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IPA Europe/Aid/136938/ID/ACT/ME
WP 2 - ANALYSES OF EU AND
GLOBAL TRENDS OF CLOUDS IN
eHealth
DEV 2.3 - Understanding the value
proposition for cloud based
solutions in eHealth
Authors:
Radovan Sekulić, MG Soft
Jelena Simićević, MG Soft
IPA Europe/Aid/136938/ID/ACT/ME project
Reference no. CFCU/MNE/010
This project has been funded with support from the European Union.
The publication (communication) reflects the view of the author, and the
Commision cannot be held responsible for any use which may be made of
the information contained therien.
I PROJECT COORDINATOR:
Institute of modern technology Montenegro (IMTM)
I
I Cetinjski put 38/a-II-14, 81000 Podgorica, Montenegro I
I Phone: +382 20 648 177 I www.imtm.me I [email protected] I
Transfer of knowledge between sectors of higher education, research and industry
IPA Europe/Aid/136938/ID/ACT/ME
Contents
Introduction............................................................................................................................................................. 3
General value proposition of Cloud computing ...................................................................................................... 3
Value proposition in Healthcare.............................................................................................................................. 7
Primary Value Processes ..................................................................................................................................... 9
Secondary Value Processes ............................................................................................................................... 12
Conclusion ............................................................................................................................................................. 13
IPA Europe/Aid/136938/ID/ACT/ME project
Reference no. CFCU/MNE/010
This project has been funded with support from the European Union.
The publication (communication) reflects the view of the author, and the
Commision cannot be held responsible for any use which may be made of
the information contained therien.
I PROJECT COORDINATOR:
Institute of modern technology Montenegro (IMTM)
I
I Cetinjski put 38/a-II-14, 81000 Podgorica, Montenegro I
I Phone: +382 20 648 177 I www.imtm.me I [email protected] I
Transfer of knowledge between sectors of higher education, research and industry
IPA Europe/Aid/136938/ID/ACT/ME
Introduction
This report provides overview and highlights different value propositions offering
and describing the quantifiable benefits that the Cloud and eHealth is delivering in
Healthcare.
Recommendations and critical factors for choosing appropriate cloud solution, as
results of previous technological surveys, are taken into account when considering
value propositions that different cloud technologies can offer. Special attention is
also placed into identifying value propositions specifically related to Healthcare,
through introduction of eHealth.
General value proposition of Cloud computing
Cloud encompasses several variations of service models (i e., IaaS, PaaS, and SaaS)
and deployment models (i.e., private, public, hybrid, and community clouds) as
described in previous analysis of the project. Depending on chosen service and
deployment model, Cloud computing can reduce the need for physical or
technological infrastructure and provide better service workload distribution on
existing hardware infrastructure. The infrastructure of cloud computing deals with
the setting up of software that is involved in cloud computing.
IPA Europe/Aid/136938/ID/ACT/ME project
Reference no. CFCU/MNE/010
This project has been funded with support from the European Union.
The publication (communication) reflects the view of the author, and the
Commision cannot be held responsible for any use which may be made of
the information contained therien.
I PROJECT COORDINATOR:
Institute of modern technology Montenegro (IMTM)
I
I Cetinjski put 38/a-II-14, 81000 Podgorica, Montenegro I
I Phone: +382 20 648 177 I www.imtm.me I [email protected] I
Transfer of knowledge between sectors of higher education, research and industry
IPA Europe/Aid/136938/ID/ACT/ME
Value proposition for Cloud computing has the following five attributes:
Multitenancy (Shared Resources)
Unlike previous computing models, which assumed dedicated resources, for
example, computing facilities allocated to a single user or owner, cloud computing
is based on a business model in which resources are shared, for example, multiple
users use the same resource, at the network level, host level, and application level.
Massive Scalability
Although users might have large number of systems, cloud computing allows for
scalability of systems as well as scale bandwidth and storage space.
Elasticity
Users can rapidly increase and decrease their computing resources as needed and
release resources for other uses when they are no longer required.
Pay as You Go
Users pay for only the resources they actually use and for only the time they require
them. This attribute have limited benefits when considering private cloud
deployments. Savings can be achieved by providing other cloud services needed
computing infrastructure when it is not needed by services with reduced workload.
Self-Provisioning of Resources
Users self-provision resources, such as additional systems (processing capability,
software, storage) and network resources. One of the attributes of cloud computing
is elasticity of resources. This cloud capability allows users to increase and
decrease their computing resources as needed.
IPA Europe/Aid/136938/ID/ACT/ME project
Reference no. CFCU/MNE/010
This project has been funded with support from the European Union.
The publication (communication) reflects the view of the author, and the
Commision cannot be held responsible for any use which may be made of
the information contained therien.
I PROJECT COORDINATOR:
Institute of modern technology Montenegro (IMTM)
I
I Cetinjski put 38/a-II-14, 81000 Podgorica, Montenegro I
I Phone: +382 20 648 177 I www.imtm.me I [email protected] I
Transfer of knowledge between sectors of higher education, research and industry
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Moving to a cloud-based platform does, however, pose challenges and concerns as
described in Dev 2.2 project analysis. Dealing with standards, security,
performance, legal requirements and availability issues has to be taken into account
for cloud computing to offer a true value proposition.
Having in mind privacy, security and national legislation requirements, setup of
private cloud solution with hybrid connection for implementation of less restrictive
healthcare services, is suggested in findings and conclusions of previous project
analysis.
Private cloud delivers similar advantages to public cloud, including scalability and
self-service, but through a proprietary architecture. Unlike public clouds, which
deliver services to multiple organizations from various fields, a private cloud is
dedicated to a single organization (in our case public healthcare sector).
A hybrid hosting service or hybrid server is a type of Internet hosting which is a
combination of a physically-hosted server with virtualization technology. A hybrid
server is a new kind of dedicated server that offers both the power of a classic
dedicated server and the flexibility of cloud computing. Hybrid cloud storage is an
approach to managing storage that uses both local and off-site resources. Hybrid
cloud storage is often used to supplement internal storage with public cloud
storage.
Implementation of private and hybrid cloud solutions require existence of onpremise data center. Existing Integral Healthcare Information System of
Montenegro is hosted at Health Insurance Fund (HIF) of Montenegro data center.
HIF data center hosts wide range of web-centric applications and Information
Systems in Healthcare sector (primary healthcare centers, general hospitals,
pharmacies, Institute of Public Health etc.). Most of the Healthcare applications are
hosted in HIF data center. Others include healthcare applications hosted at Clinic
Center of Montenegro data center, Agency for Drugs and Medical Devices of
Montenegro data center and data centers of some private hospitals and companies
IPA Europe/Aid/136938/ID/ACT/ME project
Reference no. CFCU/MNE/010
This project has been funded with support from the European Union.
The publication (communication) reflects the view of the author, and the
Commision cannot be held responsible for any use which may be made of
the information contained therien.
I PROJECT COORDINATOR:
Institute of modern technology Montenegro (IMTM)
I
I Cetinjski put 38/a-II-14, 81000 Podgorica, Montenegro I
I Phone: +382 20 648 177 I www.imtm.me I [email protected] I
Transfer of knowledge between sectors of higher education, research and industry
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related to healthcare. All are integrated into Integral Healthcare Information
System of Montenegro, using Service Oriented Architecture (SOA) Web services.
Recent technological developments in HIF data center include introduction of
virtualization of existing hardware infrastructure through usage of VM ware,
Oracle VM and similar software products. These, together with usage of Service
Oriented Architecture (SOA) and Web Services, present proper bases for further
development of Cloud computing compatible data center infrastructure.
With typical data center costs running to approximately 25 percent of total IT
budgets, healthcare providers are under pressure to find cost-efficient business
solutions and models to operate their data centers. A cloud computing data center
model enables rapid innovation, scalability, and support of core functions, resulting
in significant economies of scale.
A cloud computing data center reduces the need for additional hardware, software
and facilities; for server network storage; operating systems and middleware
provisioning; and for dealing with security issues, all of which are costly and timeconsuming functions. Sharing of infrastructure platform for various supported
cloud services, in private cloud deployment model provides more efficient service
workload distribution.
A cloud computing platform also increases the utilization of servers, which can
range from 20% to 70%, resulting in a decrease in required infrastructure. This
hardware reduction translates to a dramatic drop in some associated operations
expenditures: rack space, real estate, power, and cooling.
IPA Europe/Aid/136938/ID/ACT/ME project
Reference no. CFCU/MNE/010
This project has been funded with support from the European Union.
The publication (communication) reflects the view of the author, and the
Commision cannot be held responsible for any use which may be made of
the information contained therien.
I PROJECT COORDINATOR:
Institute of modern technology Montenegro (IMTM)
I
I Cetinjski put 38/a-II-14, 81000 Podgorica, Montenegro I
I Phone: +382 20 648 177 I www.imtm.me I [email protected] I
Transfer of knowledge between sectors of higher education, research and industry
IPA Europe/Aid/136938/ID/ACT/ME
Value proposition in Healthcare
In order to fully understand value proposition of using such technologies, we
will have to consider and analyze types of healthcare processes that will benefit
the most.
Healthcare processes can be divided into two types:
 Primary Value Processes (PVPs)
 Secondary Value Processes (SVPs).
Primary value processes represent core processes in Healthcare related to direct
provision of healthcare services to the patient, while secondary value processes
include all support processes that allow functioning of healthcare system (fig1.).
IPA Europe/Aid/136938/ID/ACT/ME project
Reference no. CFCU/MNE/010
This project has been funded with support from the European Union.
The publication (communication) reflects the view of the author, and the
Commision cannot be held responsible for any use which may be made of
the information contained therien.
I PROJECT COORDINATOR:
Institute of modern technology Montenegro (IMTM)
I
I Cetinjski put 38/a-II-14, 81000 Podgorica, Montenegro I
I Phone: +382 20 648 177 I www.imtm.me I [email protected] I
Transfer of knowledge between sectors of higher education, research and industry
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As it was described in previous project reports, most of the stated processes are
supported by Integral Healthcare Information System of Montenegro. It
provides access to healthcare information to healthcare professionals during
medical decision making, supporting primary value processes while providing
necessary support for secondary value processes. System is oriented towards
healthcare professionals (doctors, nurses and support staff) and patients does
not have direct access to the system.
eHealth cloud computing value proposition will have the most to offer
concerning services that are provided directly to the patient, using innovative
technology solutions.
Mobile communication, accelerated developments in broadband networking,
open source technologies, and Web 2.0 have made on-demand services more
reliable and affordable. Mobile technology is increasing day by day. At 178%
Montenegro had the second highest mobile cellular phone penetration rate in
Europe, only behind Russia, and ranked 9th worldwide. Mobile access is
significantly greater than access to computers. Mobile communications and
advancement of smartphones made health care delivery very handy. These
technologies offer powerful means for restructuring many health service
processes, and there currently are increasing arrays of communication channels,
media, and devices from which communication services can be constructed.
Gradual Cloud computing introduction to already supported processes in
Integral Healthcare Information System, will result in savings in hardware
IPA Europe/Aid/136938/ID/ACT/ME project
Reference no. CFCU/MNE/010
This project has been funded with support from the European Union.
The publication (communication) reflects the view of the author, and the
Commision cannot be held responsible for any use which may be made of
the information contained therien.
I PROJECT COORDINATOR:
Institute of modern technology Montenegro (IMTM)
I
I Cetinjski put 38/a-II-14, 81000 Podgorica, Montenegro I
I Phone: +382 20 648 177 I www.imtm.me I [email protected] I
Transfer of knowledge between sectors of higher education, research and industry
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infrastructure and in increased efficiency of the system, as described earlier in
this report.
Primary Value Processes
As we stated, eHealth cloud computing will have the most to offer concerning
processes related to provision of healthcare services directly to patients.
Primary Value Processes (PVP) includes the core functionalities of the
healthcare sector, i.e., accurate reliable disease diagnosis, provision of
appropriate treatment, and prevention of crisis via disease management. The
key stakeholders associated with PVPs include the healthcare professionals
such as doctors, nurses, laboratory specialists, radiologists etc. and healthcare
consumers i.e., patients. Insurance companies also play a critical role in
countries like Montenegro, where the payment to the healthcare professionals
for their services comes from insurance companies (from Health Insurance
Fund of Montenegro for Montenegro citizens - mandatory healthcare
insurance).
IPA Europe/Aid/136938/ID/ACT/ME project
Reference no. CFCU/MNE/010
This project has been funded with support from the European Union.
The publication (communication) reflects the view of the author, and the
Commision cannot be held responsible for any use which may be made of
the information contained therien.
I PROJECT COORDINATOR:
Institute of modern technology Montenegro (IMTM)
I
I Cetinjski put 38/a-II-14, 81000 Podgorica, Montenegro I
I Phone: +382 20 648 177 I www.imtm.me I [email protected] I
Transfer of knowledge between sectors of higher education, research and industry
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First step in providing primary value processes is the Pre-Diagnosis. The
primary actors in this process are the healthcare professionals who have the
responsibility to be abreast with relevant medical information such that they are
capable of providing best possible services to the patient at a given point in time.
eHealth can be used to conduct online consultations with patients and medical
specialists. Web based tools can be very beneficial in early detection and
prevention of diseases. Advancement in mobile applications also paved away
to provide better healthcare by using mobile applications for contact with
patient.
Accurate reliable diagnosis and treatment refers to the process of healthcare
professionals using relevant “pre-diagnosis” knowledge to providing accurate
diagnosis and appropriate treatment to the patients. The two primary
stakeholders in this stage include the healthcare professionals and patients.
Accurate diagnosis is directly related to the healthcare professionals’ prior
knowledge and precise patient information pertaining to medications, test
results, etc.
Adoption of smartphones and other innovative technologies in daily life can
provide new means for contact with the patient, allowing for more productive
and efficient healthcare workflow with significant reduction of costs to the
patient and to the healthcare system (travel costs, space for treating patients,
time saving).
IPA Europe/Aid/136938/ID/ACT/ME project
Reference no. CFCU/MNE/010
This project has been funded with support from the European Union.
The publication (communication) reflects the view of the author, and the
Commision cannot be held responsible for any use which may be made of
the information contained therien.
I PROJECT COORDINATOR:
Institute of modern technology Montenegro (IMTM)
I
I Cetinjski put 38/a-II-14, 81000 Podgorica, Montenegro I
I Phone: +382 20 648 177 I www.imtm.me I [email protected] I
Transfer of knowledge between sectors of higher education, research and industry
IPA Europe/Aid/136938/ID/ACT/ME
A downfall to this approach is that many patients are not specialized users or
consumers of technology. Many times patients prefer face-to-face interaction
rather than technology. E-health does not allow healthcare professionals to
provide emotional support towards their patients and in many circumstances
patients are in need of emotional connection with their healthcare professional.
Post-Diagnosis/Treatment Disease Management and Crisis Prevention refers to
the process that focuses specifically on disease management and prevention of
crisis. The core of this process lies in ensuring that patients understand the
consequences/risks associated with the disease and the benefits/probable sideeffects of the corresponding treatment, and that patients comply with the
prescribed treatments. Disease management based on pervasive monitoring of
patients to ensure compliance and to detect anomalies before they lead to crisis
can translate into reduction in healthcare costs associated with avoidable
hospitalizations and an improved lifestyle for patients outside of the hospital.
Patients are able to manage their health in an efficient way. Patients do not have
to rely on appointments; instead many of their questions will be answered
through an e-health system. Healthcare professionals can monitor patients’
health as well, without need for patient to visit healthcare institution.
eHealth involves a new and different form of communication between
physicians and patients. Controlling how much information patients should
receive is another important issue. Too much information could be harmful in
many situations. Test results that patients can view without explanation from
the physician can be harmful in many ways.
IPA Europe/Aid/136938/ID/ACT/ME project
Reference no. CFCU/MNE/010
This project has been funded with support from the European Union.
The publication (communication) reflects the view of the author, and the
Commision cannot be held responsible for any use which may be made of
the information contained therien.
I PROJECT COORDINATOR:
Institute of modern technology Montenegro (IMTM)
I
I Cetinjski put 38/a-II-14, 81000 Podgorica, Montenegro I
I Phone: +382 20 648 177 I www.imtm.me I [email protected] I
Transfer of knowledge between sectors of higher education, research and industry
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Secondary Value Processes
Secondary Value Processes (SVPs) include all the functions that support the
PVPs such as: billing to insurance companies/patients for service fees, legal
department to ensure services are meeting the minimal standards, human
resources, financial and accounting services, medical supplies procurement of
desired quality at reasonable cost for day-day functioning of healthcare sector,
research and innovation to find cure to existing ailments, and increasing the
knowledge base.
Most of the stated processes are supported by the Integral Healthcare
Information System of Montenegro, through implementation of Enterprise
Resource Planning (ERP) software solutions and Core IS in Health Insurance
Fund of Montenegro, General hospitals, Pharmacies and other institutions in the
Healthcare system.
Gradual Cloud computing introduction to already supported processes will
result in savings in hardware infrastructure and in increased efficiency of the
system, while introduction of Cloud computing through development of new
support services will provide additional efficiency of the system with possible
usage of hybrid and public cloud deployment models for less restricted health
support services.
IPA Europe/Aid/136938/ID/ACT/ME project
Reference no. CFCU/MNE/010
This project has been funded with support from the European Union.
The publication (communication) reflects the view of the author, and the
Commision cannot be held responsible for any use which may be made of
the information contained therien.
I PROJECT COORDINATOR:
Institute of modern technology Montenegro (IMTM)
I
I Cetinjski put 38/a-II-14, 81000 Podgorica, Montenegro I
I Phone: +382 20 648 177 I www.imtm.me I [email protected] I
Transfer of knowledge between sectors of higher education, research and industry
IPA Europe/Aid/136938/ID/ACT/ME
Conclusion
Introduction of Cloud computing and eHealth into provision of healthcare services, will
result in significant benefits to healthcare providers and patients. This benefits include
increased efficiency of healthcare processes and reduction of associated costs through
better sharing of resources, scalability and more efficient usage of infrastructure
resources.
Described benefits can be achieved with conducted careful analysis of existing
organization and infrastructure in healthcare sector, systematization and planning for
innovation in existing healthcare services and proper development of new healthcare
services based on best suitable cloud computing service and deployment models.
Analysis conducted through this report (Dev 2.3) and previously conducted analysis
(Dev 2.1-Technological surveys and analyses of cloud trends in EU and global eHeath
systems and Dev 2.2-Critical factors to overcome challenges of deploying cloud
solutions), form bases for development of a cloud based solution model and Road Map
for Deployment of Cloud Solution in Healthcare system in Montenegro (WP3 of the
project).
IPA Europe/Aid/136938/ID/ACT/ME project
Reference no. CFCU/MNE/010
This project has been funded with support from the European Union.
The publication (communication) reflects the view of the author, and the
Commision cannot be held responsible for any use which may be made of
the information contained therien.
I PROJECT COORDINATOR:
Institute of modern technology Montenegro (IMTM)
I
I Cetinjski put 38/a-II-14, 81000 Podgorica, Montenegro I
I Phone: +382 20 648 177 I www.imtm.me I [email protected] I