2018 Third International Conference on Fog and Mobile Edge Computing (FMEC)

Feasibility Study and Requirements for Mobile Cloud Healthcare Systems in Saudi
Arabia
Suhaila Habeeb1 and Lo’ai A. Tawalbeh1,2
Department of Computer Engineering
1
Umm Al-Qura University, Makkah, Saudi Arabia,
2
Jordan University of Science & Technology, Irbid, Jordan

Email: [email protected], [email protected]

Abstract- There is a significant improvement in the healthcare The other columns in both tables show sequential list of
services recently due to the integration of Information and different computing systems, including centralized, client-
Communication Technology (ICT). There are new service models server, the Internet computing (Table 1), virtualized, and cloud
in Healthcare systems being developed and used nowadays computing (Table 2) [7]. Since the beginning of ICT,
influenced by the use different technologies. Cloud computing healthcare stakeholders have deployed several technological
and Mobile computing technologies are playing a major role in
solutions, such as centralized, client-server and the Internet
this transfer. Physicians can use their smart mobile devices to
run useful medical applications, access patients records, and [8].
place lab orders. However, mobile devices limitations including System Centralized Client- Internet
battery lifetime and processing capabilities prevent the ultimate characteristic computing Server computing
use of these devices. Mobile Cloud Computing (MCC) can resolve computing
many mobile computing limitations. However, MCC has its Hardware Mainframe Personal PCs,high
challenges including high latency and large transmission power computers; performance
consumption when accessing compute and storage resources over high computers
the network. In this paper, we investigate the feasibility and performance
requirements of a converged mobile healthcare cloud computers
infrastructure for Saudi Arabia. This study aims to identify the Platform OS/360, DOS, Unix, Unix,Linux,
requirements for cloud infrastructures that will be needed in the Z/OS Linux, Windows
kingdom to support integrated countrywide interoperable Windows server, Database
healthcare applications and systems. In the future, we are server, server, Internet
planning to propose designs of network and system architectures Database Information,
for next generation mobile cloud-based healthcare system in server Application
Saudi Arabia. server, Email
Exchange server
Keywords—Cloud Computing, Healthcare Applications, Mobile Application run on the run on thick Web browser
Devices, Converged systems. mainframe clients based
and an personal applications and
interface is computers locally run on
I. INTRODUCTION made the client, PCs
available to
Recently, the applications of information and end-users
communication technologies are integrated in many aspects of Data storage On the Data stored Data stored on
our life such as: transportation, economy, education, and even mainframe on servers servers and
health. The governments worldwide encourage the adoption of computer and accessed
the ICT developments in building Electronic Health Record accessed through client
(EHR) to better organize the health care sector [1, 2]. The use through software or
client-server browser-based
of HER automates the medical workflow by integrating
connectivity client software
possible medication, decision support, X-rays, and detailed software using PCs
reports [3 - 6]. The comprehensive Electronic Health Record Processing Minimal Process Process locally
should contain: the patients names, vital signs, health local locally or at or at servers
problems, past medical histories, immunizations, and lab processing servers
results [3]. Communication Personal Personal Internet, Virtual
We referred to many healthcare literatures to understand network network network Private Network
what the healthcare stakeholders’ demands are and what they Logical layers One layer Two layers Multi-layers
are looking for based on the existing ICT solutions. Table 1 Business model high cost of low cost of Low cost of
and Table 2 summarize the various ICT solutions available (Organizations HW and hardware, hardware,
from 1960 up till now. The first column of each table lists owns the SW perpetual perpetual
system) license for license for OS
characteristics of different ICT systems, which are hardware, OS and and applications
platform, application, data storage, processing, applications
communications network, logical layers and business model.
Table 1 Centralized, client-server and the Internet computing systems

978-1-5386-5896-3/18/$31.00 ©2018 IEEE 300

 2018 Third International Conference on Fog and Mobile Edge Computing (FMEC)

and made it easier [14]. People use mobile devices to

System Virtualized Cloud computing accomplish variety of daily tasks such as online shopping,
Characteristic computing business management, educating and also health monitoring.
Hardware Personal computers; Infrastructure as a
high performance Service – personal
computers computers, high
performance
computers
Platform Unix, Linux, Platform as a Service -
Windows server, Unix, Linux, Windows
Database server, server, Database server,
Internet Information Internet Information
Service server, Service server, Glassfish
Glassfish Application Application server, Email
server, Email Exchange server,
Exchange server, VMware
VMware
Application Runs on the server Software as a Service –
and the interface is runs on the server and the
made available to interface is made
end-users available to the end-user
Data storage Data stored on Data stored on servers
servers and accessed and accessed through the Figure 1 The NIST Cloud Computing Reference Architecture
through the browser browser or a thin client
or a thin client software The concept of Cloud Computing (CC) relies on a network-
interface based resource sharing to increase resource availability and
Processing Minimal local Minimal local processing reduce financial and management costs [15].
processing is desired There are several examples for emerging Cloud computing
Communicatio Internet, Virtual Internet, Virtual Private infrastructures/ platforms such as Microsoft Azure, Amazon
ns network Private Network Network EC2, Google App Engine, and Aneka [16]. Cloud Computing
Logical layers Multi-layers with Multi-layers with utilizes a wide range of different computing technologies, and
virtualization layer virtualization layer
involves distributed systems, virtualization, storage,
Business model Organizations own Organizations rent the
the system, low cost system – pay as you go
networking, security, management and automation, service-
of the hardware, and pay for what you use oriented architecture (SOA), and service-level agreement
perpetual license for (SLA). Furthermore, CC helps companies improve the IT
operating system and services, develop applications to achieve unlimited scalability
application software and automaticity on demand services of the IT infrastructure,
and increase their revenues (figure 1).
Table 2 Virtualized and cloud computing systems Moreover, the development and the spread of mobile
devices allow the users to benefit from wide range of useful
As shown in Table 1, in the 1970s, mainframes were used in services and mobile applications at any time and from any
healthcare sector specially to process patients' information and place in the world.
centrally storing the health records [9]. It cost a lot to buy and Mobile Cloud Computing (MCC) integrates mobile
maintain a mainframe computer; so, few organizations could devices to utilize the cloud unlimited service [17]. The Cloud
afford it at that time. In the 1980s, it was the advent of low- Computing depends on network-connected resources pooled
cost minicomputers and healthcare stakeholders used them in to maximize their utilization resulting in reduced management
healthcare administrative process such as hospital billing, and capital costs. Many sectors can benefit from MCC
commercial applications and so on [9,10]. including the cloud-healthcare system. As an example, there is
Recently, cloud computing solutions have been offered by a MCC healthcare system that was built to observe and
IT vendors to support healthcare field. To build a cloud analyze real time biomedical signals (such as ECG) for users
computing system; hypervisors are installed on top of the in multiple locations. A personalized healthcare application is
hardware physical layer. The users can use healthcare installed on the mobile device, and health data are being
applications from anywhere and at any time via the Internet synchronized into the healthcare cloud computing service to
and thin client software. Cloud computing can provide a be stored and analyzed [18].
central and efficient control of storage, processing, memory, A mobile device challenges are the limited available space, the
and bandwidth devices [11]. Using EHR on cloud computing fats energy drain from batteries, and the limited CPU
may solve many healthcare challenges by maintaining a user’s capability. MCC increases the capabilities of the mobile
lifelong data to a centralized location [12]. By this approach, devices and overcomes their limitations, so the users will not
healthcare providers can manage patient records from any be concerned about the required CPU power and memory size
device connected to the Internet [12, 13]. to run intensive tasks [19].
The communication technologies including mobile
computing and wireless communications changed people lives

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 2018 Third International Conference on Fog and Mobile Edge Computing (FMEC)

Although all the great features of the MCC, the MCC faces manage security issues such as data protecting and data
some challenges such as the delay between the mobile device ownership preserving.
request and cloud service response especially when there is a Authors in [29] and [30] proposed a framework for secure
far distance between the cloud and the mobile device. A health information system based on big data analytics in
cloudlet is a recent concept that could be considered a mobile cloud computing environment. This framework
solution. A cloudlet is small equipped cloud to be placed provides a high level of integration, availability,
between the enterprise cloud and the mobile device, to reduce interoperability, and sharing of healthcare data among
the connection latencies and mobile power consumption [20]. healthcare stakeholders. Due to the massive size of healthcare
There are other challenges related to storing data on the data and the complexity of healthcare data types, the proposed
cloud, essentially is about data privacy and deny unauthorized framework employs big data analytics to help physicians take
access and malicious attacks. The availability of the owners' critical decision at the right time. In addition, the proposed
data at all times for any request is challange. Also, the framework applies a set of access control and security
integrity of the data and prevent alternation or modification on constraints to provide integrity, privacy and confidentiality of
the data by intruders is another issue. These information medical information.
security concerns could be solved by using cryptographic
techniques [21, 22]. III. MOBILE APPLICATIONS IN HEALTHCARE FIELD
It is clear that many computational and communication
resources are required for healthcare applications, and The mobile applications play undeniable role in our lives.
dynamic access to large amounts of data within and outside People use mobile applications to do their daily life routines
the health organization is involved. So there is a need for such as socializing, studying, shopping, and even health
networked healthcare system [23]. MCC could offer the monitoring. Some types of healthcare mobile applications that
required computational resources at any place and anytime used by clinicians are:
through cloudlet and fog computing based architectures. 1. Electronic medical record management: they help
Furthermore, big data and related technologies could provide clinicians document and review patients information.
the data management and analytics solutions that can reduce This type of applications allow clinicians to know the
healthcare costs and enhance system and clinical status of patients within and outside the hospital
inefficiencies. Big data analysis is about using emerging environment. Examples of these applications are
technologies that are designed to extract value from data or drchrono [31] and meditab [32].
analyze data having four Vs characteristics; variety, velocity, 2. Disease diagnosis assist: these apps help clinicians
veracity and volume [23]. For more details about big data the diagnosis the disease by asking queries which should
reader is referred to [24]. be answered according to the patient situation. There
are other applications that are used to display medical
II. RELATED WORK images such as X-ray and Ultrasound. Then the
application will provide disease diagnosis and
Authors in [25] discussed networked healthcare and how recommend treatment. Examples of these
mobile cloud computing and big data analytics could enable it. applications are Mobile MIM [33] and VueMe [34].
They presented the motivation and development of networked 3. Patient monitoring: clinician can remotely monitor
healthcare applications with the adoption of cloud computing. the behavior or symptoms of a patient. The
They described a usable cloudlet-based mobile cloud- monitoring application collects data coming from
computing infrastructure for healthcare big data application. heterogeneous wearable sensors, analyze the data
In [26] authors developed care pathway software based on then send message to clinician. As an example is the
technologies of mobile cloud computing and they proposed a Tactio application [35] as can be seen from figure 2
design architecture to provide organized control on
development of advanced care pathway software.
In [27], the authors discussed EHR sharing and integration
in healthcare clouds and related concepts. They analyzed the
critical security and privacy issues in EHRs accessing and
managing. An EHR security reference model was described to
manage healthcare cloud security issues. They presented EHR
security reference model through a use-case scenario and
described the corresponding security countermeasures and
state of the art of applicable security techniques that can be
primary security guards.
As an infrastructure for assistive healthcare, the Mobile
Cloud for Assistive Healthcare (MoCAsH) is proposed in [28]. Figure 2 Tactio mobile remote monitoring application
MoCAsH deployed intelligent mobile agents, context-aware
middleware, and collaborative protocol for efficient resource
sharing. MoCAsH deployed P2P paradigm to federate cloud to

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IV. CLOUD-BASED HEALTHCARE SYSTEM IN SAUDI ARABIA

In this section, we present details about analysis of mobile ACKNOWLEDGMENT
cloud-based networked healthcare systems and propse
topology for possible converged mobile healthcare cloud The authors would like to thank the Deanship of Scientific
infrastructure for Saudi Arabia. The city that we are studying Research at Umm Al-Qura University for the continuous
is Makkah. The healthcare systems network contains three support. This work was supported financially by the Deanship
hospitals which are Al Noor Specialist Hospital, King of Scientific Research at Umm Al-Qura University-
Adbullah Medical City Specialist Hospital, and Maternity and KSA, (Grant Code: 15-COM-3-1-0017) to Dr Lo’ai Tawalbeh.
Children Hospital. Error! Reference source not found.
shows the proposed Makkah city hospital network. The three
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