# Centralized vs. Decentralized Cloud Computing in Healthcare
###### Abstract
HIE [10] is an IT platform that facilitates the exchange of health-related data between and among healthcare organizations, which includes hospitals, clinics, laboratories, and pharmacies among others; HIE is related to EHRs as it provides a platform through which data can be exchanged, while EHR provides a comprehensive record of patients. This is especially crucial during disasters because information about a patient could mean the difference between life and death [11]. A number of benefits are provided by EHR systems that enable the smooth sharing of patient data between hospital systems. However, healthcare organizations must also consider certain drawbacks, especially regarding the storage of sensitive patient health information. This requires strict privacy and security measures to protect the patient data from unauthorized access, breaches, or cyberattacks [12; 13]. In this regard, cloud-based solutions are advantageous over traditional on-premise EHR systems, in terms of HIE [14], as cloud providers implement strong security measures to protect patient data, including encryption, access controls, and regular security audits. Cloud-based HIE solutions leverage these security features to ensure the secure transmission and storage of sensitive patient information [15]. In addition to this, HIE systems that implement cloud technology are flexible since they can accommodate the level of need for sharing information more so when established to suit the set standards. These platforms also provide enhanced integration on the account of providing standard interfaces and protocols for real-time data sharing and interoperability. This makes it possible for a provider to obtain the most current patient information as they need it [16]. Previous research categorized cloud technology solutions under two primary types: centralized and decentralized. In the centralized cloud architecture, all the HIE infrastructure and services involved are hosted and managed in a single, centralized cloud environment. This enables all of the participating healthcare organizations to connect to and access the HIE platform via the central cloud infrastructure. In contrast, in the decentralized cloud architecture, the HIE infrastructure and services are distributed across multiple cloud instances [17]. Our role is to assist healthcare organizations in making informed decisions regarding the most suitable cloud architecture to meet their health information exchange (HIE) requirements. This includes carefully evaluating the advantages and disadvantages of centralized cloud computing architecture versus decentralized architecture. We offer a thorough analysis and assessment of both cloud computing solutions for healthcare architecture, which are considered the primary contributions of our paper. This paper discusses both centralized and decentralized cloud computing in healthcare by addressing the following research questions:  
* RQ1: What are the benefits and limitations of the use of centralized cloud computing in healthcare that aims to improve HIE? * RQ2: What are the benefits and limitations of the use of decentralized cloud computing in healthcare that aims to improve HIE? * RQ3: What are the differences between centralized and decentralized cloud healthcare solutions regarding the system's performance, response times, latency, the privacy of patient data, and cost efficiency? * RQ4: What are the research gaps within centralized cloud healthcare solutions? * RQ5: What are the research gaps within decentralized cloud healthcare solutions? The aim of this study was to assess and compare centralized and decentralized cloud computing architecture solutions for the development of healthcare systems. The objective was to determine how these different cloud computing approaches can provide hospitals with the best possible performance and cost efficiency while also ensuring the maintenance of patient privacy and data security.