{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T07:48:57Z","timestamp":1781941737507,"version":"3.54.5"},"reference-count":66,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2012,7,4]],"date-time":"2012-07-04T00:00:00Z","timestamp":1341360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Future Internet"],"abstract":"<jats:p>As the costs of healthcare services rise and healthcare professionals are becoming scarce and hard to find, it is imminent that healthcare organizations consider adopting health information technology (HIT) systems. HIT allows health organizations to streamline many of their processes and provide services in a more efficient and cost-effective manner. The latest technological trends such as Cloud Computing (CC) provide a strong infrastructure and offer a true enabler for HIT services over the Internet. This can be achieved on a pay-as-you-use model of the \u201ce-Health Cloud\u201d to help the healthcare industry cope with current and future demands yet keeping their costs to a minimum. Despite its great potential, HIT as a CC model has not been addressed extensively in the literature. There are no apparent frameworks which clearly encompass all viable schemes and interrelationships between HIT and CC. Therefore, analyzing and comparing the effectiveness of such schemes is important. In this paper we introduce the concept of \u201ce-Health Cloud\u201d highlighting many of its constituents and proposing building an e-health environment and elucidating many of the challenges confronting the success of the e-Health Cloud. We will also discuss different possible solutions to address challenges such as security and privacy.<\/jats:p>","DOI":"10.3390\/fi4030621","type":"journal-article","created":{"date-parts":[[2012,7,4]],"date-time":"2012-07-04T23:52:03Z","timestamp":1341445923000},"page":"621-645","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":172,"title":["e-Health Cloud: Opportunities and Challenges"],"prefix":"10.3390","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0246-0417","authenticated-orcid":false,"given":"Eman","family":"AbuKhousa","sequence":"first","affiliation":[{"name":"Faculty of Information Technology, United Arab Emirates University (UAEU), P.O. Box 17551, Al Ain, UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nader","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Faculty of Information Technology, United Arab Emirates University (UAEU), P.O. Box 17551, Al Ain, UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jameela","family":"Al-Jaroodi","sequence":"additional","affiliation":[{"name":"Faculty of Information Technology, United Arab Emirates University (UAEU), P.O. Box 17551, Al Ain, UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2012,7,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1145\/1089107.1089141","article-title":"HIT and MIS: Implications of health information technology and medical information systems","volume":"48","author":"Goldschmidt","year":"2005","journal-title":"Commun. ACM"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1080\/10580530601036786","article-title":"Bridging the IT adoption gap for small physician practices: An action research study on electronic health records","volume":"24","author":"Davidson","year":"2006","journal-title":"Inf. Syst. Manag."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1057\/palgrave.ejis.3000719","article-title":"An empirical examination of patient-physician portal acceptance","volume":"16","author":"Klein","year":"2007","journal-title":"Eur. J. Inf. Syst."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"5","DOI":"10.3912\/OJIN.Vol8No02Man04","article-title":"Challenges and solutions for care of frail older adults","volume":"8","author":"Young","year":"2003","journal-title":"Online J. Issues Nurs."},{"key":"ref_5","unstructured":"(2006). HEALTHCAST 2020: Creating a Sustainable Future, PricewaterhouseCoopers."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1007\/s11606-007-0393-z","article-title":"Reducing diagnostic errors through effective communication: Harnessing the power of information technology","volume":"23","author":"Singh","year":"2008","journal-title":"J. Gen. Internal Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1002\/smj.301","article-title":"Understanding competitive advantage in the general hospital industry: Evaluating strategic competencies","volume":"24","author":"Douglas","year":"2003","journal-title":"Strateg. Manag. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.datak.2006.04.007","article-title":"IT support for healthcare processes\u2014Premises, challenges, perspectives","volume":"61","author":"Lenz","year":"2006","journal-title":"Data Knowl. Eng."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1109\/RBME.2008.2008217","article-title":"In the spotlight: Health information systems","volume":"1","author":"Saranummi","year":"2008","journal-title":"IEEE Rev. Biomed. Eng."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1109\/RBME.2009.2034699","article-title":"In the spotlight: Health information systems\u2014PHR and value based healthcare","volume":"2","author":"Saranummi","year":"2009","journal-title":"IEEE Rev. Biomed. Eng."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1109\/RBME.2011.2176998","article-title":"In the spotlight: Health information systems\u2014Mainstreaming mHealth","volume":"4","author":"Saranummi","year":"2011","journal-title":"IEEE Rev. Biomed. Eng."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1109\/TITB.2010.2043299","article-title":"Special section on affective and pervasive computing for healthcare","volume":"14","author":"Vasilakos","year":"2010","journal-title":"IEEE Trans. Inf. Technol. Biomed."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Foster, I., Zhao, Y., Raicu, L., and Lu, S. (2008, January 12\u201316). Cloud Computing and Grid Computing 360-Degree Compared. Proceedings of the Grid Computing Environments Workshop (GCE), Austin, TX, USA.","DOI":"10.1109\/GCE.2008.4738445"},{"key":"ref_14","unstructured":"Shimrat, O. Cloud Computing and Healthcare. Available online:http:\/\/www.himss.org\/content\/files\/Code%2093_Shimrat_CloudComputingandHealthcare_2009.pdf."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Teng, C.C., Mitchell, J., and Walker, C. (2010, January 16\u201318). A Medical Image Archive Solution in the Cloud. Proceedings of the 2010 IEEE International Conference on Software Engineering and Service Sciences (ICSESS), Beijing, China.","DOI":"10.1109\/ICSESS.2010.5552343"},{"key":"ref_16","unstructured":"Cloud Computing: Clear Benefits: The Emerging Role of Cloud Computing in Healthcare Information Systems. Available online:http:\/\/www.techrepublic.com\/whitepapers\/cloud-computing-clear-benefits-the-emerging-role-of-cloud-computing-in-healthcare-information-systems\/2384337."},{"key":"ref_17","unstructured":"Kaletsch, A., and Sunyaev, A. (2011, January 4\u20137). Privacy Engineering: Personal Health Records in Cloud Computing Environments. Proceedings of the 32nd International Conference on Information Systems (ICIS 2011), Shanghai, China."},{"key":"ref_18","unstructured":"Mahony, M. Trust remains key barrier to eHealth. Available online:http:\/\/euobserver.com\/893\/31958."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Zhang, T., and Liu, L. (2010, January 5\u201310). Security Models and Requirements for Healthcare Application Clouds. Proceedings of the IEEE 3rd International Conference on Cloud Computing, Miami, FL, USA.","DOI":"10.1109\/CLOUD.2010.62"},{"key":"ref_20","unstructured":"Maria, A.F., Fenu, G., and Surcis, S. (2009, January 10\u201313). An Approach to Cloud Computing Network. Proceedings of the 3rd International Conference on Theory and Practice of Electronic Governance, Bogota, Colombia."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Lohr, H., Sadeghi, A., and Winandy, M. (2010, January 11\u201312). Securing the E-Health Cloud. Proceedings of the 1st ACM International Health Informatics Symposium (IHI 2010), Arlington, VA, USA.","DOI":"10.1145\/1882992.1883024"},{"key":"ref_22","unstructured":"AbuKhousa, E., and Najati, H.A. (2012\u20132, January 30). UAE-IHC: Steps towards Integrated E-Health Environment in UAE. Proceedings of the 4th e-Health and Environment Conference in the Middle East, Dubai, UAE."},{"key":"ref_23","unstructured":"Kaletsch, A., and Sunyaev, A. (2011, January 4\u20137). Privacy Engineering: Personal Health Records in Cloud Computing Environments. Proceedings of the International Conference on Information Systems (ICIS 2011), Shanghai, China."},{"key":"ref_24","unstructured":"Protecting Your Personal Data. Available online:http:\/\/ec.europa.eu\/justice\/data-protection\/individuals\/index_en.htm."},{"key":"ref_25","unstructured":"Protecting Personal Health Information in Research: Understanding the HIPAA Privacy Rule. Available online:http:\/\/privacyruleandresearch.nih.gov\/pdf\/HIPAA_Booklet_4-14-2003.pdf."},{"key":"ref_26","unstructured":"ITU-T Technology Watch Report\u2014Standards and eHealth. Available online:http:\/\/www.itu.int\/dms_pub\/itu-t\/oth\/23\/01\/T23010000120003PDFE.pdf."},{"key":"ref_27","unstructured":"Wootton, R., Patil, N.G., Scott, R.E., and Ho, K. (2009). Telehealthin the Developing World, Electronic Version, Royal Society of Medicine Press\/IDRC."},{"key":"ref_28","unstructured":"Agency for Healthcare Research and Quality. Available online:http:\/\/www.ahrq.gov\/."},{"key":"ref_29","unstructured":"Public Law 111\u20145\u2014American Recovery and Reinvestment Act of 2009. Available online:http:\/\/www.gpo.gov\/fdsys\/pkg\/PLAW-111publ5\/pdf\/PLAW-111publ5.pdf."},{"key":"ref_30","unstructured":"Progress report. Available online:http:\/\/www.thecommonwealth.org\/files\/189921\/FileName\/HealthProgressReports-E-Health.pdf."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Momtahan, L., Lloyd, S., and Simpson, A. (2007, January 20\u201322). Switched Lightpaths for E-Health Applications: Issues and Challenges. Proceedings of the Twentieth IEEE International Symposium Computer-Based Medical Systems (CBMS\u201907), Maribor, Slovenia.","DOI":"10.1109\/CBMS.2007.104"},{"key":"ref_32","unstructured":"Agrawal, D., Abbadi, A., Antony, S., and Das, S. (2010, January 29\u201331). Data Management Challenges in Cloud Computing Infrastructures. Proceedings of the 6th International Workshop on Databases in Networked Information Systems (DNIS 2010), Aizu-Wakamatsu, Japan."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.tele.2011.02.002","article-title":"Effective telemedicine project in Bangladesh: Special focus on diabetes health care delivery in a tertiary care in Bangladesh","volume":"29","author":"Hasan","year":"2012","journal-title":"Telemat. Inform."},{"key":"ref_34","unstructured":"Rayport, J.F., and Heyward, A. Envisioning the Cloud: The Next Computing Paradigm. A MarketspaceNext Point of View. Available online:http:\/\/marketspacenext.com\/inthemedia\/envisioning-the-cloud\/."},{"key":"ref_35","unstructured":"(2009). Introduction to Cloud Computing Architecture, Sun Microsystems."},{"key":"ref_36","unstructured":"Varia, J. Cloud Architectures. Available online:http:\/\/aws.amazon.com\/articles\/1632?_encoding=UTF8&jiveRedirect=1."},{"key":"ref_37","unstructured":"Hosseini, A., Sommerville, I., and Sriram, I. Research Challenges for Enterprise Cloud Computing. Available online:http:\/\/arxiv.org\/abs\/1001.3257."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Mei, L., Chan, W.K., and Tse, T.H. (2008, January 9\u201312). A Tale of Clouds: Paradigm Comparisons and Some Thoughts on Research Issues. Proceedings of the Asia-Pacific Services Computing Conference (APSCC\u201908), Yilan, Taiwan.","DOI":"10.1109\/APSCC.2008.168"},{"key":"ref_39","unstructured":"Armbrust, M., Fox, A., Griffith, R., Joseph, A., Katz, R., Konwinski, A., Lee, G., Patterson, D., Rabkin, A., Stoica, I., and Zaharia, M. Above the Clouds: A Berkeley View of Cloud Computing. Available online:http:\/\/inst.cs.berkeley.edu\/~cs10\/fa10\/lec\/20\/2010-11-10-CS10-L20-AF-Cloud-Computing.pdf."},{"key":"ref_40","unstructured":"Sriram, I., and Khajeh-Hosseini, A. (2010, January 10\u201311). Research Agenda in Cloud Technologies. Proceedings of the 1st ACM Symposium on Cloud Computing, SOCC 2010, Indianapolis, IN, USA."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Youseff, L., Butrico, M., and da Silva, D. (2008, January 12\u201316). Toward a Unified Ontology of Cloud Computing. Proceedings of the Grid Computing Environments Workshop (GCE\u201908), Austin, TX, USA.","DOI":"10.1109\/GCE.2008.4738443"},{"key":"ref_42","first-page":"15","article-title":"Is cloud computing really ready for prime time?","volume":"42","author":"Leavitt","year":"2009","journal-title":"Computer"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1145\/1496091.1496100","article-title":"A Break in the clouds: Towards a cloud definition","volume":"39","author":"Vaquero","year":"2009","journal-title":"ACM SIGCOMM Comput.Commun. Rev."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s10723-010-9171-y","article-title":"Architectural requirements for cloud computing systems: An enterprise cloud approach","volume":"9","author":"Rimal","year":"2011","journal-title":"J. Grid Comput."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.jnca.2011.07.013","article-title":"Service-oriented middleware: A survey","volume":"35","author":"Mohamed","year":"2012","journal-title":"J. Netw. Comput. Appl."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"322","DOI":"10.3390\/fi4010322","article-title":"Blueprinting Approach in Support of Cloud Computing","volume":"4","author":"Nguyen","year":"2012","journal-title":"Future Internet"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Chow, R., Golle, P., Jakobsson, M., Shi, E., Staddon, J., Masuoka, R., and Molina, J. (2009, January 9\u201313). Controlling Data in the Cloud: Outsourcing Computation without Outsourcing Control. Proceedings of the 2009 ACM Workshop on Cloud Computing Security, Chicago, IL, USA.","DOI":"10.1145\/1655008.1655020"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Pearson, S. (2009, January 23). Taking Account of Privacy when Designing Cloud Computing Services. Proceedings of the ICSE Workshop on Software Engineering Challenges of Cloud Computing at CLOUD\u201909, Washington, DC, USA.","DOI":"10.1109\/CLOUD.2009.5071532"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1377\/hlthaff.19.6.140","article-title":"Virtually exposed: Privacy and e-health","volume":"19","author":"Goldman","year":"2000","journal-title":"Health Aff."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1504\/IJHTM.2002.001128","article-title":"Health information privacy and e-healthcare","volume":"4","author":"Kelly","year":"2002","journal-title":"Int. J. Healthc. Technol. Manag."},{"key":"ref_51","unstructured":"International Classification of Diseases (ICD). Available online:http:\/\/www.who.int\/classifications\/icd\/en\/."},{"key":"ref_52","unstructured":"Cote, R.A. (1986, January 25\u201326). Architecture of SNOMED: Its Contribution to Medical Language Processing. Proceedings of the Annual Symposium on Computer Applied Medical Care, Washington, DC, USA."},{"key":"ref_53","unstructured":"Guo, L., Chen, F., Chen, L., and Tang, X. (2010, January 17\u201318). The building of cloud computing environment for e-health. Proceedings of the International Conference on e-Health NetworkingDigital Ecosystems and Tech. (EDT), Shenzhen, China."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Chen, P., Freg, C., Hou, T., and Teng, W.-G. (2010, January 16\u201318). Implementing RAID-3 on Cloud Storage for EMR System. Proceedings of the 2010 International Computer Symposium (ICS), Taiwan.","DOI":"10.1109\/COMPSYM.2010.5685395"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Rolim, C.O., Koch, F.L., and Westphall, C.B. (2010, January 10\u201316). A Cloud Computing Solution for Patient\u2019s Data Collection in Health Care Institutions. Proceedings of the Second International Conference on eHealthTelemedicineand Social Medicine (ETELEMED'10), St. Maarten, The Netherlands.","DOI":"10.1109\/eTELEMED.2010.19"},{"key":"ref_56","unstructured":"Lo, O., Fan, L., Buchanan, W., Th\u00fcmmler, C., Khedim, A., Lawson, A., Uthmani, O., and Bell, D. (2011, January 23\u201326). Patient Simulator: Towards Testing and Validation of e-Health Infrastructures. Proceedings of the Pervasive Health, Dublin, Ireland."},{"key":"ref_57","unstructured":"White, J. Cloud Computing in Healthcare: Is there a Silver Lining?. Available online:http:\/\/www.aspenadvisors.net\/results\/whitepaper\/cloud-computing-healthcare-there-silver-lining."},{"key":"ref_58","unstructured":"Fan, L., Buchanan, W., Thummler, C., Lo, O., Khedim, A., Uthmani, O., Lawson, A., and Bell, D. (, January July). DACAR Platform for eHealth Services Cloud. Proceedings of the 4th International Conference on Cloud Computing, Miami, FL, USA."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Baru, C., Botts, N., Horan, T., Patrick, K., and Fedman, S.S. (2012, January 4\u20137). A Seeded Cloud Approach to Health Cyberinfrastructure: Preliminary Architecture Design and Case Applications. Proceedings of the 45th Hawaii International Conference on System Sciences, Maui, HI, USA.","DOI":"10.1109\/HICSS.2012.82"},{"key":"ref_60","unstructured":"He, C., Jin, X., Zhao, Z., and Xiang, T. (2010, January 29\u201331). A Cloud Computing Solution for Hospital Information System. Proceedings of the Intelligent Computing and Intelligent Systems (ICIS), Xiamen, China."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Yu, W.D. (2011, January 13\u201315). A Service Modeling Approach to Service Requirements in SOA and Cloud Computing\u2014Using a U-Healthcare System Case. Proceedings of the IEEE 13th International Conference on e-Health NetworkingApplications and Services, Columbia, MO, USA.","DOI":"10.1109\/HEALTH.2011.6026754"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"469","DOI":"10.3390\/fi4020469","article-title":"Security analysis in the migration to cloud environments","volume":"4","author":"Rosado","year":"2012","journal-title":"Future Internet"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1109\/MSP.2010.115","article-title":"Understanding cloud computing vulnerabilities","volume":"9","author":"Grobauer","year":"2011","journal-title":"IEEE Secur. Privacy Mag."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Li, M., Yu, S., Ren, K., and Lou, W. (2010, January 7\u20139). Securing Personal Health Records in Cloud Computing: Patient-centric and Fine-grained Data Access Control in Multi-owner Settings. Proceedings of the 6th International ICST Conference on Security and Privacy in Communication Networks (SecureComm 2010), Singapore.","DOI":"10.1007\/978-3-642-16161-2_6"},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Yu, S., Wang, C., Ren, K., and Lou, W. (2010, January 15\u201319). Achieving secure, scalable and fine-grained data access control in cloud computing. Proceedings of INFOCOM 2010, San Diego, CA, USA.","DOI":"10.1109\/INFCOM.2010.5462174"},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Ahmed, S., and Raja, M.Y.A. (2010, January 19\u201321). Tackling cloud security issues and forensics model. Proceedings of the High-Capacity Optical Networks and Enabling Technologies (HONET 2010), Cairo, Egypt.","DOI":"10.1109\/HONET.2010.5715771"}],"container-title":["Future Internet"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-5903\/4\/3\/621\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T21:51:07Z","timestamp":1760219467000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-5903\/4\/3\/621"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,7,4]]},"references-count":66,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2012,9]]}},"alternative-id":["fi4030621"],"URL":"https:\/\/doi.org\/10.3390\/fi4030621","relation":{},"ISSN":["1999-5903"],"issn-type":[{"value":"1999-5903","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,7,4]]}}}