A Cloud Computing Solution for Hospital Information System

Chenghao He, Xi Jin, Zhanxiang Zhao, Tian Xiang
Department of Physics
University of Science and Technology of China
Hefei, Anhui Province, China
E-mail: hech@mail.ustc.edu.cn
Abstract¬Existing Hospital Information System (HIS) is only
shared within separated hospitals or districts, which resulted
in high construction costs and waste of resources, especially for
small township hospitals and other health care systems which
are incapable to set up an independent information platform.
We propose a solution to simplify this construction by using
network module attached to existing systems that are
connected within the hospitals. The proposal is based on the
concepts of cloud computing so the information sharing and
high-end processing is available in the "cloud". Furthermore,
existing medical equipments can be rebuilt to be more efcient
and low-cost as medical terminal units.
Keywords-cloud computing;hospital information system
1. INTRODUCTION
Hospital Information System(HIS) refers to the computer
system which is applied in medical information management
and online operations. It covers all the hospital services and
business[1,2]. General HIS also concludes Laboratory
Information System(LIS), Radiology Inforation System
(RIS), Ultrasound Information System(UIS) etc. The
standard HIS framework based on DICOM protocol is as
Fig. 1.
HIS construction in China relates to various aspects of
hospital affairs like digital acquisition, storage, management
and transport of medical inforation. So far, the Computer­
based Patient Records(CPR), Picture Archiving and
Communication System(PACS) and other advanced
technologies have been widely adopted[3,4]' However, we
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Figure 1. Standard HIS famework based on D1COM protocol.
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517
should also realize that the late start, weakness of technology
and lack of fnds make the HIS not as successful as in other
industries. Especially in township hospital, there have more
problems[ 5].
In order to reduce the diffculty of HIS construction and
maintenance, information sharing is realized to be important.
In the framework of Fig. 1, there is interface for connecting
interet. But as lack of proper technology to realize an
effective and safe connection, hospitals have been
established HIS system independently. Except the high-cost
of construction and management, it cannot supply
satisfactory inforation sharing. Though there is province
begins to establish a unifor medical archives[6], but it's
still hard to expand and unable to solve the repeat
construction. All these problems are expecting to be worked
out, which relies on innovation and improvement of the
overall structure of HIS.
II. MOTIVATION
Traditional HIS construction serves to independent
hospitals, so from the frst HELP system at LDS Hospital [7],
to recent HIS in Peking University ShenZhen Hospital [8],
the following questions are hard to avoid.
A. Problems of Traditional HIS
1) Lack of uniorm standards for data-sharing
HIS is realized and widely applied based on Computer­
based Patient Records(CPR); but before carrying out CPR
system, it is most important to work out the problem such as
the data storage and transmission standards. Unifed forat
and content of data storage are the basis for communication
between systems. Since the patients would not seek
treatment in a fxed hospital, and in the present case of
hospitals with independent inforation systems, it can cause
information non-recognition and incompatibility between
inforation systems during the referal process of the CPR.
At the same time, within hospital there are a large
number of medical equipment such as ultrasound, CT,
radiology equipment, monitoring equipment, anesthesia
equipment etc., producing a large number of data of different
storage forms and encoding methods. Information
classifcation and data standards are not of strictly unifor.
Although there are interfaces among different systems, it is
very difcult to realize the integration between various
subsystems. Therefore it directly causes the inforation
unable to be shared effectively among different hospitals,
even between different departments in the same hospital,
thus resulting in duplication and waste of resources.
2) High cost for independent constrction
It costs much for any hospital to set up a complete
platform combining all aspects such as hardware, software,
management, maintenance, for the existing HIS construction.
Township hospitals in particular, are neither possible n

r
necessary to establish a set of independent system, but It
bears the important burden to provide medical services to
rural residents.
Even for medium and large hospitals, the independent
construction of HIS is a heavy burden, such as the
construction for Picture Archiving and Communication
System (P ACS). From the short term, P ACS framework
could not save medical costs but increase the burden of
hospital expenditures. Thus the hospitals with not abundant
capital prefer to continue using flm and paper materials to
record the clinic information.
3) Difcult to Management, Upgrades and Maintenance
Separate HIS requires separate management and
maintenance for hospitals. With the problems arising during
operation, such as technical shortage, incorrect use of
software, or lack of experts, the management and
maintenance of HIS requires continuous investment, which
is a great cost to hospitals.
Besides, different scale or specialized hospitals produce
kinds of individual needs for HIS. The request for upgrade
also comes up in usage. But independent HIS requires the
maintenance and upgrade separately to progress in each
hospital, thus a lot of HIS can not get proper technical
services[9].
B. Related Works
To solve these problems, the key is to realize sharing of
sofware, hardware and medical data. There is some related
works that envision similar solutions.

The work in [6] introduces that Fujian province has
started to establish a unifed medical archive by the
Department of Health. It is estimated to cover many
hospitals to achieve their CPR, prescriptions,
medical advices, inspection fndings and other
information sharing.

The work in [10] proposes a HIS constructed on the
technology and method of XML application. It can
realize integration and sharing of information
between hospitals and other departments.
But based on the traditional database technology, it's
hard to expand with above frameworks. Also the
maintenance and management is unsatisfactory. A suitable
framework needs to be found. Cloud computing is a new
network application model. And it has spacious room for
development in hospital inforation areas for its fexible and
extensible.
III. CLOUD COMPUTING
A. Development
Proposed in recent years, cloud computing is an
innovative model of network and being promoted by
518
Figure 2. Te cloud
Amazon, Google, IBM, Microsof, Yahoo and other large
companies. Narrow cloud computing is the delivery and
usage patter of IT infrastructure, to demand the resources
with expanded necessaries and facilities by network. A
broader sense of cloud computing extend this network model
to any service[1l-14].
Google is now the largest user of cloud computing with
its search engine built on more than one million servers in
the distribution of more than 200 locations; Amazon's Elastic
Compute Cloud (EC2) and Simple Storage Service (S3)
provide services mainly for enterprises; IBM's "Blue Clo

d"
computing platform, provides an open cloud computmg
system for customers with buy-to-use cloud platfor;
.
at the
same time, including Microsof, many large companIes are
actively expanding the feld of cloud computing.
B. Cloud in Medical Afairs
Cloud computing model provides a new way to solve
foregoing problems. Some studies have been performed
recently in an attempt to employ Cloud method in medical
affairs.

The work in [15] presents the issues MIA (Medical
Imaging Analysis) researchers and clinicians deal
with and proposed a new famework based on cloud
computing concept for cancer imaging research.
Though it's not exactly focus on hospital affairs, the
difculties in processing medical information and
potentials of cloud computing are analyzed in detail.

Moreover, the work in [16] proposes cloud method
to patient's data gathering. It can automate the
process from bedside data collection to information
distribution and remote access by medical staff This
work shows how cloud computing works in hospital
affairs and suggests frther development in HIS.
IV. PROPOSAL
Our proposal is a system to share the information of
different hospitals via virtual private network (VPN) and
public Interet access. Fig.3 is the proposed construction of
cloud-based HIS. The health department establishes the
private cloud to store and manage important information
such as computer-based patient records, etc. While other data
of noral management and business can be put into
commercial cloud server.
Small Hospital
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Cloud based HIS
o
Figure 3. Construction of cloud-based HIS
This framework is easy to realize by adding a network
module or control center just attached to existing systems.
The network module is to connect within the cloud, and can
use the resources in cloud to achieve hardware, software and
data-storage according to the need. Using this method to
optimize and reduce existing HIS gradually, thus obtains
adjustable fexible structure.
It's very afordable to use cloud computing in medical IT
services, many hospitals can share the infrastructure formed
by connecting large number of systems together, thus the
hospitals can become more effcient, and construction costs
can be reduced. At small hospitals like township hospitals,
most business can be processed within the cloud, so as to get
rid of the heavy burden of complete construction and
management. They only need to complete the patients'
information collection and result display, the others that
including management, storage, maintenance, and even
disease diagnosis can be achieved in the central servers. Also
large hospitals reduce its costs from this fexible and
extensible framework.
There are several practical advantages in this
implementation, such as:

Reduce the costs: Using cloud computing
technology, hospitals can get the services provided
by millions of servers in the cloud but pay a little,
then higher efciency, lower cost can be achieved.
Compared with spending lots of money to buy a
dedicated server, using cloud services is clearly more
cost-effective.

Flexible and extensible framework: The cloud
framework supports heterogeneous equipments and
alterable system scale. Small hospitals can frst set
up a simple system with necessary component. As
the hospital becomes bigger and bigger, it can easily
scale up the cloud in a short time[17].

Better information sharing: Through the cloud model,
the health and medical institutions can work together
to build information-sharing space of medical
519
resources. This can share infastructure without
having to update the related hardware, reduce costs
while efciency is greatly enhanced.

Reduce maintenance expenses: The user terminal
architecture is unlimited in cloud computing model,
therefore, the technical staffs do not have to pay
much attention to upgrading the hospital hardware,
while the daily maintenance of the server is also
provided by the cloud service provider, and thus they
have more time to undertake other work .

Reliable operation of the server: The data of hospital
daily business are concentrated in the server in the
present hospital inforation systems, so the hospital
cannot work norally once a server failure occurs;
seriously key data will be lost in extreme cases. The
cloud computing model can quickly copy data in the
failed server to another server, and start the new
server to provide services, that obtains real
continuous security services.

Further application prospects: Meanwhile, in the
cloud computing model, experienced major hospital
doctors can help diagnose patients of rural hospitals
directly by collected patients' condition, images and
other data, because of the unifed data storage and
sharing, we can even implement electronic disease
diagnosis based on powerful cloud computing[6].
V. CLOUD-BASED MEDICAL DEVICES DESIGN
To set up a cloud-based terminal hospital system, besides
applying existing system to upgrade, the best approach is to
develop new medical equipment, including image acquisition
equipment, monitoring equipment, management equipment,
etc. As only to complete terminal mission, other tasks
including video processing, data storage, etc. can be placed
in the cloud, it greatly reduces the equipment cost and
maintenance difculties. The following will make briefy
introduction on the cloud-based image acquisition devices.
Medical image is an important means of clinical
diagnosis and medical science, also applied for the Picture
Archiving and Communication System (P ACS). Medical
image acquisition devices are mainly including X-ray,
magnetic resonance, ultrasound, CT, which are in different
physical principles to realize the imaging methods for non­
intervention of the human interal organs, tissues, blood and
others.
Traditional digital image data acquisition device should
not only complete digital image formation and acquisition,
but also image processing and data storage. A number of
high-end applications, such as three-dimensional ultrasound
imaging, speckle noise attenuation are achieved through
equipment upgrades. However, with the cloud model, the
device can be simplifed accordingly, so that it just requests
to complete the front end of data collection and video images
formation, then by a compatible data forat of standard
DICOM, and through the network module directly to the
central servers of cloud; then receiving the processed real­
time image and display. FigA shows the basic block diagram
of cloud-based medical image acquisition equipment.
...
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.
. \ �
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Figure 4. Block diagram of cloud-based medical image acquisition
equipment
VI. CONCLUSION
This article describes the HIS based on cloud computing
which realizes the fexible, extensible and practicable
framework by regarding all the hardware, sofware and data
of hospitals as resources acquirable from the cloud. It has not
only signifcantly reduces the construction cost and provides
wide medical application for village and town hospitals, but
can realize the information sharing and effective use of
resources to the greatest extent. Meanwhile, it reduces
hospital operating costs and signifcantly improves operating
efciency. The infastructure of "cloud" contributes to help
hospitals save the time and efforts required for IT systems.
Moreover, we suggest further applications of this
architecture such as the construction of Health Information
System. And based on the new platform and depending on
powerfl servers, it can be realized of the medical images to
be automated diagnosed. Besides, cloud Infastructure not
only makes updating and application of new technologies
simpler, but also can be the unifed base for hospital system
construction.
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(14) Kim, W., "Cloud computing: Today and tomorrow," Joural of
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[16] Rolim, C. 0., Koch, F. L., Westphall, C. 8., Werer, 1., Fracalossi, A.
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(17) Sun Microsystems Inc. 'Take your business to a higher level", 2009.

Amazon. Also the maintenance and management is unsatisfactory. Narrow cloud computing is the delivery and usage pattern of IT infrastructure. it's hard to expand with above frameworks. While other data of normal management and commercial cloud server. the work in [16] proposes cloud method to patient's data gathering.even between different departments in the same hospital. The health department establishes the private cloud to store and manage important information such as computer-based patient records. Though it's not exactly focus on hospital affairs. B. 3) Difficult to Management. A broader sense of cloud computing extend this network model to any service[1l-14]. such as technical shortage. The cloud construction for Picture Archiving and Communication System (PACS). IBM. for the existing HIS construction. PACS framework could not save medical costs but increase the burden of hospital expenditures. CLOUD COMPUTING Our proposal is a system to share the information of different hospitals via virtual private network (VPN) and public Internet access. Google. A suitable framework needs to be found. Development Proposed in recent of years. provides an open cloud computmg system for customers with buy-to-use cloud platform. or lack of experts. 2) High cost for independent construction It costs much for any hospital to set up a complete platform combining all aspects such as hardware. It can automate the process from bedside data collection to information distribution and remote access by medical staff. IV. Amazon's Elastic Compute Cloud (EC2) and Simple Storage Service (S3) provide services mainly for enterprises. are neither possible n�r necessary to establish a set of independent system. the independent construction of HIS is a heavy burden. thus resulting in duplication and waste of resources. B.3 is the proposed construction of cloud-based HIS. • The work in [10] proposes a HIS constructed on the technology and method of XML application. thus a lot of HIS can not get proper technical services[9]. including Microsoft. It is estimated to cover many hospitals medical to achieve their CPR. There is some related works that envision similar solutions. And it has spacious room for development in hospital information areas for its flexible and extensible. Some studies have been performed recently in an attempt to employ Cloud method in medical affairs. management. and other • The work in [15] presents the issues MIA (Medical Imaging Analysis) researchers and clinicians deal with and proposed a new framework based on cloud computing concept for cancer imaging research. It can realize integration and sharing of information between hospitals and other departments. many large companIes are actively expanding the field of cloud computing. prescriptions. Yahoo and other large companies. Township hospitals in particular. etc. which is a great cost to hospitals. This work shows how cloud computing works in hospital affairs and suggests further development in HIS. Microsoft. From the short term. software. But based on the traditional database technology. Thus the hospitals with not abundant capital prefer to continue using film and paper materials to record the clinic information. to demand the resources with expanded necessaries and facilities by network. the difficulties in processing medical information and potentials of cloud computing are analyzed in detail. • software. Cloud in Medical Affairs Cloud computing model provides a new way to solve Related Works To solve these problems. Google is now the largest user of cloud computing with its search engine built on more than one million servers in the distribution of more than 200 locations. maintenance. the management and maintenance of HIS requires continuous investment. hardware and medical data. Besides. But independent HIS requires the maintenance and upgrade separately to progress in each hospital. Even for medium and large hospitals. The request for upgrade also comes up in usage. the key is to realize sharing of foregoing problems. such as the Figure 2. Fig. inspection findings information sharing. same time. • The work in [6] introduces that Fujian province has started to establish a unified medical archive by the Department of Health. but It bears the important burden to provide medical services to rural residents. incorrect use of software. at the . With the problems arising during operation. business can be put into A. Upgrades and Maintenance HIS requires separate management and Separate maintenance for hospitals. IBM's "Blue Clo�d" computing platform. cloud and computing is an by model network being promoted innovative 518 . Cloud computing is a new network application model. different scale or specialized hospitals produce kinds of individual needs for HIS. III. PROPOSAL advices. Moreover.

However. the health and medical institutions can work together to build information-sharing space of medical 519 . ultrasound.. " · · · I� Public /. so as to get rid of the heavy burden of complete construction and management. FigA shows the basic block diagram of cloud-based medical image acquisition equipment. software and data-storage according to the need. images and other data. then receiving the processed real­ time image and display.\ \': Internet 1/ '. Compared with spending lots of money to buy a dedicated server. we can even implement electronic disease diagnosis based on powerful cloud computing[6]. which are in different physical principles to realize the imaging methods for non­ intervention of the human internal organs. the others that including management. etc. other tasks including video processing. so that it just requests to complete the front end of data collection and video images formation. then by a compatible data format of standard DICOM. can be placed in the cloud. It's very affordable to use cloud computing in medical IT services. The following will make briefly introduction on the cloud-based image acquisition devices. hospitals can get the services provided by millions of servers in the cloud but pay a little. As only to complete terminal mission. so the hospital cannot work normally once a server failure occurs. etc.resources. Small hospitals can first set up a simple system with necessary component. At small hospitals like township hospitals. then higher efficiency. maintenance. seriously key data will be lost in extreme cases. reduce costs while efficiency is greatly enhanced. and start the new server to provide services. with the cloud model. most business can be processed within the cloud. Medical image acquisition devices are mainly including X-ray. using cloud services is clearly more cost-effective. CT. therefore. thus the hospitals can become more efficient. data storage. it can easily scale up the cloud in a short time[17]. and can use the resources in cloud to achieve hardware. the best approach is to develop new medical equipment. magnetic resonance. but also image processing and data storage. are several the practical advantages cloud in this implementation. Medical image is an important means of clinical diagnosis and medical science. • Reduce maintenance expenses: The user terminal architecture is unlimited in cloud computing model. including image acquisition equipment. besides applying existing system to upgrade. lower cost can be achieved. because of the unified data storage and sharing. blood and others.. The cloud computing model can quickly copy data in the failed server to another server. in the cloud computing model. many hospitals can share the infrastructure formed by connecting large number of systems together. the technical staffs do not have to pay much attention to upgrading the hospital hardware. Small Hospital �$)Public . • Flexible and extensible framework: The cloud framework supports heterogeneous equipments and alterable system scale. and even disease diagnosis can be achieved in the central servers. As the hospital becomes bigger and bigger. and thus they have more time to undertake other work. Construction of cloud-based HIS • Further application prospects: Meanwhile. and through the network module directly to the central servers of cloud. The network module is to connect within the cloud. storage. 1/ 'I . There • To set up a cloud-based terminal hospital system. A number of high-end applications. CLOUD-BASED MEDICAL DEVICES DESIGN This framework is easy to realize by adding a network module or control center just attached to existing systems. also applied for the Picture Archiving and Communication System (PACS). management equipment. i • Reliable operation of the server: The data of hospital daily business are concentrated in the server in the present hospital information systems. such as three-dimensional ultrasound imaging. that obtains real continuous security services. Also large hospitals reduce its costs from this flexible and extensible framework. thus obtains adjustable flexible structure. and construction costs can be reduced. it greatly reduces the equipment cost and maintenance difficulties. Using this method to optimize and reduce existing HIS gradually. Cloud based HIS o Figure 3. • Better information sharing: Through the cloud model. V. This can share infrastructure without having to update the related hardware. speckle noise attenuation are achieved through equipment upgrades. monitoring equipment. Traditional digital image data acquisition device should not only complete digital image formation and acquisition. experienced major hospital doctors can help diagnose patients of rural hospitals directly by collected patients' condition. tissues. They only need to complete the patients' information collection and result display. the device can be simplified accordingly. such as: Reduce costs: Using computing technology. \���t � ternet . while the daily maintenance of the server is also provided by the cloud service provider.

2005. 520 . Reed.-Feb. IEEE Press. II. IEEE Symp. Song. S. 7-9. Jun. Xu. It has not only significantly reduces the construction cost and provides wide medical application for village and town hospitals.1109/ICSSSM.. Fracalossi. Sep 2008. 8. 14981501. 1989. 529-537. 0. Block diagram of cloud-based medical image acquisition equipment [7) VI. X." Proc. I9." Proceedings of the Sixth Conference on Medical Informatics." Chinese Medical Equipment Journal. and T. it reduces hospital operating costs and significantly improves operating efficiency. 31. Aug. X. Chen. M. and Dang. 297.11 09/eTELEMED. pp.A shipping container stuffed with servers could usher in the era of cloud computing. "A cloud computing solution for patient's data collection in health care institutions. [13] Milojicic." Ieee Internet Computing.. pp. Y. extensible and practicable framework by regarding all the hardware. vol. pp. Z." Scientific American.. "Exploration in constructing digital hospital. 2003. it can be realized of the medical images to be automated diagnosed. 17. but can realize the information sharing and effective use of resources to the greatest extent. 109-113. May. "Cloud computing .. Hu. vol. 90-93. Lu. M.. (15) Tsumoto.Interview with Russ Daniels and Franco Travostino. 2007. Liu "The design and implementation of a hospital management information system for Peking Union Medical College Hospital.. [12] Weiss. L. Hou. "Informatization of distant medium-small hospital. E. software and data of hospitals as resources acquirable from the cloud. C. S.. 12. but also can be the unified base for hospital system construction. "Study on and realization of hospital information integration based on XML. D. vol. pp. vol. X. and Li.. "Availability of software services for a hospital information system. 'Take your business to a higher level".. pp. IEEE Symp." NetWorker. Ye. 104-105. vol. D. Westphall. 47-50. Oct." International Journal of Medical Informatics. Werner. et al. C." Journal of Object Technology. Gardner. C. N. Jun. Jan. Allan Pryor and Homer R. pp.Shen. Besides. M. vol 8. A. Moreover. vol.. 65-72. and Sun. which realizes the CONCLUSION [8] [9] This article describes the HIS based on cloud computing flexible. (17) Sun Microsystems Inc. and Hirano.. 2009. [10] Waldrop.." Cars 2003: Computer Assisted Radiology and Surgery.. G.1016 IS0920-5489(03)00017-5. 54. and Social Medicine. T. pp. "Cloud computing: Today and tomorrow.1016/S05315131(03)00458-8." 2009 Icme International Conference on Complex Medical Management. Feb.. Telemedicine. A. Jun. cloud Infrastructure not only makes updating and application of new technologies simpler. doi: 1O. W. [16] Rolim. 2010. T. Meanwhile. 23. pp. Proceedings. May. T. and Salvador." Journal of Huaihai Institute of Technology (Natural Science Edition). P. pp. ===¢� EJ [3] [4) Zhanjun. 2003. we suggest further applications of this architecture such as the construction of Health Information System. G. "Realization of integration and working procedure on digital hospital information system. The infrastructure of "cloud" contributes to help hospitals save the time and efforts required for IT systems. 843-848. P. 2007. C. 8. W. IEEE Press. (14) Kim. 49. 25. pp.[2) Storage �ISPlay Patient Temlnal \ � Printer 8�GJ � .. and Chen. 2005 International Conference on Services Systems and Services Management. S. J.. Dec. Warner.." International Journal of Medical Informatics. 2009. 8. 2010 Second International Conference on Health. "Data center in a box . 18. G. pp. 2010. Sun W. Mar. Jan. 1998. H. Hu. [II) Sakamoto. C. 16-25. Wang." Computer Standards & Interfaces. And based on the new platform and depending on powerful servers. pp. X. W. S.. Sep. 36-39." Chin J Hosp Admin. [5) [6] Figure 4. 8. pp. F. and M. Li. 1998. Wang. pp. 2005. 95-99. "Study on information system of health care services management in hospital.. doi: 10. "Large-scale hospital information system in clinical practice. 2008.201O. 169-182. vol. vol. Z. Koch. vol." Medical Information. C.." Proc. 1. J. Sep. and Zang. 89-96. W. vol. "The HELP hospital information system: update 1998. "COMPUTING IN THE CLOUDS. 2005.1500249. vol. REFERENCES [1) Pietka. "Data mining in hospital information system for hospital management. 2007. doi: 10. 1256. doi: 10.. "Construction of citizen healthy information system in Xiamen.

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