Background to the Study

The cross-cloud integration healthcare strategies can strongly benefit by using Kubernetes and MuleSoft. The cross-cloud integration comprises of APIs that can be dynamically interchanged to suit the system [6]. The MuleSoft with its ability to connect data and devices can enhance the scalability and agility of multiple clouds. The Kubernetes on the other hand uses an orchestration system for automating, deploying, scaling and managing containerised applications. Kubernetes manages a set of host applications for monitoring and deploying [7]. The application of Kubernetes and MuleSoft can ensure improved management for healthcare applications.

1. Overview

The cross-cloud integration in healthcare is ensuring critical advantages such as enhancing the accessibility and sharing of medical records. There is a distribution of workload possible with the cross-cloud applications. There is faster diagnosis and strategic collaboration across the healthcare units possible with the cross-cloud integration. The container management capabilities of Kubernetes pave the way for the synchronisation needed across the components [8]. MuleSoft enables unified integration across the multi-cloud architectures [9]. The applications can benefit the cross-cloud integration strategies to yield improved applications in healthcare. However, there are security threats and compliance issues that can arise through the integrations.

Problem Statement

The integration of Kubernetes and MuleSoft in the cross-cloud strategies can lead to focused outcomes. However, there are challenges of security and compliance that may create obstacles in the implementation [10]. There is an examination of the integration strategies, challenges and responsive measures essential for seamless adoption across the healthcare processes. The organisational enablers and techniques that can lead to the successful adoption of Kubernetes and MuleSoft should be analysed.

Objectives

The primary objectives of this research are: 1. To identify how MuleSoft and Kubernetes facilitate data integration and cross-cloud management in the healthcare domain. 2. To highlight the effect of Cross-Cloud Healthcare Integration on data accessibility, interoperability, and patient outcomes. 3. To identify compliance and security threats of cross-cloud integration in the healthcare sector. 4. To identify core technological and organisational enablers that lead to the successful incorporation of MuleSoft and Kubernetes. Furthermore, these research objectives aim to identify the incorporation and effects of cross-cloud integration strategies through MuleSoft and Kubernetes in the healthcare landscape.

Scope and Significance

The scope of the study is to identify how Kubernetes and MuleSoft can enable cross-cloud integration. The impacts on patient outcomes, data accessibility and interoperability are being analysed. The security threats and compliance issues in cross-cloud integration are being studied. The study identifies the core organisational and technological enablers that can ascertain successful incorporation of the applications. The study is having significant owing to the core knowledge acquired by healthcare companies. Healthcare companies are shifting to cross-cloud applications and the results will aid them. The knowledge received will ensure successful adoption of Kubernetes and MuleSoft within the systems

Role of MuleSoft and Kubernetes

Integrating cloud services in healthcare has become significant due to the higher need for sharing data, flexibility, and data security. MuleSoft allows healthcare organisations to incorporate a planned method for integrating several cloud providers' systems using APIs. Healthcare systems with MuleSoft's Anypoint Platform can effectively manage APIs, hence, applications such as EHRs, patient portals, and systems for diagnosis are used and integrated in any cloud environment. These APIs make sure data is processed safely and regularly, despite various infrastructures. A cross-cloud application utilises more than one cloud API under an individual version of the application [1]. Additionally, Kubernetes plays a critical role by adapting containerised microservices that highlight healthcare applications produced around the cloud. Since hospitals need their service to run smoothly and without failures, it provides dynamic scaling, fault tolerance, and service discovery, which are all necessary. Thus, Kubernetes is an ideal platform for facilitating cloud-local applications [2]. Combined with MuleSoft, Kubernetes provides more flexibility and strength to healthcare integration systems.

Thus, MuleSoft works effectively with Kubernetes to form vendor-independent, effective, and compliant integration layers. Both ensure the sharing of medical information between different cloud systems, enable avoiding staying with the same vendor, and improve healthcare services by making important patient details easily available.

Effect of Cross-Cloud Healthcare Integration

Cross-cloud integration in the healthcare domain effectively improves accessibility, data interoperability, and patient outcomes. Cross-cloud integration supports massive data sharing between cloud services and medical records, including all information about patients. As an outcome, teamwork, informed decision-making, and possible reduction of errors are easier to achieve. When healthcare systems use different cloud services, they can share and communicate data using the cross-cloud approach. Additionally, the "Cross-Cloud Federation" (CCF) is effective for "heterogeneous Cloud Service Providers" (CSPs) [3]. Health providers, due to cross-cloud integration, can coordinate well, avoid performing the same tests, and ensure faster care or services.  As data silos are eliminated, there is a clearer overview of a patient's healthcare, with details from various sources. Additionally, healthcare providers can get information and relevant data about patients from any location using any internet-connected device. The improvement in access allows healthcare providers to get the necessary details to help them decide during emergencies. With the help of data that can be accessed remotely, telehealth and remote patient care become possible.

Figure 1: Cloud Computing Architecture[1]

The above figure has highlighted CC architecture based on parameters such as application, platforms, infrastructure, and hardware [1]. Moreover, the combined use of cloud platforms in healthcare increases the quality of patient care because it gives experts diverse paths to access and use patient information. Thus, by cultivating patients’ information scattered across various clouds, experts can learn about frequent threats and suggest new strategies to handle them. Furthermore, reductions in flaws, upgraded care coordination, and real-time access to data lead to “improved patient outcomes” such as improved chronic disease management, decreased readmission rates in hospitals, and higher satisfaction rates of customers.

Compliance and security threats of cross-cloud integration in the healthcare

The application of "cross-cloud healthcare" has certain compliance and security-oriented threats, such as "data privacy and protection." This threat is highlighted for PHI or "sensitive patient information." This includes specifying "end-to-end encryption" for both transit and at rest around several cloud landscapes, which has become problematic because of varying provider norms and core management processes. Thus, working with a consistence overview of information of data across several clouds is complex, developing major blind spots for the security members. Compliance with GDPR and HIPAA regulations is essential [4]. This leads to a consistence integration of audit logging, access controls, as well as data residency norms, even while data traverses varied cloud providers and authorities. Operating with "fragmented identity and access management" or IAM around clouds creates illegal access.  

MuleSoft and Kubernetes highlight additional measurements, while MuleSoft leads to an effective API security function, such as encryption and OAuth 2.0, Kubernetes creates private "container orchestration," and its development in a "multi-cloud healthcare" environment needs configuration [2]. Specifying the least access, secure communication, and ongoing vulnerability scanning between continuous microservices on Kubernetes clusters in clouds is crucial to decreasing data breaches. Thus, the difficulty of applying legacy healthcare processes along with contemporary "cloud-native" design further inflates these threats.     

Core technological and organisational enablers towards the integration of MuleSoft and Kubernetes

Proactive cross-cloud healthcare application, along with MuleSoft and Kubernetes, is enhanced with major organisational and technological enablers. An organisation needs a strategy for using multiple clouds, strong API controls, a central hub to store reusable resources, and staff capable of using MuleSoft, Kubernetes, and healthcare interoperability methods. IT, security, and clinical teams should collaborate in various parts of their work. Additionally, hybrid cloud infrastructures support latency and scalability in sectors [5]. Technologically, one needs to set up APIs with MuleSoft, arrange consistent containers with Kubernetes, and automate CI/CD processes. Therefore, end-to-end encryption and constant monitoring are needed to make sure the data remains safe and secure in this complex area.

Research Design

The research is applying an explanatory design to identify how Kubernetes and MuleSoft can benefit cross-cloud integration in healthcare. The explanatory design is aimed at explaining the phenomenon that can lead to enhanced understanding [11]. The explanatory design aids in identifying the features of MuleSoft and Kubernetes that can provide advantages to cross-cloud integration. The explanatory design leads to the challenges and the enablers that can overcome the challenges. The explanatory design is establishing the links between the features of the applications and their impacts on the core processes of healthcare. The explanation is explaining the vital aspects of Kubernetes and MuleSoft that can integrate cross-cloud applications.

Data Collection

The study is utilising and interpreting both quantitative and qualitative data in order to reach results. The quantitative data is being assimilated from the statistics, graphs and charts from the secondary sources. The quantitative data is enabling to understand the exact benefits of Kubernetes and MuleSoft. The impacts on cross-cloud integration owing to their functionalities are being derived from the quantitative data. Qualitative data is being collected from the journal articles, books and industry reports. The qualitative data is revealing the possible challenges and the organisational enablers that can tackle the issues. A more comprehensive interpretation is possible due to the collection and interpretation of the data.

Case Studies/Examples

Case Study I: Pfizer

Pfizer makes use of Cloud applications to enhance its processes and care models. The company making use of cloud applications has experienced a 45.5% increase in the patient-related care [13]. The cloud applications within the company have ensured that critical patient data can be accessed. There has been more informed decision-making possible considering the treatment needed by the patients. The cloud innovation has allowed the company to leverage the interoperability features. There have been more holistic outcomes reached.

Case Study II: GlaxoSmithKline

GSK has made use of cross-cloud applications in order to improve their outcomes. GSK has integrated its cloud applications with governance solutions. The strategic move has allowed the company to deliver crucial applications and tools in a reduced time {14]. The time and effort have been lessened with the cloud applications making use of advanced system configuration. The capabilities of GSK have improved significantly with the cloud applications integrated in their applications. The company has received access to a more resilient workplace with smooth processes.

Evaluation Metrics

The comparing and interpretation of data is attained with the application of evaluation metrics [12]. The evaluation metrics of precision and accuracy have been used in the current study. The precision of Kubernetes in container management is being studied to assess their capacities for cross-cloud integration. The accuracy of MuleSoft in the unified integration is being measured to analyse its impacts. The challenges and capability of organisational enablers' precise influences are being examined. The evaluation metrics on the data is revealing the benefits and challenges of the applications in healthcare.

1. Data Presentation 

Figure 2: Usage of electronically received patient health information from external sources

Source: [15]

The chart shows changes in non-federal acute care hospitals using electronically transferred patient health information in the U.S. from 2015 to 2017. In 2017, 59% of hospitals reported regularly or sometimes relying on such data, which is an increase of 6% since 2015 [15]. During this time, the number of hospitals that did not use this data at all dropped, showing greater involvement of hospitals in health information exchange.

Figure 3: Methods used to electronically search for patients’ health information, 2018

Source: [16]

This figure represents several electronic ways hospitals search for patient health records from external resources. About half (46%) of hospitals used state, regional, or local Health Information Organisations (HIOs). Some other common ways to access EHRs were having a single vendor network (34%), a network of multiple EHRs (32%), accessing EHRs directly (31%), or provider portals (30%) [16]. This pattern shows that people depend more on different digital systems to manage patient records outside the hospital database.

1. Findings

It can be seen from the data that U.S. non-federal acute care hospitals are moving toward relying on cross-cloud and interoperable systems for accessing patient health details. Since 2015, there appeared to be a 6% increase in cases where hospitals said they often or sometimes used data sent electronically by outside providers, with that number reaching 59% in 2017 [15]. 

In the year 2018, over half the hospitals (46%) said they use HIOs to gather patient data, while the remainder used either provider portals (30%), EHR access straight from the hospitals (31%), networks with data from several EHR vendors (32%), or networks that only share data of one EHR vendor (34%) [16]. This matches the research emphasis on Cross-Cloud Healthcare Integration Strategies using MuleSoft and Kubernetes, as it confirms more dependence on interconnected and compatible platforms to handle vital data from multiple sources. As a result, there is an increased demand for MuleSoft and Kubernetes to ensure better use and exchange of data, more effective treatment choices, and better outcomes for patients.

1. Case Study Outcomes

Table 1: Case Study

(Source: self-created)

The case studies reveal how cloud applications have benefitted their core processes. Pfizer has been able to deliver enhanced patient care. GSK has been able to develop a resilient workplace with reduced efforts and improved employee applications.

1. Comparative Analysis

Table 2: Comparative Analysis of Literature Review Sources

[Source: Self-Created]

In Table 2, comparative analysis helps to achieve research aims and objectives by identifying aims, trends, and gaps of several articles, specifying existing understanding of the cross-Cloud Healthcare Integration through MuleSoft and Kubernetes.

Interpretation of Results

The analysis shows that healthcare services are now moving towards systems that work across different clouds with the help of MuleSoft and Kubernetes. An increase in the use of electronic patient information and the use of various external systems for EHR helps promote interoperability. Pfizer and GSK showed that businesses in pharmacology are improving both healthcare for patients and internal operations by using cloud technology [13]. These results highlight that using cloud-native solutions makes healthcare more accessible and improves its outcomes. Besides, using both MuleSoft’s APIs and Kubernetes increases the security and makes the entire system easier to expand and work well with other providers. According to the data and case insights, cross-cloud approaches help organisations deliver better services, improve the way things are done, and connect more effectively with patients.

Practical Implications

The study emphasises that merging MuleSoft and Kubernetes in healthcare cloud systems can greatly boost how medical information is shared, the system’s adaptability, and patients’ health outcomes. Availability of patient data in real time, effortless communication between employees, and fewer inappropriate tests help improve healthcare organisations. Scalability and agility of IT infrastructure are made possible by using standard APIs and containerised services. Also, collaboration between clinical, IT, and security teams leads to better control and reaction in the case of emergencies [17]. Using cross-cloud integration approaches helps organisations rely less on a single cloud vendor, use data wisely, and encourage innovation in telehealth and remote tracking, which makes the healthcare system respond better to patients’ needs.

Challenges and Limitations

Even though cross-cloud integration is useful for healthcare, it comes with several challenges. It is still hard to maintain the same level of data privacy and compliance on different cloud platforms since their regulations may be very different. Having multiple methods for identity and access management can result in people being able to access data unauthorised, and some hidden security risks [18]. Because modern cloud systems are not compatible with older healthcare systems, merging them can be both expensive and take a lot of time. Besides, tools like MuleSoft and Kubernetes only perform well with the help of talented people, who are ready for the task, and all departments are working together. 

Recommendations

Strong investment in API management systems and Kubernetes is the best way to maximise cross-cloud connections in healthcare. A single way to control governance should be set up, as well as a centrally managed system of authentication and access, to secure data and comply with rules in all clouds. Effective training is needed for IT and clinical staff to learn what they need [19]. Healthcare providers have to put together a gradual migration plan to handle existing systems. Working together with cloud service firms can make it simpler to set up virtual machines. More studies are needed that use original data and follow people over time to watch for outcomes related to integration. Regulatory organisations should come up with one set of standards for handling data and security across all multi-cloud healthcare systems.

It is demonstrated in this study that integrating MuleSoft and Kubernetes into healthcare systems across clouds boosts their compatibility, data access, and overall work efficiency. The evidence from Pfizer and GSK, along with data trends, indicates that these new technologies enhance care for patients, allow for smooth sharing of data, and help develop emerging cloud solutions.

In the future, it would be useful to conduct studies directly with health IT workers and clinicians to better understand the issues and thoughts related to using technology in healthcare. Besides, it is important to examine how cross-cloud strategies influence results for patients, expenses, and the ability of systems to recover from failures. Making frameworks for compliance using common rules for multi-cloud and using AI to handle continuous monitoring helps improve both security and performance.

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