# Centralized vs. Decentralized Cloud Computing in Healthcare
## 7 Results
#### 7.1.2 Limitations of Centralized Cloud Computing in Healthcare  
Centralized cloud computing for HIE relies on reliable and high-speed network connectivity. Healthcare providers can face difficulties with the access and exchange of patient data in areas with limited or unstable internet access, hindering HIE efforts [57]. Therefore, healthcare organizations must have a robust internet connection to maintain seamless access to cloud services, and to avoid latency issues and slower response times that can negatively impact the overall performance of HIE [54]. Despite rigorous protective protocols implemented by digital infrastructure vendors, vulnerabilities persist regarding the unauthorized retrieval of sensitive health information and potential compromise of data confidentiality [57]. Therefore, healthcare organizations should select trustworthy cloud providers and implement additional security measures in order to safeguard the confidentiality of patient information [79; 80]. RQ2: What Are the Benefits and Limitations of the Use of Decentralized Cloud Computing in Healthcare That Aims to Improve HIE? This section highlights the fact that while the utilization of decentralized cloud computing in healthcare can improve HIE, there are also limitations. 7.2.1. Benefits of the Use of Decentralized Cloud Computing in Healthcare  
Decentralized cloud computing is a concept in which the data of healthcare can be segmented and can be stored in various servers; therefore, control, security, and privacy can be enhanced [61]. In a centralized architecture, data are generally exchanged farther from the healthcare providers, which provides the throughput and latency of the system. In addition, this strategy can facilitate healthcare companies in decentralizing processing and utilizing the cloud on demand. It allows them to adjust the extent to which they rely on centralized computing and a single cloud architecture, enabling flexibility in scaling up or down. Available horizontal scalability indicates that as an organization seeks to add more nodes to the system, it is not necessary for it to have a detrimental effect on the organization, especially in terms of resource usage [71]. It is defined by the fact that it involves the direct transfer of information from node to node, and this means that it does not allow bottlenecks like a central server [66]. In addition, due to the decentralized applications and computation, it can also be available as the decentralized data storage and optimization of the large data centers. There is a decrease in vulnerability to a single point of failure as data circulation makes health information available from various nodes of a network; even if data are acquired in one node, the data can be retrieved in another node [81]. 7.2.2. Limitations of Decentralized Cloud Computing in Healthcare  
In decentralized cloud computing, there is always data transferred from multiple nodes to others, and hence, HIE can be a problematic area as it has to be synchronized correspondingly across various nodes [67]. Most often, decentralized architectures are even more complex to design, implement, and manage than centralized cloud computing [66]. In decentralized cloud computing, healthcare organizations must have reliable network connectivity to ensure seamless data exchange for HIE; any network problems can hinder its effectiveness [66]. Decentralized cloud computing requires strong security measures at each node in order to safeguard patient data and ensure privacy, ensuring adherence to data protection rules across all nodes might provide difficulties, requiring careful planning and continuous monitoring [72]. Decentralized cloud computing may require a higher initial investment than a centralized approach. This is due to the setup and maintenance of multiple nodes, the assurance of their synchronization, and the management of the distributed resources, which can incur additional expenses [82]. 7.3.