The SUCRE State of the Art Analysis: Cloud solutions in the Healthcare Sector

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1 Deliverable D2.1: The SUCRE State of the Art Analysis: Cloud solutions in the Healthcare Sector Date: 22 January 2013 Authors: Timo Mustonen (MFG) Dissemination level: PU WP: Work Package 2 Version: 1.0 Keywords: State of the Art, Cloud Computing, Open Source, Virtualization, Healthcare Description: The State of the Art analysis provides an overview of current types of cloud solutions available for the healthcare sector. FP7-ICT Coordination and Support Action SUCRE (SUpporting Cloud Research Exploitation) Project No.: Project Runtime: 10/ /2014 Copyright SUCRE Consortium

2 Document Metadata Quality Assurors and Contributors Quality assuror(s): Giovanna Calabro (ZPH) Contributor(s): Sven Meintel (MFG), George Athanasopoulos, Eleni Toli, Michael Pantazoglou (UoA), Ariana Polyviou (SLG) Version History Version Date Description /12/2012 First draft, Table of Contents /12/2012 Second draft, refinement Table of Contents /12/2012 Section 1 Introduction, Section 3 developed outcomes /12/2012 Appendix, Section 2 research initiatives, update Section 3, Section 4 Concluding remarks /12/2012 First internal review /01/2013 Version with internal review updates /01/2013 Version with second internal review updates /01/2013 Version with quality review updates /01/2013 Final version ready for submission SUCRE_D2.1_SoA_HC Page 2 of 48

3 Disclaimer This document contains description of the SUCRE project findings, work and products. Certain parts of it might be under partner Intellectual Property Right (IPR) rules so, prior to using its content please contact the consortium head for approval. In case you believe that this document harms in any way IPR held by you as a person or as a representative of an entity, please do notify us immediately. The authors of this document have taken any available measure in order for its content to be accurate, consistent and lawful. However, neither the project consortium as a whole nor the individual partners that implicitly or explicitly participated in the creation and publication of this document hold any sort of responsibility that might occur as a result of using its content. This publication has been produced with the assistance of the European Union. The content of this publication is the sole responsibility of SUCRE consortium and can in no way be taken to reflect the views of the European Union. The European Union is established in accordance with the Treaty on European Union (Maastricht). There are currently 27 Member States of the Union. It is based on the European Communities and the member states cooperation in the fields of Common Foreign and Security Policy and Justice and Home Affairs. The five main institutions of the European Union are the European Parliament, the Council of Ministers, the European Commission, the Court of Justice and the Court of Auditors. (http://europa.eu.int/) SUCRE is a project partially funded by the European Union SUCRE_D2.1_SoA_HC Page 3 of 48

4 Executive Summary The European Commission s digital agenda for Europe highlights both open source and cloud computing as two important directions for future technological development. The SUCRE project itself is driven by a key objective that aims to bring these two directions under one roof by targeting the area of open source cloud computing. The project aims to foster the consolidation of the European Cloud Computing and Open Source communities by creating a critical mass of stakeholders in EU and Japan who will collaborate on promoting the use of Open Source in Cloud Computing. Alongside this effort, the project aims to investigate the possibility of open source cloud adoption in two important sectors; the public and the healthcare sectors. This report regards the case of open source cloud adoption for the healthcare sector and aims to provide a state of the art analysis illustrating the current state of open source cloud computing initiatives available for healthcare. However, as the open cloud initiatives concerning healthcare are limited, this report also draws insights from initiatives of other related disciplines that could bring significant input towards our effort. Hence, after the consideration of a variety of initiatives towards this direction, a selected set of cases ranging from research and development initiatives to applied solutions is being summarized in this report. In addition, throughout this effort, the main risks and benefits associated to the adoption of open source cloud services for the healthcare sector are being enlisted based on their nature into technical, economic and legal or policy. Finally, gaps associated to our target area are also being discussed. The outcome of this report is to serve as a reference point for directing the future actions of the SUCRE project associated with the healthcare provisioning industry. More specifically, at an initial stage this report will provide direction for the deployment of the use-case of the SUCRE project for the health care sector. This work is also linked with the conduction of interviews with key stakeholders from this discipline as well as the engagement of this community with the SUCRE project through the organization of a workshop. In addition, at a later stage this report will assist the drafting of the Health Care Industry Primer to be derived through the SUCRE project. SUCRE_D2.1_SoA_HC Page 4 of 48

5 Table of Contents 1 Introduction Goal of this report About the document Research and Development Initiatives Open Source Cloud Research VISION Cloud, EU Midas, EU CELAR, EU neugrid, EU KC Class, EU Stratosphere, Germany e-health GATEway to the Clouds, JISC An Open Source Cure to Cancer, Italy Non-Open Source Cloud Research TClouds, EU Nationwide database for patient data, Finland Summary Developed Outcomes and Applied Solutions Open Source Solutions ClearHealth, USA OpenEMR, USA Commercial Solutions EMC 2, Worldwide Microsoft Cloud Services for Health, Worldwide Infoway Blueprint, Canada VMware, Worldwide MedScribbler, US CareCloud, US Summary Concluding Remarks - Risks, Challenges, Benefits and Gaps Risks and Challenges Technological Risks Legal and Policy Risks Financial Risks Benefits Technological Benefits Legal & Policy Benefits SUCRE_D2.1_SoA_HC Page 5 of 48

6 4.2.3 Financial Benefits Gaps Technological Gaps Legal and Policy Gaps Financial Gaps Conclusions What is a Cloud? Terminology Types of Clouds Characteristics of Clouds Non-functional Aspects Economic Aspects Technological Aspects Open Source Clouds Cloud Usage Deployment Types of Cloud Solutions Cloud Service Models Virtualisation as a Concept Related Areas Internet of Services Internet of Things Service Oriented Architectures References SUCRE_D2.1_SoA_HC Page 6 of 48

7 List of Tables Table 1: Comparison of presented solutions SUCRE_D2.1_SoA_HC Page 7 of 48

8 1 Introduction 1.1 Goal of this report In the past decade the Healthcare Provisioning Industry has experienced a significant transformation through the use of Information Technologies. The deployment of cloud computing technologies in the service of healthcare could provide, however, additional benefits and added value to several domains of healthcare. This wide spectrum of domains ranges from electronic medical records to medical imaging and from patient case studies dissemination to care management. In the frame of this report, healthcare is not only patient care, but also diagnosis, analysis, research and collaboration. For example, 3D brain scans can be considered as big data, as the image sizes need to be large for sharp imaging and accurate research and patient diagnosis. From the SUCRE point of view, this shows the potential of cloud computing in healthcare research. With more results, improved access to data and large storage capability much can be achieved in research. Moreover, speed with which information can be accessed and distributed provides researchers improved ways to collaborate. This is the first report produced for the SUCRE project, Work Package 2, aiming to derive information about the use of cloud computing for the healthcare sector and serve as a reference point for the rest of the tasks of Work Package 2. In particular, this report will guide the exploration of the open source cloud computing applications in the medical sector through the conduction of interviews with healthcare practitioners. In addition, it will serve as a reference point for the organization of a hands-on workshop that will bring together cloud system suppliers with healthcare representatives. Input from this report is expected to be used for drafting the health care industry primer. For the above reasons the scope of this report is kept broad enough to capture all related disciplines of healthcare to which cloud computing technology could contribute. This scope is expected to be refined and narrowed down as we proceed with further tasks and deliverables attached to the same work package. With regards to the types of initiatives from the healthcare domain being captured, this report keeps its scope broad as well. More specifically, the report captures both, current research and development initiatives as well as developed outcomes and applied solutions. To this end, the report does not aim to provide a definitive look of the field, but to provide an overview of the cross-cut attempts, successes and solutions recorded either in Europe or SUCRE_D2.1_SoA_HC Page 8 of 48

9 beyond. Hence, we present initiatives that span over the boarders mentioned above rather than addressing the issue from a consumer, or provider, or even high-end research point of view. More specifically, the selection criteria used for the initiatives captured, have been multiple including, but not limited to: the innovative aspects of a research effort, the societal impact, the technological challenges involved with it, the wide adoption, and the possibilities it offers. In this report both open source and proprietary solutions are considered. However, the weight is on open source, as SUCRE focuses on the promotion of open source solutions for cloud computing. Where available information enables us to, the approaches/solutions described are looked from a set of viewpoints, including: Technical: this includes aspects such as security, data privacy, availability of services and infrastructures, connectivity options, interoperability in terms of information and services, etc. Economic: which addresses aspects such as the ones related to migration and usage costs or elasticity and associated financial concerns. Legal or Policy: that addresses issues concerning management, legal and policy aspects with regards to the use, storing, manipulation or accessing of information and services as well as other aspects such ecological footprint of the applied solution. 1.2 About the document This document is divided into three main parts, illustrated in chapters two, three and four. Chapter two provides insights regarding current projects in research and development initiatives. Chapter three presents existing commercial solutions available, including open source and proprietary solutions. Based on information discussed in chapters two and three, chapter four presents the risks and benefits associated with the use of cloud computing in healthcare. An annex is also attached to this document. The purpose of this annex is to provide the basic terminology and concepts of cloud computing. It aims to introduce background information to the general topic of clouds and open SUCRE_D2.1_SoA_HC Page 9 of 48

10 source. Even though it is not essential to the content of the document, it allows conceptual clarity and expands the theoretical base. It must be noted, that there is a limited amount of data available on open source cloud computing solutions specifically for healthcare sector. Even less so with the case of open source in Europe. To compensate for this lack, this report includes non-european initiatives, as well as relevant cloud solutions and projects which may be not open source. We follow this approach, as it could illustrate what Europe can learn from the rest of the world as well as it can denote cloud solutions for healthcare that could alternatively be developed on an open source basis. Finally, this document is complementary to another state of the art analysis report provided by the SUCRE project for the purposes of Work Package one. Contrary to this, that report analyses the start of the art on the adoption of open source cloud services for the public sector. 2 Research and Development Initiatives The European Commission Expert Group Report titled The Future Of Cloud Computing states that by 2010 only a limited amount of dedicated research had been done on cloud computing (EC 2012). Through our investigation we concur that this is valid, even to a greater extent, in the healthcare sector. Nevertheless, several contemporary projects have a research track within them dedicated to cloud computing. These tracks mainly investigate the migration possibilities from existing solutions to cloud based ones. The European Commission Expert Group report concludes with the mark that research and the development from open source communities tends to centre on individual capabilities and not on integration and middleware solutions. It could even be that a complete infrastructure system is not within the scope or interest of the community. This is seen due to the tendency of developed projects to drift towards proprietary solutions to fill gaps in specifications and existing tools. This tendency to use proprietary solutions is imminent in healthcare, as few open source solutions are available at the moment. Proprietary solutions are perceived as more secure, reliable and stable. However, this is not necessarily the case, as several large proprietary solutions have been targets of malicious attacks, e.g. Microsoft and Google have not been without targeting. There is development toward interoperability of open source solutions as most research results adhere to SOA paradigms and try to maintain standard SUCRE_D2.1_SoA_HC Page 10 of 48

11 interfaces. In this regard, our investigation shows a much higher interoperability in open source clouds over proprietary solutions. In the two years, after the release of the European Commission Expert Group report, some development has taken place. Yet challenges on adopting an open source cloud solution to healthcare still remain. These challenges are being under research and solutions are starting to emerge. For instance, the current Call 8 of the European Commission FP7 framework program funds promising projects that aim to address the challenges discussed in more detail in chapter four. Many of them address directly healthcare related issues, through the implementation of related use cases. These will be presented in the current report, though the projects are in an early phase and results have not been presented yet. In the following we present contemporary research initiatives in the provision of cloud systems for the healthcare domain. These are classified in accordance to the specified scheme as open-source and non-open source initiatives. Presented solutions have been selected in accordance to the criteria set previously. 2.1 Open Source Cloud Research Under open source category there are several research cases and implementation projects that are discussed next. Most of these solutions are still in development phase and therefore constitute research projects or initiatives. This chapter uses two viewpoints, i.e. one from open patient data perspective and the other from an academic research point of view to illustrate solutions published as early as This unveils that presented ideas are part of an ongoing discussion and also marks a starting point indicating the progress made since that point. The former viewpoint works as an example to illustrate the positive strength of open source ideology and highlights that not all data must be hidden behind strong walls and impenetrable firewalls. Sharing parts can be very beneficial in finding alternatives and getting second diagnoses and opinions VISION Cloud, EU Moving towards a media-aware Data Access Layer is the goal of this EUfunded project. The project identifies that cloud computing offers cost flexibility. In the past, a company or user with high storage needs would have to buy servers or even build a data center. Today, there are already many options to simply move to cloud platforms and pay just for what is really used. SUCRE_D2.1_SoA_HC Page 11 of 48

12 On this premise the project wishes to expand on what is available to address the gap of unexploited solution areas. It suggests innovative platforms, where patients, doctors and hospitals could securely exchange files and data, resulting in better services at lower costs, or ways to work on media projects with large HD video files and big data analysis. All in all, its goal is to introduce a powerful ICT infrastructure for reliable and effective delivery of data-intensive storage services, facilitating the convergence of ICT, media and telecommunications. The primary deliverables of VISION Cloud will be an architecture and a reference implementation of a cloud-based infrastructure, built on open standards and new technologies, to provide a scalable, flexible and dependable framework for optimized delivery of data-intensive storage services. It does this through supporting new emerging teleco/media services and aims to achieve significant and quantifiable improvements in service delivery productivity, quality, availability, reliability and cost. The project will include a use case from the healthcare sector. If patients, doctors, hospitals and insurances could exchange data both securely and more efficiently, there is a promise of huge cost savings all around the world. In VISION Cloud the Healthcare use case will focus on data and files exchange that where not possible in the past. Privacy of sensitive data at all time is one of the challenges that have to be solved convincingly in this particular area. This use case is yet to be implemented, but seems to promise interesting possibilities Midas, EU According to the description available in the Software and Services FP7 Project Portfolio, the objective of the MIDAS project is to realize a comprehensive framework able to support automation and intelligent management of Service Oriented Architecture (SOA) testing. The framework supports all the testing cycle activities: test case planning, development and execution, reporting and result analysis, test campaign management and scheduling. Moreover, the framework supports the main testing domains such as functional, interactional, fault-tolerance, security and usage-based testing. In order to provide these features, the architecture of the MIDAS framework includes: an environment for design time and run time (on the fly) generation of test cases and oracles; SUCRE_D2.1_SoA_HC Page 12 of 48

13 an environment for SOA automatic testing configuration, initialization and execution of the Services Architecture Under Test (SAUT), based upon a Test and Test Control Notation (TTCN 3) distributed engine; probabilistic and symbolic inference based methods and tools for test result analysis and test campaign planning and scheduling. MIDAS framework is made available as a Platform as a Service (PaaS) on a cloud infrastructure so as to support the elastic scalability of the testing environment, i.e. allocation of huge amounts of computation resources for relatively short test campaigns on very large services architectures. To evaluate the effectiveness and the usability of the provided facilities, two pilot SOA testing experiences are carried out in different business domains: Healthcare (HC) and Supply Chain Management (SCM). In HC, the MIDAS framework will be used for building test campaigns upon the HSSP services implementation, provided by the Italian HealthSOAF research project CELAR, EU CELAR project recognizes that auto-scaling resources are one of the top obstacles and opportunities for Cloud Computing. Meaning that consumers can minimize the execution time of their tasks without exceeding a given budget, cloud providers can maximize their financial gain while keeping their customers satisfied and minimizing administrative costs. It will address the existing gap of adaptive elasticity through the automation of elastic provisioning in a fully customizable manner. It aims to deliver a fully automated and highly customizable system for elastic provisioning of resources in cloud computing platforms. This project directly addresses the gap of scalability important to healthcare applications as well. Scalability, both upwards and downwards, is an aspect that defines resourcing in cloud computing. Through automated scalability savings in cloud, maintenance can be achieved and a more thorough and accurate pricing model can be established limiting gray areas in billing for cloud services. The project will test the above in two exemplary applications. The first is dealing with online gaming and the second use case, which is of interest of the purposes of this document, focuses on scientific computing, requiring compute- and storage-intensive genome computations. In particular CELAR will try to form a pipeline for the early translation of cancer detection. The two use cases have different runtime and resource requirements; they will verify though the CELAR technology in real world context. SUCRE_D2.1_SoA_HC Page 13 of 48

14 2.1.4 neugrid, EU In the past years the EC has encouraged efforts to use grid and cloud infrastructure to analyze big data related to Health. In this light, it has funded a number of projects that had been linked to each other. neugrid was a cloudcomputing infrastructure funded by the European Commission that stored and analyzed a vast database of 3D brain scans. neugrid built on research conducted by two prior EU-funded projects: Mammogrid, which set up a grid infrastructure to analyze mammography data, and AddNeuroMed, which sought biomarkers for Alzheimer's disease. The team continued their work in a series of follow-up projects and neugrid expanded globally to help find treatments for Alzheimer s disease. The aim of this initiative was to develop a global online system to centralize and boost Alzheimer s research initiatives. Following its three-year development, neugrid was successfully tested in 2009 when it extracted an Alzheimer s biomarker in a record time of two weeks instead of the usual five years. NeuGRID ended in 2011, but follow up projects have developed, two most prominent ones being Neugrid for You and outgrid. Neugrid for You (N4U) builds upon the grid infrastructure integrating it with High performance computing and cloud computing resources. Using EUR 3.5 million in European Commission funding, it also expands the user services, algorithm pipelines and datasets to establish a virtual laboratory for neuroscientists. N4U expands the grid infrastructure from the initial five computing clusters through connections with CPU nodes at new sites, including 2,500 CPUs recently added in Paris in collaboration with the French Alternative Energies and Atomic Energy Commission (CEA), and in partnership with 'Enabling grids for e-science Biomed VO', a biomedical virtual organization. In addition the project aims to simplify the tools and services available for infrastructure, so learning their use is no more difficult than that of learning to use an iphone. neugrid had in parallel established outgrid (ended on October 2011), its international brand, that was seeking to converge neugrid with two e- infrastructures (CBRAIN in Canada, LONI in the US) into one unique interoperable platform. This would allow scientists worldwide to share their medical data while accessing the extensive information available online KC Class, EU Interregional EU funding is used to finance this project that is based in Slovenia. The main project objective with KC Class is the development of services and products in the area of cloud computing and it has a healthcare SUCRE_D2.1_SoA_HC Page 14 of 48

15 track within it. Research and competence building in the project focuses on safety, mobility, multi-tenancy, identity management, reliability, data management and open interfaces. This knowledge will be applied for construction of a new generation of applications for implementation in the cloud. The project gives special attention to subcategories such as distributed processes, product management, knowledge development, health and environment. All these competences will be upgraded with the services and products, which will be marketed on the global market with the help of the competence centre. One of the key goals of the KC operation is to penetrate to international markets with more services and products. KC class will be based on the development of relevant competencies of individual partners and their mutual interconnection. International KC engagement will be secured by the project with the enrollment in international organizations and standardization bodies. KC class management will be based on years of experiences of consortium members that have already participated in many international projects and produced several services and products for global corporations. One of the key tasks of KC is ensuring knowledge transfer from research organizations to the companies and thus to services and products. The program connects all key organizations in Slovenia that deal with cloud computing. It enjoys a wide support from industry and international organizations. The program includes the critical mass of knowledge and engages different disciplines of the computing domain for the development of innovative services and products. The possible benefits of this project for healthcare come especially from the point of view of data security. Patient records are private information of individuals and needs to be kept safe and secure. Safety, security and identity management are in the centre of this very problem. This has been a gap in cloud computing that KC class will address Stratosphere, Germany Stratosphere is a German research project (DFG-funded) investigating "Information Management on the Cloud" and creating the Stratosphere System for Big Data Analytics. The Stratosphere System is an open-source cluster/cloud computing framework for Big Data analytics. Through PACT programming model, Meteor programming language and a data flow engine of their design they provide an open solution for optimized and integrated customer solutions on big data. SUCRE_D2.1_SoA_HC Page 15 of 48

16 Stratosphere is examining real-world use-cases in the area of information extraction and integration of unstructured data in the life-sciences, climate research, as well as linked open data. To healthcare this means that they are looking at the problem of unstructured data, e.g. patient records, and try to make it more analyzable and easier to integrate to real-life solutions. As a result there is possibility for increased interoperability between different cloud solutions that need to deal with patient records. This would allow the easier adoption of cloud computing as well as the reduction of cost and vendor lockin e-health GATEway to the Clouds, JISC The e-health GATEway to the Clouds Project (ended on August 2012) established a cloud-based research platform on the White Rose Grid to support e-health records research. It addressed the identity management challenge of shared access by researchers to the text within e-health patient records which, if left in its original form, may identify patients and their clinicians, carers and family members. The project created a new software plug-in for the open source GATE natural language processing (NLP) system, which helped pseudonymise free format text such that it can be safely used by researchers following best practice in ethics and information governance. The project built upon cloud computing research at the School of Computing in Leeds and created a case study on the use of the Wshite Rose Grid as a research platform for UK HEIs. The work builds on the strengths of the White Rose Consortium (the Universities of Leeds, Sheffield and York) and complements plans to establish an e-health Informatics Research Centre (e- HIRC) between the three Universities, centred on linking the White Rose Grid to the e-health records of The Phoenix Partnership (TPP), the commercial partner in this bid. All three Universities have expertise in e-health Natural Language Processing (NLP) research and are linked to Sheffield s GATE software, which is recognised as the leading open source text mining system worldwide. The GATEway to the Clouds project demonstrated how GATE can remove one of the barriers to cloud infrastructure being used for research with sensitive identifiable free text. It provides a specific first of type demonstrator linking e-health records from the NHS, through a commercial company and then via HEI infrastructure with anonymisation by GATE into a secure research environment. This was achieved in a pilot using fictional but realistic e-health records created by 1,200 Leeds medical students who have used TPP s GP record system for training between 2008 and It involved a single case study managed through three work packages: 1) Software SUCRE_D2.1_SoA_HC Page 16 of 48

17 environment development to create one or more secure cloud-based research environments to hold anonymised e-health records from TPP (the Clouds).2) Software development of an NLP pseudonymisation module for GATE (the GATEway). 3) Service model development based on evaluation of the value of the tools and infrastructure and opening these for wider exploitation by the research community An Open Source Cure to Cancer, Italy People are understandably wary of publicizing their private health records. They fear not only that other individuals could access their private data, but that their health records could be used against them by insurance companies and potential employers. This worry is also mirrored in the development of legislation for healthcare data storage. However, this widespread apprehension and at times legal restrictions makes it difficult for those wishing to build big, comprehensive healthcare databases. This is noted by Salvatore Iaconesi (Web: Datanami, 2012). He may have laid the first stone on the path out of medical secrecy when he posted his medical information of a diagnosed cancer to a special section of his Art is Open Source website. Through open sourcing his medical information he wished to find an alternative way to cure cancer that would not be either surgery or chemotherapy. As a result, he requested his digital health information from the hospital and went home so he could share the information in an open source, collaborative arena. As a somewhat noted figure, Iaconesi was able to bypass the database form and go straight to fellow doctors who had second, and in Iaconesi s eyes superior, opinions. For example, within a day of posting information to his site, a couple of Italian doctors outlined the potential surgical options. According to Iaconesi, the Italian parliament is considering providing more open access to medical records in the country, leading to more stories like this one. After all, geneticists and cancer researchers are always looking to add more to their datasets This example is not as such a technological solution, but it illustrates the potential of sharing data that is in a standard form and openly available in a cloud solution. 2.2 Non-Open Source Cloud Research In addition to the open-source research initiatives, there are non-open source solutions that are being researched and aimed to implementing cloud SUCRE_D2.1_SoA_HC Page 17 of 48

18 solutions for healthcare. A list of indicative initiatives, conforming to our selection criteria, is presented in this chapter TClouds, EU Mission statement of TClouds tells us that the project aims to develop an advanced cloud infrastructure that can deliver computing and storage that achieves a new level of security, privacy, and resilience, yet it is cost-efficient, simple, and scalable. It also wants to change the perceptions of cloud computing by demonstrating the prototype infrastructure in socially significant application areas: energy and healthcare. As TClouds has some large companies behind it and it does not directly state itself as an open source project. The project acknowledges that the current cloud computing model comes with perceived risks concerning resilience and privacy. It notes three fundamental trends in ICT whose risks mutually reinforce each other: the push towards an Internet of Services, the migration of ICT into so-called Infrastructure clouds, and growing importance of ICT as the critical nervous system for socially relevant smart infrastructures. It also notes that protecting data and services in the cloud is very important to governments and organizations, including healthcare. Thus, the perceived security and dependability risks of cloud computing are limiting its application. The TClouds project targets cloud computing security and aims to minimize the widespread concerns about the security of personal data by putting its focus on privacy protection in cross-border infrastructures and on ensuring resilience against failures and attacks. What this means to healthcare is that the privacy of sensitive patient data will be enhanced. Through their case study in healthcare we will most likely observe a secure way to use cloud computing in healthcare sector and through their aim of changing perceptions of security of cloud computing towards a more trusting stance, we can possibly observe an increase in public trust to cloud computing solutions for the sector. They have strong and trusted names like IBM and Siemens in the partnership, so the initial stand of the image campaign looks promising Nationwide database for patient data, Finland There is an ongoing call in Finland for developing a nationwide patient database through a cloud solution. This would include both data structure standardization in a national level as well as interoperability of hospital software and infrastructure. SUCRE_D2.1_SoA_HC Page 18 of 48

19 Initial plans are being set, but the project is currently stagnating. Mainly due to the high price tag associated to the project and public outcry when the consultant company hired to assess the situation and best possible solution ended up recommending their own cloud solution. It is estimated that this project, when covering the whole country, would cost approximately 1,8 Billion. Public advocates have given alternatives on this solution including open source solutions. However there is little indication as to when the project will be re-initiated. There are smaller projects going on all over the country, most notably in the Helsinki area. These projects provide regional solutions, but they also wait for a nationwide solution as the initial investments of migrating into the cloud might increase through the introduction of a possibly different national solution. 2.3 Summary The table below summarizes all projects and initiatives presented in Chapter 2 and highlights the main aspect they cover. Of course all of them address technical issues, as almost all of them are research projects. As, however, the early efforts in the Open Clouds for Healthcare lie already a few years behind, the focus of this second round of projects moves from covering only technical matters; legal and economic issues are gaining in importance. Projects Technical Legal Economic Vision Cloud MIDAS CELAR neugrid / N4Y KC Class StratoSphere e-health GATEway An Open Source Cure to Cancer TClouds Nationwide database for patient data, Finland Table 1: Comparison of presented solutions SUCRE_D2.1_SoA_HC Page 19 of 48

20 3 Developed Outcomes and Applied Solutions Apart from research and development initiatives, there has been a set of solutions, labeled as either commercial products or open-source solutions. These have come to address the current trend towards the migration of existing applications, services, and data once held from local computers or local servers to the cloud. In the following we go through a list of such solutions, i.e. either packaged as commercial products or open-source ones, which are not solely of European origin. These solutions have been selected using the criteria set in the beginning of this report and have been classified under the open-source and commercial categories. 3.1 Open Source Solutions SUCRE research unveils that several open source solutions for healthcare exist. Just to give a very good example of this: the European Federation for Medical Informatics (EFMI) and the International Medical Informatics Association (IMIA) have both established working groups who work collaboratively and support the adoption of Free/Libre and Open Source Software (FLOSS) in the Healthcare domain. In this context they have created an open information portal that provides a comprehensive and structured overview of FLOSS projects in the domains of medical informatics and health care 1. Moreover, many of the solutions that are available for businesses and public administrations can partly be used in the healthcare sector. E.g. running a practice, a research centre or a hospital requires CRM, document management, ing, data storage, and so on. Such solutions can be found at the State of the Art report on Cloud Computing in Public Administrations by the SUCRE project. It has to be noted, however, that not many efforts exist that combine the use of open source models in cloud environments and applications for the Healthcare domain. In this report we focus on Open Source services specifically designed for healthcare. It should be noted that the scope in this chapter has been widened to include solutions from all over the world, as there are especially in the US remarkable efforts in the domain and oversee experience can serve as best practice for Europe. Existing projects range from handling patient records, practice management, billing and visualization, to a more diversified field of community health management, data analysis and specialized solutions for different branches of 1 SUCRE_D2.1_SoA_HC Page 20 of 48

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