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are expecting an increase in the data volume up to
25%, while approximately one fifth of them (18%) is
expecting a growth from 25% to 50%. Besides
traditional Healthcare Information Systems, there
are other emerging fields of eHealth that could lead
to exponential growth in the database size. For
example remote monitoring, especially if the
patient’s monitoring is continuous (regardless of the
activity to be monitored, e.g., ECG, physical
activity, etc.), and with a lot of patients, we can
expect rapid expansion of the data volume. Cloud
Computing allows to easily scale storage capacity
when needed.
b) IaaS - Computing Scalability: Cloud
Computing offers also computing power scalability
which may be particularly important for some
eHealth domains. One example is the Grid Services
for Clinical Research. Health institutions which
perform also clinical/medical research can have the
need to perform analysis on large volumes of data,
requiring also large computational power. However
these studies are not continuous, which makes Cloud
Computing particularly suitable for these
applications, with its pay-per-use model. Another
example may be the information search on large
database of trusted medical knowledge. In this case,
a lot of computing power may be needed if several
users perform searches on journals, articles, etc. at
the same time, but this is hard to predict in advance.
c) IaaS - Virtual Networks: An interesting IaaS
feature that the Cloud could offer is the creation of
virtual networks to connect healthcare institutions
(like in the case of Virtual Healthcare Professionals
networks), or to connect patients and healthcare
institutions (like in the case of remote monitoring,
e.g., telemedicine, AAL, etc.).
d) IaaS - Disaster Recovery: The results from
BridgeHead survey reported what are the top
priorities in the next investments for IT budget in
healthcare organizations. Disaster recovery, together
with Data Backup and Business Continuity, was a
priority for 44.3% of the respondents. Cloud
Computing could offer backups and redundancy at
lower costs with respect to legacy systems.
e) PaaS - Data Backup: In line with the previous
point, Data Backup is a top priority for many
organizations. It was separated because Data Backup
deals more with databases and data structure (PaaS
level), while Disaster Recovery deals more with
storages and virtualization (IaaS level).
f) PaaS - Data Integrity: Medical data integrity
should be guaranteed to assure the correctness of the
care process. This should be guaranteed both in
Healthcare Information Systems and in possible
EHR applications running on the Cloud.
g) PaaS - Availability/Continuity of Service:
Business continuity and availability are very
important in most of the medical applications,
especially those dealing with possible emergency
situations detection (e.g., remote patients’
monitoring) and management (e.g., availability of
the EHR in a dangerous situation). The main
objection to the adoption of Cloud Computing (65%)
in the BridgeHead survey was the hospitals’
concerns about the security and availability of
healthcare data given the great number of threats,
including privacy breaches and identity theft. Other
objections include cost (26.1%) and a lack of
confidence that Cloud offers greater benefits with
respect to local storage media (26.1%). In theory,
Cloud solutions will assure better continuity than
legacy systems, but on this Cloud Providers still
need to convince their possible customers, as shown
from the results of the BridgeHead survey.
h) PaaS - Auditability: The possibility to ensure
that the IT system is compliant with existing
regulations is very important for eHealth
applications, in particular for what concerns the
management of patients’ data in accordance with
privacy protection directives. PaaS type of services
should ensure the auditability to attract Health
Organization in investing in this kind of solutions.
This is particularly critical for example in managing
EHR or PHR applications, but also in case the Cloud
will host and run Hospital Information Systems.
i)
SaaS - Patient Empowerment in Self-
management: One of the main driver for the
adoption of Cloud Computing in eHealth can be the
trend that sees the patients becoming more and more
protagonist of their health management process
(Mandl and Kohane, 2008). Thanks to the
information and communication technologies,
patient-doctor relationship is evolving and may be
potentially resulting in more shared decision making
process. A study conducted over 6369 persons
claimed that almost two thirds (63.7%) of adults
searched online for some type of health or medical
information either for themselves or for someone
else through the Internet. In general, evidence shows
that, even if health professionals remain the most
trusted source of Health information, electronic
media are becoming more and more important too,
and in some cases, patients are looking for
information online before talking with their
physicians (Hesse et al, 2005). In the new scenario
just depicted, it clearly shows the limitations of the
vision of EHR stored locally on an internal
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