TechnologyDevelopmentforDistributedHealthcareInformationStore

Technology Development for

Building Distributed, Scalable, and
Reliable Healthcare Information
Store

Technical Annexure

R&DPartners
CentreforDevelopmentofAdvancedComputing(CDAC),Pune
&
SwedishInstituteofComputerScience(SICS),Sweden

MedicalInformaticsGroup(HQPune)
CentreforDevelopmentofAdvancedComputing

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TechnologyDevelopmentforDistributedHealthcareInformationStore

Contents

TechnologyDevelopmentfor
BuildingDistributed,Scalable,andReliableHealthcareInformationStore

.................

1
TechnicalAnnexure

......................................................................................................

1
1Introduction

.................................................................................................................

3
1.1CurrentScenarioandAssociatedProblems

.........................................................

3
1.2RequirementsofaFutureEHRSystem

...............................................................

4
1.3CurrentInitiativesatCDACandSICS

...............................................................

4
2FurtherEffortsNeededforaCompleteSolution

........................................................

6
2.1BuildingaCommonStandardEHR

.....................................................................

6
2.2ScalableDistributedStorage

................................................................................

6
2.3ReliableDistributedStorage

................................................................................

7
2.4NeedbasedConsistentDistributedStorage

.........................................................

7
2.5EfficientDistributedAccessofEHRs

..................................................................

8
2.6Technique,Specification,andFrameworkforConversionTools

........................

8
3ProjectProposal

...........................................................................................................

9
3.1RolesofSICS(SwedishInstituteofComputerScience)

.....................................

9
3.2RolesofCDAC(CentreforDevelopmentofAdvancedComputing)

..............

10
3.3EstimatedResourceNeed

...................................................................................

10
3.4OtherApplicationsoftheResults

......................................................................

10
4WorkProgram

...........................................................................................................

11
4.1WP1:StateoftheartReview

...........................................................................

11
4.2WP2:RoutingtoCluster

...................................................................................

11
4.3WP3:DefiningCommonEHRStandard

..........................................................

11
4.4WP4:ClusterFailoverAlgorithms

..................................................................

12
4.5WP5ClientSideDisconnectedOperation

.......................................................

12
4.6WP6:DistributedConsensusandReplicationAlgorithmsforWANs

.............

12
4.7WP7:DevisingPoliciesandMechanismforaCommonSingleEHRand
ImplementationofDistributedEHR

........................................................................

13
4.8WP8:SecureStorageandAccessofEHR

........................................................

13
4.9WP9:ResearchingandImplementingReplicationandNeedbasedConsistency
Algorithms

................................................................................................................

14
4.10WP10:PrototypeDevelopmentforIntegrationofEHRandAlgorithmsand
Validation

.................................................................................................................

14
4.11WP11:Techniques,Specifications,andFrameworkforConversionTools. 14
.
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CentreforDevelopmentofAdvancedComputing

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TechnologyDevelopmentforDistributedHealthcareInformationStore

4.12WP12:DisseminationofResultsandExploitationofIP

................................

15
5ExploitationandUtilizationofProjectResults

.........................................................

16
6RiskAnalysis

.............................................................................................................

16

1 Introduction
With theextensiveuseofcomputerized medical equipment inhealthcare domain,
healthdataofindividualsisoftenavailableinelectronicform.Severalinformation
systems developed to deal with healthcare parameters also generate and handle
individuals healthcare information in electronic form. A few examples of such
systemsareHospitalInformationSystems(HIS),TelemedicineSystems,andTele
FollowUpSystems.Severalofthesesystemshavebeenoperationalforthelastfew
yearsandhavegeneratedhealthcaredatainelectronicformforthetreatedpatients.
TheDepartmentofInformationTechnology(DIT),MinistryofCommunicationand
InformationTechnology(MCIT)havefundedseveralprojectsduringthepastdecade
for development of ITbased Healthcare solutions. During the course of these
projects, the need for a standard EHR for the nation has been strongly felt for
interoperablehealthcaresolutions.DuringthemeetingsoftheNationalKnowledge
CommissionforcreatingthenationalhealthinformaticsvisionforIndia,theneedfor
standardEHRwithsecurestorageandaccessofEHRsinastoragesystemspanning
nationalgeopoliticalhierarchyhasbeendiscussed.Hencethecurrentproposalfor
developingtechnologiesforadistributedhealthcareinformationstoreisinlinewith
thevisionofDITandNationalKnowledgeCommissionforbetterhealthcareservices
forcitizensofIndia.

1.1 CurrentScenarioandAssociatedProblems
Thecurrentwayofdevelopingandusinghealthcareinformationstoresystemshasled
toachaoticstateofaffairsduetofollowingreasons:

Theyhavebeendevelopedindependentlyanddonoteasilyinteroperatewitheach
other.
Theyfollowtheirownconventionofcreating,maintaining,andstoringElectronic
HealthRecords(EHRs)ofpatients.
Ifapatientistreatedatdifferenthospitalsatdifferentinstances,differentEHRs
aregeneratedandstoredforthesamepatientbythetwodifferentinformation
systemsinuseatthetwohospitals.AsingleEHRforanindividualisdesirable
irrespectiveofhis/hertimeandplaceoftreatment.
Each system has its own wayof creating andmanaging its storage ofEHRs.
Obviously, such an information store is based on both relational database
technology, due to its ubiquity and maturity in managing large volume of
information, andmedia storagesoftware,forexample Xraypicture archiving.
Differentsystemsusedifferentrelationaldatabasesanddifferentmediastorage
softwaremakingdatatransferacrosssystemsimpossible/inconvenient.

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TechnologyDevelopmentforDistributedHealthcareInformationStore

Mostoftheexistingsystemsusecentralizedstorage,leadingtolimitedscalability
andpoorreliability(singlepointoffailure).

Asaresult,ithasbecomedifficulttoexchangeEHRsacrossdifferentsystemsandto
haveaunifiedinformationsystemtodealwithoneEHRperindividual,irrespective
ofthetimeandplaceoftreatmentofanindividual.

1.2 RequirementsofaFutureEHRSystem
To overcome the problems mentioned above, there is an urgent need to create a
frameworkforbuildingadistributed, scalable, andreliable healthcare information
storesystemthatcanhaveasingleEHRforeveryindividualofanation.Building
such a system is a challenging task involving several research and development
problems.Someofthekeyissuesthatwillneedtobeaddressedare:
EvolvingastandardforcommonEHR
EvolvingpoliciesandmechanismsforasingleEHRforeachindividual
EvolvingpoliciesandmechanismsforsecurestorageandaccessofEHR
Buildinganationaldistributed,scalable,andreliablehealthcareinformationstore
forstorageandaccessofallEHRsofanation

1.3 CurrentInitiativesatCDACandSICS
CDAChasalreadyinitiatedeffortstowardsaddressingsomeoftheissuesmentioned
above.Inparticular,itiscurrentlyworkingtowards:
EvolvingastandardforcommonEHR
EvolvingpoliciesandmechanismsforasingleEHRforeachindividual
EvolvingpoliciesandmechanismsforsecurestorageandaccessofEHRsina
storagesystemspanningnationalgeopoliticalhierarchy
CDAChasextensiveexperienceindevelopingdistributedcomputingsystemsand
Grid based networks, emulation of Grid, Parallel Processing and Programming
architectures. CDAC is an active contributor to the telemedicine and health
informatics domain in India. The organization has developed multiple products
servicingthehealthsectorinvariousnations.
SICS has actively been doing research in the context of distributed, reliable, and
scalableinformationsystems.Withintheareaofdistributedcomputing,thegroups
focushasbeenonoverlaynetworks,contentdistributionnetworks,selfmanagement,
gossipbasedalgorithms,middleware,emulation/simulationoflargescaledistributed
systems,andanalyticalmethodsforanalyzingtheperformanceofthesesystems.The
grouphas,overtheyears,builtandrefinedaneventbasedmiddlewareforbuilding
largescalefaulttolerantdistributedsystems.Thismiddlewarehasbeenthebasisof
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TechnologyDevelopmentforDistributedHealthcareInformationStore

thegroupsoverlaynetworks,andwillbesharedwithallconsortiumpartnersforthe
developmentofEHRproducts.

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2 FurtherEffortsNeededforaCompleteSolution
Although CDACs currentefforts aretargeted towards conceptualizing, evolving,
designing,anddevelopingthecoreframeworkforaprototypedemonstrationofa
nationalhealthcareinformationsystem,severaladditionalissuesneedtobeaddressed
totransformitintoacompleteoperationalsolution.Thatis,tobuildanationwide
distributed,scalable,andreliablehealthcareinformationstore,furtherresearchneeds
tobecarriedouttowardsthefollowing:

2.1 BuildingaCommonStandardEHR
Thecurrentwayofdevelopingandusinghealthcareinformationstoresystemshasled
toachaoticstateofaffairsduetofollowingreasons:
Independentlydevelopedsolutionsdonoteasilyinteroperatewitheachother.
Followownconventionofcreating,maintaining,andstoringElectronicHealth
Records(EHRs)ofpatients.
Treatment at different hospitals at different instances results in generation of
differentEHRsforthesamepatient.
OwnwayofcreatingandmanagingitsstorageofEHRs.Differentsystemsuse
different relational databases and different media storage software makes data
transferacrosssystemsimpossible/inconvenient.
Existingsystemsusecentralizedstorage,leadingtolimitedscalabilityandpoor
reliability(singlepointoffailure).
Asaresult,ithasbecomedifficulttoexchangeEHRsacrossdifferentsystemsandto
haveaunifiedinformationsystemtodealwithoneEHRperindividual,irrespective
ofthetimeandplaceoftreatmentofanindividual.
Thereisanurgentneedtocreateaframeworkforbuildingadistributed,scalable,and
reliablehealthcareinformationstoresystemthatcanhaveasingleEHRforevery
individualofanation.Buildingsuchasystemisachallengingtaskinvolvingseveral
researchanddevelopmentproblems.

2.2 ScalableDistributedStorage
Currentrelationaldatabasetechnologyhasmaturedtothelevelwheresystemscan
storeterabytesofdatainadatabaseclusterusingStorageAreaNetworks.However,
centralizedinformationstoragearchitecturesprovideimpedimentstoscalabilityand
highavailability,includingacentralpointoffailureinthesystem,andtheneedtouse
expensivehighavailabilityhardware.
Recently, an increasing number of companies operating in extreme computing
environments(wheretherateofupdatesandaccessareveryhigh),suchasTelecom

andInternetcompanies,havedevelopedgeographicallydistributedinformationstore
architecturestoprovidebothhighscalabilityandhighavailability.Examplesofsuch
systems include telecom products such as Home Location Registers and Internet
servicessuchasGoogleMail.Typically,thesesystemspartitiondatageographically,
generallyusingauserspecificidentifier,sothatuserspecificdataislocatedonthe
samepartition,preventingdataqueriesthatspanmultiple,geographicallydistributed
partitions.Thepartitioningofuserdataenablesrelationaldatabaseandimagestores
to handle vastly increased data sizes, and to massively increase read and write
throughputbyremovingthecentralizedbottleneckinthesystem.
Obviously, the National EHRs repository will be so large that it will have to be
modeled on scalable distributed storage mechanism mentioned above. Suitable
databasepartitioningalgorithmswillhavetobedevisedforgeographicaldistribution
of EHRs, while ensuring that data access is efficient and within acceptable time
limits.

2.3 ReliableDistributedStorage
TheEHRdatabasealsoneedstohavehighavailabilityfeaturetoensurethatthedata
isalwaysavailable.Suitabledatareplicationmechanismsneedtoberesearchedfor
making this possible. Since the EHR database will behuge in size, implicit data
replication mechanisms are desirable in which the entire replication process is
automaticallycontrolledbythesystemwithoutusersknowledge.Thatis,thenumber
ofreplicasofanEHRandtheirlocationsshouldbetransparenttotheusers.

2.4 NeedbasedConsistentDistributedStorage
SincetheEHRdatabasewillusedatareplicationtechnologiesforhighavailability
feature,itisimportanttoalsoresearchsuitableconsistencyalgorithmstoguarantee
consistencyofreplicateddata.
Existingdatabasesystemssupportthegeographicreplicationofdatatoensurethat
data is always available. However, existing geographic replication support for
MySQL and Oracle is based on asynchronous replication: they provide no data
consistencyguaranteesforreplicateddata.So,intheeventofthecrashofapartition,
thereispotentialfordataloss.Thisisnotacceptableinthehealthcaredomain.
AlthoughstrictconsistencyofmultiplecopiesofreplicatedEHRsisintuitivelythe
most desirable consistency model, this may unnecessarily degrade performance.
Moreover,sinceanEHRisahugesetofinformation,notallinformationwillrequire
strict consistencyofdatafortheinformation systemtofunctioncorrectly. Hence,
there is a good scope of research to identify and implement weaker consistency
modelstoenablethesystemtofunctionbothefficientlyandcorrectly.Theideaisto
define a set of consistency models with varying degrees of consistencies and to
associate them with different sets of information in an EHR depending on the
consistencyneedsofthesystem.

2.5 EfficientDistributedAccessofEHRs
ClientsoftwarethataccessesdatainthedistributedrepositoryofEHRswillneedto
provideroutingandlookupfunctionalitytoenabledataupdatesandqueriestobesent
tothepartitionwheretheEHRofcurrentinterestisstored.

2.6 Technique, Specification, and Framework for

ConversionTools
Several conversion tools also need to be developed for migration of existing
healthcare data fromexisting data stores tothe proposednational data store.The
projectwillevaluate,consolidate,refine,andevolvecommontechniques,standard
approaches,andframeworkfordevelopmentofconversiontools.

3 ProjectProposal
TheJointProjectProposalforSwedenIndiaCooperationfocusesonaddressingthe
issuesmentionedaboveunderthesectiononFurtherEffortsNeededforaComplete
Solution.Thefocusoftheproposedprojectisto:

Incorporatedistributedinformationstoretomakethesolutionscalable.
Devisepolicies andmechanismsforcreation,uniqueidentification,andproper
managementofasingleEHRforeveryindividualindistributedenvironment.
DesignandbuildagenericsiloframeworkforpartitioningEHRs.Inparticular,we
proposetheuseofDistributedHashTable(DHT)technologytomodelanation
widescalabledistributedstorageforefficientstorageandretrievalofEHRs.The
DHTtechnologyhasprovensuccessfulinbuildingpartitioneddistributedstorage
systems, such as OceanStore. Hence, its application to build a partitioned
distributedstoragesystemfornationalEHRswithsuitablecustomizationwould
beresearched.Routingandlookupfunctionalitywillalsobedevelopedtoenable
dataupdatesandqueriestobesenttothepartitionwhereEHRofcurrentinterest
isstored.
ToensurehighavailabilityofEHRs,itisproposedtodevelopscalablegeographic
replication algorithms with implicit data replication mechanisms. Needbased
consistencyalgorithmswillalsobedevelopedtoensurethatmultiplereplicasof
anEHRarekeptconsistenttotheextentrequired.Thiswillenablethesystemto
functionbothefficientlyandcorrectly.
Incorporatesuitablesecuritypolicies andmechanisms topreventcorruptionor
theftofEHRdataindistributedenvironment.
Design and develop several conversion tools to enable smooth migration of
existing healthcare data from existing data stores to the proposed nationwide
distributeddatastore.

3.1 RolesofSICS(SwedishInstituteofComputerScience)

SICSandCDACwilljointlyworktowardsevolvinganoverallframeworkdesign
foraDistributedEHRstoretomakethesolutionscalable.
SICSwillcarryoutresearchtowardsthefollowing:

DesigningandbuildingagenericsiloframeworkforpartitioningEHRsbased
onDistributedHashTable(DHT)technology

DevelopingreplicationalgorithmsforhighavailabilityofEHRdata
Developingroutingandlookupfunctionalitytoenabledataupdatesandqueries

3.2 Roles ofCDAC (Centre forDevelopmentofAdvanced

Computing)

SICSandCDACwilljointlyworktowardsevolvinganoverallframeworkdesign
foraDistributedEHRstoretomakethesolutionscalable.
CDACwillcarryoutresearchtowardsthefollowing:

Devising policies and mechanisms for a single, unique EHR for every
individualindistributedenvironment

DevelopingneedbasedconsistencyalgorithmsforreplicatedEHRs
Incorporatingsecuritypoliciesandmechanismstopreventcorruptionortheft
ofEHRdataindistributedenvironment

Developingtechnique,specification,andframeworkforconversiontools
3.3 EstimatedResourceNeed

Toperformtheresearchdescribedaboveanddevelopafunctionalprototypeofthe
distributedinformationstore,followingrequirementsareestimated:

Projectdurationofthreeyears
Approx.3peopleperyear(startingwith2andrampingupto4)atSICS
Approx.10peopleperyear(startingwith4andrampingupto14)atCDAC

3.4 OtherApplicationsoftheResults
Theproposedprojecthasaclearfocusondevelopingenablingtechnologiesfora
futureEHRsystem.However,thedevelopedtechnologieswouldalsobeapplicableto
manyotherdistributedapplications.Forexample,largescaledistributeddatabasesare
relevantforapplicationsintelecommunications(e.g.HLRs)andInternetservices(e.g.
webmail),whilereliabledistributeddatabasesarerelevantforapplicationsine.g.
disasterreliefandrobustwebservicesingeneral.

4 WorkProgram
Note: M0 signifies Month0, M1 signifies Month01 and so on, from start of the
project.

4.1 WP1:StateoftheartReview
Task Description: The review will cover an analysis of existing replication,
consensusalgorithms,aswellasstandard,policies,andmechanismsforacommon
singleEHR,andsecurestorageandaccessofEHR.
Timeframe:IntensivelyM0toM3,thereafterongoingcoverageofrelatedresearch
whichresultsindocumentupdatesasneeded.
Contribution:SICS2personmonths(PMs),CDAC40personmonths(PMs).
Dependencies:None.
Deliverable: Report on Stateoftheart on replication, consensus, common
standard/policies/mechanismsforsingleEHR,andsecurestorage.

4.2 WP2:RoutingtoCluster
TaskDescription:Thistaskinvolvestheroutingofinformationstorereadandwrite
operationstotheappropriatecluster.WewillinvestigatebothDHTandconsistent
hashingapproaches.
Timeframe:M0toM6.
Contribution:SICS6personmonths(PMs),CDAC2personmonths(PMs).
Dependencies:None.
Deliverable:RoutingAlgorithms.
Milestone:ReviewofWorktoDate.FirstlookattheMiddleware.

4.3 WP3:DefiningCommonEHRStandard
TaskDescription:ThistaskinvolvesevolvingastandardforcommonEHRforeach
individual.
Timeframe:M3toM9.

Contribution:SICS2personmonths(PMs),CDAC65personmonths(PMs).
Dependencies:None.
Deliverable:AnEHRstandarddocument.

4.4 WP4:ClusterFailoverAlgorithms
TaskDescription:Thistaskinvolvesdevelopingasuiteofalgorithmsformanaging
the failover of clusters. It involves developing failure detectors for WANs, data
recovery from failed clusters, replication event conflict detection, and replication
eventconflictresolution.
Timeframe:M0toM18.
Contribution:SICS11personmonths(PMs),CDAC2personmonths(PMs).
Dependencies:None.
Deliverable:ImplementationsofthealgorithmsforClusterFailover.

4.5 WP5ClientSideDisconnectedOperation
TaskDescription: Thistaskinvolvesdevelopingcachingalgorithmsforclientside
storage of EHRs during network disconnection, the synchronization of clientside
cacheswiththeInformationStore.
Timeframe:M0toM24.
Contribution:SICS11personmonths(PMs),CDAC2personmonths(PMs).
Dependencies:None.
Deliverable: Disconnected operation algorithms and needbased consistency
replication.

4.6 WP 6: Distributed Consensus and Replication

AlgorithmsforWANs
Task Description: This task involves the development of distributed consensus
algorithmstosupportsynchronousreplicationofdatatomultipleclusters.Thistask

involves designing consensus and replication algorithms to handle delaytolerant

networksthatmaybecommoninpartsofIndia.
Timeframe:M0toM30.
Contribution:SICS29personmonths(PMs),CDAC3personmonths(PMs).
Dependencies:None.
Deliverable:DesignandEvaluationofdistributedconsensusalgorithms,Designand
simulationofconsensusandreplicationalgorithmsfordelaytolerantnetworks.
Milestone:ReviewofWorktoDate.Setoftestalgorithmssimulatedforthesystem.

4.7 WP7:DevisingPoliciesandMechanismforaCommon
SingleEHRandImplementationofDistributedEHR

TaskDescription: Thistaskinvolvesdevisingpoliciesandmechanismforasingle
commonEHR,andimplementingthecommondistributedEHR.
Timeframe:M9toM19.
Contribution:SICS5personmonths(PMs),CDAC75personmonths(PMs).
Dependencies:WP3.
Deliverable: Report on single EHR policies and mechanisms and evaluation of
CommonDistributedEHR.

4.8 WP8:SecureStorageandAccessofEHR
TaskDescription: Thistaskinvolvesevolvingpoliciesandmechanismsforsecure
storageandaccessofEHR.
Timeframe:M11toM24.
Contribution:SICS6personmonths(PMs),CDAC60personmonths(PMs).
Dependencies:WP3.
Deliverable:DesignandEvaluationofsecurestorageandaccessofEHR.
Milestone:ImplementationofSecureStorageandaccessmechanisms.

4.9 WP 9: Researching and Implementing Replication and

NeedbasedConsistencyAlgorithms
TaskDescription:Thistaskinvolvesresearchingvariousreplicationandneedbased
consistencyalgorithmsandimplementingmostefficientalgorithms.
TimeFrame:M11toM24.
Contribution:SICS12personmonths(PMs),CDAC90personmonths(PMs).
Dependencies:None.
Deliverable:Efficientalgorithmsforreplicationandneedbasedconsistency.

4.10 WP 10: Prototype Development for Integration of EHR

andAlgorithmsandValidation
Task Description: This task involves developing a prototype for integrating
replicationandconsistencyalgorithmsandElectronicHealthRecord.
TimeFrame:M25toM36.
Contribution:SICS3personmonths(PMs),CDAC110personmonths.
Dependencies:Completionofresearchoverreplicationandconsistencyalgorithms
(WP5).
Deliverable:PrototypeforIntegrationprocessofEHRandalgorithms.

4.11 WP11:Techniques,Specifications,andFrameworkfor
ConversionTools
Task Description: Several conversiontools are tobe developed formigration of
existinghealthcaredatafromexistingdatastorestotheproposednationaldatastore.
Timeframe:M25toM31.
Contribution:SICS5personmonths(PMs),CDAC24personmonths(PMs).
Dependencies:None.
Deliverable:ConversionToolsFrameworkwithdocumentation.

4.12 WP12:DisseminationofResultsandExploitationofIP
TaskDescription:Thesoftwareoutputoftheprojectwillbemadeavailableunderan
opensource license. Commercialization and exploitation opportunities for project
Intellectual Property will be realized through regular meetings with the Business
DevelopmentpartnersinSwedenandIndia.
Contribution:SICS3personmonths(PMs),CDAC3personmonths(PMs).
Dependencies:OtherWPs
Timeframe:M0toM36.OngoingforthedurationoftheProject.
Deliverable:Publicationswillbeproducedthroughoutthedurationoftheproject.

5 ExploitationandUtilizationofProjectResults
SICSandCDACwillexploittheresultsoftheirresearchbypublishingtheirresults
inhighqualityjournalsandconferences.Beforepublication,thepartnerswilldiscuss
whetherthecorecontribution ofthepublication shouldbepatented ornot.Thus,
resultswhichgivetechnologicalcompetitiveadvantagewillbepatentedbeforepublic
publication.Theseresultsshouldopenupnewresearchdirectionsandopportunitiesto
pursue further research funding in the fields of peertopeer networks and
decentralizedoptimizationofdistributedsystems.
CDACisintheprocessofsettingupacorporateentityforcommercializationofits
research output. The technologies developed as part of this project will be
commercialized through this corporate entity. CDAC will also make efforts to
identify other parties in India who are interested in commercializing the research
outputsofthisproject.Similarly,SICSwillmakeeffortstoidentifysuitablepartiesin
Swedenwhoareinterestedincommercializingtheresearchoutputs.TogetherbothC
DACandSICSwillalsomakeeffortstoidentifypartiesforcommercializationofthe
researchoutputsinternationally.
The common EHR standard which will be developed can be put forward for
considerationasanInternationalStandardfordefininghealthrecords.Inparticular,
the nascent area of decentralized optimization offers the opportunity for SICS to
providegloballeadershipinagrowingresearcharea.

6 RiskAnalysis
The main risks SICS may face that could affect the success of the project are
summarizedbelowinTable1:
RiskFactor

Probability
of
Occurrence
The design and implementation of Low
clientside routing algorithms and
disconnected operation may not be
successful.
Keypersonnelwillleavetheproject.

Low

The design and implementation of Low

cluster failoveralgorithms maynotbe
successful.

Consequences

SICS has extensive

experience in building
robust P2P and routing
systems; instability is
unlikely but would affect
systemperformance.
There is a large enough
team to handle loss of a
person.
SICS has extensive
experience with cluster
based systems, but failure

The system may be selfmanaging in Low

normal operation, but has not been
designed to handle unexpected
situations.
Distributed Consensus Algorithms not Medium
as efficient as Asynchronous
ReplicationforClusterReplication.

would increase user

involvement in data
recovery after cluster
failure.
Extensive testing should
ensure that this does not
happen.
Revert to asynchronous
replication algorithms for
clusterreplication.

Table1:SummaryofRiskFactorsfortheEHRprojectSICS
The main risks CDAC may face that could affect the success ofthe project are
summarizedbelowinTable12:
RiskFactor

Probability
of
Occurrence
The definition of national level Low
commonEHRandaccessmechanisms
maynotbesuccessful

Consequences

Needbasedconsistencyalgorithmsfor Low
replicationmaynotbeefficient

Thereisampleknowhowas
CDAC has been involved
in developing distributed
applications over Grid
Computingnetworks
This can be mitigated by
using Strong encryption
algorithms and devising
secure access mechanism.
Security can never be
guaranteed it can only be
strengthened.
Thereisalargeenoughteam
to handle loss of a person.
Transfer of Technology
amongpersonswillbedone
on a continuous basis to

Breach of security in Storage and Low

AccessofEHRmayoccur.

Keypersonnelmayleavetheproject.

Low

Ample knowhow and

experienceispresentinthe
organization

for
development ofthis partof
the project as the
organization has built a
Telemedicine Solution,
healthcaresolutions,Garuda
grid,etc.

maintaincompetencyinthe
team
Table2:SummaryofRiskFactorsfortheEHRprojectCDAC

NOTES
______________________________________________