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E-Health Dedicated Hybrid Cloud: a Solution to Ghanas Health Delivery Problems

Mensah Kwabena Patrick, David Sanka Laar
AbstractLow-income countries such as Ghana are known to have the Worlds major share of sicknesses and a low doctor-topatient ratio coupled with lack of proper health care facilities. The few available doctors are not well motivated leading to numerous industrial actions that further worsen the situation. In addition, there is a clear disparity between the quality of health care delivery in urban and rural areas which favors the urban areas. Information and Communication Technology (ICT) solutions are seen as the requisite tools that can be used to resolve the shortcomings in the health sectors of these countries. In this paper, we propose a low-cost e-health model that is based on hybrid cloud to effectively reduce the numerous problems in the health delivery sector of Ghana. Index TermsCloud computing, E-Health, Information and Communications Technology, Web Server.

1 INTRODUCTION
ROPER Health delivery is a major problem in lowincome countries with the system almost near collapse in some of these countries. This is due to low commitment shown by governments, resulting in brain drain of the few health professionals, low expertise on modern diagnosis, and extreme poverty which prevents ordinary people from accessing quality health care. People die needlessly from preventable diseases due to long waits at the hospitals. These waits are mostly caused by the fact that patient records are kept in thick medical files that are buried among thousands of other patient records. Most hospitals lack medical experts in certain fields, patients who are suffering from such ailments are either referred to other hospitals in or outside the country for treatment. Many hospitals do not have the requisite drugs in their pharmacies; hence patients are referred to privately owned pharmacies where the drugs are charged exorbitantly. This phenomenon heavily tilts the health delivery system in favor of the urban rich. In an attempt to reverse this situation, countries such as Kenya [1], South Africa [2], and other Sub-Sahara countries have resorted to e-Health as the medium and longterm solution to their health delivery systems. E-Health involves the application of Information and Communications Technology in the health care industry with the aim of improving access, efficiency, quality of service, and training. Through e-Health, patient records can be made shareable between both the patient and the doctor, the shortage of medical experts in a given field can be compensated for as nurses or other medical doctors can through telemedicine diagnose and treat sicknesses they are not experts in. Proper Hospital administration practices, good health education, and access to

low cost health care services can be realized through eHealth. E-health has been shown to reduce health care cost, increase efficiency through better management of both records and diseases, reduce travel time and cost, introduce shorter and fewer hospital waits, and sharing of patient records to authorized users [3]. Although eHealth has numerous advantages over the traditional health delivery system, it is expected to face many challenges notably amongst which include user readiness (both Doctor and Patient), availability of the requisite ICT infrastructure, interoperability, and lack of higher educational programs in the area of ICT in health. Presently, there is limited research in e-Health in many low-income countries, and limited interoperability between medical records of different hospitals, preventing the health sector from being able to forecast future sicknesses via data mining on available records.

2 REVIEW OF LITERATURE AND RELATED WORK

2.1 e-Health According to the World Health Organization (WHO), ehealth is the use of Information and Communication Technology for health [4]. It is a cost-effective and secure use of information and communications technologies to improve health and health-related fields, such as health care services, health surveillance, health literature, health education, knowledge, and research. In advanced countries, e-Health is more developed with key application areas including Health information Networks that encompasses Telemedicine and Telecare services, decission support tools, virtual reality, robotics, multi-media, computer assisted surgery, wearable and portable monitoring systems, health portals and Electronic medical records which also includes patient records, Mensah Kwabena Patrick is with the Computer Science Department of the clinical administration systems , digital imaging and arUniversity for Development Studies, Box 24, Navrongo, Ghana. chiving, e-prescribing, and e-booking [5], [6]. David Sanka Laar is with the Computer Science Department of the UniE-Health makes it possible to generate, capture, transversity for Development Studies, Box 24, Navrongo, Ghana. mit, store and retrieve digital data for clinical, educational

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Fig. 1. Basic components of e-health Service.

and administrative purposes. Through Telemedicine, such data can be shared among health professionals and even patients who might not be found in the same geographical location. Most existing e-Health implementations are based on the architecture shown in Fig.1. E-Health services can be provided by government institutions or private companies with their own ICT infrastructure or making use of ICT infrastructure owned by a second party. Communication is bi-directional, as users have the opportunity to monitor their own health at home and store their health information to the e-Health providers database as well as being able to access health information from the e-Health provider. Most of the existing e-Health projects are based on Portal technology allowing users to access these services over the Internet. We will cover only the basics of Portal Technology and e-Health in this section, extensive coverage of the subject can be found in [7]. The Client layer is a thin layer where users can access eHealth services via their local Web browser. The client device can be mobile or fixed as depicted in Fig. 2. The advantage with mobile clients is that, they can be carried along to remote locations guaranteeing access to e-Health services irrespective of the geographical location as long
PD A w e b b ro w ser

[7]. The second layer is made up of servers such as Web Servers, Authentication and Authorization Servers, etc. This layer may have Calender and Message Servers which can be used to schedule appointments and send reminders respectfully. The Data layer acts as one big repository of e-Health data. It holds information on personal health records and applications that operate on these data. This is the source of information that is used to fulfill a given users requests; it is also the destination where personal health information is written to when users want to store their health information. With this technology, clients can monitor their own health at home, and supply the information for their doctors to prescribe the appropriate drugs and give remedies. In Ghana, it is costly to setup ones own Portal. Coporate organizations also consider it unprofitable to setup Portals for e-Health purposes. The infrastructure is not adequate, and government support is minimal or even nonexistent. It is on this backdrop that we are proposing the use of a Hybrid cloud for e-Health. The cloud has numerous advantages aside the cost. Although details of hybrid cloud will be explored in the next subsection, it suffices to emphasize that cloud users pay based on how much they use (pay-as-you-go or pay per use). There are also existing (Public) clouds which are open source and others are into e-Health. Such clouds can be used as starting point for low-income countries struggling to establish their own ICT infrastructure for e-Health. Health care in developing countries is bedeviled with numerous challenges such as the ability to provide wide coverage health care, better health care, stable resource base, faster access to health care, improved productivity, new clinical techniques, more staff, and more assets. It is believed that e-health will provide patient safety, quality of care, availability, empowerment, and continuity of care among others [8]. Notwistanding, lack of interoperability and infrastructure are the major barriers facing e-Health in developing countries such as Ghana.

c e ll u l a r phone

C lie n t T i e r

W e b S e rv er

A p p li c a t i o n S e r v e r P o r ta l S e r v e r I d e n ti t y S e r v e r

S e r v e r T ie r

Legacy S y s te m

d a ta b a s e s

D ire c to ry S e rv e r

D a t a T ie r

Fig. 2. Architecture of Portal based e-Health System [7].

as there is internet connection. This is very useful as medical personel are always moving from one location to another especially during emergency cases such as accidents

2.2 Hybrid Cloud Chee and Curtis [9], defined Cloud Computing as follows: an information-processing model in which centrally administered computing capabilities are delivered as services, on an as-needed basis, across the network to a variety of user-facing devices. Cloud computing offers many things as a service (XaaS) over the Internet. Hence users need not own their own data centers and applications before they can make use of powerful, most current and up-to-date software and hardware. This alleviates the cost of software, hardware and upgrades from the user, who only needs to pay for how much they use. Services available on the cloud include Infrastructure as a Service (IaaS), Platform as a Service (PaaS), Software as a Service (SaaS), Storage as a Service (SaaS), Organization as a Service (OaaS), IT as a Service (ITaaS), etc. Cloud computing (Fig. 3.) has evolved from Grid and High Performance Computing (HPC), which by themselves also originated from Internet com-

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Fig. 3. Cloud Computing paradigm [10].

of both cloud paradigms. The major advantage is that, there is seamless interoperability between Private clouds and the resources of one or more Public clouds. However, there is a complexity of introducing applications accross both forms of clouds in Hybrid clouds, hence it is best to keep the enterprise data on site while the processing and applications stay in public clouds.

puting, with the first in the line being Mainframe Computing [10]. Cloud Computing can be categorized according to Fig. 4. Private clouds are built on private networks for the exclusive use of services by company employees and individuals associated with the organization. The companys IT staff can build the cloud based on the IT infrastructure available. In such situations, computing occurs in-house, on hardware and software owned and managed by the businesses themselves. This method of computing is a fertile ground for storing applications and data that need

Fig. 4. The three types of Cloud Computing [10].

more security and privacy. They also provide full control over data and improves quality of service. Private clouds can be used to perform preliminary task on projects until the concerned project is secure enough to be deployed on a Public cloud. The use of test Servers in Private clouds can alleviate the cost associated with testing applications and services on a Public cloud. In Public clouds, computing resources are made available to a wide range of users on the Internet via Web based applications or services. They are run by third-party organizations and hosted away from customer premises with the ability to provision applications from different customers. Users do not need to acquire their own hardware and software before they can perform a specific task; they are also relieved of the tasks of updating and upgrading of software. Public clouds have the ability to autoscale; i.e. scale up or down depending on rise or fall in load respectively. However, issues of privacy, data insecurity and lock-in are obstacles that need to be adressed in Public clouds. Hybrid clouds are a mix of both public and private clouds as depicted in Fig. 4. They inherit the advantages

2.3 Related Work There is extensive literature on e-Health with some of them covering the situation in low-income countries especially those found in sub-sahara Africa. The World Health Organization (WHO) has taken the lead role in championing this cause; it carries out extensive research and surveys on e-Health and other health related issues in low-income countries. In their 2011 global report on mHealth [10], it was established that countries in the European region are the most active in mHealth, whiles the African region is the least active. It futher stated that, more than 70% of the over 5 billion wireless subscribers reside in low and middle income countries. Therefore, eHealth can be a success in these regions when given the needed attention. Pilot e-Health (mHealth) projects such as Mobile Doctors Network (MDNet)/Medicareline programme where doctors in Ghana are provided with a reliable mobile communication system for conducting consultations, referring patients, and receiving alerts for emergency cases exist. Mars and Seebregts [11] undertook a country case study of e-Health in South Africa. Major findings include the fact that the South African Telecom market is the largest in Africa. Despite this, there is limited broadband access in the country which consequently retards ICT initiatives such as e-Health, e-Commerce, etc. A similar study was carried out by Nkqubela, Herselman and Conradie [12] to use ICT applications as e-health solutions in rural healthcare in the Eastern Cape Province of South Africa. Iluyemi and Rasmussen [13] conducted an empirical examination of current mobile health care initiatives in Africa in the context of contemporary ideas regarding societal-innovation, to create awareness of the possibilities related to developing innovative systems in rural areas that function on the basis of local premises. They proposed a conceptual framework based on which e-Health (precisely mHealth) entrepreneurship can thrive in Africa and other low-income countries. As mentioned earlier, there are numerous literatures on e-Health initiatives in low-income countries such that we cannot possible mention all in this section.

3 THE HEALTH DELIVERY SYSTEM IN GHANA

Ghanas health delivery system is not so different from the system in other low-income countries. Two significant reforms in the countrys health sector included the adoption of a sector-wide approach in 1997 and the introduction of a National Health Insurance Scheme in 2005 that was aimed at providing basic health care to everyone [14].

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TABLE 1 KEY HEALTH ECONOMIC INDICATORS IN GHANA [16]

Fig. 5. Causes of death amongs children in Ghana [15].

Upon all these reforms, preventable diseases such as malaria, HIV/AIDS, tuberculosis, meningitis, cholera, guinea worm, etc. remain some of the major causes of deaths in the country (see Fig. 5 and Table 1). There is a clear disparity between health facilities in urban hospitals and those in rural clinics. There are few trained health professionals (see Table 2), majority of whom refuse postings to rural communities notably the three Northen Regions of the country. The doctor-to-patient ratio stands at 1:10,000 [15]. Health record management is very poor as patients can wait long hours before having access to their hospital folder. In many instances the patient is told that his/her folder is missing. There are many cases where the old and children queue to see a doctor but are left unattended to due to the fact that young people are given priority to see the doctor either because they know the doctor, or they have protocol. Few hospitals have their own drugs; patients are always told to buy prescribed drugs from privately owned pharmacies most at times owned by medical doctors. Some of these drugs are expensive for the average citizen to afford, since majority of them are not covered by the National Health Insurance Scheme. It is difficult to find specialists for most medical conditions necessitating the transfer of patients from one hospital to a supposedly bigger one. Conditions of patients caught in this scenario get complicated, with many of them dying before reaching their destination. Ambulances are only found in urban areas and National emergency telephone lines are not operating. Even though a National Health Insurance Scheme is meant to provide universal basic access to health delivery, most people find it very difficult to pay the registeration fee and subsequent renewals due to extreme poverty.

TABLE 2 HUMAN RESOURCE REQUIREMENTS (2010) AND STATUS AS AT 2007 [17]

3.1 Pilot e-Health Projects in Ghana Novartis Foundation for Sustainable Development in collaboration with Ericsson, Medgate and other organisations decided to invest in e-Health in Ghana via the Millenium Villages project at Bonsaaso [18]. The pilot project aimed at connecting health professionals to their peers through mobile phones (m-Health), and providing a Telemedical Consultation Center in Kumasi to offer quality teleconsultation services for all health professionals [19]. The Ghana Health Digest is a medical publication that targets medical practitioners, administrators, government policy makers and other stake holders in the health deliv

ery system. It contains information and articles written by local health practitioners on relevant health issues in the country [20]. Solutions to common local health problems are provided by experts in the Digest. The Health Net Project in Navrongo was established in 1989. The main aim is to improve the quality of health care in Northern Ghana. The major causes of child mortality in Northern Ghana are malnutrition, measles, lung infection and malaria. As a result, for every 1,000 children born, 222 die before age 5 [20]. The Health Net Project Center is well equipped with radio modem, computers and a satellite ground station that permit communications and information exchange through the Health Net. The Center uses Digital Mapping to educate the population and to determine which areas require attention. With support from dornor countries and a local telecom operator, the Ghana Medical Association (GMA) launched the Mobile Doctors Network (MDNet) Medicareline programme in Ghana in 2008 [21]. It provides free voice and SMS services to doctors who are registered with the service. It includes a one way bulk SMS service to facilitate rapid response to emergency cases. The Sene District PDA project [22] was introduced in 2004 in collaboration with Berekum District Assembly and Access to Health an NGO from the United States. Communi

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facilitate national coverage and to also improve health delivery in the country.

Fig. 6. Architechture of proposed e-Health Cloud.

ty Health Nurses uses Pocket Digital Assistants (PDAs) or mobile phones to generate monthly reports in record time. These reports are then used to improve the follow up of patients who are registered in the service. Mobile Technology for Community Health (MoTeCH) is an initiative of Grameen Foundation, Columbia Universitys Mailman School of Public Health, and Ghana Health Service. It is funded by the Bill & Melinda Gates Foundation, and aims at improving antenatal and neonatal care in rural Ghana [22]. MoTeCH runs a Java application on a mobile phone with which a community nurse collects patients health record on the field. This data can be sent to a central database (OpenMRS) which will sync the new record with existing records belonging to the patient on the database server. MoTeCH analyses the patients record against standards of a healthy person from which it determines the type of care to give and when to give it to the patient. It has the facility to send reminders to patients to fulfill their appointments with the medical personels. The USAID Deliver Project was established in 2009 to promote the use of Episurveyor; mobile phone survey software used to collect data on malaria [22]. The facility has improved the collection and dessermination of quarterly reports on malaria in the country. USAID sponsored the Early Warning System project [22] which uses mobile phones to collect data on health and send them via SMS to toll-free short code registered with each of the mobile phone networks to be sent to a centralized database server. The aim of the project is to get realtime health data for decision makers and health professionals. Interestingly, Ghana launched the national ehealth strategy only in July 2010 [23]. It has not been put into practice yet; hence ehealth projects are implemented independent of this policy. In [24], the World Health Organization evaluates the preparedness of Ghana in terms of establishing national e-Health. It examines aspects such as enabling environment for e-Health which encompasses a National Policy framework, Legal and ethical frameworks, expenditures and source of funding, and Capacity building. Other areas examined include Telemedicine, mHealth, eLearning, and eLearning target groups. The country general response for majority of the items in the report is no or no data. It is on this backdrop that we are proposing e-Health implementation on the cloud to

3.2 Contribution of this Paper The health delivery system in Ghana is bedeviled with hosts of problems amongs which include poverty, lack of health facilities in rural areas, low doctor-patient ratio, lack of expertise in critical sectors, mismanagement of health records, lack of transparency, corruption and low efficiency among others. Due to these problems, many people resort to traditional medicine which sometimes can be effective but dangerous in the long term due to its side effects. To help create awareness and solve the above mentioned problems, we propose a low-cost e-health design based on hybrid cloud that can be used to provide quality health care to every individual no matter their location in the country. According to [25], the use of mobile phones in Ghana has been growing exponentially since 2006. This implies that majority of Ghanaians already have access to devices that can connect to the e-Health cloud. We acknowledge the fact that some e-Health pilot projects already exist. We also acknowledge that this is not the first of its kind in Africa. However, most of the existing eHealth projects center only on mobile health (mHealth) with hardly any of them having nationwide coverage. The proposed health cloud will enable mHealth, telemedicine, teleconsultation, eLearning, etc. It will also have a nationwide/global coverage since it will be hosted in the cloud.

4 THE PROPOSED E-HEALTH HYBRID CLOUD

The Ministry of Health (MoH) and the Ghana Health Service (GHS) are the authorized agencies that are tasked to ensure that every citizen have access to good affordable health care. Private health care providers including traditional healers also play a significant role in the health sector. The work of these agencies can be enhanced and given wider audience if their expertise, information and requirements are migrated to the cloud. Figure 6 depicts the proposed e-Health Hybrid cloud for the MoH. The Hybrid cloud is made up of the aggregation of both the Private and Public Clouds. For security reasons, sensitive data are to be hosted in the Private cloud with less sensitive data and applications hosted on a Public cloud that the MoH deems appropriate. In the Private cloud, a minimum of three Servers are to be maintained to help separate tasks and improve performance. It is assumed that Electronic Health Records (EHR), Personal Health Records (PHR), and Hospital Information Systems (HIS) must have dedicated Servers/Virtual Machine Servers and are to be hosted in the Private cloud. This is to ensure that the MoH has the opportunity to implement their own security protocols on the data and to enable them also have total control over the data. EHRs may contain health information on individual patients (restricted version of PHR) or the entire

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Fig. 7. Flow chart of the existing health delivery system

population in a given geographical location. It may include data on immunization, medication, demographics, family medical history, history of infectious diseases, tests results and general clinical history of people in a given locality among others. PHR may include but not limited to home care and monitoring on allergies and adverse drug reactions, chronic diseases, and Observations of Daily Living (ODLs). It may incorporate features such as sending of alerts, allow ePrescriptions, teleconsultations and computer assisted imaging reports. Our model allows only the medical practitioner the exclusive right to write to/read from the EHR repository upon authentication. The EHR shall be operated and maintained by the MoH and the GHS. It will be made available to doctors in all public sector hospitals and selected private clinics in the country. The PHR will host information relating to the care of a patient. Doctors are to give patients access to their medical records so as to allow them store them in their PHR accounts. Patients are given the exclusive right to maintain the data in their PHR accounts; hence any changes in their health can be uploaded to their PHR accounts. They may consequently alert their doctors to take a look at their PHR upon authorization for the necessary advice. HIS is the third and last service to be hosted in the Private cloud of our model. It will host data and services such as Administration, Medical billing and Health Insurance, Personnel and appointments, Planning, Budgeting, general medical practitioner information, peer to peer consultation between medical officers, etc. Our model gives the patient access rights to limited services/data on the HIS such as general medical practitioner information, Health Insurance, and Appointments. Other Services in the HIS must remain inaccessible to the patient/ordinary citizens. The Administrators at MoH and GHS however, have exclusive read/write control over the data in the HIS. The Health Resources Repository and the Platform as a Service (PaaS) are outsourced to a Public cloud and are accessible to everyone as shown in Fig. 6. The Health Resources Repository is intended to contain health related

Fig. 8. Use case diagram of what a health professional can do in the eHealth cloud

data such as comprehensive in formation on health providers, pharmacies (both private and public), health training institution and the programmes they run, and other such information that may be deemed necessary by the MoH and GHS. Services to be provided include health education (eg. via multimedia), eLearning, health research, health surveillance info., health related data mining, and decision support systems, as well as accepting user inputs. The Administrator is given access control to maintain the Health Resources Repository. However, ordinary citizens are only allowed to access the repository. The model provides for PaaS in order to enable software developers use the opportunity to develop e-Health related software customized to solve Ghanas health problems. It is believed that, eHealth application developers can use this platform to develop applications that can take decisions a doctor will take upon analyzing a patients PHR.

4.1 Requirements The MoH is a government agency; we therefore assume that they have the capacity to maintain their own Private cloud. The ministry might need to make a choice among Open Source Cloud platforms that are available today. Open Nebula could be a good choice since it is Free and Open Source software for operating cloud computing. It orchestrates storage, network, virtualization, security and monitoring. Other equally good Free and Open Source Cloud platforms include Eucalyptus and CloudStack. The choice of a platform is based on a number of factors including scalability, availability and data security. A number of technology considerations such as choice of Hypervisor, choise of OS, choice of Server, choice of Storage, etc. must also be made. Choice can be made of a Hypervisor among Xen, VMWare, Microsofts Hyper-V, etc. The criteria for choosing a given Hypervisor must be performance, ease of manageability, OS, and ease of metering among others. The choice of a Sever may depend on its

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Fig. 9. Use case diagram of what a patient can do in the eHealth cloud

Fig. 10. Use case diagram of what an administrator can do in the eHealth cloud

hardware specifications, cost and support for integrating with the storage and network fabrics of the Private cloud. The choice of a Public cloud provider depends but not limited to security and compliance, cost, data lock-in, scalability, availability, reliability, and performance. To determine the type of services and data that can be deployed over the Hybrid cloud (Private and Public clouds); Oracle in December 2011 produced an excellent white paper [26] that can be used as a guide. MoH could make use of a wired Intranet as a backbone for connecting Servers hosting the services to the web. The network can be extended by a number of fixed wireless access points by roaming mesh routers to cover the hospitals and clinics in the country. Alternatively, MoH could liase with the over 5 telecom providers in the country to provide infrastructure for the project. For reliability and availability reasons, one telecom provider can be chosen as the main partner with another one on stand-by in case the main provider goes down. Telecom providers must agree to allocate enough bandwidth and support for the e-Health cloud. The choice of a telecom provider as a partner must be informed by the quality of service (QoS) considerations from their operational history. To cater for rural dwellers, the MoH may set up ICT centers in these areas to fascillitate access to the eHealth cloud. To guarantee high availability, we recommend at least the following specifications for the hardware: Cloud Servers o Dual Core 4.0 GHz Processor o 40 GB Dual Rank 800MHz Main Memory o 80GB SCSI 10, 000RPM Storage o Intel Pro 1000PT LAN o 1Mbps Optical Fibre WAN Cloud Controller o Quad Core Xeon 3GHz Processor o 20GB DDR3, 1333MHz Main Memory o 2TB SATA 7, 200RPM Storage o Intel Pro 1000PT LAN o 1Mbps Optical Fibre WAN

4.2 How would an e-Health Hybrid Cloud Improve Ghanas Health delivery system? We believe that a dedicated e-Health Hybrid cloud will offer the average citizen the ability to store their basic health data securely in the cloud for their physicians to access when authorized. They can also consult with their physicians online, take prescriptions online, and help fast track folder search in the hospitals. Figure 7 is a system flow chart depicting the processes patients goe through to access the current health delivery system in the country. A patient is either a member of the National Health Insurance Scheme (NHIS) or not. If it is the first time the patient is asseccessing health delivery, s/he will have to acquire a Folder in which their demographic information will be recorded. Otherwise, the patient will have to go to the folder section of the health facility to retrieve their folder. Currently, this process can take hours. There are instances when patients are told that their folder is missing. They either have to go for a new one or come back the following day to continue the search. Figures 8,9, and 10 are use case diagrams depicting some of the activities each character can perform in the eHealth cloud. Either the National Health Insurance number or the ongoing National Biometric Identification programme Number (when completed), can be used as unique identifier for identifying individual patients in the eHealth cloud. In extreme cases, both the National Health Insurance Number and the National Biometric Identification Number can be used together. An eHealth cloud is expected to provide the following services that are currently unavailable: Sharing of national medical summary (seamless accessibility) of the patient to reduce average time patients spend at the hospital. Securely send and receive emails, voice and SMS messages to patients as: o immunization reminders, o submission of treatment/lab results, o post-appointment follow-up reminders, o etc.

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Reduce healthcare cost due to avoidance of repeated diagnosis, and drug administration. Fast track the billing process. Improved rural health care: ICT centers powered by solar energy can be setup in remote areas to serve as call centers where rural patients can access the eHealth cloud. Healthcare professionals may also use these centers or their mobile devices to carry out telepsychiatry, telepathology, teledermatology, and telemedicine. Accessing and ordering drugs in the cloud from certified ePharmacies. Home care: Patients can be monitored at home to help reduce the congestion that characterizes Ghanaian hospitals. Enables patients to take full control over the monitoring of their own health since they are the true owners of the PHR with the right to create, edit and remove data. Their right to access can also be set to their trust circles.

Ghana. We plan to develop the lab prototype for this design.

REFERENCES
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4.2 Some Issues Listed below are some of the challenges perculier to eHealth clouds in developing countries such as Ghana: Lack of requisite ICT infrastructure Inacurate/incomplete health records Inadequate human resources (Brain drained) Financial and sustainability issues User perception Availability and security o Are you talking to a fake doctor on the other side? Who has the authority to access the patients PHR when s/he is unconscious? Lack of interoperability between health care providers and existing eHealth providers. In an attempt to solve some of the above mentioned problems, we recommend the following: Users of the services in the Private cloud of the eHealth hybrid cloud should be duely authenticated. The system should not store only the core health data. Data about the eHealth data (Metadata) should be stored, for instance the capturer, location, time and device used to capture the data. Similar data should also be kept on anyone who accesses the eHealth cloud. This is expected to improve the integrity of the data. Data must be encrypted. Different health care providers must reconcile their methods of operation.

CONCLUSION AND FUTURE WORK

In this paper, we presented a design model as guidance for the health authorities in Ghana to implement eHealth services in a hybrid cloud. It is believed that, an eHealth cloud has the potential to reduce or eliminate the numerous health delivery problems in the

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[23] GINKS ICT and Health Seminar, Report on an Overview of eHealth Projects in Ghana. http://www.google.com.gh/url?sa=t&rct=j&q=&esrc= s&source=web&cd=1&ved=0CFIQFjAA&url=http%3A%2F %2Fwww.ginks.org%2FCMSPages%2FGetBizFormFile.aspx% 3Ffilename%3Dad1ba7fa-7e8c-41f2-92c1f9effd1c0251.pdf&ei =K2H9T_m3DYWm0QWFydT8Bg&usg= AFQjCNE88yQcjqndeyJS-UZFOQsdPENRLA&sig2= MC51AA6zYBKGf2R0YWVM8Q (Retrieved on 10th July 2012). [24] ATLAS , eHealth country profiles, Global Observatory for eHealth series, Volume 1, pp. 87-88, 2009. http://www.google.com.gh/url?sa=t&rct=j&q=&esrc= s&source=web&cd=2&ved=0CFAQFjAB&url=http%3A %2F%2Fwhqlibdoc.who.int%2Fpublications%2F2011 %2F9789241564168_eng.pdf&ei=iR_8T7_6O6qx0QWqg KmbBw&usg=AFQjCNGhO8dHTN4gXyylLLV47va7egq Psg&sig2=sXMANpz8XBmBpxKXfK4d8g (Retrieved on 7th July 2012). [25] Mensah Kwabena Patrick, David Sanka Laar, Alirah Michael Adaliwei, Proposed Framework for Improving the Payment System in Ghana Using Mobile Money, International Journal Of Research In Computer Application & Management, Volume No. 2 ,Issue No. 6, pp. 34, June 2012. [26] Bob Hensle, Cloud Candidate Selection Tool: Guiding Cloud Adoption, Oracle White Paper, pp. 4-7, December 2011. http://www.google.com.gh/url?sa=t&rct=j&q=&esrc= s&source=web&cd=1&ved=0CEIQFjAA&url=http%3A %2F%2Fwww.oracle.com%2Ftechnetwork%2Ftopics% 2Fentarch%2Foracle-wp-cloud-candidate-tool-r3-01434931.pdf&ei=QHwJUPjnGO7kmAWSocGACg&usg= AFQjCNG0hHIF_s4yvbGWADEeVu5skkkjEw&sig2= 6NVb1qCM1AbZtyU0qOvsOw (Retrieved on 20th July 2012). Mensah Kwabena Patrick is with the Department of Computer Science, Faculty of Mathematical Sciences at the University for Development Studies, Navrongo, Ghana. David Sanka Laar is a Lecturer in the Department Of Computer Science, University for Development Studies Navrongo, Ghana.

2012 Journal of Computing Press, NY, USA, ISSN 2151-9617