This study attempts to investigate the issues of aging population in the context of Singapore through metaphorical approach and the potential of tapping on the collaborative characteristics of a health service cloud computing system to meet the needs in elderly care, hence allowing active aging. The use of electronic health records (EHR) in various countries, particularly the meaningful use of EHR in USA is examined to understand its current features and usage. By employing conceptual mapping and blending of metaphorical study, the concepts in cloud computing are probed to gain better understanding on the characteristics of the technology. Similarly, with concepts drawn from an eco-system blended with concepts in a health service system, the characteristics of EHR and finally the characteristics of a health service cloud computing system are illustrated. With understanding in aging population, present usage of EHR and potential of cloud computing in Singapore, multi-methods research consisting of intensive interviews and archival document collations are employed. Triangulation amongst the datasets collated using open coding via ATLAS.ti resulted in 6 issues of concern in aging population pertaining to the Singapore context to arise, namely (i) primary care, (ii) familial support, (iii) awareness in health maintenance and transparency in information, (iv) improved efficiency and accuracy in healthcare with seamless transfer of care and (v) intermediate care and (vi) collaboration between stakeholders. Further analysis of the results draws up the possibilities for enhancing meaningful use of health service cloud computing system for active aging, which criteria are: (i) empowerment and ownership, (ii) sustainable homecare and (iii) seamless transfer of care. Finally, a conceptual mapping of health service cloud computing system and the criteria for effective aging give rise to a model framework that is set for active aging.

This study attempts to investigate the issues of aging population in the context of Singapore through metaphorical approach and the potential of tapping on the collaborative characteristics of a health service cloud computing system to meet the needs in elderly care, hence allowing active aging. The use of electronic health records (EHR) in various countries, particularly the meaningful use of EHR in USA is examined to understand its current features and usage. By employing conceptual mapping and blending of metaphorical study, the concepts in cloud computing are probed to gain better understanding on the characteristics of the technology. Similarly, with concepts drawn from an eco-system blended with concepts in a health service system, the characteristics of EHR and finally the characteristics of a health service cloud computing system are illustrated. With understanding in aging population, present usage of EHR and potential of cloud computing in Singapore, multi-methods research consisting of intensive interviews and archival document collations are employed. Triangulation amongst the datasets collated using open coding via ATLAS.ti resulted in 6 issues of concern in aging population pertaining to the Singapore context to arise, namely (i) primary care, (ii) familial support, (iii) awareness in health maintenance and transparency in information, (iv) improved efficiency and accuracy in healthcare with seamless transfer of care and (v) intermediate care and (vi) collaboration between stakeholders. Further analysis of the results draws up the possibilities for enhancing meaningful use of health service cloud computing system for active aging, which criteria are: (i) empowerment and ownership, (ii) sustainable homecare and (iii) seamless transfer of care. Finally, a conceptual mapping of health service cloud computing system and the criteria for effective aging give rise to a model framework that is set for active aging.

1. Introduction Pg 1–3
2. Literature Review
2.1 Electronic Health Records (EHR) Pg 4-16
2.1.1 The development of EHR
2.1.2 Shifting the Paradigm - USA’s initiative towards a patient-centered healthcare system
2.1.3 A patient-centered approach to tackling issues of aging population
2.1.4 Cloud computing in EHR
2.1.5 Delivery modes of cloud computing
2.2 Concepts of metaphor Pg 17-23
2.2.1 Using metaphors for new inventions
2.2.2 Conceptual metaphor
2.2.3 Conceptual blending in metaphors
2.2.4 Applying conceptual metaphor of ‘cloud’ on ‘computing
2.3 The Dossia Health Service SystemPg 24-28
2.4 Characteristics of ecosystem Pg 29-40
2.4.1 Determining if a health service system satisfy the characteristics of an ecosystem
2.4.2 Sustaining the effectiveness of an ecosystem
2.4.3 Concept of keystone metaphor in ecosystem
2.4.4 Conceptual blending of cloud computing technology and electronic health records system
2.4.5 The component that links – Water as a metaphor for data and information
2.4.6 Opening possibilities – Entailments of water
2.5 Aging population in Singapore Pg 41-47
2.5.1 Problems of aging population in Singapore
2.5.2 Importance of familial support in Singapore
2.5.3 Present EHR system in Singapore
2.5.4 Tapping on cloud computing for healthcare in Singapore
3. Research Methodology:Multi-methods research Pg 48-52
3.1 Data Collection
3.2 Triangulation
4. Results Pg 53-64
4.1 Primary Care
4.2 Familial Support
4.3 Awareness in health maintenance and transparency in information
4.4 Improved efficiency and accuracy in healthcare with seamless transfer of care
4.5 Intermediate care sectors
4.6 Collaboration between stakeholders
5. Discussion Pg 65-77
5.1 Empowerment and ownership
5.2 Homecare as key pillar of support for effective aging
5.3 Primary and intermediate care support for seamless transfer of care
5.4 Collaboration through health service cloud computing system for effective aging
6. Conclusion Pg 78-80
7. References Pg 81-86
8. Appendix 1: Intensive interview questionsPg 87-88
9. Appendix 2: Results of research data Pg 89-97

List of Figures and Tables

Figure 1: Standards of cloud computing taxonomy (Cloud Computing case use white paper, 2010) Pg 15
Figure 2: The architecture of cloud computing (Boroujerdi & Nazem, 2009) Pg 16
Figure 3: Conceptual blending between cloud and computing technology Pg 22
Table 1: Players and their responsibilities in Dossia Health Service System Pg 24
Figure 4: Pictorial representation of system in Dossia Health Service System Pg 26
Figure 5: Conceptual Blending between health service system and ecosystem Pg 32
Figure 6: Conceptual blending between cloud computing technology and Electronic Health Records (EHR) Pg 37
Figure 7: Population age pyramid (Statistics Singapore, 2010) Pg 42
Figure 8: Old age support ratio (Statistics Singapore, 2010) Pg 42
Table 2: List of intensive interview stakeholders and archival documents Pg 49 – 51
Figure 9: Inter-relationships between concepts derived from coding and analysis of data Pg 66
Table 3: Possible stakeholders in health service cloud computing system for elderly care in Singapore Pg 67
Figure 10: Conceptual mapping between health service cloud computing system and criteria for active aging Pg 77

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