## 3 e-Health Cloud Challenges
### Non-Technical Challenges  
* **Organizational change:** the move towards e-Health Cloud will require significant changes to clinical and business processes and also to the organizational boundaries in the healthcare industry. This challenge is concerned with the changes that an e-Health Cloud will introduce upon participants. Examples of such changes could be in the form of new policies, procedures and workflows in addition to changes in how medical processes and documentation are done.
* **Legislations and standards:** there are still no clear or adequate legislations and guidelines for clinical, technical and business practices of healthcare in the e-context. This includes the lack of standards for medical informatics, policies, inter-operability, and transmission methods in e-Health Cloud. In such a case, the stakeholders in the e-Health Cloud do not have a solid base to start offering and using it. As a result, more issues and problems may occur due to this shortage and technical, social and ethical concerns will arise. Currently, there are some standards and classifications for health information systems in general some of which can be adopted for the e-Health Cloud. One example is the International Classification of Diseases tenth revision (ICD-10) issued by the World Health Organization (WHO) [51]. It defines a medical classification list for the coding of diseases, signs or abnormal findings, complaints, social conditions, and external causes of injury or diseases. Another classification is The Systematized NOmenclature of MEDicine (SNOMED) which was designed as a detailed categorization of clinical medicine for the purpose of storing and/or retrieving records of clinical care in human and veterinary medicine [52]. The e-Health Cloud developers can agree on adopting some of these defined standards and classifications to enable interoperability among different organizations.
* **Data ownership:** ownership of data in the healthcare industry in general is an area with no clear guidelines. A patient's record for example could be the sole property of the patient, yet can his physician also claim ownership? What about the patient's insurer or the hospital management? This challenge is concerned with the creation of policies and guidelines that draw clear ownership boundaries.
* **Privacy, trust and liability issues:** this challenge is concerned with the risks of private data exposure, data leakage, and data loss and the lack of knowledge about the location and jurisdiction of the medical data. From the healthcare providers' perspective, e-Health Cloud presents a high risk of liability (legal responsibility) in cases of data loss or leakage causing loss of reputation and patients' trust.
* **Usability and end users experiences:** this challenge is concerned with the degree and level of adoption obtained by the e-Health Cloud users including patients, healthcare professionals, and administrative and insurance personnel. Proper and adequate pre-implementation training and marketing along with continuous post-implementation training are important to help overcome this challenge.  
Among all the challenges listed above, trust, privacy and security emerge as the major concerns for the e-Health Cloud. Hence, several efforts in this area try to offer solutions to tackle these concerns and improve the security and privacy of the e-Health Cloud.