Abstract— Cloud Computing solves some

problems of traditional computing but it also

carries some risks in safety and privacy. Its use in

eHealth can be pretty useful in order to have

lower integration costs, optimizing resources and

making a widely medical system. Some solutions

of Cloud Computing applications for eHealth are

DACAR, Practice Fusion and Athenahealth. Keywords— Cloud Computing, eHealth, DACAR,

Practice Fusion, Athenahealth.

I. INTRODUCTION

In the last few years, new technologies have

been appeared and developed so the concept

Cloud Computing has emerged.

Cloud Computing is the use of computing

resources which are delivered as a service over a

network and has become a significant

technology trend nowadays so there are many

applications that are based on it.

Healthcare can be one of them and the use of

Cloud Computing can bring some benefits not

only for patients but also for hospitals and

healthcare institutions. Reducing costs is really

important nowadays with the actual situation of

economic crisis; the quality of the attention can

also be increased due to the possibility of

collaboration between doctors and hospitals

using Cloud Computing networks.

This article contains a brief summary of how

Cloud Computing works, how it can be used in

eHealth system with the benefits and risks and

some solutions of this application.

II. BACKGROUND

A. Cloud Computing

First of all, we are going to see what Cloud

Computing is and which its features are.

Cloud Computing is a model for enabling

widely configurable computing resources over a

network, usually the Internet. The main

difference between other computer paradigms

and this one is that Cloud Computing might

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,

the bandwidth and the security.

Cloud Computing is structured as an

architecture with layers. It can be thought as a

collection of services and each layer tries to

offer one of the services. We can found these

layers:

- SaaS (Software as a Service): It is the upper

layer of the stack and it allows users to run

applications from the cloud.

- PaaS (Platform as a Service): This layer is

in charge of implementing the security systems.

It provides an operative system for the

applications which are implemented on the

cloud.

- IaaS (Infrastructure as a Service): It offers

computation resources and storage as a service.

The aim of this layer is similar to the PaaS but it

is referred to the hardware.

- Virtualization: It is not a layer indeed, but

the data virtualization in really important in

order that the other layers work properly.

-dSaaS (data Storage as a Service): It is the

lower layer of the stack and it is formed by the

servers of the network. It provides the storage

used by the client and the bandwidth required

for the storage.

In Fig. 1 we can see the stack organization

and how the different layers require from the

lower layer to provide its service. It can be read

also in [1].

Application

SaaS

Platform

PaaS

Infrastructure

IaaS

Virtualization

Servers and Storage

dSaaS

Fig. 1. Layered architecture of Cloud Computing (extracted form [2])

Cloud Computing applications for eHealth

Óscar Barba Manzano, Héctor Martín García

In order to understand how Cloud Computing

works we are going to pay attention to Fig. 2,

where we can observe the typical structure of a

Cloud Computing network. It consists of servers

where clients connect to use the applications,

disks arrays in order to provide storage and a

control/metadata path that makes all the system

work properly. All of the elements are

connected between themselves and to the

clients, mainly by an Internet connection.

Fig. 2. The architecture of Cloud Computing (extracted from

[3])[4]

B. Cloud Computing in e-Health

Once we have seen the features of Cloud

Computing and before studying different

solutions which involve the use of it we are

going to show the reasons why it is used in e-

Health, a term that defines the healthcare data

exchanging through the Internet.

By using Cloud Computing many problems

in healthcare can be solved, such as integration

costs, optimizing resources and ushering in new

era innovations, as it is said in [4].

With the technological improvement,

hospitals and other healthcare organizations the

number of electronic fields stored in their

systems is increasing, so moving them to [5]the

cloud seems to be a good idea. On the other

hand, despite the fact that there are some

benefits to moving to a cloud system, there are

also some risks that have to be taken into

account because they are related with the

privacy and the safety of the net.

Taking a look to the benefits, the most

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

SOLUTIONS FOR E-HEALTH

A. Data Capture and Auto Identification Reference Project [DACAR]

This project was funded in October 2009 by

the Technology Strategy Board (TSB). The aim

of this project was create a highly secure, “in

the cloud” infrastructure for storage and

viewing of healthcare data[6].

Cloud Systems are divided into three

categories: Public Clouds, private Clouds and

hybrid Clouds [2]. Looking for guaranteeing the

data privacy, DACAR uses a private Cloud for

data storage and a hybrid Cloud for hosting

service instances.

Fig. 3. Work flow (extracted from [ENLACE 8])

The eHealth service is developed in DACAR

in five steps, as we can see in Fig. 3 [7]. First of

all, users has to be identified by an username

and a password. Immediately after, the client

software forwards this information to the

responsible Single Point of Contact (SPoC) with

the service request. Then the SPoC checks it and

decide if the user is able to use the service

required. If it is allowed, the SPoC creates a

Service Ticket; however, if it is not permitted, it

sends a message with the reason of the error.

The last step is the use of the service by the

user.

Another issue related to this project was the

secure integration of smart devices related to the

health care.

DACAR uses Radio Frequence Identification

(RFID) for data capture. RFID is used not only

for data storage but also for gathering

information from the environment.

B. Practice Fusion

It was awarded the most valued Electronic

Health Record (EHR) in Customer Satisfaction

in 2011. Practice Fusion provides a free, web-

based HER system to primary care physicians

[8]. Here is where we find the first thing that

surprises to us. A health feature which has no

costs at all, it includes some advertisements in

the program which not interfere with the

workflow. However, a paid advertisements-free

version is available if it is required.

Secondly, we can use it without the necessity

of using our own computer, it is web-based, and

so it is directly available by using a computer

with internet connection. The security of the

connection is ensured with Fortune 500-level

infrastructure guaranteeing constant availability.

The users’ privacy data is a crucial issue. The

data centers of the organization have biometric

security, data back-ups, redundant power

supplies, continuous surveillance systems and

so on.

It includes the possibility of schedule the

visits to the doctor, and its calendar will

advertise us if we have an appointment with a

doctor. Other interesting feature included is the

e-Prescribing [9]. It includes not only these two

features but also medical charting, referral

letters and so on.

C. Athenahealth

Athenahealth [10] is a company which is

trying to extend the world of Cloud Computing

to the health services. Because of that, they have

developed four platforms: athenaClinicals,

athenaCollector, athenaComunicator and

athenaCoordinator.

First of all, we are going to study

athenaClinicals. It is a web-based HER designed

to overcome the limits of a traditional HER. It is

a pay-for-Performance program, so the costs

related to the use of it will be less than those

who would be if a traditional system were used.

It is based in the Patient Centered Medical

Home (PCMH) model in order to reduce the

time to focus on patients care without reducing

the quality of the assistance.

AtheneaCollector is a tool that tries to help

doctors with the billing operations; it maintains

the hospital joined to medical providers. In

order to make administrative tasks easier,

athenahealth has developed a tool called

athenaComunicator; it will advertise you if you

have an appointment scheduled.

Finally, athenaCoordinator is a cloud-based

care coordinator. It is really useful not only for

big hospitals, because they have to manage a lot

of works involving a lot of doctors and people

working for the hospital, but also for medical

practices in sending patients to different

hospitals depending on their necessities.

IV. METHODOLOGY

First at all we have been searching

information about Cloud Computing in order to

understand what it is it, how it works and what

benefits and risks bring its use.

Afterwards we have been looking for

different solutions of Cloud Computing in

eHealth in Technical articles and websites, then

after collecting the information and analyze it,

we decided to show 3 examples and how them

work.

Finally we made and scheme with all the

information chosen and started to write this

article.

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”.