This is my Final Paper submission for TECHNICAL STRUCTURES IN HI (31585).

Cloud Computing:

What is it and How it Impacts Healthcare

Brian Chang

Loma Linda University

        Cloud computing has been a major topic of conversation as of late and is emerging as one of the most important technologies of this decade.  This article will discuss briefly on the inception of cloud computing and what it exactly is. Once we understand how the technology works, we can then understand how it impacts healthcare. Cloud technology is changing the face of healthcare in a sense that healthcare is now becoming increasingly EHR integrated.  Communication efforts have been one of the more highlighted features of the cloud, in which its ability to connect multiple users and platforms at high speeds is irreplaceable in businesses all across the world.  Other highlights of cloud computing include storage, business application and infrastructure use.  Cloud computing giants such as Google and Amazon offer one-in-all services that encompass multiple applications and business solutions.

What is the “Cloud”?

            Essentially, the “cloud” is a metaphor for several utility and application programs that are contained in a central virtual location.  The term cloud initially came during the internet boom in the late 1990s.  Cloud computing allows severs, desktops, laptops, etc. to connect remotely and share the cloud’s resources together.  As businesses grow, their infrastructure and application requirements become more complex.  The variety of software and hardware that is essential for everyday business applications become a cumbersome task.  The more desktops there are, the more complex networks become.  Systems architects, network administrators, database administrators, and various other IT professionals are needed to maintain an organization’s application needs.  Cloud computing simplifies and eliminates the need for a business to have their own IT professionals and hardware alike.  There are companies like Amazon and Google who have cloud-computing services in which their customers may choose the services that they need.
            There are some characteristics that cloud computing has proven to show since its inception into daily business infrastructure.  Speed is a key characteristic in which users are able to transmit and receive information much faster than before.  Cloud computing also introduces an Application Programming Interface in which PCmag.com defines as: “A language and message format used by an application program to communicate with the operating system or some other control program such as a database management system or communications protocol” (http://www.pcmag.com/encyclopedia/term/37856/api).  The API allows machines to interact with the cloud server in the same way a person would interact with their personal computers. 

         Another major characteristic of cloud computing is the potential of cost savings.  Businesses continuously seek ways to save money through cost cutting and budgeting.  Many cloud computing providers offer a pay-as-you-go service in which their clients only pay for what they use.  Some providers ask for a one-time fee for each of their services or applications.  Cost reductions can also be found through the elimination of purchasing hardware and software for multiple users throughout the organization.  Also, the needs for expensive IT personnel as mentioned previously are no longer necessary.  Cloud computing providers have their own in house IT personnel that are able to oversee networks, servers, databases, etc for their customers.  Devices are also independent of individual hardware needs as modern technologies are able to connect to their cloud services via Internet.   All services are centralized, which allows for utilization efficiency across an organization.  Lastly, productivity and performance are increased because multiple users can work on the data simultaneously.  Software updates do not constantly need to be installed or monitored because the provider is maintaining the remote server’s resources with their own personnel. 
            Cloud computing offers several different models for their services.  Likely the most popular service model is the Software as a Service or SaaS.  Customers may access their provider’s applications and services through the cloud infrastructure.  A common method of accessing the cloud infrastructure is through a internet browser such as Google Chrome or Mozilla FireFox.  Another method of access is through the application program interface as mentioned earlier.  Users can access cloud resources through the API on their devices such as laptops, smartphones, and desktops. What makes the SaaS so popular and effective?  “The consumer does not manage or control the underlying cloud infrastructure including network, servers, operating systems, storage, or even individual application capabilities, with the possible exception of limited user-specific application configuration settings” (http://faculty.winthrop.edu/domanm/csci411/Handouts/NIST.pdf).  In other words, SaaS is extremely user friendly and assumes many of the tedious responsibilities that IT professionals are trained to do. 
            A Platform as a Service or PaaS is another service model in which consumers have available.  PaaS is a more complex service model in which some programming knowledge may be required of users.  Cloud providers offer users a computing platform in which programming languages can be used to configure and execute various commands.  It is essentially an execution environment in which consumers have control over deployed applications.  Users however do not have the ability to manage or control over the network, servers, operating systems, or storage.  Some examples of PaaS models are Microsoft Azure and Google App Engine.  Microsoft Azure is described as: “a growing collection of integrated services—compute, storage, data, networking, and app—that help you move faster, do more, and save money” (http://azure.microsoft.com/en-us/overview/what-is-azure/).  With Microsoft Azure, users are able to build infrastructure through virtual environments like Linux, and develop applications.  Thus, PaaS requires users to be experienced with programming languages and coding environments.
            The Infrastructure as a Service or IaaS is the last of the service models and is considered the most basic cloud offering.  Providers who offer IaaS, often have virtual machines that allow users to run servers, storage, networks, and several other infrastructural applications.  A virtual machine can virtualize an operating system in which users can deploy their application software to test in the virtual environment.   IaaS Cloud providers also provide utilities such as storage, IP addresses, and firewalls to aid customers with their virtualization needs.
            Another concept to understand about cloud computing are the deployment models.  Deployment models are essentially the method in which cloud services are offered depending on organizational structure and location.  Organizations with multiple users will typically deploy a Private Cloud.  The private cloud may be operated by the organization itself, however it may also be provided by a third party, or a combination of both.  The private cloud can be located on premises or remotely as well.  If a private cloud is hosted internally, the level of difficulty and its physical footprint should be taken into consideration.  Running a private cloud on an organization’s premises can prove to be extremely labor intensive and costly.  It also requires a significant amount of physical space due to the sheer amount of hardware such as servers and data storage devices required to support the sheer amount of users on the cloud.  Running an on premise cloud server can prove to be inversely effective in which it may defeat the purpose of having a cloud in the first place. 
            A public cloud is “provisioned for open use by the general public.  It may be owned, managed, and operated by a business, academic, or government organization, or some combination of them” (http://faculty.winthrop.edu/domanm/csci411/Handouts/NIST.pdf).  There essentially is no difference in the make up of a public cloud and private cloud.  The only difference is that the clouds resources are made available to the public and in most cases, free.  Large public cloud services providers such as Amazon AWS, Microsoft, and Google offer their services for free through the internet.  A community cloud is made exclusively for use by a specific community of users in which can be offered remotely and on premises much like a private and public cloud.  A combination of the private, public, and community cloud characteristics is the hybrid cloud.  A cloud can be considered hybrid when they store a part of their data in a private cloud application and offer their application services in a public cloud such as Amazon AWS.

Cloud Computing in Healthcare

             With healthcare becoming increasingly electronic with mandatory electronic health record or EHR implementation, cloud computing technology is rapidly becoming relevant in the industry.  Cloud computing is thus becoming an important business strategy in many healthcare organizations because the sheer quantity of data these entities possess.  Recent studies highlights contributions in which cloud computing can improve decision-making and systematic improvements in healthcare organizations.  Improvement of data warehousing and the analysis of hospital data can significantly increase productivity of business functions of healthcare organizations.