Thesis Defense MBI

Towards a Healthy CloudCloud Computing Solutions for the Dutch Healthcare Sector

Kor Tops

Ronald van den Heuvel

Ronald Batenburg

Slinger Roijackers

Juan Hernández ColominaBusiness Informatics Master Thesis

Thursday, 29th of April 2010

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• Research Description• Research Findings• Conclusion• Validity & Contribution• Questions

Index

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Index

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Research Scope

SlideResearch Description

ICT TrendsBusiness Trends

IT Consumerization

Enterprise 2.0

iPhone

Kindle Chrome OS

Internet Devices

Real-time Web

SOA

Social Media

Web Services

Network Capacity

Climate Friendly

Compliance

Extended Value Chains

Prosumers

IT Dependance

Collaboration

From Push to Pull

Globalization Transparency

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Research Scope


Some Key Facts & Figures

• Increased complexityServer utilization 5% to 20%80% of IT budget to keep lights “on”

•Human resources & energy costs vary strongly across the globe

•Sustainability & Green IT

Business/IT alignment still an issue

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Research Scope


Source: Gartner 2009

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Research Scope


Source: Gartner Hype Cycle, July 2009

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Research Questions


Research Questions Group 1: Definition of Cloud Computing

What is Cloud Computing? How is it defined by scientists, ICT vendors, consultants, analysts and commercial publications? What types of solutions are available? What are its main benefits and risks? What type of cloud solutions are being currently offered in the market?

Research Questions Group 2: The Dutch Healthcare Sector

What are the current trends, challenges and opportunities in the Dutch Healthcare sector? What is the current role of ICT in the Dutch Healthcare sector? What are the main policies and legislations affecting the use of ICT in Dutch Healthcare organizations?

Research Questions Group 3: Cloud Computing in NL Healthcare

What are the most relevant opportunities and challenges for adopting Cloud Computing in the Dutch Healthcare sector? Which type of Cloud Computing solutions fit within the current legislative context and political agenda? How do current regulations facilitate or difficult the adoption of Cloud Computing?

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Research Approach & Methods


Phase #

Type of Questions

Research Approach

Research Methods Deliverables

1 What is ...? Conceptual-Analytical

-Literature Study-Online Field Study-Expert Reviews

• Definition of Cloud Computing• Overview of characteristics• Overview of main vendor solutions• Expert review validation

2 What is ...? Conceptual-Analytical

-Literature Study-Expert Reviews

• Description of the Dutch Healthcare sector• Current trends, challenges and opportunities in the

Dutch Healthcare sector • The role of ICT in the Dutch Healthcare sector• Policies and regulations governing the use of ICT in

the Dutch Healthcare sector• Expert review validation

3 How does...? Design Science-Artifact building / instrument development

• Matching-model linking requirements with cloud computing features

• Opportunities and barriers for Cloud Computing in the Dutch Healthcare sector

• Recommendations for stakeholders

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Index

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Phase 1 Results

SlideResearch Findings

SCIENTIFIC / RESEARCH•UC Berkeley RADSL: “as applications delivered as a service over the Internet (SaaS) and the infrastructure that delivers them” •Telefonica R&D: “large pool of easily usable and accessible virtualized resources ... dynamically reconfigured ... exploited by a pay-per-use model...”

IT ANALYSTS•Gartner: “A style of computing where massively scalable (and elastic) IT-related capabilities are provided as a service to external customers using Internet technologies.” Forrester: “A pool of abstracted, highly scalable, and managed compute infrastructure capable of hosting end-customer applications and billed by consumption”

STANDARDS•NIST: “... on-demand network access to a shared pool of configurable computing resources.... that can be rapidly provisioned and released with minimal management effort or service provider interaction”

CONSULTANTS / VENDORS•Google: “...giant clusters of computers that house immense sets of data too big for traditional computers to handle” Capgemini: “…the use of massively scaled offsite IT resources assembled virtually, accessed over the internet, used on demand in real-time or near real-time on a pay-per-use or subscription basis, where the workloads are shared among multiple customers”•McKinsey: “Clouds are hardware-based services offering (...) capacity where: hardware management is highly abstracted from the buyer, buyers incur infrastructure costs as variable OPEX & infrastructure capacity is highly elastic”

Component Extracted from definitionApplications Berkeley University

As-a-service / Service Based Berkeley University, IEEE, Gartner, NIST

Internet / Ubiquitous Network Access Berkeley University, IEEE, Media, Gartner, Capgemini, Accenture, NIST

Supporting Infrastructure Berkeley UniversityLarge Amounts of Resources Telefonica

Easily Usable / Unified Presentation / Self-service Telefonica, Melbourne University, Media, Forrester, NIST

Easy Accessible / On-demand Telefonica, IEEE, Media, Capgemini, NISTVirtualized Resources / Assembled Virtually Telefonica, Melbourne University, IEEE, Media, Capgemini

Dynamic / Scalable / Elastic / Automatic Workload Distribution / Workflow

Management

Telefonica, Melbourne University, IEEE, Media, Forrester, Gartner, Capgemini, Accenture, NIST

Resource Optimization / Pooling / Shared Resources / Multi-tenant Telefonica, Media, Forrester, Gartner, Capgemini, NIST

Pay-per-use / Usage Based Pricing & Metering Telefonica, Media, Gartner, Capgemini, NIST

Customized SLAs / SLA based Telefonica, Melbourne UniversityLocation Independent Media

Lack of Ownership / Offsite / From Third Party Media, Capgemini, Accenture

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Phase 1 Results


Cloud Computing DefinitionCloud Computing is the delivery model where on-demand elastic IT capabilities are offered as-a-

service through the Internet following a usage based pricing model.

SaaSSaaSSaaSSaaS

Service Model

Other models: - Deployment Model: External vs Internal - Access Model: Private vs Public- Hybrids, Inclusions, Aggregations, etc

PaaSPaaSPaaSPaaS

IaaSIaaSIaaSIaaS

Flexibility Abstraction

Use Patterns

Use Pattern Examples

Resource Optimization PresidioHealth (GoGrid), Rentokil (Google Apps), LA County (Google Apps)

Scalability & Elasticity PresidioHealth (Appistry IQ Cloud), Wordpress (MS Azure), Twitter (Amazon S3)

HPC NYT (Amazon EC2), Harvard Medical School (Amazon EC2 & Oracle), BT (Amazon EC2)

Fail-over / Backup 37signals (Amazon S3), Zmanda (Amazon S3), Jungle Disk (Amazon S3)

Faster time-to-market PresidioHealth (Appistry), Siemens (Windows Azure), SugarCRM (Windows Azure)

External Knowledge GoGrid (Windows Azure), Associated Press (Windows Azure), Rover (Rackspace Cloud)

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Phase 1 Results


ConclusionsCloud is certainly not only a hype, but it is neither the “Holy Grail” A (disruptive) delivery model from the evolution of existing technologiesApplicability depends on type of data, app, size, network, etcFrom secure internal private clouds to efficient external public clouds

Considerations•Lack of standards increases the risk of vendor lock in•Availability and performance not always as advertised•Security incidents•Data geo-localization

Predictions•New roles: cloud broker, inter-cloud•PaaS-ification of services

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Phase 2 Results


Healthcare in The NetherlandsHigh impact on citizens = timely decision making & decreasing error toleranceHigher demand (and costs) due to demographic changes, (new) pervasive global

threats, unhealthy lifestyles, etc.Multi-disciplinair approach often neededDutch government strategy: shift the power from healthcare providers to

consumers and control from public bodies to insurers.Economic Sustainability = do more and better with less

ICT in Dutch HealthcareLarge potential to increase availability and quality while meeting demand and costs.

50% of all citizens in NL have experienced medical problems due to the lack of coordination10% of the GPs have had to repeat tests

Most relevant technologies: tools for collaboration, information exchange, eProcurement, interactive patient information and web services

EPD: increasing the availability of accurate, complete and relevant clinical data can improve the quality of services and its sustainability.

Improve Quality & Reduce Costs

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Phase 3 Results


Cloud Features

Enforced By Delimited By

Directly Indirectly

On-demandZSP-CON-01, ZSP-BSC-01,

ZSP-BSC-02, GBZ-5.1, GBZ-5.7

ZSP-CON-11

ElasticZSP-CON-01, ZSP-BSC-01,

ZSP-BSC-02, GBZ-5.1, GBZ-5.7

ZSP-CON-11

As-a-service

ZSP-BVL-01 ZSP-BVL-02 ZSP-BVL-03 ZSP-BVL-06 ZSP-BVL-07 ZSP-BVL-08, ZSP-BSC-06, ZSP-BSC-07, ZSP-BSC-08, ZSP-ORG-01, ZSP-BEH-07, ZSP-BEH-08, GBZ-1.1, GBZ-1.2, GBZ.3.8, GBZ-3.10, GBZ-4.1, GBZ-4.2, GBZ-

4.4, GBZ-4.6, GBZ-4.7, GBZ-4.8GBZ-6.1, GBZ-6.2, GBZ-6.3

ZSP-GBO-01 & ZSP-GBO-02, ZSP-RSP-01, ZSP-RSP-03, ZSP-BEH-03, ZSP-BEH-04,

ZSP-BEH-05

Internet delivery ZSP-CON-03, ZSP-CON-07

ZSP-DNS-01, ZSP-DNS-02, ZSP-DNS-04, ZSP-DNS-05, ZSP-DNS-06, ZSP-CON-05, ZSP-CON-06, ZSP-CON-08, ZSP-CON-09, ZSP-CON-10, ZSP-BVL-05, ZSP-RSP-01 &

ZSP-RSP-03

Usage-based pricing

not applicable not applicable not applicable

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Index

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Conclusion

SlideConclusion

Perfect Storm for Cloud Computing in Healthcare: economic crisis, demographic and social developments, global threats, etc

On-demand scalability for improving cost efficiency and quality of care

Small organizations can use External Clouds for cost efficient EPD connectivity

Large organization can deploy Internal Private Clouds for resource optimization & Hybrid Clouds for HPC

NICTIZ certification requirements determine feasible cloud models:

Cloud GBZ: Hospital’s Internal Private Cloud

Cloud ZSP: LSPconnect (Enovation)

Cloud XIS: any certified SaaS applicationThe EPD is a Cloud Computing environment from each healthcare provider’s perspective Providers outside NL are excluded by definitionPublic Clouds excluded by known issues and incompatibility with connectivity, security, support and transparency requirements.

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Conclusion

SlideConclusion

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Conclusion

SlideConclusion

Recommendation for healthcare organizations:• Start Pilot now with Internal Private Cloud• Plan for hybrid models in selected use cases• Use strong encryption when using Public Clouds

Recommendations for Dutch government:• Improve un-realistic requirements in IT projects• Government Cloud best practices (e.g. USA gov)• Patient Centric Healthcare

Recommendations for ICT providers in NL:• XIS-SaaS for EPD• Internal Private Clouds for Hospitals• Cloud Broker role

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Index

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Research Validity & Contribution

SlideValidity & Contribution

Research ValidityExternal validity: specific country, sector and IT delivery modelInternal validity: incremental validation of (sub)findingsReliability: replicability supported by describing research stepsValidation methods: expert reviews & (Twitter) field studyInstantiation of the meta-artifact needed in further research

Research Contribution•Continue IS research on the relationships between IT, individuals and organizations•Descriptions of two parts of reality: Cloud Computing and Dutch healthcare•A suitable meta-artifact (matching-model) for this context•Twitter as an innovative research method•Pluralism of research paradigms in IS research

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Questions

Thesis Defense MBI

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