A Cloud Computing Solution for Hospital Information System

Chenghao He, Xi Jin, Zhanxiang Zhao, Tian Xiang

Department of Physics University of Science and Technology of China

Hefei, Anhui Province, China E-mail: hech@mail.ustc.edu.cn

Abstract-Existing Hospital Information System (HIS) is only

shared within separated hospitals or districts, which resulted

in high construction costs and waste of resources, especially for

small township hospitals and other health care systems which

are incapable to set up an independent information platform. We propose a solution to simplify this construction by using

network module attached to existing systems that are

connected within the hospitals. The proposal is based on the

concepts of cloud computing so the information sharing and

high-end processing is available in the "cloud". Furthermore,

existing medical equipments can be rebuilt to be more efficient and low-cost as medical terminal units.

Keywords-cloud computing;hospital information system

1. INTRODUCTION

Hospital Information System(HIS) refers to the computer system which is applied in medical information management and online operations. It covers all the hospital services and business[1,2]. General HIS also concludes Laboratory Information System(LIS), Radiology Information System (RIS), Ultrasound Information System(UIS) etc. The standard HIS framework based on DICOM protocol is as Fig. 1.

HIS construction in China relates to various aspects of hospital affairs like digital acquisition, storage, management and transport of medical information. So far, the Computer­based Patient Records(CPR), Picture Archiving and Communication System(PACS) and other advanced technologies have been widely adopted[3,4]' However, we

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should also realize that the late start, weakness of technology and lack of funds make the HIS not as successful as in other industries. Especially in township hospital, there have more problems[ 5].

In order to reduce the difficulty of HIS construction and maintenance, information sharing is realized to be important. In the framework of Fig. 1, there is interface for connecting internet. But as lack of proper technology to realize an effective and safe connection, hospitals have been established HIS system independently. Except the high-cost of construction and management, it cannot supply satisfactory information sharing. Though there is province begins to establish a uniform medical archives[6], but it's still hard to expand and unable to solve the repeat construction. All these problems are expecting to be worked out, which relies on innovation and improvement of the overall structure of HIS.

II. MOTIVATION

Traditional HIS construction serves to independent hospitals, so from the first HELP system at LDS Hospital [7], to recent HIS in Peking University ShenZhen Hospital [8], the following questions are hard to avoid.

A. Problems of Traditional HIS

1) Lack of uniform standards for data-sharing HIS is realized and widely applied based on Computer­

based Patient Records(CPR); but before carrying out CPR system, it is most important to work out the problem such as the data storage and transmission standards. Unified format and content of data storage are the basis for communication between systems. Since the patients would not seek treatment in a fixed hospital, and in the present case of hospitals with independent information systems, it can cause information non-recognition and incompatibility between information systems during the referral process of the CPR.

At the same time, within hospital there are a large number of medical equipment such as ultrasound, CT, radiology equipment, monitoring equipment, anesthesia equipment etc., producing a large number of data of different storage forms and encoding methods. Information classification and data standards are not of strictly uniform. Although there are interfaces among different systems, it is very difficult to realize the integration between various subsystems. Therefore it directly causes the information unable to be shared effectively among different hospitals,

even between different departments in the same hospital, thus resulting in duplication and waste of resources.

2) High cost for independent construction It costs much for any hospital to set up a complete

platform combining all aspects such as hardware, software, management, maintenance, for the existing HIS construction. Township hospitals in particular, are neither possible n�r necessary to establish a set of independent system, but It bears the important burden to provide medical services to rural residents.

Even for medium and large hospitals, the independent construction of HIS is a heavy burden, such as the construction for Picture Archiving and Communication System (P ACS). From the short term, P ACS framework could not save medical costs but increase the burden of hospital expenditures. Thus the hospitals with not abundant capital prefer to continue using film and paper materials to record the clinic information.

3) Difficult to Management, Upgrades and Maintenance Separate HIS requires separate management and

maintenance for hospitals. With the problems arising during operation, such as technical shortage, incorrect use of software, or lack of experts, the management and maintenance of HIS requires continuous investment, which is a great cost to hospitals.

Besides, different scale or specialized hospitals produce kinds of individual needs for HIS. The request for upgrade also comes up in usage. But independent HIS requires the maintenance and upgrade separately to progress in each hospital, thus a lot of HIS can not get proper technical services[9].

B. Related Works

To solve these problems, the key is to realize sharing of software, hardware and medical data. There is some related works that envision similar solutions.

• The work in [6] introduces that Fujian province has started to establish a unified medical archive by the Department of Health. It is estimated to cover many hospitals to achieve their CPR, prescriptions, medical advices, inspection findings and other information sharing.

• The work in [10] proposes a HIS constructed on the technology and method of XML application. It can realize integration and sharing of information between hospitals and other departments.

But based on the traditional database technology, it's hard to expand with above frameworks. Also the maintenance and management is unsatisfactory. A suitable framework needs to be found. Cloud computing is a new network application model. And it has spacious room for development in hospital information areas for its flexible and extensible.

III. CLOUD COMPUTING

A. Development

Proposed in recent years, cloud computing is an innovative model of network and being promoted by

518

Figure 2. The cloud

Amazon, Google, IBM, Microsoft, Yahoo and other large companies. Narrow cloud computing is the delivery and usage pattern of IT infrastructure, to demand the resources with expanded necessaries and facilities by network. A broader sense of cloud computing extend this network model to any service[1l-14].

Google is now the largest user of cloud computing with its search engine built on more than one million servers in the distribution of more than 200 locations; Amazon's Elastic Compute Cloud (EC2) and Simple Storage Service (S3) provide services mainly for enterprises; IBM's "Blue Clo�d" computing platform, provides an open cloud computmg system for customers with buy-to-use cloud platform;

. at the

same time, including Microsoft, many large companIes are actively expanding the field of cloud computing.

B. Cloud in Medical Affairs

Cloud computing model provides a new way to solve foregoing problems. Some studies have been performed recently in an attempt to employ Cloud method in medical affairs.

• The work in [15] presents the issues MIA (Medical Imaging Analysis) researchers and clinicians deal with and proposed a new framework based on cloud computing concept for cancer imaging research. Though it's not exactly focus on hospital affairs, the difficulties in processing medical information and potentials of cloud computing are analyzed in detail.

• Moreover, the work in [16] proposes cloud method to patient's data gathering. It can automate the process from bedside data collection to information distribution and remote access by medical staff. This work shows how cloud computing works in hospital affairs and suggests further development in HIS.

IV. PROPOSAL

Our proposal is a system to share the information of different hospitals via virtual private network (VPN) and public Internet access. Fig.3 is the proposed construction of cloud-based HIS. The health department establishes the private cloud to store and manage important information such as computer-based patient records, etc. While other data of normal management and business can be put into commercial cloud server.

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Figure 3. Construction of cloud-based HIS

This framework is easy to realize by adding a network module or control center just attached to existing systems. The network module is to connect within the cloud, and can use the resources in cloud to achieve hardware, software and data-storage according to the need. Using this method to optimize and reduce existing HIS gradually, thus obtains adjustable flexible structure.

It's very affordable to use cloud computing in medical IT services, many hospitals can share the infrastructure formed by connecting large number of systems together, thus the hospitals can become more efficient, and construction costs can be reduced. At small hospitals like township hospitals, most business can be processed within the cloud, so as to get rid of the heavy burden of complete construction and management. They only need to complete the patients' information collection and result display, the others that including management, storage, maintenance, and even disease diagnosis can be achieved in the central servers. Also large hospitals reduce its costs from this flexible and extensible framework.

There are several practical advantages in this implementation, such as:

• Reduce the costs: Using cloud computing technology, hospitals can get the services provided by millions of servers in the cloud but pay a little, then higher efficiency, lower cost can be achieved. Compared with spending lots of money to buy a dedicated server, using cloud services is clearly more cost-effective.

• Flexible and extensible framework: The cloud framework supports heterogeneous equipments and alterable system scale. Small hospitals can first set up a simple system with necessary component. As the hospital becomes bigger and bigger, it can easily scale up the cloud in a short time[17].

• Better information sharing: Through the cloud model, the health and medical institutions can work together to build information-sharing space of medical

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resources. This can share infrastructure without having to update the related hardware, reduce costs while efficiency is greatly enhanced.

• Reduce maintenance expenses: The user terminal architecture is unlimited in cloud computing model, therefore, the technical staffs do not have to pay much attention to upgrading the hospital hardware, while the daily maintenance of the server is also provided by the cloud service provider, and thus they have more time to undertake other work .

• Reliable operation of the server: The data of hospital daily business are concentrated in the server in the present hospital information systems, so the hospital cannot work normally once a server failure occurs; seriously key data will be lost in extreme cases. The cloud computing model can quickly copy data in the failed server to another server, and start the new server to provide services, that obtains real continuous security services.

• Further application prospects: Meanwhile, in the cloud computing model, experienced major hospital doctors can help diagnose patients of rural hospitals directly by collected patients' condition, images and other data, because of the unified data storage and sharing, we can even implement electronic disease diagnosis based on powerful cloud computing[6].

V. CLOUD-BASED MEDICAL DEVICES DESIGN

To set up a cloud-based terminal hospital system, besides applying existing system to upgrade, the best approach is to develop new medical equipment, including image acquisition equipment, monitoring equipment, management equipment, etc. As only to complete terminal mission, other tasks including video processing, data storage, etc. can be placed in the cloud, it greatly reduces the equipment cost and maintenance difficulties. The following will make briefly introduction on the cloud-based image acquisition devices.

Medical image is an important means of clinical diagnosis and medical science, also applied for the Picture Archiving and Communication System (P ACS). Medical image acquisition devices are mainly including X-ray, magnetic resonance, ultrasound, CT, which are in different physical principles to realize the imaging methods for non­intervention of the human internal organs, tissues, blood and others.

Traditional digital image data acquisition device should not only complete digital image formation and acquisition, but also image processing and data storage. A number of high-end applications, such as three-dimensional ultrasound imaging, speckle noise attenuation are achieved through equipment upgrades. However, with the cloud model, the device can be simplified accordingly, so that it just requests to complete the front end of data collection and video images formation, then by a compatible data format of standard DICOM, and through the network module directly to the central servers of cloud; then receiving the processed real­time image and display. FigA shows the basic block diagram of cloud-based medical image acquisition equipment.

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VI. CONCLUSION

This article describes the HIS based on cloud computing which realizes the flexible, extensible and practicable framework by regarding all the hardware, software and data of hospitals as resources acquirable from the cloud. It has not only significantly reduces the construction cost and provides wide medical application for village and town hospitals, but can realize the information sharing and effective use of resources to the greatest extent. Meanwhile, it reduces hospital operating costs and significantly improves operating efficiency. The infrastructure of "cloud" contributes to help hospitals save the time and efforts required for IT systems.

Moreover, we suggest further applications of this architecture such as the construction of Health Information System. And based on the new platform and depending on powerful servers, it can be realized of the medical images to be automated diagnosed. Besides, cloud Infrastructure not only makes updating and application of new technologies simpler, but also can be the unified base for hospital system construction.

REFERENCES

[1) Pietka. E, "Large-scale hospital information system in clinical practice," Cars 2003: Computer Assisted Radiology and Surgery, Proceedings, vol. 1256, Jun. 2003, pp. 843-848, doi: 1O.1016/S0531-5131 (03)00458-8.

520

[2) Zhanjun, C. and M. Song, et al. "Realization of integration and working procedure on digital hospital information system," Computer Standards & Interfaces, vol. 25, Sep. 2003, pp. 529-537, doi: 10.1016 IS0920-5489(03)00017-5.

[3] Hu, D. P., Xu, W. G.,Shen, H. Z. and Li, M. Y., "Study on information system of health care services management in hospital," Proc. IEEE Symp. 2005 International Conference on Services Systems and Services Management, IEEE Press, Jun. 2005, pp. 1498-1501, doi: 10.1109/ICSSSM.2005.1500249.

[4) Li, 8. and T. Liu "The design and implementation of a hospital management information system for Peking Union Medical College Hospital," Proceedings of the Sixth Conference on Medical Informatics, Oct. 1989.

[5) Wang, X. and Dang, J., "Informatization of distant medium-small hospital," Chinese Medical Equipment Journal, vol. 31, May. 2010, pp. 104-105.

[6] Wang, J. W., Sun W., Ye, X. and Chen. S. T., "Construction of citizen healthy information system in Xiamen," Medical Information, vol. 18, May. 2005.

[7) Reed, M. Gardner, T. Allan Pryor and Homer R. Warner, "The HELP hospital information system: update 1998," International Journal of Medical Informatics, vol. 54, Jun. 1998, pp. 169-182.

[8] Chen, C. T., Lu, Z. X. and Sun, C. 8., "Exploration in constructing digital hospital," Chin J Hosp Admin, vol. 23, Jan. 2007, pp. 47-50.

[9] Hu, W. 8., Hou, X. P. and Zang, C. G., "Study on and realization of hospital information integration based on XML," Journal of Huaihai Institute of Technology (Natural Science Edition), vol. 17, Sep. 2008, pp. 36-39.

[10] Waldrop, M., "Data center in a box - A shipping container stuffed with servers could usher in the era of cloud computing," Scientific American, vol. 297, Aug. 2007, pp. 90-93.

[II) Sakamoto, N. "Availability of software services for a hospital information system," International Journal of Medical Informatics, vol. 49, Mar. 1998, pp. 89-96.

[12] Weiss, A., "COMPUTING IN THE CLOUDS," NetWorker, vol. II, Dec. 2007, pp. 16-25.

[13] Milojicic, D., "Cloud computing - Interview with Russ Daniels and Franco Travostino," Ieee Internet Computing, vol. 12, Sep 2008, pp. 7-9.

(14) Kim, W., "Cloud computing: Today and tomorrow," Journal of Object Technology, vol 8, Jan.-Feb. 2009, pp. 65-72.

(15) Tsumoto, S. and Hirano, S., "Data mining in hospital information system for hospital management," 2009 Icme International Conference on Complex Medical Management, pp. 109-113.

[16] Rolim, C. 0., Koch, F. L., Westphall, C. 8., Werner, 1., Fracalossi, A. and Salvador, G. S., "A cloud computing solution for patient's data collection in health care institutions," Proc. IEEE Symp. 2010 Second International Conference on Health, Telemedicine, and Social Medicine, IEEE Press, Feb. 2010, pp. 95-99, doi: 10.11 09/eTELEMED.201 O. I 9.

(17) Sun Microsystems Inc. 'Take your business to a higher level", 2009.