title: Real-Time and Retrospective Health-Analytics-as-a-Service: A Novel Framework.
abstract: BACKGROUND
  Analytics-as-a-service (AaaS) is one of the latest provisions emerging from the cloud services family. Utilizing this paradigm of computing in health informatics will beneﬁt patients, care providers, and governments signiﬁcantly. This work is a novel approach to realize health analytics as services in critical care units in particular.
  
  
  OBJECTIVE
  To design, implement, evaluate, and deploy an extendable big-data compatible framework for health-analytics-as-a-service that offers both real-time and retrospective analysis.
  
  
  METHODS
  We present a novel framework that can realize health data analytics-as-a-service. The framework is flexible and conﬁgurable for different scenarios by utilizing the latest technologies and best practices for data acquisition, transformation, storage, analytics, knowledge extraction, and visualization. We have instantiated the proposed method, through the Artemis project, that is, a customization of the framework for live monitoring and retrospective research on premature babies and ill term infants in neonatal intensive care units (NICUs).
  
  
  RESULTS
  We demonstrated the proposed framework in this paper for monitoring NICUs and refer to it as the Artemis-In-Cloud (Artemis-IC) project. A pilot of Artemis has been deployed in the SickKids hospital NICU. By infusing the output of this pilot set up to an analytical model, we predict important performance measures for the ﬁnal deployment of Artemis-IC. This process can be carried out for other hospitals following the same steps with minimal effort. SickKids' NICU has 36 beds and can classify the patients generally into 5 different types including surgical and premature babies. The arrival rate is estimated as 4.5 patients per day, and the average length of stay was calculated as 16 days. Mean number of medical monitoring algorithms per patient is 9, which renders 311 live algorithms for the whole NICU running on the framework. The memory and computation power required for Artemis-IC to handle the SickKids NICU will be 32 GB and 16 CPU cores, respectively. The required amount of storage was estimated as 8.6 TB per year. There will always be 34.9 patients in SickKids NICU on average. Currently, 46% of patients cannot get admitted to SickKids NICU due to lack of resources. By increasing the capacity to 90 beds, all patients can be accommodated. For such a provisioning, Artemis-IC will need 16 TB of storage per year, 55 GB of memory, and 28 CPU cores.
  
  
  CONCLUSIONS
  Our contributions in this work relate to a cloud architecture for the analysis of physiological data for clinical decisions support for tertiary care use. We demonstrate how to size the equipment needed in the cloud for that architecture based on a very realistic assessment of the patient characteristics and the associated clinical decision support algorithms that would be required to run for those patients. We show the principle of how this could be performed and furthermore that it can be replicated for any critical care setting within a tertiary institution.
authors.affiliation: IBM, Canada Research and Development Center, Markham, Toronto, ON, Canada. hamzeh.k.h@ieee.org.
authors.forename: Hamzeh
authors.identifier: http://orcid.org/0000-0001-5439-8024
authors.initials: H
authors.lastname: Khazaei
authors.forename: Carolyn
authors.identifier: http://orcid.org/0000-0002-0491-4403
authors.initials: C
authors.lastname: McGregor
authors.forename: J Mikael
authors.identifier: http://orcid.org/0000-0001-7233-3136
authors.initials: JM
authors.lastname: Eklund
authors.forename: Khalil
authors.identifier: http://orcid.org/0000-0002-5960-6942
authors.initials: K
authors.lastname: El-Khatib
keywords: analytics-as-a-service; big data, health informatics; cloud computing; decision support system; performance modeling; physiological data; premature babies; real-time analytics; retrospective analysis