CLOUD BASED HIMS

An Indian Perspective

Sourav Saha and Ambuj Mahanti

Indian Institute of Management Calcutta, Department of Management Information Systems, Joka, Kolkata 700104, India

Keywords: Cloud Computing, Hospital Information and Management System (HIMS), e-Health.

Abstract: The advent of Cloud Computing has opened up newer avenues for business. Traditional industry verticals

like the healthcare are yet to reap the benefits of such cutting-edge technology in India. In an age of

collaboration over virtual medium, the lack of coordination and an effective communication mechanism is

creating information “silos” that are not propagated at other levels. In this paper we briefly discuss the state

of Health Information Management Systems (HIMS) in India, the challenges faced en-route deployment of

the solution. We then introduce some interesting aspects of cloud computing to show that how a cloud-

based system can help reduce the technical barriers to HIMS acceptance and endorsement. Our contribution

lies in addressing issues for HIMS deployment in an Indian scenario and arguing for a cutting-edge

technology like Cloud Computing as an agent of change.

1 INTRODUCTION

Many business organizations have successfully

transformed and moved up the value chain with the

successful adoption of Information and

Communication Technology (ICT). Government

adoption of ICT in developed countries have

resulted in transparency and reinforced faith on the

public systems. With effective control flow and

instant response facilitating effective communication

and feedback, the distance between the citizens and

the government has narrowed in instances of

successful ICT deployment. In a country like India

where the healthcare service requirements are more

than the available resources, it’s necessary to have

the resources utilized properly in order to gain

maximum utility. Unfortunately, the government’s

public service system in this area has failed to reap

the benefits of technological advancements owing to

very low adoption rate. The reasons for such low-

penetration are manifold, policy, people, politics and

system to name a few. The issues one faces with the

system are the lack of awareness, lack of support,

obsolesce of technology and inappropriate

deployments. This has resulted in loss of faith on e-

health system putting in more barriers towards

maturing of a proper ICT-enabled healthcare system.

In this paper, we discuss the state of Health

Information and Management System (henceforward

termed as HIMS) in India. We have shown that how

the existing technology deployment plan has put

barriers towards adoption and making the system

obsolete with policy changes. We have then shown

how a technology like Cloud Computing can wade

off some of the barriers.

The rest of the paper is organized as follows. Section

2 contains a brief description of related works.

Preliminaries like the definition of Cloud Computing

and its advantages over the traditional computing

models are discussed in Section 3. Section 4

introduces the early works of Health Information

Management System (HIMS) in India. Section 5

does a SWOT analysis of HIMS implementation and

future implementation barriers. Arguments that

support the implementation of Cloud Computing in

HIMS are presented in Section 6. Section 7

discusses some future scopes of work and the paper

is concluded Section 8.

2 RELATED WORKS

Research in the area of e-Health is not new in India.

Ramani (2004) has discussed the pitfalls in ICT

implementation in the health segments in the mid

90s. Bedi et al. (2010) has done an in-depth study

with the HIMS solution in Government Hospital in

India. Cellary and Strykowski (2009) has provided

438

Saha S. and Mahanti A..

CLOUD BASED HIMS - An Indian Perspective.

DOI: 10.5220/0003961504380442

In Proceedings of the 2nd International Conference on Cloud Computing and Services Science (CLOSER-2012), pages 438-442

ISBN: 978-989-8565-05-1

 2012 SCITEPRESS (Science and Technology Publications, Lda.)

arguments for cloud computing in the public

segment and has shown the role of effective

governance and strong leadership for successful

rollout. Their work fosters openness and includes

local innovators and entrepreneurs. Buyya et al.

(2008) propose Cloud Computing as the 5

utility

after water, electricity, gas and telephony and has

put forth an architecture for dynamic provisioning of

cloud services. Most of the work focuses on the

applicability of cloud computing as a whole with its

novel features and how the government can benefit

from it. Lately, the government in developing

countries like India are waking up to the digital

revolution. Competitive technology with adequate

support from the government has made inroads for

e-Governance. Sadly, the health department is yet to

catch up with the pace of such newer trends and

there hasn’t been much works in this area that can

reap such benefits. Our work tried to identify the

roadblocks and makes a strong case for Cloud

Computing adoption for HIMS.

3 CLOUD COMPUTING

Cloud Computing is an extension of the idea of

utility-computing where the necessary resources like

computing, memory and data-storage are all handled

in the “Cloud”. In simpler words, all the vital

resources are being managed by some third-party

vendors who are specialized in handling the data and

computing centres. Typically such data centres

comprise a collection of machines that are pre-

configured and provisioned dynamically. The

machine allocation may take place by explicit user

request or implicitly when the provisioned capacity

is insufficient to meet the computing requirements.

The user accesses the resources through some

dedicated network or over the public network like

the internet and is generally billed to the extent of

his usage by the vendor. For enterprises, moving to

the cloud means doing away with the capital

expenditure of hardware, software and support staff

for the desired service. Instead, the services are

available on demand and generally backed by some

SLA (service level agreements) that acts as a

binding contract for the provider to deploy necessary

services as agreed. Some prominent players in this

arena are Amazon, Salesforce.com, Google and

Microsoft.

Cloud computing provides the following

advantages over traditional computing models of the

enterprise:

i. Significant reduction in initial setup costs:

This is achieved by converting the in-house

IT capital expense to operating expenses

ii. Increased Flexibility: On demand solutions

and lesser implementation times with

support from a large ecosystem of providers.

iii. Ubiquitous Access: Services can be accessed

over the internet

iv. Elastic Scalability: Capacity alteration as per

changing needs.

v. Pay-per-use: Payment only for the capacity

utilized. EOS (economies of scale) reduces

the cost of usage.

vi. Easy to Deploy: The user doesn’t need to

purchase hardware or software. All a user

needs is a compatible web-browser.

vii. Auto-upgrade: Since the system is managed

centrally, all updates and policy

requirements can be enforced at all locations

simultaneously

viii. Reliable Service Quality: Large storage and

computing achieved through distributed

fault-tolerant systems

ix. Focus on Core Competence: Traditional

organizations need to have a dedicated IT

team and sometimes there is a conflict of

interest during system upgrades. With cloud

computing, the organization can focus on its

core-competence while leaving the chores of

the system to the service provider.

x. Collaboration: Since application and data are

accessible from anywhere, it encourages

collaboration

xi. Disaster Recover Capabilities: Since the data

and the application are replicated at multiple

locations, in the event of any disaster or

natural calamity, business resume can be fast

xii. Business Migration and Continuity: As

business expands, the cloud computing

model can enable rapid capacity additions.

New business units can start functioning

immediately without needing to wait for

system deployment and configurations.

4 HEALTH INFORMATION

MANAGEMENT SYSTEM IN

INDIA – EARLIER STUDIES

A survey conducted by C-DAC (Bedi et al. 2010)

revealed that on average, there is 1 bed for every

2315 people in India. Some states like Assam in the

country has only 1 bed per 9293 people. Such high

patient/bed ratio invariably puts a pressure on the

infrastructure resulting in crippling of the entire

CLOUDBASEDHIMS-AnIndianPerspective

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system. This calls for an efficient HIMS (Hospital

Information Management System) that will make

best use of the available resources. The C-DAC

already had built an ERP package, namely e-Shusrut

for Hospital in India. This is a major step from the

government towards adopting technology for

healthcare. The capabilities of e-Shusrut exceeds the

capabilities of any traditional Hospital Management

System to encompass ancillary activities like

accounts, payroll and procure management. It is has

been implemented in several government hospitals.

During each of the rollouts, C-DAC had to take the

entire onus of infrastructure building, application

development, deployment and go-live of the various

modules. In spite of the government support for an

electronic healthcare, the movements in the direction

are considerably low owing to very low

participation, resistance and lack of enthusiasm.

Similar to a traditional e-government system

(Jayaradha and Shanthakumar, 2003 & Rastogi,

2010), a typical Hospital Information Management

System also suffers from the common symptoms of

ICT barriers, namely:

i. Inadequate ICT infrastructures

ii. Inadequate human resources

iii. Inadequacy of funds

iv. Adapting to frequent technology changes

v. Inability to make informed decision

vi. Application life-cycle management

vii. Software Support

viii. Accountability

ix. Modifiability

x. Physical Security

In this paper, we are not going to address all the

issues mentioned above. Poor literacy, inadequate

infrastructures, lack of enthusiasm, absence of

incentives and low participation can bring down any

established process or system. There are many

fundamental challenges in implementation of an e-

health system in India. Issues like inadequacy of

funds or inadequate human resources are not in the

purview of our scope. Instead, what we are going to

argue is that how evolutionary information

management systems like cloud computing can

minimize barriers to ICT adoption in health,

analyzing from a SWOT perspective for the cloud.

5 TRADITIONAL HIMS IN INDIA

– A SWOT ANALYSIS

Taking the case of e-Sushrut, we would undertake a

SWOT analysis of traditional HIMS based

implementation in India

Table 1: SWOT Analysis.

Strength

 C-DAC has established a working

ERP that has been rolled out

successfully

 Being a govt. enterprise, it can

provide low-cost solution custom

made for the people

 Regionalization possible with a

HIMS solution like e-Sushrut

 Ability to interface with the

government for policy changes and

its impact on system

Weakness

 High initial setup costs of

infrastructure during first rollout

 Decreased interests due to non-

sustained awareness and poor

support post implementation

 Shortage of specialized manpower

to support individual rollouts

 Hardware system faults stalls the

software functionalities

 In times of disaster or any natural

calamity at the health-center, the

data might get lost forever

 System is expensive to maintain and

upgrade

Opportunities

 Focus on a centralized system

 Smart resource utilization

 Replicable model for enterprises

resulting lower lead-time and lower

initial costs for rollouts

 Shared centralized server for

efficient use of resources and EOS

 Lower costs of change requests due

to centralized system

 Policy updates can be synchronized

at multiple locations instantaneously

Threats

 High cost of change requests due to

multiple rollout versions

 Software is generally maintained in-

house after a small training post

implementation. If the employee

leaves, the knowledge is lost

 Policy changes at both government

and regional levels calls for software

modifications. A long lead-time for

change requests makes the product

infeasible

6 ARGUMENTS TO SUPPORT

CLOUD COMPUTING FOR

HIMS

In terms of architecture, Cloud Computing comes in

various flavours as show below.

CLOSER2012-2ndInternationalConferenceonCloudComputingandServicesScience

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Figure 1: Cloud Computing Architecture

In case of the SAAS (Software as a Service

model), the service provider itself hosts the system

and the necessary software that runs on the system.

In case of PAAS, the Cloud Service provides the

platform to host the in-house applications. Services

like Network Management, Database management

and system availability are still the onus of the cloud

service provider.

In IAAS, the Cloud Service provider only

provides the infrastructure required for the

functioning of the enterprise. The service provider

gives the necessary instances to the requester and is

only responsible for the server uptime.

In the given case of e-Shusrut, C-DAC has

already built a strong working ERP for health. The

issues that arose were mainly operational rather than

technical. A robust application development and

deployment environment to host the necessary

services would successfully reduce the barriers in

adoption of the designated services. This forms an

excellent case for the government to adopt the

PAAS Cloud architecture from a qualified vendor.

The software developed can be hosted on the cloud –

so effectively C-DAC would have full control over

the software and its functioning. The elements of

uncertainty in case of centralized system, like

service queuing, resource allocation, automatic

backup, sudden increase in HIMS usage in case of

any disaster – all would be handled by the platform

provider.

From our SWOT analysis, we understood that

managing a decentralized system was one of the

main reasons that led to the failure of a mature ERP

like e-Sushrut. The issues that decentralization

brings with it can be handled by building a

centralized system as discussed in the opportunities

section. However a centralized system cannot fully

account for the high initial rollout cost and

subsequent maintenances costs. Further, in instances

like loss of vital data or a DOS (denial of service)

attacks, a centralized system might cripple

altogether.

Cloud Computing, as discussed earlier turns

Capital Expenses to operating expenses. This means

that the initial expenses in setting up infrastructure

and hardware are heavily reduced. The usage of

system is now an operating expense in business, like

those of gas and electricity. The business needs to

pay as per the metered usage. This effectively

manages the initial hurdle of implementation.

The deployment of e-Shusrut met with criticism

for lack of support. One of the main reasons for lack

of support was the decentralized system and non-

availability of staffs. Cloud computing with a

supporting PAAS architecture eliminates the need

for staff at every location. The issues that ask for

critical support can be monitored and solved

centrally resulting in greater post-implementation

user satisfaction. Policy changes can be managed

and deployed centrally hence the system faces lesser

chances of obsolesce. Since the service is being used

over some dedicated network or internet, a

functioning system at the user’s end is sufficient to

access all the hosted services. Sometimes during

disaster, the demand on HIMS increases manifold.

Traditional systems sometimes fail to meet the

changing demands. Owing to the elastic and fault-

tolerant nature of the cloud, provisions are

automatically enhanced during a crisis to ensure that

the HIMS doesn’t face any downtime due to over-

usage. A cloud computing system automatically

replicates data across several networked locations

with version control. This ensures that critical-data

is always safe and can be recovered in case any

compromises may happen.

7 FUTURE SCOPE OF WORK

There are some risks with every deployment of

cloud computing in the light of data and access

security. Such risks cannot be totally shielded but

proper preventive measures, SLA’s and supporting

architecture can help mitigate such risks to a great

extent. A risk-management perspective of the cloud

in the Indian Scenario would be an interesting area

to explore. Developing countries are sensitive to

huge budget for e-governance. Compared to

developed countries, health expenses don’t feature

very high in the list of government agendas. Some

innovative pricing mechanism can bring about an

accelerated cloud acceptance for more e-government

agendas. Finally cloud is just another piece of

CLOUDBASEDHIMS-AnIndianPerspective

441

technology. A framework that can simplify the cloud

adoption process in critical areas like health would

be beneficial for both the academia as well as govt.

8 CONCLUSIONS

In this paper we have tried to build a case for Cloud

Computing implementation in Health Information

Management System. Our paper has considered the

technology aspects only finding a great fit of Cloud

Computing in making the implementations viable

and making inroads for more services on the cloud.

We would like to extend the work in a scenario

where there is interplay between all the affected

agents like govt, business, citizen and technology.

ACKNOWLEDGEMENTS

The first author would like to thank Advocate Arnab

Chatterjee for arranging interview with expert to

help understand the design-reality gap in HIMS

deployment in India.

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