Cloud and health white paper

Health and Wellbeing:
faster, better, broader and cheaper
Why Europe Must Reach for Cloud Computing

A MICROSOFT WHITE PAPER

www.microsoft.eu/health

Health and Wellbeing:
faster, better, broader and cheaper

A Microsoft White Paper

Co-authors
Peter Wrobel, Clarity in Science Communication, and
Elena Bonfiglioli, Director Corporate Citizenship, Microsoft

Design
Chris Jones, Design4Science Ltd

Microsoft would like to thank the following people for their
input into this document:

Belgian Federal Ministry of Health: Lieve Deschoolmeester,
Jan Eyckmans
EuroRec: Jos Devlies, EuroRec
Microsoft: Julie Anderson, Lisa Boch-Andersen,
Jens Dommel, Rüdiger Dorn, Vincent Dupont, Tracey Ferriss,
Wendy Frodyma, Bruna Guimaraes, Mark Lange, Andre Piso,
Paul Smolke, Michael Yamartino, Tanya Znamenskaya
Open Line Consultancy: Jo Verstappen

© Microsoft Corporation 2010

Contents

1 Health and wellbeing: challenge and opportunity 4

2 What cloud computing is, and how it can help 6

3 Vital value from the cloud 10

4 Power to the people: patients and citizens 13

5 Policy recommendations 15

1 Challenge and opportunity in health and wellbeing

Europe’s policy makers know full well power, storage – a whole range of connectivity into a wide range of health
what their challenges are. Put simply, infrastructures and applications – reside in the devices, complemented by Internet-scale
everyone needs to do more, better, quicker, “cloud”, that is to say, off your own premises services, is creating a new paradigm for
with greater involvement from their and accessed via the Internet. Instead of being computing. As a result, a new paradigm for
citizens and above all do this at lower cost. a drain on capital and human resources, cloud health and wellbeing is emerging. Such new
computing enables rapid, agile and cost- ways of managing information translate into an
Nowhere are the challenges, the pain points, effective solutions. improved experience for patients, leading to
more evident than in health, where shrinking Governments, health ministries, health better outcomes, more control, more
real budgets are set on a collision course with providers – public and private alike – and convenience, better and broader service, and
rising health costs and ageing populations. In pharmaceutical companies have started to ultimately better value for money.
addition, there are calls from all sides for use cloud computing to address a variety of The uptake of cloud computing in a few
patients to be more involved in the business and medical challenges. We are health provider organisations in Europe has
management of their own health and getting a glimpse of the benefits for physicians shown impressive gains in terms of cost
wellbeing. There are requests for innovation as knowledge workers. As professionals, they efficiency. The challenge and the opportunity
and technology developments to be driven by are increasingly getting the right data in the for cloud computing is to match its ability to
patients’ needs. Add to the mix concerns right format at the right time, enabling them to deliver solid cost reduction while improving the
about data security and privacy, and you have provide better treatment and preventive care. quality of care and broadening access to
a perfect recipe for systemic stress. The infusion of intelligence and health and wellbeing services.
In administration, as with most medicines,
there is no “magic bullet”. Economic
constraints mean that everyone has to keep “Doctors are competing against time, and
their feet firmly on the ground. And in the past the technology offered by Microsoft helps us
few years a new ally has emerged: this new to decrease pre-surgical death rates and
ally is called cloud computing. prolong people’s lives.”
The term cloud computing describes a new
way of working whereby software, computing Vladlen Vladlenovich Bazylev, Chief Doctor, Penza
Federal Center for Cardiovascular Surgery, Russia

4| HEALTH AND WELLBEING: FASTER, BETTER, BROADER AND CHEAPER

“The European Union must be an ‘Innovation
Union’, a fertile business environment where
entrepreneurship flourishes, where small ideas
can grow into big breakthroughs, and where the
information economy is the growth engine for
Europe. This strategy can only be realised when
all industry players, both major or small, invest in
and promote innovation and new technologies,
such as cloud computing, fostering the sector’s
growth and sharing the agenda for innovation
and European success.”
José Manuel Barroso, President of the European Commission

THE CLOUD IN ACTION – SWEDEN
Swedish Red Cross: Flexibility for a distributed workforce
The Swedish Red Cross (SRC) is the organisation. The changeover also freed
largest humanitarian voluntary up time for the IT department; the IT staff
The ability to respond more effectively to organisation in Sweden. Its work member responsible for managing the
pandemics provides an illustration of the improving conditions for people requires a previous system now has 25 per cent of
benefits of cloud computing. The cloud offering great deal of coordination across the his time freed to spend on more strategic
for disaster recovery and business continuity organisation, especially when responding development projects.
built on the Windows Azure platform has to a crisis. Although cost reduction was one of
helped health managers to cope with the Two important considerations led the the main drivers in the decision to move
massive surges in the public demand for SRC to adopt the cloud-based Microsoft to the cloud, the new system also had to
information that came with the threat from the Online Services offering: cost reduction improve communication and
H1N1 flu virus – with peak traffic an and the need for reliable and up-to-date collaboration. “For an organisation like
unexpected 365 per cent higher than the communication. ours, running dispersed operations across
previous day. Data replication and mirroring “We estimate that we will achieve a the country, Online Services enable field
using the cloud creates another layer of return on our investment in the [migration communications that deliver
protection when it comes to managing project] within two years. Over the next immeasurable benefits,” says Pettersson-
pandemics and disaster recovery, offering new five years, we estimate that we’ll be Winter.
ways of providing resilience, data recovery and saving approximately 20 per cent in The integrated cloud-based system
business continuity. overall costs,” says Joakim Pettersson- allows SRC to switch from their PC,
Let’s look at another essential aspect for Winter, SRC’s Chief Technology Officer. laptop or mobile phone and have all the
health: collaboration. During Belgium’s The SRC no longer pays SEK 250,000 information at their fingertips. Since the
Presidency of the European Union, the cloud (€25,800) annually for the push email launch web mail and instant messaging
has been helping the Belgian Ministry of Health services which were not providing the has gone up by 50 per cent in the
to address the collaboration challenge it faced. level of functionality required in the organisation.
The cloud is enabling a shared working
environment across national ministries of
health quickly and flexibly, without having to
procure and install new hardware to meet the relationship between patients and so far been a quiet one, sometimes even
increased capacity requirements. The same healthcare by making personal electronic proceeding unnoticed. This paper looks at the
technology is enabling Russian doctors from health records a practical reality. experiences of early adopters across several
different clinics to work together with Momentum is building around cloud countries. We hope to stimulate more
professionals at the Penza Federal Centre for scenarios applied to health and wellbeing. But innovators to look at the cloud as the emerging
Cardiovascular Surgery to get online there is still a long way to go. The cloud may enabling technology that can unlock Europe’s
consultancy and reach a correct diagnosis be hailed as a revolution in computing, but as potential in health and wellbeing. We all stand
faster. And cloud computing is set to transform far as Europe is concerned the revolution has to gain.

HEALTH AND WELLBEING: FASTER, BETTER, BROADER AND CHEAPER |5

2 What cloud computing is, and
how it can help in health and wellbeing

The Internet has long been used as a computing comes not from its basic concept, (like email, or an online company store, or a
medium for accessing and exchanging but from the number and variety of staff vacation scheduling tool), you have to
information. With the development of cloud possibilities that it offers to users. acquire, install, configure and test a new
computing the Internet has become server. Whenever you want to use a new
radically different: a place where Before the cloud program it has to be installed or upgraded and
computing happens. Cloud programs, In the old paradigm, in the health sector as in tested on multiple machines. Cloud
platforms and storage take the strain away other areas, organisations run programs on computing, by contrast, can be instantly and
from individual organisations and, crucially, their own machines – servers or mainframes almost infinitely expandable.
have the ability to link and exchange that they must set up and maintain. All the
information with smart devices. processing takes place in-house. All the data Ubiquity. Care organisations often have to
is stored on the premises. It may seem like a manage software in geographically distributed
Although the term “cloud computing” is new neat and tidy approach – but there are a environments. But a programme that enables
and unfamiliar to many people, it has been number of drawbacks. a number of clinicians in different locations to
around for a long time. An early example is view and discuss the same patient record, for
Microsoft’s Hotmail, introduced almost 15 Cost. Doing everything in-house means example, can be difficult to install if each
years ago: an email service users could access paying for server capacity and programs that location is using a different system, or if
from anywhere in the world with an Internet you might only use occasionally. Paying for systems and data formats are incompatible
connection and a browser and which did not storage you might never need. Diverting the with each other. Or it might require a level of
require them, or IT departments, to invest in resources of skilled IT departments to install, computing power simply not available to
and maintain the hardware and software update and maintain software programs on servers or individual desktop machines in each
necessary to make an email service function. individual machines and keeping those location. Cloud computing can help by making
In a sense, cloud computing is the Hotmail machines running. the same application available over a large
idea expanded to cover any type of program, geographic area, without the need for “custom
any kind of data, and any kind of user. It really Time. The in-house approach means that plumbing” to connect all the disparate
is that simple. The complexity of cloud every time you want to add a new application systems.


“All you need is the Internet and you can start working.”
Jan Eyckmans, Head of Communication, Belgian Ministry of Health

Cloud computing offers the European
Commission a unique opportunity to THE CLOUD IN ACTION – GLOBALLY
successfully achieve the goals set out H1N1 Flu Response Centre: A swift
in the European Digital Agenda. response to a massive challenge
Particularly in the field of health, the
cloud offers the features needed “to The availability of healthcare data can already in HealthVault (such as health
equip Europeans with secure online transform the ability of health history, allergies or chronic conditions),
access to their medical health data by organisations to respond to public health print a summary, or share the results
2015 and to achieve by 2020 crises. At the peak of the H1N1 (swine electronically with their chosen doctor,
widespread deployment of flu) pandemic, one of the big challenges again through HealthVault.
telemedicine services.” (Key Action for health authorities in affected Using the Windows Azure platform
13, Digital Agenda for Europe) countries was dealing effectively with the allowed the application to be deployed to
massive number of people needing the cloud very quickly, making it available
assessment and guidance. The H1N1 Flu to the public. Increased demand and
Collaboration. Many organisations have user Response Center usage was handled effectively by the
and beneficiary communities stretching far (http://h1n1.cloudapp.net), built and scalability features of Windows Azure –
beyond their own walls. Physicians and carers deployed on Windows Azure, allows users without investing in servers and data
interact with patients in multiples locations and to take an Emory University-designed flu centres. The site saw peak traffic on 9
patients many times must see multiple health self-assessment, and then offers the November 2009 with 123,746 page
practitioners. Even governments are appropriate advice. views – an unexpected leap of 365 per
collaborating on particular health projects. Users can give explicit consent to cent over the previous day.
Increasingly, organisations and individuals share the anonymous information they “Using Windows Azure we were able
want to share data – but without provide during self-assessment for public to go from idea to deployment in just
compromising security or privacy. health, education and research purposes. three weeks. As anybody who has built
As a result, apart from the assessment out data centres can tell you, this is a
Risk. Traditional IT puts all data and and advice given to the individual, the really incredible timeline. Being able to
applications in one place. Even modern application also provided valuable use our existing skills and all of our
systems typically have only a single backup, aggregated information for assessing the familiar tools, such as the Microsoft
and that backup often has lower capabilities progress of the epidemic. Visual Studio development system, was
than the primary system. Cloud automates the The H1N1 Flu Response Center also another plus. Without all of this, there is
process of providing multiple, geographically allows users with HealthVault accounts to no way we could have had the site ready
dispersed backups, meaning that even a store the results of the assessment, in time for flu season,” says Sean Nolan,
natural disaster in one area is unlikely to take combine them with their information Microsoft Distinguished Engineer.
down your IT systems.


How the cloud delivers
There are three broad kinds of cloud service. When combined,
these are referred to as “IT as a Service”.

With Software as a Service, SaaS, the user simply uses
applications provided by a supplier that run on the provider’s
infrastructure. An example is Microsoft’s Office 365 a set of
“For an organisation like ours,
messaging and collaboration tools. This is what the Belgian
Ministry of Health used to facilitate collaboration with the various running dispersed operations across
ministries in the member states, the WHO and its own highly the country, Online Services enable
mobile staff during Belgium’s Presidency of the European Union. field communications that deliver
The suite includes Microsoft Exchange Online for email and
shared calendars and SharePoint Online for sharing documents
immeasurable benefits.”
and portals. Another example is how the pharmaceutical giant Joakim Pettersson-Winter, Chief Technology Officer,
GlaxoSmithKline has cut its operational IT costs by 30 per cent2. Swedish Red Cross

With Platform as a Service, PaaS, the cloud provider hosts
applications developed by the user, or on behalf of the user, using
the cloud provider’s operating system – much like custom
programs developed for Windows. An example is the Windows Resource pooling is increasingly attractive in
Azure platform, a group of cloud technologies that can run either these difficult times. Multiple organisations can
in the cloud or on the user’s premises. Image archiving is one use the same programs, servers and data
example of using cloud services to offset the effects of the centres, and the provider allocates resources
exponential growth in data and in requirements for on-demand dynamically according to demand. This can
storage. lower the user’s costs considerably, since the
same infrastructure is serving several clients
Infrastructure as a Service, IaaS, provides on-demand data while achieving new flexibility and reducing
centres with servers, storage and networking, typically priced by costs. It can also give users access to
the hour. Users can store any kind of data and run whatever programmes and infrastructures that they
programs they want, but the physical infrastructure is maintained would otherwise be unable to afford. A recent
by the cloud provider. whitepaper published by Microsoft3 indicates
that the benefits of pooling resources into
large-scale shared clouds can reduce costs
more than tenfold compared with smaller,
dedicated clouds and extremely well-run IT
With the cloud need to be thrown by human operative, and it operations.
Cloud computing encompasses five does not matter what time of day or night it is:
characteristics1: on-demand self-service; the service is there when you want it, and you Rapid elasticity. Any system that involves
broadband network access; resource pooling; help yourself to it. In health, even more than in large numbers of users demands the ability to
rapid elasticity; and the opportunity to provide other areas, “on demand” becomes a vital cope with huge spikes in the numbers of people
a measured service. And as cloud technology value proposition. seeking to use it, or surges in the amount or
evolves, two other principles are beginning to complexity of the calculations it needs to make.
become more apparent: collaboration – as Broadband network access. To reach the And traditional IT systems are most likely to fail
briefly mentioned in the previous pages – and cloud you just need to switch on your laptop, or at the most critical moments, when demand is
interoperability. a mobile phone, a home computer and go to highest. Without the cloud, the only solution is
the web – if it can connect to the Internet, to pay for expensive backup systems that might
On-demand self-service. When a health normally over broadband, it can connect to the lie idle for 99 per cent of the time. With the
organisation needs new computing power, or cloud. As we look at independent living and cloud, the service provider looks after the
storage, or a new programme, it simply health and active ageing as well as active elasticity, managing even large-scale spikes in
accesses what it needs from the cloud – or prevention for Europe 2020, cloud computing demand, so even small operations can use vast
more specifically, from a cloud supplier. can help make these visions a reality. resources only when they need them, and not
Access to services is automated, no switches pay for them when they don’t.


‘Public clouds’ and ‘private clouds’ THE CLOUD IN ACTION – BELGIUM

Cloud services can run on infrastructure that is shared with
Ministry for Health: A platform for
other organisations and companies (so-called “public clouds”) policy development
– or developed and maintained on infrastructure dedicated to
just one customer (the “private cloud”). Organisations will A year ago Belgium’s health ministry had a problem. With the
make their choices depending on their development roadmap country due to take over the Presidency of the European Union
and timeframe, their own size, the confidentiality of the data to in July, it had to move quickly to set up a collaboration
be stored in the cloud, and regulatory requirements. platform for all the policy documents that would be produced
The choice between public and private cloud will not affect during the six-month tenure. Conferences, policies – all
what end users see on their screens, but it will have a big needed to be prepared in conjunction with colleagues in the
impact on cost. While private clouds still offer economies of European Commission, in other Member States, at the World
scale for large organisations, according to one analysis3, over Health Organization, and foreign universities. To make matters
time the premium for private clouds can rise to be 10 times as more complicated, the Belgian officials in charge of the
high as public clouds. projects would be permanently on the move between different
locations in Europe.
Chief Information Officer Lieve Deschoolmeester opted for
the SharePoint platform, hosted by Microsoft. Why go for the
cloud? “We didn’t have SharePoint competences in house –
not enough to offer it quickly to our users,” she says. “And it is
A measured service. You pay for what you more cost-effective to pay a licence per user than to have the
use, and you know what you are paying for – platform installed in house. Plus there was the time issue.”
rather like a water or electricity meter. This Another crucial factor: the assurance that the platform would
gives organisations detailed knowledge about be online 24/7.
where they are spending their money, and with For Jan Eyckmans, Head of Communications at the
that the opportunity to monitor and control Ministry, a vital advantage is SharePoint’s ability to deal with
costs. IT becomes an operating expense based changing texts. “When talking about policy documents,
on actual use, reducing upfront capital versioning is very important. Otherwise if someone forgets to
expenditure on servers that has no relation to mail back new versions, everything gets mixed up.” Now, he
actual use. That can lead to considerable says, there is less risk of ending up with the wrong version of
savings. a text when a minister is trying to explain it.
The project got the go-ahead in mid-December 2009, staff
Collaboration. Cloud applications are natural training began in April, and all was ready for the start of the
collaboration hubs. Since the application exists Presidency on 1 July. “All you need is the Internet and you can
“in the cloud” and is accessible to anyone with start working,” says Eyckmans.
a fast-enough Internet connection, all users, all
devices, and all locations are equal.
Collaboration and sharing data become easy in
this environment. concerns are prompting organisations to • It is also important to monitor ongoing
explore the option of private clouds, dedicated developments as the reliability and security
The transition to the cloud to their use, as a way of achieving some of the of public clouds continue to improve. Public
While the real advantages of cloud computing benefits of the cloud, especially in the near clouds already have some considerable
are becoming more evident, the fundamental term. security, stemming from the enhanced
concerns of any health organisation with There are a number of factors that scrutiny and expertise that can be deployed
respect to their present and future IT systems organisations must consider when reviewing the by cloud providers, and the fact that cloud
remain. Security, privacy, trust, data potential transition to cloud computing, whether systems are automatically patched and
governance and compliance are such concerns. private or public cloud solutions. These include: updated in a timely manner. Many security
And during times of transition, many • A natural tendency to control your own IT issues arise because systems are out of
organisations worry about the compatibility of department, to maintain security and direct date, and more vulnerable to be exploited –
their current systems with new ones, and how management of data. This can have the burden of IT system maintenance is
to move existing applications to the public cloud advantages, and dedicated private clouds currently a major cost for organisations.
(see Box, ‘Public clouds’ and ‘private clouds’), could be a solution that would meet the That is a burden that cloud computing can
which is shared with other users. Such needs for tighter control. help alleviate.


3 Vital value from the cloud

Not every technological advance results in for health and wellbeing organisations – software combined with Microsoft Exchange
lower costs. But cloud computing brings the large and small. Online Deskless Worker to add another 650
benefit of unprecedented economies of scale Dutch orthopaedic centre Annatommie, for deskless users (mainly nurses) at less than 30
to IT operations. This is particularly the case example, used the Business Productivity per cent of the cost of traditional licences.
for health-orientated organisations, because Online Suite, now called Office 365, to take on “Without Microsoft Online Services, we could
the cloud allows them to concentrate more of 30 per cent more patients without having to never have deployed this number of mailboxes
their resources and time on health, rather than increase its own staff. The payoff comes to our users in such a short [time] and cost-
on IT. After all, they are in the health business, through more efficient communication and effective manner,” says Jan van Glabbeek, the
not the IT business. data access, saving employees between one hospital’s head of IT.
When applied to health and wellbeing, and two hours a day and providing consistent Along with other industries, healthcare is
cloud computing can add vital value by and reliable scheduling of appointments. experiencing an explosion in the amount of
connecting a wide range of medical Meanwhile, the centre has also saved data being collected from a variety of
technologies and data sources into a seamless €28,000 a year in software licensing fees. diagnostic and monitoring equipment. That
whole. In Sweden, the country’s Red Cross moved data needs to be stored securely and
For the first time, at this scale and level of to the cloud with Microsoft Online Services in efficiently – and made available when needed.
affordability, cloud computing helps to provide 2009 and reckons that it will recoup its Radiology image archives and other types
patients, providers and payers with a complete investment within two years. And its of health data can take advantage of cloud
and holistic picture of health, enabling a truly employees are benefiting from a system storage, with increased capacity often
patient-centric approach to medicine. As such, where they can switch between their PC, available in a matter of seconds rather than
the cloud enables a focus on the continuum of laptop or mobile phone and have all the the days or months required to deploy in-
care, balancing the priorities from treatment information at their fingertips. house systems. Historical clinical data that is
and cure only to focus also on prevention and And when Ziekenhuis Amstelland, a Dutch rarely accessed is a prime target for archiving
lifelong wellbeing. hospital, was faced with new government – it could be moved to the cloud storage to
The cloud is still in its early stages in regulations on safety requiring all 1,200 make room for data that is operational and
Europe, but the experience so far gives more employees to have access to email – at the requires frequent access from clinical
than a hint of what the technology can deliver time only 550 had email – it used the same systems.

10 | HEALTH AND WELLBEING: FASTER, BETTER, BROADER AND CHEAPER

“There may be private information involved, and
we needed a guarantee that the information
would remain secure.”
Jan van Glabbeek, Head of IT, Ziekenhuis Amstelland

THE CLOUD IN ACTION – THE NETHERLANDS
Meander Care Group: Rapid deployment, with flexibility
Zorggroep Meander provides care for the Business Productivity Online Standard
elderly and children in a number of Suite, now called Office 365, as a service,
nursing homes and children’s centres in with servers and backup hosted on Open
the Netherlands, along with care in Line’s premises. This allowed them to add
Individuals – patients and citizens alike – clients’ own homes. It came to Jo 4,500 new users – the deskless health
also stand to benefit. Research published by Verstappen’s Open Line consultancy providers who were the main reason for
health provider Kaiser Permanente in looking for a quick way of recording the going to the cloud for a solution.
collaboration with the American Heart hours of its employers digitally, rather Three months after Meander
Association (AHA) in May 2010 showed that than on paper. approached Open Line, the new system
the use of at-home blood-pressure monitors The Meander group has about 5,500 went live. “Speed is the point,” says
and web-based reporting tools that connect employees, with 900 “normal” office staff Verstappen, and flexibility. The system
clinicians and patients via the Internet appears working from desks and the rest, currently provides the human resources
to improve patients’ ability to manage their deskless, providing healthcare. Open Line solution for recording hours. Other
own blood pressure to healthy levels. The realised that the quickest way to meet functions, such as Exchange email and
patients in the study were connected to the Meander’s aims was to provide the calendars, can be added later.
Microsoft HealthVault cloud platform (see
Chapter 4, “Power to the people: patients and
citizens”) and managed their data with a free
online tool provided by the AHA. At six
months, patients in the home monitoring
group were 50 per cent more likely to have The cloud is not an all-or-nothing
their blood pressure controlled to healthy solution.
levels than the usual care group. Similarly, the Reaching for the cloud does not mean moving
home monitoring group had significantly everything onto cloud platforms. The cloud
lowered systolic blood pressure at six months gives health organisations the flexibility to mix
(-21 mm Hg) than the usual care group (-9 and match. They can and should evaluate
mm Hg). what makes sense to move to the cloud now,
and plan a longer-term strategy to take
advantage of the opportunities as both they
and the cloud develop.

HEALTH AND WELLBEING: FASTER, BETTER, BROADER AND CHEAPER | 11

Cloud value: reduction in cost of processing

THE CLOUD IN ACTION – RUSSIA
Penza Federal Centre for Cardiovascular
Surgery: Collaboration for clinicians

Penza is the fifth largest cardiovascular centre in Russia,
carrying out 100 operations a week. With heart disease, a fast
and accurate diagnosis can make the difference between life
Cloud value: reduction in total cost of
operation (TCO) and death. The centre is using cloud computing to speed up the
sharing of test results and improve its decisions on treatment
and surgery. Audio, video, web conferencing, instant messaging
and telephony are integrated via Microsoft Office
Communications and SharePoint.
“Doctors can contact their colleagues quickly and discuss
treatment options, and make decisions about further treatment,
surgical decisions and rehabilitation,” says Oleg Anisimov from
Lotsman Plus, which developed the system for Penza. “Location
is not an issue for making decisions, because all communication
is done over the Internet.” Colleagues from remote areas can
now be involved in decision-making. The system also provides
Cloud value: data centres in public and
the security and confidentiality that people expect for medical
private clouds
records.
“This takes us to a different level of technology,” said
cardiologist Nadejda Galtseva. “It enables us to keep up-to-date
with state-of-the-art diagnostic requirements.”

A private cloud is cost prohibitive for companies with a
data centre of up to hundreds of servers.
An enterprise with a larger data centre (more than
1,000 servers) still faces a significant incentive to
choose the public cloud.
Source: Forecast: Improved economy in the cloud, A
Microsoft U.S. government white paper, March 2010.

The bigger the cloud, the bigger the those customers to divide the costs of
savings operating the application and can reduce
• Economies of scale result from consolidating costs by an additional 20 per cent.
overhead costs, purchasing power and
power efficiency: large data centres are up Put together, these economies of scale can
to 50 per cent more cost effective than result in long-term savings of up to 80 per
smaller data centres. cent when comparing large and small clouds. 3
• The overall cost of IT is also determined by That is one reason why, in the US, the
the degree to which the capacity is budget submitted to Congress in February
efficiently utilised. Currently, infrastructure is 2010 commits the country to the use of cloud
built to meet peak demand. Pooled computing technologies and to a reduction in
computing improves the utilisation of IT the number and cost of federal data centres.
resources and reduces costs by another 50 Europe has the opportunity to consider a
per cent. similar direction and take up the cloud to help
• Finally, public clouds, where multiple deliver on the health measures indicated by
customers share the same application, allow the Digital Agenda for Europe.


4 Power to the people: patients and citizens

There are many ways in which the cloud cloud-based offering called HealthVault allows
can help patients and their families manage individuals to open their own, free, account HealthVault: putting people in
personal health information. Here’s one (parents can also open accounts for their control
challenging scenario: how can patients see children), into which they can upload data HealthVault offers a privacy- and security-
their own health data – wherever they are – about their health either manually or enhanced foundation. This allows a broad
and both edit and add to their own records, automatically from a range of online health and ecosystem of stakeholders – from medical
while allowing their trusted doctors and wellness applications, as well as from providers to health and wellbeing device
specialists to also read these records, compatible health devices. The data covered manufactures to health associations – can
controlling who else can see their records includes information taken from blood- build innovative solutions and services to
and guaranteeing privacy and pressure cuffs, weight scales, heart rate help put people in control of their own and
confidentiality? monitors, pedometers, blood glucose monitors their families’ health. Through HealthVault
and peak flow meters for measuring lung applications individuals can gain greater
It’s not a hypothetical question. Health and capacity. Microsoft has recently launched insights from their data to help them better
wellbeing are driven by data – information HealthVault in Europe, starting in the UK and manage their own health. If the account
about people. The days when doctors would not Germany (where it is known as Assignio). holder permits, HealthVault applications
allow patients even to see their own medical In the UK, Microsoft has partnered with also allow health and wellbeing providers
records are gone, or going, across Europe. MSN Life & Style and Nuffield Health to provide to access the information and provide
Increasingly citizens both ill and well are looking an application called My Health Info that services accordingly.
to have access to and control over their own
health data.
Cloud computing is able to respond to just “A unique opportunity for us to put our patients first by giving
this challenge and turn it into an opportunity by them their medical data, and to empower them to manage their
allowing multiple users to share information in a
own healthcare.”
secure environment. Imagine a web-based
platform designed to put people in control of Aurelia Boyer, Chief Information Officer, New York-Presbyterian Hospital, on linking their own
their health data. In a move in this direction, a data system with HealthVault.


Stepping into the cloud and
unlocking Europe’s potential
Popular cloud computing services outperform internal
infrastructure – with 99.9 per cent uptime or better in many
cases – so the road to the cloud looks good. But is the cloud
“With Assignio we are able to offer an right for you?
eHealth solution for all stakeholders within
Step 1: Evaluate cloud services
the healthcare industry but one where the • Analyse the business case for cloud services.
citizen is at the centre. The basic principles • Start by discovering how much cloud computing is already
of Assignio are trust and security; this is taking place in your organisation or other agencies, and
consider how your existing applications could take
extremely important for us and will allow us advantage of the cloud.
to add true value to all users. • Ensure that you will meet or even exceed regulatory
standards for privacy and confidentiality.
Roland Neuhuber, Global Head of SIS Healthcare, Siemens

Step 2: Plan for the cloud
• Start small. Start the journey in a limited scope to confirm
the business case and understand the impact on the
enables wellbeing management, giving people, policies and processes in your organisation.
individuals insight into how to improve their • Plan in phases. The cloud is not an all-or-nothing approach.
health. My Health Info helps them monitor their Some things may make sense today; others will need to be
blood pressure, calculate their body mass left for later consideration.
index and measure the amount of steps they • Know when to make your move. Some cloud strategies pay
take as exercise. off over time, so factor in how long it might take to recoup
In Germany, Siemens IT Solutions and your investment, and set expectations accordingly.
Services has introduced a HealthVault-based • Examine the benefits and trade-offs of public and private
offering called Assignio, starting with a suite of cloud solutions, or a combination of the two, factoring in
four related applications. The idea is to help cost, security and all other considerations.
bridge the information gap between citizens
and the professional medical and healthcare Step 3: Integrate cloud services
organisations that they interact with on an • Look for ways to integrate applications and databases held
ongoing basis. on your own premises with cloud technologies to offer more
Three Assignio applications help patients or faster services.
with, respectively, fitness and wellbeing, • Think big – especially if you’re a small organisation or
prevention, and the management of chronic government agency. Cloud services are massively scalable,
disease. The fourth application allows the both up and down. Who else might benefit? Keep potential
patient to involve hospitals and doctors that partners in the loop.
they trust, by sharing the information with • Build a governance structure to measure progress and to
them. German health company Asklepios, keep all stakeholders informed.
which runs a network of more than 100 clinics,
is developing “Meine Gesundheit” (“My
Health”) – a service linked to Assignio that will
support patients in managing their own health sensitive, citizens and healthcare providers
with an application that makes medical will only share data if they trust that their
information – on their appointments, privacy will be protected. When trust is References
1
As defined by the US National Institutes of Standards and
medication or treatment plans, for example – established and data flows freely, everyone Technology, see http://csrc.nist.gov/groups/SNS/cloud-
available in their Assignio account. benefits. HealthVault has translated these computing/cloud-def-v15.doc
2
GlaxoSmithKline Leads the Way with Microsoft Online Services,
Trust is essential to a patient-centric principles into clear privacy principles, which Microsoft case study, October 2009.
http://www.microsoft.com/casestudies/Case_Study_Detail.asp
healthcare system. For the system to succeed, augment Microsoft’s industry-leading x?casestudyid=4000005460
3
participants must be willing to share health corporate privacy policies and put citizens in Source: The Economics of Cloud Computing in the EU Public
Sector, Microsoft, November 2010.
data. Because health data can be highly control of their health information. http://microsoft.eu/Cloudeconomics.aspx


5 Policy recommendations
on “transactional” care of patients when
they’re sick to lifetime health management,
data needs to be liquid – able to move from
Health and wellbeing stand to benefit and secure environment. The newly place to place, and country to country as it is
enormously from the cloud. The global scale launched European Innovation Partnership used by computers in the cloud within a
of the cloud will enable the costs of for Healthy and Active Ageing is an ideal secure, private and trusted environment.
computing to be driven down – at a time platform for pilot technology This call for data to move freely and safely
when health organisations are under experimentation and testing. The European responds to the fast developing needs of
immense pressure to reduce costs. Commission should consider setting up a patients and citizens. This aspect stretches
Taskforce for Cloud in Health and Wellbeing outside the EU boundaries. It should be
The cloud has collaboration built into it – and within this Innovation Partnership. considered in the current discussions
collaboration is the lifeblood of the health • Information. The European Union should between the European Commission and the
sector. The cloud makes health data “liquid” by consider establishing Europe-wide US Department of Health and Human
taking it out of its individual silos and letting it principles that would provide consumers Services on the Memorandum of
flow at the right time to where it can help the with clear information about what a cloud Understanding on eHealth (Mandate 403) as
patient most – under the patient’s control and service provider is permitted to do with a well as the Key Action 13 of the European
with an emphasis on privacy and security. consumer’s or business’s information. This Digital Agenda.
should be harmonised at national level as
How, then, can policy makers and decision well. The Taskforce could help drive this 4. Interoperability and innovation
makers ease Europe’s way into the cloud? Here forward. • Interoperability and standardisation. The
are a few suggestions across four key areas: • Transparency. Cloud service providers maximum degree of interoperability should
should be transparent about data be encouraged. Standardisation should not
1. Fostering the economics of cloud management practices and inform prevent the market from being able to
computing consumers, customers, business and innovate rapidly in the early stages of this
• Due diligence for cloud readiness. In this governments about how they are going to new generation of computing. Discussions
tough fiscal environment, governments keep their information secure. around Mandate 403 should also integrate
should be encouraging their own health this need to balance innovation and
organisations to analyse where the cloud 3. Security, privacy and data standardisation as work focuses on standard
could appropriately save time and money. protection in a cloud environment development and effective deployment.
This analysis of “cloud readiness” should be • Help data to remain secure. The right to • Supporting the fast pace of innovation.
an integral part of national plans for eHealth. privacy requires that data be secure. That Both medicine and technology are advancing
Countries should then review and discuss means effective and coherent laws and law at a fast pace. We recommend developing an
their analysis within the framework of the enforcement to protect cloud services. In enhanced regulatory framework that enables
European eHealth Governance process. particular, cloud service providers should innovation, rewards experimentation, and
• Support by EU Cohesion Funds. As we have the legal right of action to protect ultimately drives value – by encouraging the
aim to achieve more (access and quality) with data. dynamic flow of data across the health
less (cost), the next wave of European social • Allow data to move safely. Europe needs ecosystems within a secure, private and
and structural funding to support cohesion a comprehensive approach and coherent trusted environment. We recommend that the
policy should provide incentives for countries agreements for data protection, data use EU eHealth Governance process take on
that look to integrate cloud computing into and data portability. The new and emerging board this topic, working closely with industry
health and wellbeing. needs of patients and health professionals and stakeholders.
as well as the opportunities brought about
2. Awareness raising and capacity by cloud computing in health and wellbeing Moving to a focus on lifetime health
building should be taken into account in the management means that we need to
• Consultation. Governments should framework of the current revisions of the provide tools for citizens to participate in
stimulate a programme of consultation and Data Protection Directive 95/46/EC. managing their health across that
awareness raising with health professionals, • Allow data to move freely. We see the continuum. Cloud computing offers us this
health stakeholders and IT architects and need both to protect information and to opportunity. Let’s take the right steps and
providers on how to obtain additional value empower citizens and patients with health embrace the cloud to unlock Europe’s
from public cloud infrastructures in a safe data. As health systems shift from a focus potential in health and wellbeing.


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