## 6 Discussion
As a result, the e-Health Cloud could be viewed as a suitable method to provide a potential solution to the value equation in the healthcare industry: \"high quality services at the lowest cost.\"  
Adopting the e-Health Cloud to provide IT solutions for the healthcare industry comes with many advantages. Some of these include  
1. Reducing the cost of owning and maintaining an IT infrastructure and support personnel within each organization. 2. Providing better integration and exchange of medical records across multiple organizations and across sparse geographical areas. 3. Allowing multiple parties to benefit from the information repository to streamline processes, enhance diagnosis, support medical research activities, and simplify administrative operations. 4. Increasing the availability, scalability and flexibility of the health information systems. However, these benefits come with a high tax. Several issues and challenges need to be addressed before the e-Health Cloud is considered the best approach to take for healthcare providers. The major concern is security and privacy issues. To date, the available security and privacy measures offer some level of confidence, yet they also involve high overheads and many weaknesses and loopholes. Issues of ownership and control over the security policies involve very complex tasks that need to be taken care of by several of the e-Health Cloud participants. However, the simple task of deciding who is responsible for which part is difficult and has no clear way of being done. In addition, if we include strong security measures, we also risk being in critical situations where someone must have access to some protected data when the owner is not available. One simple example is when a patient who is the only one who can release his/her medical records is involved in a severe accident and he/she becomes unable to release the records. In such case, is it possible/acceptable to have a back door for the records? Who should be responsible for such a task? On what grounds, would this person/entity be allowed to open the records? Should there be some type of legal action involved? Our study revealed that most approaches tackling this issue do not offer a satisfactory solution. Privacy assurance and management is a complex task and cannot be isolated into independent entities to be handled by one or another of the service participants (_i.e._, the patient, service provider, medical personnel and the cloud owner). Collaborative approaches to this issue may present some feasible solutions where responsibilities and control are distributed among different participants rather than only one. However, the issue of trust becomes a very delicate point and everyone needs to contribute into building solutions that would increase the participants trust levels in each other and in the system itself. Beyond security, other challenges and issues arise including the lack of standards and guidelines governing the design, implementation and utilization of e-Health Cloud. This is mostly the responsibility of the cloud owners and the authoritative entities in the Internet and Cloud world. Some level of understanding should be reached that will help in setting up the proper environment where such authorities can collaborate and come up with acceptable guidelines for the e-Health Cloud services. Such guidelines could then be used as the ground work for standardization and better interoperability among different Cloud owners, service providers and users. In addition, the ownership (of data, services, applications, _etc._) issues, orchestrating services among the different stakeholders, and flexibility and interoperability are also issues that must be addressed. Many of these issues are being addressed and some have been solved. However, more effort is needed and we believe that setting up proper guidelines and development environments will help in this regard.