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Health and Wellbeing:faster, better, broader and cheaperWhy Europe Must Reach for Cloud Computing

www.microsoft.eu/health

S|B MS cloud health 2010PRESSqrk7:d4s 25/11/10 12:32

Health and Wellbeing:faster, better, broader and cheaperWhy Europe Must Reach for Cloud Computing

A Microsoft White Paper

Co-authorsPeter Wrobel, Clarity in Science Communication, andElena Bonfiglioli, Director Corporate Citizenship, Microsoft

DesignChris Jones, Design4Science Ltd

Microsoft would like to thank the following people for theirinput into this document:

Belgian Federal Ministry of Health: Lieve Deschoolmeester,Jan EyckmansEuroRec: Jos Devlies, EuroRecMicrosoft: Julie Anderson, Lisa Boch-Andersen,Jens Dommel, Rüdiger Dorn, Vincent Dupont, Tracey Ferriss,Wendy Frodyma, Bruna Guimaraes, Mark Lange, Andre Piso,Paul Smolke, Michael Yamartino, Tanya ZnamenskayaOpen Line Consultancy: Jo Verstappen

© Microsoft Corporation 2010


1 Health and wellbeing: challenge and opportunity 4

2 What cloud computing is, and how it can help 6

3 Vital value from the cloud 10

4 Power to the people: patients and citizens 13

5 Policy recommendations 15

Contents


connectivity into a wide range of healthdevices, complemented by Internet-scaleservices, is creating a new paradigm forcomputing. As a result, a new paradigm forhealth and wellbeing is emerging. Such newways of managing information translate into animproved experience for patients, leading tobetter outcomes, more control, moreconvenience, better and broader service, andultimately better value for money.

The uptake of cloud computing in a fewhealth provider organisations in Europe hasshown impressive gains in terms of costefficiency. The challenge and the opportunityfor cloud computing is to match its ability todeliver solid cost reduction while improving thequality of care and broadening access tohealth and wellbeing services.

HEALTH AND WELLBEING: FASTER, BETTER, BROADER AND CHEAPERWhy Europe Must Reach for Cloud Computing

Europe’s policy makers know full wellwhat their challenges are. Put simply,everyone needs to do more, better, quicker,with greater involvement from theircitizens and above all do this at lower cost.

Nowhere are the challenges, the pain points,more evident than in health, where shrinkingreal budgets are set on a collision course withrising health costs and ageing populations. Inaddition, there are calls from all sides forpatients to be more involved in themanagement of their own health andwellbeing. There are requests for innovationand technology developments to be driven bypatients’ needs. Add to the mix concernsabout data security and privacy, and you havea perfect recipe for systemic stress.

In administration, as with most medicines,there is no “magic bullet”. Economicconstraints mean that everyone has to keeptheir feet firmly on the ground. And in the pastfew years a new ally has emerged: this newally is called cloud computing.

The term cloud computing describes a newway of working whereby software, computing

power, storage – a whole range ofinfrastructures and applications – reside in the“cloud”, that is to say, off your own premisesand accessed via the Internet. Instead of beinga drain on capital and human resources, cloudcomputing enables rapid, agile and cost-effective solutions.

Governments, health ministries, healthproviders – public and private alike – andpharmaceutical companies have started touse cloud computing to address a variety ofbusiness and medical challenges. We aregetting a glimpse of the benefits for physiciansas knowledge workers. As professionals, theyare increasingly getting the right data in theright format at the right time, enabling them toprovide better treatment and preventive care.

The infusion of intelligence and

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1 Challenge and opportunity in health and wellbeing

“Doctors are competing against time, andthe technology offered by Microsoft helps us

to decrease pre-surgical death rates andprolong people’s lives.”

Vladlen Vladlenovich Bazylev, Chief Doctor, PenzaFederal Center for Cardiovascular Surgery, Russia


The ability to respond more effectively topandemics provides an illustration of thebenefits of cloud computing. The cloud offeringfor disaster recovery and business continuitybuilt on the Windows Azure platform hashelped health managers to cope with themassive surges in the public demand forinformation that came with the threat from theH1N1 flu virus – with peak traffic anunexpected 365 per cent higher than theprevious day. Data replication and mirroringusing the cloud creates another layer ofprotection when it comes to managingpandemics and disaster recovery, offering newways of providing resilience, data recovery andbusiness continuity.

Let’s look at another essential aspect forhealth: collaboration. During Belgium’sPresidency of the European Union, the cloudhas been helping the Belgian Ministry of Healthto address the collaboration challenge it faced.The cloud is enabling a shared workingenvironment across national ministries ofhealth quickly and flexibly, without having toprocure and install new hardware to meetincreased capacity requirements. The sametechnology is enabling Russian doctors fromdifferent clinics to work together withprofessionals at the Penza Federal Centre forCardiovascular Surgery to get onlineconsultancy and reach a correct diagnosisfaster. And cloud computing is set to transform


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“The European Union must be an ‘InnovationUnion’, a fertile business environment whereentrepreneurship flourishes, where small ideascan grow into big breakthroughs, and where theinformation economy is the growth engine forEurope. This strategy can only be realised whenall industry players, both major or small, invest inand promote innovation and new technologies,such as cloud computing, fostering the sector’sgrowth and sharing the agenda for innovationand European success.”

José Manuel Barroso, President of the European Commission

The Swedish Red Cross (SRC) is thelargest humanitarian voluntaryorganisation in Sweden. Its workimproving conditions for people requires agreat deal of coordination across theorganisation, especially when respondingto a crisis.

Two important considerations led theSRC to adopt the cloud-based MicrosoftOnline Services offering: cost reductionand the need for reliable and up-to-datecommunication.

“We estimate that we will achieve areturn on our investment in the [migrationproject] within two years. Over the nextfive years, we estimate that we’ll besaving approximately 20 per cent inoverall costs,” says Joakim Pettersson-Winter, SRC’s Chief Technology Officer.

The SRC no longer pays SEK 250,000(€25,800) annually for the push emailservices which were not providing thelevel of functionality required in the

organisation. The changeover also freedup time for the IT department; the IT staffmember responsible for managing theprevious system now has 25 per cent ofhis time freed to spend on more strategicdevelopment projects.

Although cost reduction was one ofthe main drivers in the decision to moveto the cloud, the new system also had toimprove communication andcollaboration. “For an organisation likeours, running dispersed operations acrossthe country, Online Services enable fieldcommunications that deliverimmeasurable benefits,” says Pettersson-Winter.

The integrated cloud-based systemallows SRC to switch from their PC,laptop or mobile phone and have all theinformation at their fingertips. Since thelaunch web mail and instant messaginghas gone up by 50 per cent in theorganisation.

THE CLOUD IN ACTION – SWEDEN

Swedish Red Cross: Flexibility for a distributed workforce

the relationship between patients andhealthcare by making personal electronichealth records a practical reality.

Momentum is building around cloudscenarios applied to health and wellbeing. Butthere is still a long way to go. The cloud maybe hailed as a revolution in computing, but asfar as Europe is concerned the revolution has

so far been a quiet one, sometimes evenproceeding unnoticed. This paper looks at theexperiences of early adopters across severalcountries. We hope to stimulate moreinnovators to look at the cloud as the emergingenabling technology that can unlock Europe’spotential in health and wellbeing. We all standto gain.



The Internet has long been used as amedium for accessing and exchanginginformation. With the development of cloudcomputing the Internet has becomeradically different: a place wherecomputing happens. Cloud programs,platforms and storage take the strain awayfrom individual organisations and, crucially,have the ability to link and exchangeinformation with smart devices.

Although the term “cloud computing” is newand unfamiliar to many people, it has beenaround for a long time. An early example isMicrosoft’s Hotmail, introduced almost 15years ago: an email service users could accessfrom anywhere in the world with an Internetconnection and a browser and which did notrequire them, or IT departments, to invest inand maintain the hardware and softwarenecessary to make an email service function.

In a sense, cloud computing is the Hotmailidea expanded to cover any type of program,any kind of data, and any kind of user. It reallyis that simple. The complexity of cloud

computing comes not from its basic concept,but from the number and variety ofpossibilities that it offers to users.

Before the cloudIn the old paradigm, in the health sector as inother areas, organisations run programs ontheir own machines – servers or mainframesthat they must set up and maintain. All theprocessing takes place in-house. All the datais stored on the premises. It may seem like aneat and tidy approach – but there are anumber of drawbacks.

Cost. Doing everything in-house meanspaying for server capacity and programs thatyou might only use occasionally. Paying forstorage you might never need. Diverting theresources of skilled IT departments to install,update and maintain software programs onindividual machines and keeping thosemachines running.

Time. The in-house approach means thatevery time you want to add a new application

(like email, or an online company store, or astaff vacation scheduling tool), you have toacquire, install, configure and test a newserver. Whenever you want to use a newprogram it has to be installed or upgraded andtested on multiple machines. Cloudcomputing, by contrast, can be instantly andalmost infinitely expandable.

Ubiquity. Care organisations often have tomanage software in geographically distributedenvironments. But a programme that enablesa number of clinicians in different locations toview and discuss the same patient record, forexample, can be difficult to install if eachlocation is using a different system, or ifsystems and data formats are incompatiblewith each other. Or it might require a level ofcomputing power simply not available toservers or individual desktop machines in eachlocation. Cloud computing can help by makingthe same application available over a largegeographic area, without the need for “customplumbing” to connect all the disparatesystems.

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2 What cloud computing is, andhow it can help in health and wellbeing


Collaboration. Many organisations have userand beneficiary communities stretching farbeyond their own walls. Physicians and carersinteract with patients in multiples locations andpatients many times must see multiple healthpractitioners. Even governments arecollaborating on particular health projects.Increasingly, organisations and individualswant to share data – but withoutcompromising security or privacy.

Risk. Traditional IT puts all data andapplications in one place. Even modernsystems typically have only a single backup,and that backup often has lower capabilitiesthan the primary system. Cloud automates theprocess of providing multiple, geographicallydispersed backups, meaning that even anatural disaster in one area is unlikely to takedown your IT systems.


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“All you need is the Internet and you can start working.”

Jan Eyckmans, Head of Communication, Belgian Ministry of Health

The availability of healthcare data cantransform the ability of healthorganisations to respond to public healthcrises. At the peak of the H1N1 (swineflu) pandemic, one of the big challengesfor health authorities in affectedcountries was dealing effectively with themassive number of people needingassessment and guidance. The H1N1 FluResponse Center(http://h1n1.cloudapp.net), built anddeployed on Windows Azure, allows usersto take an Emory University-designed fluself-assessment, and then offers theappropriate advice.

Users can give explicit consent toshare the anonymous information theyprovide during self-assessment for publichealth, education and research purposes.As a result, apart from the assessmentand advice given to the individual, theapplication also provided valuableaggregated information for assessing theprogress of the epidemic.

The H1N1 Flu Response Center alsoallows users with HealthVault accounts tostore the results of the assessment,combine them with their information

already in HealthVault (such as healthhistory, allergies or chronic conditions),print a summary, or share the resultselectronically with their chosen doctor,again through HealthVault.

Using the Windows Azure platformallowed the application to be deployed tothe cloud very quickly, making it availableto the public. Increased demand andusage was handled effectively by thescalability features of Windows Azure –without investing in servers and datacentres. The site saw peak traffic on 9November 2009 with 123,746 pageviews – an unexpected leap of 365 percent over the previous day.

“Using Windows Azure we were ableto go from idea to deployment in justthree weeks. As anybody who has builtout data centres can tell you, this is areally incredible timeline. Being able touse our existing skills and all of ourfamiliar tools, such as the MicrosoftVisual Studio development system, wasanother plus. Without all of this, there isno way we could have had the site readyin time for flu season,” says Sean Nolan,Microsoft Distinguished Engineer.

THE CLOUD IN ACTION – GLOBALLY

H1N1 Flu Response Centre: A swiftresponse to a massive challenge

Cloud computing offers the EuropeanCommission a unique opportunity tosuccessfully achieve the goals set outin the European Digital Agenda.Particularly in the field of health, thecloud offers the features needed “toequip Europeans with secure onlineaccess to their medical health data by2015 and to achieve by 2020widespread deployment oftelemedicine services.” (Key Action13, Digital Agenda for Europe)



With the cloudCloud computing encompasses fivecharacteristics1: on-demand self-service;broadband network access; resource pooling;rapid elasticity; and the opportunity to providea measured service. And as cloud technologyevolves, two other principles are beginning tobecome more apparent: collaboration – asbriefly mentioned in the previous pages – andinteroperability.

On-demand self-service. When a healthorganisation needs new computing power, orstorage, or a new programme, it simplyaccesses what it needs from the cloud – ormore specifically, from a cloud supplier.Access to services is automated, no switches

need to be thrown by human operative, and itdoes not matter what time of day or night it is:the service is there when you want it, and youhelp yourself to it. In health, even more than inother areas, “on demand” becomes a vitalvalue proposition.

Broadband network access. To reach thecloud you just need to switch on your laptop, ora mobile phone, a home computer and go tothe web – if it can connect to the Internet,normally over broadband, it can connect to thecloud. As we look at independent living andhealth and active ageing as well as activeprevention for Europe 2020, cloud computingcan help make these visions a reality.

Resource pooling is increasingly attractive inthese difficult times. Multiple organisations canuse the same programs, servers and datacentres, and the provider allocates resourcesdynamically according to demand. This canlower the user’s costs considerably, since thesame infrastructure is serving several clientswhile achieving new flexibility and reducingcosts. It can also give users access toprogrammes and infrastructures that theywould otherwise be unable to afford. A recentwhitepaper published by Microsoft3 indicatesthat the benefits of pooling resources intolarge-scale shared clouds can reduce costsmore than tenfold compared with smaller,dedicated clouds and extremely well-run IToperations.

Rapid elasticity. Any system that involveslarge numbers of users demands the ability tocope with huge spikes in the numbers of peopleseeking to use it, or surges in the amount orcomplexity of the calculations it needs to make.And traditional IT systems are most likely to failat the most critical moments, when demand ishighest. Without the cloud, the only solution isto pay for expensive backup systems that mightlie idle for 99 per cent of the time. With thecloud, the service provider looks after theelasticity, managing even large-scale spikes indemand, so even small operations can use vastresources only when they need them, and notpay for them when they don’t.

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How the cloud delivers

There are three broad kinds of cloud service. When combined,these are referred to as “IT as a Service”.

With Software as a Service, SaaS, the user simply usesapplications provided by a supplier that run on the provider’sinfrastructure. An example is Microsoft’s Office 365 a set ofmessaging and collaboration tools. This is what the BelgianMinistry of Health used to facilitate collaboration with the variousministries in the member states, the WHO and its own highlymobile staff during Belgium’s Presidency of the European Union.The suite includes Microsoft Exchange Online for email andshared calendars and SharePoint Online for sharing documentsand portals. Another example is how the pharmaceutical giantGlaxoSmithKline has cut its operational IT costs by 30 per cent2.

With Platform as a Service, PaaS, the cloud provider hostsapplications developed by the user, or on behalf of the user, usingthe cloud provider’s operating system – much like customprograms developed for Windows. An example is the WindowsAzure platform, a group of cloud technologies that can run eitherin the cloud or on the user’s premises. Image archiving is oneexample of using cloud services to offset the effects of theexponential growth in data and in requirements for on-demandstorage.

Infrastructure as a Service, IaaS, provides on-demand datacentres with servers, storage and networking, typically priced bythe hour. Users can store any kind of data and run whateverprograms they want, but the physical infrastructure is maintainedby the cloud provider.

“For an organisation like ours,running dispersed operations acrossthe country, Online Services enablefield communications that deliver

immeasurable benefits.”

Joakim Pettersson-Winter, Chief Technology Officer,Swedish Red Cross



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‘Public clouds’ and ‘private clouds’

Cloud services can run on infrastructure that is shared withother organisations and companies (so-called “public clouds”)– or developed and maintained on infrastructure dedicated tojust one customer (the “private cloud”). Organisations willmake their choices depending on their development roadmapand timeframe, their own size, the confidentiality of the data tobe stored in the cloud, and regulatory requirements.

The choice between public and private cloud will not affectwhat end users see on their screens, but it will have a bigimpact on cost. While private clouds still offer economies ofscale for large organisations, according to one analysis3, overtime the premium for private clouds can rise to be 10 times ashigh as public clouds.

A measured service. You pay for what youuse, and you know what you are paying for –rather like a water or electricity meter. Thisgives organisations detailed knowledge aboutwhere they are spending their money, and withthat the opportunity to monitor and controlcosts. IT becomes an operating expense basedon actual use, reducing upfront capitalexpenditure on servers that has no relation toactual use. That can lead to considerablesavings.

Collaboration. Cloud applications are naturalcollaboration hubs. Since the application exists“in the cloud” and is accessible to anyone witha fast-enough Internet connection, all users, alldevices, and all locations are equal.Collaboration and sharing data become easy inthis environment.

The transition to the cloudWhile the real advantages of cloud computingare becoming more evident, the fundamentalconcerns of any health organisation withrespect to their present and future IT systemsremain. Security, privacy, trust, datagovernance and compliance are such concerns.And during times of transition, manyorganisations worry about the compatibility oftheir current systems with new ones, and howto move existing applications to the public cloud(see Box, ‘Public clouds’ and ‘private clouds’),which is shared with other users. Such

concerns are prompting organisations toexplore the option of private clouds, dedicatedto their use, as a way of achieving some of thebenefits of the cloud, especially in the nearterm.

There are a number of factors thatorganisations must consider when reviewing thepotential transition to cloud computing, whetherprivate or public cloud solutions. These include:• A natural tendency to control your own IT

department, to maintain security and directmanagement of data. This can haveadvantages, and dedicated private cloudscould be a solution that would meet theneeds for tighter control.

• It is also important to monitor ongoingdevelopments as the reliability and securityof public clouds continue to improve. Publicclouds already have some considerablesecurity, stemming from the enhancedscrutiny and expertise that can be deployedby cloud providers, and the fact that cloudsystems are automatically patched andupdated in a timely manner. Many securityissues arise because systems are out ofdate, and more vulnerable to be exploited –the burden of IT system maintenance iscurrently a major cost for organisations.That is a burden that cloud computing canhelp alleviate.

THE CLOUD IN ACTION – BELGIUM

Ministry for Health: A platform forpolicy development

A year ago Belgium’s health ministry had a problem.With thecountry due to take over the Presidency of the European Unionin July, it had to move quickly to set up a collaborationplatform for all the policy documents that would be producedduring the six-month tenure. Conferences, policies – allneeded to be prepared in conjunction with colleagues in theEuropean Commission, in other Member States, at the WorldHealth Organization, and foreign universities. To make mattersmore complicated, the Belgian officials in charge of theprojects would be permanently on the move between differentlocations in Europe.

Chief Information Officer Lieve Deschoolmeester opted forthe SharePoint platform, hosted by Microsoft. Why go for thecloud? “We didn’t have SharePoint competences in house –not enough to offer it quickly to our users,” she says. “And it ismore cost-effective to pay a licence per user than to have theplatform installed in house. Plus there was the time issue.”Another crucial factor: the assurance that the platform wouldbe online 24/7.

For Jan Eyckmans, Head of Communications at theMinistry, a vital advantage is SharePoint’s ability to deal withchanging texts. “When talking about policy documents,versioning is very important. Otherwise if someone forgets tomail back new versions, everything gets mixed up.” Now, hesays, there is less risk of ending up with the wrong version ofa text when a minister is trying to explain it.

The project got the go-ahead in mid-December 2009, stafftraining began in April, and all was ready for the start of thePresidency on 1 July. “All you need is the Internet and you canstart working,” says Eyckmans.



Not every technological advance results inlower costs. But cloud computing brings thebenefit of unprecedented economies of scaleto IT operations. This is particularly the casefor health-orientated organisations, becausethe cloud allows them to concentrate more oftheir resources and time on health, rather thanon IT. After all, they are in the health business,not the IT business.

When applied to health and wellbeing,cloud computing can add vital value byconnecting a wide range of medicaltechnologies and data sources into a seamlesswhole.

For the first time, at this scale and level ofaffordability, cloud computing helps to providepatients, providers and payers with a completeand holistic picture of health, enabling a trulypatient-centric approach to medicine. As such,the cloud enables a focus on the continuum ofcare, balancing the priorities from treatmentand cure only to focus also on prevention andlifelong wellbeing.

The cloud is still in its early stages inEurope, but the experience so far gives morethan a hint of what the technology can deliver

for health and wellbeing organisations –large and small.

Dutch orthopaedic centre Annatommie, forexample, used the Business ProductivityOnline Suite, now called Office 365, to take on30 per cent more patients without having toincrease its own staff. The payoff comesthrough more efficient communication anddata access, saving employees between oneand two hours a day and providing consistentand reliable scheduling of appointments.Meanwhile, the centre has also saved€28,000 a year in software licensing fees.

In Sweden, the country’s Red Cross movedto the cloud with Microsoft Online Services in2009 and reckons that it will recoup itsinvestment within two years. And itsemployees are benefiting from a systemwhere they can switch between their PC,laptop or mobile phone and have all theinformation at their fingertips.

And when Ziekenhuis Amstelland, a Dutchhospital, was faced with new governmentregulations on safety requiring all 1,200employees to have access to email – at thetime only 550 had email – it used the same

software combined with Microsoft ExchangeOnline Deskless Worker to add another 650deskless users (mainly nurses) at less than 30per cent of the cost of traditional licences.“Without Microsoft Online Services, we couldnever have deployed this number of mailboxesto our users in such a short [time] and cost-effective manner,” says Jan van Glabbeek, thehospital’s head of IT.

Along with other industries, healthcare isexperiencing an explosion in the amount ofdata being collected from a variety ofdiagnostic and monitoring equipment. Thatdata needs to be stored securely andefficiently – and made available when needed.

Radiology image archives and other typesof health data can take advantage of cloudstorage, with increased capacity oftenavailable in a matter of seconds rather thanthe days or months required to deploy in-house systems. Historical clinical data that israrely accessed is a prime target for archiving– it could be moved to the cloud storage tomake room for data that is operational andrequires frequent access from clinicalsystems.

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3 Vital value from the cloud



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“There may be private information involved, andwe needed a guarantee that the informationwould remain secure.”

Jan van Glabbeek, Head of IT, Ziekenhuis Amstelland

Zorggroep Meander provides care for theelderly and children in a number ofnursing homes and children’s centres inthe Netherlands, along with care inclients’ own homes. It came to JoVerstappen’s Open Line consultancylooking for a quick way of recording thehours of its employers digitally, ratherthan on paper.

The Meander group has about 5,500employees, with 900 “normal” office staffworking from desks and the rest,deskless, providing healthcare. Open Linerealised that the quickest way to meetMeander’s aims was to provide the

Business Productivity Online StandardSuite, now called Office 365, as a service,with servers and backup hosted on OpenLine’s premises. This allowed them to add4,500 new users – the deskless healthproviders who were the main reason forgoing to the cloud for a solution.

Three months after Meanderapproached Open Line, the new systemwent live. “Speed is the point,” saysVerstappen, and flexibility. The systemcurrently provides the human resourcessolution for recording hours. Otherfunctions, such as Exchange email andcalendars, can be added later.

THE CLOUD IN ACTION – THE NETHERLANDS

Meander Care Group: Rapid deployment, with flexibility

Individuals – patients and citizens alike –also stand to benefit. Research published byhealth provider Kaiser Permanente incollaboration with the American HeartAssociation (AHA) in May 2010 showed thatthe use of at-home blood-pressure monitorsand web-based reporting tools that connectclinicians and patients via the Internet appearsto improve patients’ ability to manage theirown blood pressure to healthy levels. Thepatients in the study were connected to theMicrosoft HealthVault cloud platform (seeChapter 4, “Power to the people: patients andcitizens”) and managed their data with a freeonline tool provided by the AHA. At sixmonths, patients in the home monitoringgroup were 50 per cent more likely to havetheir blood pressure controlled to healthylevels than the usual care group. Similarly, thehome monitoring group had significantlylowered systolic blood pressure at six months(-21 mm Hg) than the usual care group (-9mm Hg).

The cloud is not an all-or-nothingsolution.Reaching for the cloud does not mean movingeverything onto cloud platforms. The cloudgives health organisations the flexibility to mixand match. They can and should evaluatewhat makes sense to move to the cloud now,and plan a longer-term strategy to takeadvantage of the opportunities as both theyand the cloud develop.



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The bigger the cloud, the bigger thesavings• Economies of scale result from consolidating

overhead costs, purchasing power andpower efficiency: large data centres are upto 50 per cent more cost effective thansmaller data centres.

• The overall cost of IT is also determined bythe degree to which the capacity isefficiently utilised. Currently, infrastructure isbuilt to meet peak demand. Pooledcomputing improves the utilisation of ITresources and reduces costs by another 50per cent.

• Finally, public clouds, where multiplecustomers share the same application, allow

those customers to divide the costs ofoperating the application and can reducecosts by an additional 20 per cent.

Put together, these economies of scale canresult in long-term savings of up to 80 percent when comparing large and small clouds. 3

That is one reason why, in the US, thebudget submitted to Congress in February2010 commits the country to the use of cloudcomputing technologies and to a reduction inthe number and cost of federal data centres.Europe has the opportunity to consider asimilar direction and take up the cloud to helpdeliver on the health measures indicated bythe Digital Agenda for Europe.

Cloud value: reduction in cost of processing

Cloud value: reduction in total cost ofoperation (TCO)

Cloud value: data centres in public andprivate clouds

A private cloud is cost prohibitive for companies with adata centre of up to hundreds of servers.An enterprise with a larger data centre (more than1,000 servers) still faces a significant incentive tochoose the public cloud.Source: Forecast: Improved economy in the cloud, AMicrosoft U.S. government white paper, March 2010.

THE CLOUD IN ACTION – RUSSIAPenza Federal Centre for CardiovascularSurgery: Collaboration for clinicians

Penza is the fifth largest cardiovascular centre in Russia,carrying out 100 operations a week. With heart disease, a fastand accurate diagnosis can make the difference between lifeand death. The centre is using cloud computing to speed up thesharing of test results and improve its decisions on treatmentand surgery. Audio, video, web conferencing, instant messagingand telephony are integrated via Microsoft OfficeCommunications and SharePoint.

“Doctors can contact their colleagues quickly and discusstreatment options, and make decisions about further treatment,surgical decisions and rehabilitation,” says Oleg Anisimov fromLotsman Plus, which developed the system for Penza. “Locationis not an issue for making decisions, because all communicationis done over the Internet.” Colleagues from remote areas cannow be involved in decision-making. The system also providesthe security and confidentiality that people expect for medicalrecords.

“This takes us to a different level of technology,” saidcardiologist Nadejda Galtseva. “It enables us to keep up-to-datewith state-of-the-art diagnostic requirements.”



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There are many ways in which the cloudcan help patients and their families managepersonal health information. Here’s onechallenging scenario: how can patients seetheir own health data – wherever they are –and both edit and add to their own records,while allowing their trusted doctors andspecialists to also read these records,controlling who else can see their recordsand guaranteeing privacy andconfidentiality?

It’s not a hypothetical question. Health andwellbeing are driven by data – informationabout people. The days when doctors would notallow patients even to see their own medicalrecords are gone, or going, across Europe.Increasingly citizens both ill and well are lookingto have access to and control over their ownhealth data.

Cloud computing is able to respond to justthis challenge and turn it into an opportunity byallowing multiple users to share information in asecure environment. Imagine a web-basedplatform designed to put people in control oftheir health data. In a move in this direction, a

cloud-based offering called HealthVault allowsindividuals to open their own, free, account(parents can also open accounts for theirchildren), into which they can upload dataabout their health either manually orautomatically from a range of online health andwellness applications, as well as fromcompatible health devices. The data coveredincludes information taken from blood-pressure cuffs, weight scales, heart ratemonitors, pedometers, blood glucose monitorsand peak flow meters for measuring lungcapacity. Microsoft has recently launchedHealthVault in Europe, starting in the UK andGermany (where it is known as Assignio).

In the UK, Microsoft has partnered withMSN Life & Style and Nuffield Health to providean application called My Health Info that

4 Power to the people: patients and citizens

“A unique opportunity for us to put our patients first by givingthem their medical data, and to empower them to manage theirown healthcare.”

Aurelia Boyer, Chief Information Officer, New York-Presbyterian Hospital, on linking their owndata system with HealthVault.

HealthVault: putting people incontrolHealthVault offers a privacy- and security-enhanced foundation. This allows a broadecosystem of stakeholders – from medicalproviders to health and wellbeing devicemanufactures to health associations – canbuild innovative solutions and services tohelp put people in control of their own andtheir families’ health. Through HealthVaultapplications individuals can gain greaterinsights from their data to help them bettermanage their own health. If the accountholder permits, HealthVault applicationsalso allow health and wellbeing providersto access the information and provideservices accordingly.



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References1 As defined by the US National Institutes of Standards and

Technology, see http://csrc.nist.gov/groups/SNS/cloud-computing/cloud-def-v15.doc

2 GlaxoSmithKline Leads the Way with Microsoft Online Services,Microsoft case study, October 2009.http://www.microsoft.com/casestudies/Case_Study_Detail.aspx?casestudyid=4000005460

3 Source: The Economics of Cloud Computing in the EU PublicSector, Microsoft, November 2010.http://microsoft.eu/Cloudeconomics.aspx

enables wellbeing management, givingindividuals insight into how to improve theirhealth. My Health Info helps them monitor theirblood pressure, calculate their body massindex and measure the amount of steps theytake as exercise.

In Germany, Siemens IT Solutions andServices has introduced a HealthVault-basedoffering called Assignio, starting with a suite offour related applications. The idea is to helpbridge the information gap between citizensand the professional medical and healthcareorganisations that they interact with on anongoing basis.

Three Assignio applications help patientswith, respectively, fitness and wellbeing,prevention, and the management of chronicdisease. The fourth application allows thepatient to involve hospitals and doctors thatthey trust, by sharing the information withthem. German health company Asklepios,which runs a network of more than 100 clinics,is developing “Meine Gesundheit” (“MyHealth”) – a service linked to Assignio that willsupport patients in managing their own healthwith an application that makes medicalinformation – on their appointments,medication or treatment plans, for example –available in their Assignio account.

Trust is essential to a patient-centrichealthcare system. For the system to succeed,participants must be willing to share healthdata. Because health data can be highly

“With Assignio we are able to offer aneHealth solution for all stakeholders withinthe healthcare industry but one where thecitizen is at the centre. The basic principlesof Assignio are trust and security; this isextremely important for us and will allow usto add true value to all users.

Roland Neuhuber, Global Head of SIS Healthcare, Siemens

Stepping into the cloud andunlocking Europe’s potentialPopular cloud computing services outperform internalinfrastructure – with 99.9 per cent uptime or better in manycases – so the road to the cloud looks good. But is the cloudright for you?

Step 1: Evaluate cloud services• Analyse the business case for cloud services.• Start by discovering how much cloud computing is alreadytaking place in your organisation or other agencies, andconsider how your existing applications could takeadvantage of the cloud.

• Ensure that you will meet or even exceed regulatorystandards for privacy and confidentiality.

Step 2: Plan for the cloud• Start small. Start the journey in a limited scope to confirmthe business case and understand the impact on thepeople, policies and processes in your organisation.

• Plan in phases. The cloud is not an all-or-nothing approach.Some things may make sense today; others will need to beleft for later consideration.

• Know when to make your move. Some cloud strategies payoff over time, so factor in how long it might take to recoupyour investment, and set expectations accordingly.

• Examine the benefits and trade-offs of public and privatecloud solutions, or a combination of the two, factoring incost, security and all other considerations.

Step 3: Integrate cloud services• Look for ways to integrate applications and databases heldon your own premises with cloud technologies to offer moreor faster services.

• Think big – especially if you’re a small organisation orgovernment agency. Cloud services are massively scalable,both up and down. Who else might benefit? Keep potentialpartners in the loop.

• Build a governance structure to measure progress and tokeep all stakeholders informed.

sensitive, citizens and healthcare providerswill only share data if they trust that theirprivacy will be protected. When trust isestablished and data flows freely, everyonebenefits. HealthVault has translated theseprinciples into clear privacy principles, whichaugment Microsoft’s industry-leadingcorporate privacy policies and put citizens incontrol of their health information.



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Health and wellbeing stand to benefitenormously from the cloud. The global scaleof the cloud will enable the costs ofcomputing to be driven down – at a timewhen health organisations are underimmense pressure to reduce costs.

The cloud has collaboration built into it – andcollaboration is the lifeblood of the healthsector. The cloud makes health data “liquid” bytaking it out of its individual silos and letting itflow at the right time to where it can help thepatient most – under the patient’s control andwith an emphasis on privacy and security.

How, then, can policy makers and decisionmakers ease Europe’s way into the cloud? Hereare a few suggestions across four key areas:

1. Fostering the economics of cloudcomputing

• Due diligence for cloud readiness. In thistough fiscal environment, governmentsshould be encouraging their own healthorganisations to analyse where the cloudcould appropriately save time and money.This analysis of “cloud readiness” should bean integral part of national plans for eHealth.Countries should then review and discusstheir analysis within the framework of theEuropean eHealth Governance process.

• Support by EU Cohesion Funds. As weaim to achieve more (access and quality) withless (cost), the next wave of European socialand structural funding to support cohesionpolicy should provide incentives for countriesthat look to integrate cloud computing intohealth and wellbeing.

2. Awareness raising and capacitybuilding

• Consultation. Governments shouldstimulate a programme of consultation andawareness raising with health professionals,health stakeholders and IT architects andproviders on how to obtain additional valuefrom public cloud infrastructures in a safe

and secure environment. The newlylaunched European Innovation Partnershipfor Healthy and Active Ageing is an idealplatform for pilot technologyexperimentation and testing. The EuropeanCommission should consider setting up aTaskforce for Cloud in Health and Wellbeingwithin this Innovation Partnership.

• Information. The European Union shouldconsider establishing Europe-wideprinciples that would provide consumerswith clear information about what a cloudservice provider is permitted to do with aconsumer’s or business’s information. Thisshould be harmonised at national level aswell. The Taskforce could help drive thisforward.

• Transparency. Cloud service providersshould be transparent about datamanagement practices and informconsumers, customers, business andgovernments about how they are going tokeep their information secure.

3. Security, privacy and dataprotection in a cloud environment

• Help data to remain secure. The right toprivacy requires that data be secure. Thatmeans effective and coherent laws and lawenforcement to protect cloud services. Inparticular, cloud service providers shouldhave the legal right of action to protectdata.

• Allow data to move safely. Europe needsa comprehensive approach and coherentagreements for data protection, data useand data portability. The new and emergingneeds of patients and health professionalsas well as the opportunities brought aboutby cloud computing in health and wellbeingshould be taken into account in theframework of the current revisions of theData Protection Directive 95/46/EC.

• Allow data to move freely. We see theneed both to protect information and toempower citizens and patients with healthdata. As health systems shift from a focus

5 Policy recommendationson “transactional” care of patients whenthey’re sick to lifetime health management,data needs to be liquid – able to move fromplace to place, and country to country as it isused by computers in the cloud within asecure, private and trusted environment.This call for data to move freely and safelyresponds to the fast developing needs ofpatients and citizens. This aspect stretchesoutside the EU boundaries. It should beconsidered in the current discussionsbetween the European Commission and theUS Department of Health and HumanServices on the Memorandum ofUnderstanding on eHealth (Mandate 403) aswell as the Key Action 13 of the EuropeanDigital Agenda.

4. Interoperability and innovation• Interoperability and standardisation. The

maximum degree of interoperability shouldbe encouraged. Standardisation should notprevent the market from being able toinnovate rapidly in the early stages of thisnew generation of computing. Discussionsaround Mandate 403 should also integratethis need to balance innovation andstandardisation as work focuses on standarddevelopment and effective deployment.

• Supporting the fast pace of innovation.Both medicine and technology are advancingat a fast pace. We recommend developing anenhanced regulatory framework that enablesinnovation, rewards experimentation, andultimately drives value – by encouraging thedynamic flow of data across the healthecosystems within a secure, private andtrusted environment. We recommend that theEU eHealth Governance process take onboard this topic, working closely with industryand stakeholders.

Moving to a focus on lifetime healthmanagement means that we need toprovide tools for citizens to participate inmanaging their health across thatcontinuum. Cloud computing offers us thisopportunity. Let’s take the right steps andembrace the cloud to unlock Europe’spotential in health and wellbeing.


www.microsoft.eu/health


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