Introduction

Cloud computing concept was introduced in the 1960s by JCR Licklider. Even though he did not use the term ‘cloud’ but he regarded it as ‘interconnected grid of computers.’ In general, cloud computing is activities of storing and processing data or information on the server that allows data sharing via the Internet. By selecting appropriate component and types in cloud computing model, it will create a secure, robust, flexible and cost-effective cloud computing system.

In medical imaging, cloud computing are used to facilitate the management of patient health records and medical images from various imaging modalities available at hospital or medical centre at a cheaper cost.

Cloud computing consists of the application, client, infrastructure, services, storage and processing power. There are several types of cloud computing that are commonly used which is public cloud, a private cloud, hybrid cloud and community cloud.

Besides that, there are also various types of cloud-computing model such as Infrastructure as a Service (IaaS), Platform as a Service (PaaS), Software as a Service (SaaS) and some other model types.

Figure 1: The term “cloud” refers to how the Internet is depicted in computer network infrastructure and complex applications.

Component in Cloud Computing

List of key component in cloud computing:

1. Applications are a major component in cloud computing. Used by radiologists to review medical images and reports.
2. Client is a web browser. Used as a medium to access the cloud computing system via the Internet by using a computer or smart phone.
3. Infrastructure consists of hardware and server that runs software and data storing in a storage device.
4. Service are available either in Picture Archiving and Communication System (PACS) web-based format or web-based archive format film.
5. Storage of data or information is in the form of documents and Digital Imaging and Communications in Medicine (DICOM) images.
6. Cloud computing has the potential to provide greater processing power at a lower cost.

Types of Cloud Computing

There are four types of cloud computing:

1. Public cloud: A general cloud services that can be sold to any Internet user. As example, Amazon Web Services are the largest cloud computing service providers in the world.
2. Private cloud: A dedicated cloud services that provided only to certain individuals to access data or confidential information such as the patient’s health record information. Controlled by IT workers in the hospital to prevent such data or information accessed without control.
3. Hybrid cloud: A mix between a public cloud and a private cloud. Users of this service can obtain data or information that is permitted by any hospital in their cloud.
4. Community cloud: A cloud services that allows data and information sharing within the same cloud community. Hospitals and medical centres can work together in the same community as well as sharing the same cloud infrastructure and software.

Model of cloud computing

Three main models of cloud computing:

1. Infrastructure as a Service: This model leases virtual technology with hardware such as servers, data storage space, operating system and network to consumers through online system. Users are free to create their own virtual computer group, and able to determine the installation, operation, and functions of the software by themselves. Therefore, users will only pay for what they used. Amazon.com, Inc. uses this model in managing their business.
2. Platform as a Service: This model allows user to use the existing system and developing their own systems by using equipment available in the platform without having to install and maintain the system. Google App Engine and Microsoft Azure Services are two example that using this model in their services.
3. Software as a Service: This model provides the hardware infrastructure, software products and will interact with the user through the program or service Front End Portal. Sample of services provided are in web-based emails, inventory control or database processing. Google Mail, Google Docs and Dropbox cloud model is one example of this.

Figure 2: Cloud computing service models.

Cloud Computing Functionality

Below are some of cloud computing functionality:

1. Offerfile sharing and storage of patient health records and images from Digital Imaging and Communications in Medicine (DICOM) among physicians and medical specialists in hospitals and medical institutions.
2. Serves as a database that provides storage space for each data and information uploaded to the web-based application. It’s also facilitate data monitoring activity.
3. Google and Hotmail are among the companies that provide cloud-based email servicewith limited storage space size. The email service can be accessed via Internet access.
4. Backup file is the most preferred cloud-based tools by consumers. Besides can be accessed anytime and anywhere, the large size of the storage space up to 5GB and files can also be shared with other users. Dropbox and Google Drive are amongst the providers of these facilities.

Benefit of Cloud Computing

Below are some of cloud computing benefits:

1. Extensive access of data and information: Doctors and physicians can access medical images regardless of time, location and device as long as the user has access to the Internet. Thus, health records and medical images of patients may also be referred to any physician and medical specialists from any hospital and medical institution for comment and advice.
2. Data storage:As an alternative option to store a backup copy for data, image information and patient’s heath record.
3. Unlimited space for data storage: Data or information can be stored in the available storage space. The size of the storage space can be added from time to time, and easy to implement.
4. Cost saving: Management costs can be reduced through cloud computing system as the maintenance costs (including purchase of server, software installation and training of employees) are more affordable and effective.
5. Simplify data sharing: Data and information in various formats such as medical images in DICOM format can easily be accessed and shared in cloud computing
6. Making management system more handy and secured: Data or information in cloud computing can easily be managed and monitored by using security protocols such as Hypertext Transfer Protocol Secure (HTTPS) since the infrastructure are fully managed by the provider.
7. Improve productivity: Simplify the medical image interpretation process by doctors and specialists and reduce treatments period for patients. This indirectly will increase the rate of healing of each patient.

The importance of cloud computing in medical industry

1. Enhance the efficiency and quality of service delivery to patients through partnerships between hospitals and medical institutions especially for sharing health records and medical images of patients.
2. Facilitate various parties in the medical field to access data or patient information stored in the virtual library as well as to reduce the need for every hospital and medical institutions to have the hardware and server itself.
3. As a reference platform for doctors and medical specialists from various fields from around the world to interpret medical images from challenging clinical cases.
4. The government has embarked on initiatives through the Economic Transformation Program to improve the performance of Healthcare Information Technology (HIT) system in the medical field. With the investment from private sector, cloud computing and / or server farms are created to ensure the digital files of radiology and pathology are safely archived.
5. The Ministry of Health in collaboration with the Malaysian Institute of Microelectronic Systems (MIMOS) has established integrated information management system to enable hospitals, health clinics, dental clinics, 1Malaysia clinics and clinic for mothers and children to share information and knowledge. As of 2013, there were 26 public hospitals have been equipped with the Hospital Information System (HIS), 88 clinics and seven hospitals have been equipped with Teleprimary Care (TPC), and 10 dental clinics have been equipped with the Oral Health Clinic Information System (OHCIS).
6. At this point, the Ministry of Health is in the middle to create Malaysian Health Data Warehouse (MyHDW). The project was started in 2010 and is intended as a platform to harmonize and integrate all data and health information from a variety of sources.

Security and ethical issues

Sharing health records and patient medical images through cloud computing has led to debate on issues related on security and ethical, particularly the activities of sharing patient information among non-related doctors and specialists which is outside that hospital and medical institutions involved.

Among the most common issues raised included:

1. Background, experience and expertise of the service provider to install, provide and maintain cloud computing system for a hospital or medical institution.
2. Disputes on data ownership and patient information. Concerns on the abusing of data and information for other purposes.
3. Security and confidentiality of data and patient information which can be accessed by users who are registered or not registered with the cloud computing system.
4. Security level of data encryption whenever data and patient information is uploaded, transmitted, stored and downloaded.
5. Legal action to protect data and patient information in the event of data or information being disputes and abuse.

The Personal Data Protection Act 2010 (Act 709)

This Act was created to ensure information security and network reliability and integrity. Department of Personal Data Protection (JPDP) is an agency under the Ministry of Communications and Multimedia Commission (MCMC). Established on May 16, 2011, JPDP serves to regulate the processing of personal data in respect of individual commercial transactions by User Data that is not misused and misapplied by the parties concerned. The Act also provides for penalties for certain offenses with a fine not exceeding RM500,000 or imprisonment for a term not exceeding three years or both.

Cloud Standards Customer Council

Comprising representatives from various leading IT companies such as IBM, Boeing, Pricewaterhouse Coopers and Trend Micro, this council have outlined several proposals to strengthen the security of cloud computing for existing facilities or in the process of installation studies. Among the recommendations included:

1. Identify all types of data and information held by an organization that wants to share through the cloud.
2. Categorize data and information in accordance with the sensitivity and criticality level and the need to implement data encryption.
3. Identify and define authorized users to access data and information through the implementation of logging and security event management.
4. Implement backup data for actual data and stored in the server that are using Originally Redundant Array of Inexpensive Disks (RAID) or Redundant Array of Independent Nodes (RAIN) technology.

Conclusion

1. The implementation of these initiatives is part of government effort to build needs on the facilities, databases and related technologies towards the implementation of cloud computing as a whole in health care system in Malaysia..
2. Facilities and infrastructure owned by government hospitals and medical institutions such as the Hospital Information System (HIS) and Picture Archiving and Communication System (PACS) helps to facilitate the government’s efforts in providing more dynamic and integrated cloud computing system.
3. Issues related to security and ethics is a key issue that must be addressed carefully and comprehensively along the ongoing development process of cloud computing. The success of some countries such as the United States and Britain in implementing cloud computing in health care also can be used as a reference and guidelines.
4. The creation of the Personal Data Protection Act 2010 (Act 709) is expected to reduce issues related to security and ethics especially for personal data that is employed in cloud computing.
5. The implementation of cloud computing in medical field brings a lot of advantages such as reducing the operation cost of hospital, a user friendly system, saving more time and energy and also helps to increase the patient’s lives rate.

References

1. Patel, G. (2012). DICOM Medical Image Management the Challenges and Solutions: Cloud as a Service (CaaS). OMICS Group Journals .
2. Kementerian Kesihatan. (2013). Malaysian Health Data Warehouse (MyHDW) 2011-2013. Kuala Lumpur.
3. Wikipedia. (2015). Wikipedia: Cloud Computing. Retrieved from http://en.wikipedia.org/
4. Amit T Kharat, A. S. (2012). Cloud Computing for radiologists. Indian Journal of radiology and Imaging , 150-154.
5. BERNAMA. (2013). National News Agency of Malaysia (BERNAMA). Retrieved from http://www.bernama.com/
6. Craig, D. (2010). Construction Informer Blog. Retrieved from Cloud computing History 101: http://www.constructioncloudcomputing.com/2010/08/14/cloud-computing-history/
7. George C. Kagadis, C. K. (2013). Cloud computing in medical imaging.
8. JPDP. (2015). Jabatan Perlindungan Data Peribadi (JPDP). Retrieved from http://www.pdp.gov.my/
9. Malaysia. (2010). Akta Perlindungan Data Peribadi 2010 (AKTA 709). Kuala Lumpur.
10. PEMANDU. (2010). Penjagaan Kesihatan. In The Economic Transformation Programme (ETP): A Roadmap For Malaysia.
11. Dewan Bahasa dan Pustaka. (2015). Pusat Rujukan Persuratan Melayu. Retrived from http://prpm.dbp.gov.my/
12. Ryan Kean, D. H. (2012). Security for Cloud Computing 10 Steps to Ensure Success. Cloud Standards Customer Council .