1. Cloud Computing applications for eHealth
Óscar Barba Manzano, Héctor Martín García
Abstract— Cloud Computing solves some Cloud Computing is structured as an
problems of traditional computing but it also architecture with layers. It can be thought as a
carries some risks in safety and privacy. Its use in collection of services and each layer tries to
eHealth can be pretty useful in order to have
offer one of the services. We can found these
lower integration costs, optimizing resources and
making a widely medical system. Some solutions layers:
of Cloud Computing applications for eHealth are - SaaS (Software as a Service): It is the upper
DACAR, Practice Fusion and Athenahealth. layer of the stack and it allows users to run
applications from the cloud.
Keywords— Cloud Computing, eHealth, DACAR, - PaaS (Platform as a Service): This layer is
Practice Fusion, Athenahealth. in charge of implementing the security systems.
I. INTRODUCTION
It provides an operative system for the
applications which are implemented on the
In the last few years, new technologies have cloud.
been appeared and developed so the concept - IaaS (Infrastructure as a Service): It offers
Cloud Computing has emerged. computation resources and storage as a service.
Cloud Computing is the use of computing The aim of this layer is similar to the PaaS but it
resources which are delivered as a service over a is referred to the hardware.
network and has become a significant - Virtualization: It is not a layer indeed, but
technology trend nowadays so there are many the data virtualization in really important in
applications that are based on it. order that the other layers work properly.
Healthcare can be one of them and the use of -dSaaS (data Storage as a Service): It is the
Cloud Computing can bring some benefits not lower layer of the stack and it is formed by the
only for patients but also for hospitals and servers of the network. It provides the storage
healthcare institutions. Reducing costs is really used by the client and the bandwidth required
important nowadays with the actual situation of for the storage.
economic crisis; the quality of the attention can In Fig. 1 we can see the stack organization
also be increased due to the possibility of and how the different layers require from the
collaboration between doctors and hospitals lower layer to provide its service. It can be read
using Cloud Computing networks. also in [1].
This article contains a brief summary of how
Cloud Computing works, how it can be used in Application
eHealth system with the benefits and risks and SaaS
some solutions of this application.
Platform
II. BACKGROUND PaaS
A. Cloud Computing
Infrastructure
First of all, we are going to see what Cloud IaaS
Computing is and which its features are.
Cloud Computing is a model for enabling
widely configurable computing resources over a Virtualization
network, usually the Internet. The main
difference between other computer paradigms
and this one is that Cloud Computing might Servers and Storage
dSaaS
offer infinite power and capacity.
As it is said in [1] it grows as the solution for
some problems related with traditional ways of
computing, which are mainly three, the storage, Fig. 1. Layered architecture of Cloud Computing (extracted
the bandwidth and the security. form [2])

2. In order to understand how Cloud Computing number of electronic fields stored in their
works we are going to pay attention to Fig. 2, systems is increasing, so moving them to [5]the
where we can observe the typical structure of a cloud seems to be a good idea. On the other
Cloud Computing network. It consists of servers hand, despite the fact that there are some
where clients connect to use the applications, benefits to moving to a cloud system, there are
disks arrays in order to provide storage and a also some risks that have to be taken into
control/metadata path that makes all the system account because they are related with the
work properly. All of the elements are privacy and the safety of the net.
connected between themselves and to the Taking a look to the benefits, the most
clients, mainly by an Internet connection. important one[3] is the benefit of the cloud for
the Quality of Service of the patient. With
Cloud Computing, collaboration between
doctors and hospitals is made easier. In
addition, costs for the organizations are widely
reduced by adopting the cloud model. This
model made the organization pay for what they
use.
Nevertheless, observing the risks, the first
one which comes to mind is security. Healthcare
documents contain very valuable information
about patients and privacy should be respected.
This challenge can cause the distrust of the
population. Lots of companies are working on
this issue, as we can see in [5].
III. CLOUD COMPUTING
Fig. 2. The architecture of Cloud Computing (extracted from SOLUTIONS FOR E-HEALTH
[3])[4]
A. Data Capture and Auto Identification
Reference Project [DACAR]
B. Cloud Computing in e-Health This project was funded in October 2009 by
the Technology Strategy Board (TSB). The aim
Once we have seen the features of Cloud
of this project was create a highly secure, “in
Computing and before studying different
the cloud” infrastructure for storage and
solutions which involve the use of it we are
viewing of healthcare data[6].
going to show the reasons why it is used in e-
Cloud Systems are divided into three
Health, a term that defines the healthcare data
categories: Public Clouds, private Clouds and
exchanging through the Internet.
hybrid Clouds [2]. Looking for guaranteeing the
By using Cloud Computing many problems
data privacy, DACAR uses a private Cloud for
in healthcare can be solved, such as integration
data storage and a hybrid Cloud for hosting
costs, optimizing resources and ushering in new
service instances.
era innovations, as it is said in [4].
With the technological improvement,
hospitals and other healthcare organizations the
Fig. 3. Work flow (extracted from [ENLACE 8])

3. The eHealth service is developed in DACAR
in five steps, as we can see in Fig. 3 [7]. First of C. Athenahealth
all, users has to be identified by an username
Athenahealth [10] is a company which is
and a password. Immediately after, the client
trying to extend the world of Cloud Computing
software forwards this information to the
to the health services. Because of that, they have
responsible Single Point of Contact (SPoC) with
developed four platforms: athenaClinicals,
the service request. Then the SPoC checks it and
athenaCollector, athenaComunicator and
decide if the user is able to use the service
athenaCoordinator.
required. If it is allowed, the SPoC creates a
First of all, we are going to study
Service Ticket; however, if it is not permitted, it
athenaClinicals. It is a web-based HER designed
sends a message with the reason of the error.
to overcome the limits of a traditional HER. It is
The last step is the use of the service by the
a pay-for-Performance program, so the costs
user.
related to the use of it will be less than those
Another issue related to this project was the
who would be if a traditional system were used.
secure integration of smart devices related to the
It is based in the Patient Centered Medical
health care.
Home (PCMH) model in order to reduce the
DACAR uses Radio Frequence Identification
time to focus on patients care without reducing
(RFID) for data capture. RFID is used not only
the quality of the assistance.
for data storage but also for gathering
AtheneaCollector is a tool that tries to help
information from the environment.
doctors with the billing operations; it maintains
B. Practice Fusion the hospital joined to medical providers. In
It was awarded the most valued Electronic order to make administrative tasks easier,
Health Record (EHR) in Customer Satisfaction athenahealth has developed a tool called
in 2011. Practice Fusion provides a free, web- athenaComunicator; it will advertise you if you
based HER system to primary care physicians have an appointment scheduled.
[8]. Here is where we find the first thing that
surprises to us. A health feature which has no Finally, athenaCoordinator is a cloud-based
costs at all, it includes some advertisements in care coordinator. It is really useful not only for
the program which not interfere with the big hospitals, because they have to manage a lot
workflow. However, a paid advertisements-free of works involving a lot of doctors and people
version is available if it is required. working for the hospital, but also for medical
Secondly, we can use it without the necessity practices in sending patients to different
of using our own computer, it is web-based, and hospitals depending on their necessities.
so it is directly available by using a computer
with internet connection. The security of the IV. METHODOLOGY
connection is ensured with Fortune 500-level First at all we have been searching
infrastructure guaranteeing constant availability. information about Cloud Computing in order to
The users’ privacy data is a crucial issue. The understand what it is it, how it works and what
data centers of the organization have biometric benefits and risks bring its use.
security, data back-ups, redundant power Afterwards we have been looking for
supplies, continuous surveillance systems and different solutions of Cloud Computing in
so on. eHealth in Technical articles and websites, then
It includes the possibility of schedule the after collecting the information and analyze it,
visits to the doctor, and its calendar will we decided to show 3 examples and how them
advertise us if we have an appointment with a work.
doctor. Other interesting feature included is the Finally we made and scheme with all the
e-Prescribing [9]. It includes not only these two information chosen and started to write this
features but also medical charting, referral article.
letters and so on.

4. V. CONCLUSION, RESULTS AND
DISCUSSION
Cloud Computing has a lot of benefits in not
only solving problems related with storage and
bandwidth but also in eHealth solutions, for
instance in integration costs and optimizing
resources. That is why it is becoming to be a
significant technology trend nowadays.
However, it carries also some risks mainly in
safety and privacy terms. Lots of companies are
currently trying to fix these problems and when
we gets over them, there will not be any distrust
from the population to its use in eHealth widely.
Using Cloud Computing collaboration between
doctors and hospitals is easier and has a lower
cost.
Apart from work in improving security, it is
very important the proposing and use of
common standards in these platforms in order to
its use widely so any hospital can share data and
the implementation of a global eHealth system
that could pretty useful for the patients.
VI. GREETINGS
We would like to express our gratitude to the
teacher of this subject Isabel de la Torre Díez
for all the amount of information that she has
given to us; to Joaquín Guerra de la Corte
because he informed us about the subject in
order to enroll it; and also to Inés Marbán
Bolaños for helping us with the writing.
VII. REFERENCES
[1] I.de la Torre-Díez, F. J. Díaz-Pernas, G.Fernández,
M.Antón-Rodríguez, M.Martínez-Zarzuela,
D.González-Ortega, D. Boto-Giralda, “Analysis of the
benefits and constraints for theimplementation of
Cloud Computing over an EHRs system”.
[2] B. Furht, “Handbook of Cloud Computing” Chapter 1.
2010.
[3] F. G. Lejiang Guo, X. T. Li Chen, “The Building of
Cloud Computing Environment for E-Health” in 2010
International Conference on E-Health Networking,
Digital Ecosystems and Technologies.
[4] Sanjay P. Ahuja, Sindhu Mani1 & Jesus Zambrano, “A
Survey of the State of Cloud Computing in
Healthcare” in 2012.
[5] Sthepen Allen, “Cloud Computing and Health Care
Security” in 2011.
[6] Alan Bennett, “Data Capture and Auto Identification
Reference Project [DACAR]” in 2010.
[7] L. Fan, W. Buchanan, C. Th¨ummler,O. Lo, A.
Khedim, O. Uthmani, A. Lawson, D.Bell, “DACAR
Platform for eHealth Services Cloud” in 2011.
[8] Practice fusion “http://www.practicefusion.com”.
[9] The Center for Improving Medication Management
“Clinician’s Guide to e-Prescribing” in 2011.
[10] Athenahealth “www.athenahealth.com”.