an agreement to work together to build an eHealth cloud. Telstra is one of the leading telecommunications providers in Australia; the College is the largest general practice representative body in Australia with more than 20, members and over in its National Rural Faculty.
The eHealth cloud will host health care applications including clinical software, decision-support tools for diagnosis and management, care plans, referral tools, prescriptions, training, and other administrative and clinical services [ 45 ]. The complete lifecycle, from prescription to delivery to intake to reimbursement, will be stored in the cloud and will be accessible to patients, doctors, and pharmacy staff [ 46 ].
The forecast, conducted by Mark Beccue, suggested that the number of people subscribing to mobile cloud applications will rise from 71 million to nearly a billion by [ 49 ]. In health sectors, many organizations, managers, and experts believe that the cloud computing approach can also improve services and benefit research [ 8 - 13 ].
In addition, a report by the European Network and Information Security Agency ENISA stated that this new computing model is set to see massive global investment in many sectors, including health care [ 50 ]. As with any innovation, cloud computing should be rigorously evaluated before its widespread adoption. Few research papers have systematically studied the impact of cloud computing on health care IT in terms of its opportunities and challenges. This study reviews the literature and evaluates the opportunities and challenges from the viewpoint of management, technology, security, and legality see Table 1.
The principle advantage of cloud computing is its low cost. An organization can easily get a cost-effective and on-premise IT solution through cloud computing without the need to purchase or evaluate hardware or software, or to hire internal IT staff to maintain and service in-house infrastructure [ 20 , 41 , 51 ]. The result is that the organization can focus on critical tasks without having to incur additional costs with regard to IT staffing and training.
Also, the cloud computing approach speeds deployment while maintaining vital flexibility ie, rapid elasticity and ubiquitous access to health resources. This capability means that, as demand changes, hospitals and other health care providers do not need to adjust their infrastructures to accommodate the changes.
Trust is at the heart of the resistance that many customers have to the cloud [ 52 ]. Concerns arise when their sensitive data and mission-critical applications move to a cloud computing paradigm where providers cannot guarantee the effectiveness of their security and privacy controls [ 53 ].
Cultural resistance ie, organizational inertia to share data and change traditional ways of working is a common management challenge to adopting cloud computing. In some cases, a service level agreement may not offer a commitment to allow the client to audit its data.
In some cases, certain customer services eg, credit card transactions cannot be used [ 54 ]. Smaller hospitals, medical practices, and laboratories typically do not have internal IT staff to maintain and service in-house infrastructure for mission-critical applications such as EHRs.
Therefore, eliminating the new infrastructure cost and the IT maintenance burdens can remove many obstacles to EHR adoption [ 10 , 55 ]. For bigger health organizations, placing data storage or IT application needs in the hands of a cloud provider essentially shifts the IT management burden to a third-party provider. Also, cloud computing has advantages for so-called green computing —the more efficient use of computer resources to help the environment and promote energy saving.
While it saves on electricity, it also saves on resources required to cool off computers and other components. This reduces the emission of dangerous materials into the environment [ 56 ]. Several technical challenges related to the use of cloud computing include resource exhaustion, unpredictability of performance, data lock-in, data transfer bottlenecks, and bugs in large-scale distributed cloud systems.
Low cost and computing resources available 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 resources eg, central 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 example, they may limit access to the cloud resources, or use out-of-date hardware or software or deploy older CPU technology. Unfortunately, most cloud customers are unable to govern the virtual architecture, and the providers usually do not permit an audit by the customers.
The result is variable leading to unpredictable performance in the service [ 57 ]. Data lock-in is also an important challenge. In some cases, cloud users may have to move data or services to another provider or back to an in-house IT environment because the provider ceases business or service operations. For example, Google decided to discontinue its Google Health service on January 1, Users have a year to download their health data [ 2 ]. Unfortunately, most cloud infrastructures provide very little capability on data, application, and service interoperability [ 51 ].
This makes it difficult for a customer to migrate from one provider to another, or move data and services back to an in-house IT environment. Some cloud users eg, biomedical research laboratories may need to frequently upload to or download very large amounts of data from the cloud.
Application users may find that there is a data transfer bottleneck because of physical networking bandwidth limitation. Another specific technical risk is that of bugs in large-scale distributed cloud systems. When compared with in-house IT systems, the errors in these very large distributed infrastructures are more difficult to debug [ 51 ].
Perhaps the strongest resistance to the adoption of cloud computing in health 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 cloud providers eg, Microsoft, Google, Amazon are able to devote huge resources to solving security issues that many customers cannot afford, in contrast to the destruction of many medical records and legal documents in the Japan 9.
All kinds of security measures, such as in hardware, software, human resources, and management costs, are cheaper when implemented on a large scale. 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 ]. 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 cloud computing are separation failure, public management interface, poor encryption key management, and privilege abuse. Cloud computing is usually accessible to many different customers.
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Imagine a flower shop with twenty employees. Now, the store may have one computer and everyone could share it. In this case, everyone needs to be sure that customer records have been updated on all computers every time that a change is required.
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