title: Secure Cloud-Based Solutions for Different eHealth Services in Spanish Rural Health Centers.
abstract: BACKGROUND
  The combination of eHealth applications and/or services with cloud technology provides health care staff—with sufficient mobility and accessibility for them—to be able to transparently check any data they may need without having to worry about its physical location.
  
  
  OBJECTIVE
  The main aim of this paper is to put forward secure cloud-based solutions for a range of eHealth services such as electronic health records (EHRs), telecardiology, teleconsultation, and telediagnosis.
  
  
  METHODS
  The scenario chosen for introducing the services is a set of four rural health centers located within the same Spanish region. iCanCloud software was used to perform simulations in the proposed scenario. We chose online traffic and the cost per unit in terms of time as the parameters for choosing the secure solution on the most optimum cloud for each service.
  
  
  RESULTS
  We suggest that load balancers always be fitted for all solutions in communication together with several Internet service providers and that smartcards be used to maintain identity to an appropriate extent. The solutions offered via private cloud for EHRs, teleconsultation, and telediagnosis services require a volume of online traffic calculated at being able to reach 2 Gbps per consultation. This may entail an average cost of €500/month.
  
  
  CONCLUSIONS
  The security solutions put forward for each eHealth service constitute an attempt to centralize all information on the cloud, thus offering greater accessibility to medical information in the case of EHRs alongside more reliable diagnoses and treatment for telecardiology, telediagnosis, and teleconsultation services. Therefore, better health care for the rural patient can be obtained at a reasonable cost.
authors.affiliation: Grupo de Telemedicina y eSalud, Departamento de Teoría de la Señal y Comunicaciones e Ingeniería Telemática, University of Valladolid, Valladolid, Spain.
authors.forename: Isabel
authors.identifier: http://orcid.org/0000-0003-3134-7720
authors.initials: I
authors.lastname: de la Torre-Díez
authors.forename: Miguel
authors.identifier: http://orcid.org/0000-0002-1543-9732
authors.initials: M
authors.lastname: Lopez-Coronado
authors.forename: Begonya
authors.identifier: http://orcid.org/0000-0002-9356-1186
authors.initials: B
authors.lastname: Garcia-Zapirain Soto
authors.forename: Amaia
authors.identifier: http://orcid.org/0000-0002-0539-4753
authors.initials: A
authors.lastname: Mendez-Zorrilla
mesh_terms: D000067917:Cloud Computing; D016494:Computer Security; D057286:Electronic Health Records; D006801:Humans; D020407:Internet; D019035:Rural Health Services; D013030:Spain; D017216:Telemedicine / Q000379:methods*
keywords: cloud; eHealth services; rural; security