Priti Razdan, Praveen Srivastava, Rajiv Yadav

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Glimpses of the Emerging C-DAC Healthcare Cloud

Points Covered
Cloud Computing? Cloud and Healthcare C-DACs Integrated Initiative in Cloud Computing Traditional Vs IHIS Architecture Layers of the IHIS Architecture Implementation Model Conclusion

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Cloud Computing

Cloud Computing
Cloud Computing used to denote the use of cloud or internet based computers for variety of services.
Cloud Computing now implies the user experience moving away from in-house data centers into remote applications running in a cloud of computers. The technical foundations of Cloud Computing include Service-Oriented Architecture (SOA) and Virtualizations of hardware and software.
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Cloud and Healthcare

Healthcare providers at automating processes
Lower cost Higher gains

Use the HMIS as a Service and no need to undergo the challenges

Technology Administration Implementation

Patient Health Record moves to Internet.

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CDACs Integrated Initiative in Healthcare

 C-DAC has been working in the healthcare sector for more than a decade and half. Different C-DAC centers (Noida, Mohali, Trivandrum and Pune) have taken up projects in various areas of healthcare (HMIS, Telemedicine, PACS, Development of SDKs, Interworking Standards, etc.). These efforts were user driven and hence standalone. However, they were complimentary to each other. Considering the unification opportunity provided by the cloud approach, the centers are presently working on an Integrated HIMS (IHIMS) solution that can work very well over the cloud.
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CDACs Integrated Initiative in Healthcare

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Traditional HMIS Vs IHIS Architecture

Client Server Architecture.

Server - Data Center of the hospital Client machines- Various segments of the hospital. Advantages-The load on the server reduced by making the client perform many computationally intensive tasks. Drawbacks -Inability to scale to large number of concurrent users using thin clients. Processing load was given to the client while the server acted as a traffic controller between the application and the data. Applications forced to make multiple requests for data before even presenting anything to the user. Increasing the communication load. Modification in client side software needed their roll-out in all 9 the clients that use them. C-DAC/Noida

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N-tier Architecture
Application typically runs on server machines with client side interaction handled by a thin computer able to run an internet browser. The application is split in several pieces - Logically and physically. Each piece performs a specific task (displaying UI, Data Access, Business logic etc). Applications based on this architecture employed Model-View-Controller (MVC) pattern. Disadvantages -Tight coupling in the application with the layers. Any change in the application involves re-work at different layers.
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Restful SOA Architecture

Restful SOA architecture- loose coupling within the IHIS. Representational state transfer (REST) is a style of software architecture for distributed hypermedia systems such as the World Wide Web. Conforming to the REST constraints is generally referred to as being "RESTful". REST-style architectures consist of clients and servers. Clients initiate requests to servers; servers process requests and return appropriate responses. Requests and responses are built around the transfer of representations of resources. REST relies on human readable documentation that defines requests URIs and responses (XML, JSON).
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IHIS- Architecture

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Layers of IHIS
IHIS consists of four layers User Interface Layer : The UI layer is based on the flow and sensitivity of the user and hence is left for implementation as per need of the user. The UI layer is responsible for data capture and visualization. Functional Module layer : The overall functionality of the system is broken into cohesive set of functions and treated as modules. Examples are Registration, Billing, Pharmacy, etc. The functions of the module will be consumed by the UI layer.
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Layers of IHIS
System Core Layer :This layer comprises the model part of the system. It provides the basic functionalities that are utilized by the FM layer modules to carry out its functions. The components of SC layer are: EHR: The Electronic Health Record (HER) HIR: The Hospital Information Repository (HIR) Security Rules License Data Storage Layer: The DS layer provides persistence functions to SC layer.
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Communication Interfaces
IHIS has two prominent communication Interfaces Health Bus (HB) The HB Layer will be message exchange interconnect layer between functional modules and the System Core (SC). Data Storage Bus (DSB). The components at the system core layer will send messages to the Data Storage Bus.
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Implementation Model
The roll out model of IHIS will support Software as a Service (SaaS) paradigm. Functional modules -entities for the SaaS usage. Modules will have price per usage for the module. (A floating point number. ) The conversion to monitory terms is left to the SLA with hospital. Having a price per usage value for each module allows the administrator to configure the modules that he proposes to use in his hospital in the most cost effective manner.

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Implementation Model
There is large variability in the functional requirements of the HIS modules. Approach One -All encompassing super Registration module that can be configured as per the requirements of a specific hospital using a separate configuration process. Alternative Approach -Allow multiple Registration modules to coexist. Different prices for different modules catering to the same functional area. Ultimately, modules that are heavily used will become cheap and specialized modules not used much will become costlier. Facilitation of beta testing of the modules initially and fine tuning the prices based on user responses and volume of usage.
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Conclusion
The Cloud Computing infrastructure - an ideal tool to leverage computing power at low cost. The IHIS solution over CDAC Computing Cloud- an attempt to provide seamless functioning of HIS solutions over the Cloud Infrastructure for the large number of Government hospitals in the country where the ICT penetration is very poor. The development of IHIS is in its infancy. The challenge is to modify the large Repository of Modules across C-DAC as per the architectural needs of IHIS.

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