title: A scoping review of cloud computing in healthcare.
abstract: BACKGROUND
  Cloud computing is a recent and fast growing area of development in healthcare. Ubiquitous, on-demand access to virtually endless resources in combination with a pay-per-use model allow for new ways of developing, delivering and using services. Cloud computing is often used in an "OMICS-context", e.g. for computing in genomics, proteomics and molecular medicine, while other field of application still seem to be underrepresented. Thus, the objective of this scoping review was to identify the current state and hot topics in research on cloud computing in healthcare beyond this traditional domain.
  
  
  METHODS
  MEDLINE was searched in July 2013 and in December 2014 for publications containing the terms "cloud computing" and "cloud-based". Each journal and conference article was categorized and summarized independently by two researchers who consolidated their findings.
  
  
  RESULTS
  102 publications have been analyzed and 6 main topics have been found: telemedicine/teleconsultation, medical imaging, public health and patient self-management, hospital management and information systems, therapy, and secondary use of data. Commonly used features are broad network access for sharing and accessing data and rapid elasticity to dynamically adapt to computing demands. Eight articles favor the pay-for-use characteristics of cloud-based services avoiding upfront investments. Nevertheless, while 22 articles present very general potentials of cloud computing in the medical domain and 66 articles describe conceptual or prototypic projects, only 14 articles report from successful implementations. Further, in many articles cloud computing is seen as an analogy to internet-/web-based data sharing and the characteristics of the particular cloud computing approach are unfortunately not really illustrated.
  
  
  CONCLUSIONS
  Even though cloud computing in healthcare is of growing interest only few successful implementations yet exist and many papers just use the term "cloud" synonymously for "using virtual machines" or "web-based" with no described benefit of the cloud paradigm. The biggest threat to the adoption in the healthcare domain is caused by involving external cloud partners: many issues of data safety and security are still to be solved. Until then, cloud computing is favored more for singular, individual features such as elasticity, pay-per-use and broad network access, rather than as cloud paradigm on its own.
authors.affiliation: Department of Medical Informatics, Friedrich-Alexander-University Erlangen-Nürnberg, Wetterkreuz 13, Erlangen, D-91058, Germany. Lena.Griebel@uk-erlangen.de.
authors.forename: Lena
authors.initials: L
authors.lastname: Griebel
authors.affiliation: Department of Medical Informatics, Friedrich-Alexander-University Erlangen-Nürnberg, Wetterkreuz 13, Erlangen, D-91058, Germany.
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Prokosch
authors.affiliation: Department of Medical Informatics, Friedrich-Alexander-University Erlangen-Nürnberg, Wetterkreuz 13, Erlangen, D-91058, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Köpcke
authors.affiliation: Department of Medical Informatics, Friedrich-Alexander-University Erlangen-Nürnberg, Wetterkreuz 13, Erlangen, D-91058, Germany.
authors.forename: Dennis
authors.initials: D
authors.lastname: Toddenroth
authors.affiliation: Department of Medical Informatics, Friedrich-Alexander-University Erlangen-Nürnberg, Wetterkreuz 13, Erlangen, D-91058, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Christoph
authors.affiliation: Department of Medical Informatics, Friedrich-Alexander-University Erlangen-Nürnberg, Wetterkreuz 13, Erlangen, D-91058, Germany.
authors.forename: Ines
authors.initials: I
authors.lastname: Leb
authors.affiliation: Department of Medical Informatics, Friedrich-Alexander-University Erlangen-Nürnberg, Wetterkreuz 13, Erlangen, D-91058, Germany.
authors.forename: Igor
authors.initials: I
authors.lastname: Engel
authors.affiliation: Department of Medical Informatics, Friedrich-Alexander-University Erlangen-Nürnberg, Wetterkreuz 13, Erlangen, D-91058, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Sedlmayr
mesh_terms: D000067917:Cloud Computing; D003695:Delivery of Health Care; D006801:Humans