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National Healthcare Service is the publicly-funded healthcare service provider in the UK and it is the biggest healthcare system in the world. The services are primarily government-funded and the funds for healthcare comes from general taxes and National Insurance Schemes. The number of employees working at NHS is over 1.4 billion and the budget is £134 billion in the year 2019 (NHS, 2020). Each and every legal resident of the UK can avail of the services provided by the NHS and the majority of them are free. Treat of infection and emergency conditions are free for every person residing in the UK including migrants. NHS provides services, such as social care, mental health, primary care, ambulance, and hospital services (NHS, 2020).
Being a central organization, NHS stores a wide range of data, such as patient's personal information, diagnosis information, medical practitioners' data, and hospital records, medical schemes related information, and records for the disbursement of funds (NHS, 2020). There are numerous business IT applications that NHS uses for providing quality health and social care services to people of England. These include the GPIT system, electronic patient records, email services, voice communication, e-referral, Summary Care Record, and most important patient access apps (NHS, 2020). As there are various NHS centres across England, the IT applications assist the medical officers to access the medical records of a patient from anywhere in the county.
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For this particular research wherein the role of cloud computing in the healthcare sector is determined along with the issues associated with its use. For that purpose, the primary and secondary research approach has been selected wherein only a qualitative study will be done. For collecting the opinion and understanding the benefits & security issues of implementing cloud services in the NHS, the primary survey will be conducted by using a questionnaire (see appendix). For the data collection purpose, the random sampling techniques will be used by which 50 respondents will be selected. The respondents will be the NHS's workers and patients.
Various literature sources, such as journal articles, research papers, dissertations, NHS reports and government reports and websites, newspaper articles, and other secondary data sources will be used for putting arguments and carrying out discussions.
The healthcare sector is one of those sectors that are considered as most challenging to transform as it comprises a large number of legacy systems along with personalized information. The National Health Service is making use of cloud computing services in order to deal with constraints and hard-hitting challenges. The primary concern of the organisation is the rising demand for services that have increased the stress on the systems. Cloud services are helping NHS in delivering new services, improving efficiencies, improving patient experience, and reducing costs. According to Calabrese and Cannataro (2015), the average NHS worker gets 100-200 mails per day. Since the data is stored in the cloud, workers can access the mail from anywhere. This has also facilitated workers with efficient & effective communication and support system. In addition to this, the organisation has improved the accessibility of the medical professionals and authorities to review any data or information, thereby helping the organisation to increase its productivity. With the help of cloud services, rapid access to the data is possible and also professionals can be able to prevent siloing of the data.
With the help of cloud-based services and applications, namely Carenotes, medical professionals are able to share and view patient records on mobile from any place in the country. This service has enabled them to make better and well-informed decisions regarding public health and safety. The NHS is also carrying out cloud data analytics by offering new insights into treatment outcomes and patient care for work-laden nurses and clinicians (Haufe, et.al, 2014). The utilisation of IT-based software and business intelligence by the National Health Service trust is facilitating a superior dashboard to the staff members. As a part of the customer service, it is quite important to provide customers with better access to the information related to their health. With the help of a self-tracking cloud app, patients have been enabled to keep a track of their conditions and medication (Ahuja, et.al, 2012). The patients suffering from diabetes can be able to monitor their blood glucose levels and other illness.
However, there are certain challenges or limitations that are associated with the current cloud computing services used by the NHS. The applications face issues in managing millions of records of patients electronically. Moreover, the current infrastructure of numerous hospitals, trusts, clinics, etc., are not fully integrated with the current cloud computing services, thereby causing a gap (Kabachinski,2011). In the below section, the technical, ethical, legal, and user impact of the implementation of cloud computing services are
Figure 1: Cloud Services in the NHS
Source:Ali, et.al (2018)
Technical Impact: In order to build and implement the cloud-based application and services across all the aspects of NHS, the organization needs to build the technical skills of current employees by providing training, partnering with cloud experts, and upgrading the technology.
Legal Impact: the privacy and data protection laws that focus on the protection of patient confidentiality are crucial legal obligations that are required to be followed by the NHS authority.
Ethical Impact: ethical security, compliance, privacy, and performance metrics are certainly ethical considerations that are required for the implementation of cloud computing solutions (Ahuja, et.al, 2012).
User impact: Cloud computing enables patients and other service users to access various services on demand from any part of the world.
Cloud computing is a flexible IT service that assists hospitals to leverage the servers for accessing the remotely available information related to healthcare and patients. The NHS trusts across the UK can be able to store a large amount of data in a much secured manner. After the EMR mandate, all the healthcare organizations across the UK are shifting towards the adoption of cloud computing solutions as a means of protecting and storing.
In the following report, the primary focus is provided on the infrastructure services, such as storage and software services, such as collaboration, billing, financial, legal, destock productivity, CRM, social network, and backup & recovery purposes.
Of all the aforementioned benefits, the finance department and patient healthcare research and analytics can reap the maximum benefits out of the cloud services. Haufe, et.al, (2014) mentioned that cloud computing solutions can be very useful in automating the billing services. With the help of cloud financial management services, the NHS can be able to leverage its services relate to accounts, billing, and finances. The primary objective of such services is to improve cost transparency, thereby allowing the management to keep track and control overall costs. In addition to this, it is easier to map out the consumed resources as well as deliver information to the consumers of such resources. NHS with the cloud computing solution gets a reliable cost accountability service that assigns charges to users of the cloud services (Gavrilov and Trajkovik, 2012).Calabrese and Cannataro (2015) mentioned that with the help of the cloud financial management systems, namely, Aria systems, Redi2, Zuora, Xero, Beam4D, Concur, etc., can help the NHS trusts in various operations. These include heterogeneous data collection, data aggregation & filtering, data analysis, hierarchical data mapping, budgeting, cost & price modeling.
Ahuja, et.al, (2012) mentioned that the healthcare centres can be able to manage all of their medical records of patients for storing information. This would help in improving the quality of patient care, efficiency of medical services along with the coordination of professionals across the UK. Moreover, cloud-based services and applications can help in maintaining security and patient privacy. NHS is one of those public healthcare service providers across the world which is aiming at abandoning the practice of record-keeping through files and papers. With the help of electronic record-keeping using cloud services (Kabachinski, J., 2011). The electronic health records are managed by nurses, physicians, and other healthcare professionals using cloud services.
Haufe, et.al, (2014) mentioned that cloud computing helps in streamlining collaborative healthcare services for patients. With the help of such services, doctors can be able to keep a check on the patient’s health collaboratively and share medical records among themselves while sitting on a place. Earlier, the patients used to have different medical records for different doctors and it was difficult for tracking the medication and medical history of the patient. However, with the widespread use of cloud services across the healthcare departments and operations. Bracci, et.al (2012) mentioned that organizations can buy cloud services directly from service providers like Google and Amazon without installing any additional infrastructure. This can help in cutting the up-front cost and NHS can be able to lower down the cost of patient care.
Kabachinski (2011) is also assisting in big data analytics and research. With the help of cloud technology, the researchers are able to accumulate big data sets and they can also be able to gain a better data computing power that was absent earlier. The cloud-based computing services have helped in analyzing large data set in a reduced amount of time. With the help of cloud services, the healthcare researchers can have supercomputer-like analytical abilities at a very low cost.
No doubt that there are numerous benefits of implementing cloud services in healthcare, but there are certain limitations and potential securities issues. The security dangers are high in using cloud computing services. The current cloud networks and services provider with some security tools that check for any suspicious behaviour and data theft. However, the majority of them are not properly providing security. The International Medical Informatics Association (IMIA), the primary concern with the cloud technology is related to healthcare networked systems and data protection. Bracci, et.al (2012) mentioned that system vulnerabilities are high, especially in the network are characterised by complex infrastructures. Once the system vulnerability is determined by the third party, the cloud-based platforms can be used against the organisation. Therefore, it is emphasised that the application and platform need to be upgraded on a regular basis. Bracci, et.al (2012) talked about phishing and social engineering attacks. The majority of cloud computing systems used in the healthcare organisations are quite open to social engineering and phishing attacks. If somehow any hacker gets the login credentials or other confidential information, then breaking into the systems gets easier for the hacker and the information can be used against any person.Gavrilov and Trajkovik (2012) outlined that the risks of data loss and data alterations in the cloud-based services are very high. The organisation can become vulnerable to a poor cloud system.
Usually, healthcare business organisations do not emphasise on data backups and data syncing. This makes them highly vulnerable to illicit data encryption like ransomware which is one of the common cloud security attacks. The organisations have to pay a large cost for getting their data back (Ali, et.al, 2018). Another security is associated with the negligence of employees in protecting the data and information of the healthcare organisation. Bamiah et.al (2012) called employee negligence as the biggest danger for the organisation. It has been noticed that employees are accessing the information by logging in through their mobile phones from any place and they forget to logout keeping the data open to vulnerabilities and threats. The majority of the cases related to data theft cases in the United States are caused by employee negligence and mistakes. Lo'ai, et.al (2016) mentioned a technical risk that is beyond the understanding of any medical expert. It is called “distributed-denial-of-service (DDoS) attacks which is unthinkable. The attack is associated with the use of numerous Internet of Thing (IoT) devices, computing systems, and mobile phone. In the current time, with the rise of IoT, the DDoS attacks are also increasing day by day. In addition to this, with time, there has been a rise in the installation of shared cloud computing services so as to increase the collaboration between different departments involved in providing quality healthcare services to everyone (Ali, et.al, 2018). Many cloud solutions do not provide the required level of security to organisations' clients, resources, financial records, and other important data properly. Thus, anyone within or outside the organisation can get direct access to the information through shared cloud computing applications and platforms. In fact, threats can use other cloud computing solutions to enter from one system to another (Seddonand Currie, 2013).
The analysis of the primary data collected are presented below:-
Out of 50 respondents, 30 respondents accepted that they are well aware of the cloud services and they have used them in the past. However, 20 of them accepted that they know about the cloud computing services but haven’t used them in the past.
Out of the all the services, majority of respondents have agreed that they have heard of cloud services being used for backup and treatment, patient portal, and health information. However, very few of them have seen cloud being used in HR operations.
38 respondents have agreed on the fact that cloud computing can be used by the NHS to improve the quality of treatment. This means people would be happy to see the implementation of cloud services in health services.
More than 50% of patients and medical staff believe that NHS might take 3 to 6 months to completely migrate to the cloud services. This might be due to the fact that it needs to change the current infrastructure and provide training to the employees.
48% of them believe that cloud computing is quite secure but still 20% of them believe that it is not at all a secured option due to many illegal implications in the past.
Out of numerous issues, majority of them highlighted that data security, physical & technical, and PHI data security are the crucial issues affecting the medical services. This can lead to data theft and other illicit outcomes.
The primary perks outlined by respondents are many but majority of them believe that cloud computing improves efficiency, saves money, and reduces operating costs for the NHS. Hence, cloud computing is the useful and beneficial option for NHS.
Looking into the aforementioned risks associated with the implementation of the cloud computing services for better treatment, cost-cutting purposes, and improving healthcare efficiency. There are certain solutions that can be very useful in a secured implementation of cloud services. These are enlisted below:-
In healthcare, the organisation needs to be extra conscious while choosing the cloud service provider. It is very significant to take services from a provider which is having the highest reputation, great margin, low operating costs, and highest ARPU as such providers are competitive in the market (Sultan, 2014). To achieve a competitive advantage in the market, the provider needs to control the cost and provide regular updates to their applications and services. It is important to understand that not even Google and Amazon are immune to the cyber-attacks and the data breaches are even possible in such a huge cloud service providers. The secured cloud service is the one that regularly introspects the customer network traffic and separates the company’s data form its operations.
The web platform of the cloud services facilitate a computing platform for the cloud application by which the service provider can be able to deploy the applications without much complexity and costs of managing the software and hardware underlying layer. Securing the web platform means securing all the data and content including web, email, and identity traffic taking place between the cloud and organisation (Mehraeen et.al, 2017). The following model of cloud data security analyses the security model of the cloud interface, understanding the dependency related to the API and ensuring a robust control and genuineness associated with the encrypted transmission.
Cloud infrastructure is required to hold the development environment wherein one can be able to get access to the hosting environment for building application. For better security, the password security feature can be used that would provide access to the data only after entering the ID and password. There are various service providers that are making use of various infrastructure for protecting the data. These include administering credentials and LDAP controls for preventing scattering of the data, running scripts for preventing access after employees leave at the end of the day (Guo, et.al, 2012). In addition to this, all the unauthorized access and changes are monitored regularly and conducting configuration audits and vulnerability testing on a regular basis. Furthermore, determining security breaches via notification features can help the organisation in knowing any attack on the security or data.
In order to protect the data from any internal and external attacks, multi-tenancy, storage tiering, and chargeback systems can also be provided. The former one is used for protecting multiple users' data and allocating resources to such users on-demand. In the chargeback systems, the cloud service providers need to track the usage of data with the help of a wide range of infrastructure optimisation methods (Mehraeen et.al, 2017). Storage tiering is the process of allocating disk drives to the pool of storage as per the requirement for a particular set of data.
Ethical Considerations with the Recommendations
Having very little experience of carrying out a research project, in the initial phase of the project I faced a lot of challenges. However, watching online videos and referring to literature work, I developed my work breakdown structure that helped me in carrying out the research work in a very structured manner. I completed each phase in the given amount of time which helped me in completing the project well on time. I got to know that a literature review is very crucial for setting up the project aim and making arguments. I developed my basic understanding of the topic I chose for this assessment. I carried out the primary research and based on which I listed out the benefits and key security issues associated with the cloud computing services. Overall, I learned a lot from this project and this knowledge would help me in the future as well.
For the following project, I have made four stages, namely, initiation, planning, execution, and reporting (see appendix). In the first stage which is the initiation stage, the primary focus was to define the research problem and identify the sector and organisation for the research. In the second stage i.e., planning stage, I decided on my research methodology based on the preliminary literature studies. In the execution stage, I carried out primary research using a questionnaire tool for collecting people's opinions on the use of cloud computing services. In addition to this, I also referred to the secondary data sources for better understanding and stating arguments. The last stage is all about reporting the findings of the research and presenting recommendations based on the analysis. Overall, the whole project management process helped me in understanding the primary stages of a project and carrying out to develop relevant results or outcomes.
Ethical Issues
From the following research work, the impacts of cloud computing on the healthcare industry were determined and for a better understanding, the National Health Service organization was chosen. The current status of the cloud computing services being used in the NHS was noted down in the report and legal, social, technical, and organizational impacts were also highlighted. Furthermore, the benefits and potential security issues that might impact the use of cloud services in the healthcare services were outlined. For a better understanding, a questionnaire survey was conducted wherein 50 people were surveyed. Based on the result, the recommendations are provided.
Ahuja, S.P., Mani, S. and Zambrano, J., 2012. A survey of the state of cloud computing in healthcare. Network and Communication Technologies, 1(2), p.12.
Ali, O., Shrestha, A., Soar, J., and Wamba, S.F., 2018. Cloud computing-enabled healthcare opportunities, issues, and applications: A systematic review. International Journal of Information Management, 43, pp.146-158.
Bamiah, M., Brohi, S. and Chuprat, S., 2012, December. A study on significance of adopting cloud computing paradigm in healthcare sector. In 2012 International Conference on Cloud Computing Technologies, Applications and Management (ICCCTAM) (pp. 65-68). IEEE.
Bracci, F., Corradi, A. and Foschini, L., 2012, July. Database security management for healthcare SaaS in the Amazon AWS Cloud. In 2012 IEEE Symposium on Computers and Communications (ISCC) (pp. 000812-000819). IEEE.
Calabrese, B. and Cannataro, M., 2015. Cloud computing in healthcare and biomedicine. Scalable Computing: Practice and Experience, 16(1), pp.1-18.
Gavrilov, G. and Trajkovik, V., 2012. Security and privacy issues and requirements for healthcare cloud computing. ICT Innovations, pp.143-152.
Guo, Y., Kuo, M.H. and Sahama, T., 2012, December. Cloud computing for healthcare research information sharing. In 4th IEEE International Conference on Cloud Computing Technology and Science Proceedings (pp. 889-894). IEEE.
Haufe, K., Dzombeta, S. and Brandis, K., 2014. Proposal for a security management in cloud computing for health care. The Scientific World Journal, 2014.
Kabachinski, J., 2011. What's the forecast for cloud computing in healthcare?. Biomedical Instrumentation & Technology, 45(2), pp.146-150.
Lo'ai, A.T., Bakhader, W., Mehmood, R. and Song, H., 2016, December. Cloudlet-based mobile cloud computing for healthcare applications. In 2016 IEEE Global Communications Conference (GLOBECOM) (pp. 1-6). IEEE.
Mehraeen, E., Ghazisaeedi, M., Farzi, J. and Mirshekari, S., 2017. Security Challenges in Healthcare Cloud Computing: A Systematic. Global Journal of Health Science, 9(3).
NHS, 2020. Overview - Care UK - NHS. [online] Nhs.uk. Available at: [Accessed 26 March 2020].
Seddon, J.J. and Currie, W.L., 2013. Cloud computing and trans-border health data: Unpacking US and EU healthcare regulation and compliance. Health policy and technology, 2(4), pp.229-241.
Sultan, N., 2014. Making use of cloud computing for healthcare provision: Opportunities and challenges. International Journal of Information Management, 34(2), pp.177-184.
Work Breakdown Structure
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Survey Questionnaire
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