DEPENDABLE SYSTEMS FOR QUALITY HEALTHCARE

INTRODUCTION

• The healthcare is undergoing a dramatic transformation from today’s inefficient,

costly, manually intensive, crisis driven model of care delivery to a more efficient,
consumer-centric, science-based model that proactively focuses on health
management.
• This transformation is driven by several factors:
• The skyrocketing cost of healthcare delivery
• The exposure of patient-safety problems
• And an aging ‘’baby boom’’ population that recognizes the potential for information technology
(IT) to dramatically reduce the cost and improve the quality of care.
• Other key application are:

• Clinical information system (CIS) with integrated

• Outcomes-based decision support
• Clinical knowledge bases
• Computerized physical order entry (CPOE)
• Electronic prescribing
• Consumer knowledge bases and decision support
• And supply chain automation
• The technologies that enable the transformation are largely state
of the art and include enterprise application integration (EAI):
• Wireless communication
• Hand-held and tablet computers
• Continues speech recognition
• Integration
• Interpretation
• Electronic sensor technology
• Radio frequency identification (RFID) tagging
• And robotics
• The functional capabilities of these application and technologies
can provide are indeed impressive and can vastly improve quality
of healthcare delivery
• The electronic health record (EHR) will form the foundation for pervasive,
personalized, and science-based care. Other key applications are clinical
information systems (CIS) with integrated, outcomes-based decision support,
clinical knowledge bases, computerized physician order entry (CPOE),
electronic prescribing, consumer knowledge bases and decision support, and
supply chain automation.

• The international Council of nurses (ICN) Code of ethics for Nurses affirms
that the nurse “holds in confidence personal information” and “ensures that
the use of technology… [Is] compatible with the safety, dignity, and rights of
the people” (ICN, 2000).
• Thus, ethical obligations drive requirements for:
• System reliability
• Availability
• Confidentiality
• Data integrity
• Responsiveness
• Safety attributes collectively referred to as
dependability
DEPENDABILITY

• Is a measure of the extent to which a system can

justifiability be relied on the deliver the
services expected from it.
DEPENDABILITY COMPRISES THE FOLLOWING SIX
ATTRIBUTES:

1. System reliability: The system consistently behaves in the same way.

2. Service availability: Required services are present and usable when they are needed.
3. Confidentiality: Sensitive information is disclosed only to those authorized to see it.
4. Data integrity: Data are not corrupted or destroyed.
5. Responsiveness: The system responds to user input within an expected and acceptable time period.
6. Safety: The system does not cause harm.
GUIDELINES FOR DEPENDABILITY SYSTEMS
All computer system are vulnerable to both human-created threat, such as malicious
code attack, and software bugs, and natural threats, such as hardware aging and
earthquakes.

Removing all system vulnerability is not practical particularly given complex,

heterogeneous environments where software and hardware changes are a part of
routine operations

A more practical approach to attaining dependability is to build tolerant system.

TOLERANT SYSTEM

• Is a system that anticipate problems; that detect faults,

software glitches and intrusions; and that take action so
that services can continue and data are protected from
corruption, destruction, and authorized disclosure.
FIVE FUNDAMENTALS THAT CAN HELP INCREASE THE
DEPENDABILITY OF HEALTHCARE SYSTEM

GUIDELINE 1: ARCHITECT FOR DEPENDABILITY

• A fundamental principle of system architecture is that enterprise system architecture should
be developed from the bottom up so that no critical component is dependent on a
component less trustworthy than itself.
• Physical and logical networks that support the enterprise and provide the “pipes” that carry
data from system to system.
• One or more computers are connected to this network, and the software foundation of each
computer is an operating system that is responsible for managing all of the resources in the
computer system.
• Distributed architecture can tolerate failures more easily than large, centralized system.
GUIDELINE 2: ANTICIPATE FAILURES
• As computers are getting faster systems are getting more and more complex,
and design flaws are becoming an increasingly catastrophic problem.
• The infrastructure level features that transparent to software application
should be implemented to detect faults, to fail over to redundant components
when faults are detected, and recover from failures before they become
catastrophic.
• Security features to detect, disable, and recover from malicious attacks, while
preserving system stability and security, should be implemented.
• Unfortunately, minimizing complexity is more easily said than done.
Consistent with Moore’s law` (Moore, 1965), the speed of processors is
doubling every 18 months, while the cost for that computing power is halving
within the same time.
GUIDELINE 3: ANTICIPATE SUCCESS
• The systems planning process should anticipate business
success-and the consequential need for larger networks, more
systems, new applications, and additional integration.
• Modeling of use-case scenarios that anticipate hospital and
clinic mergers, acquisitions, and a growing patient/consumers
base will enable the system designer to visualize the data flows,
system loading, and network impact resulting from business
growth and success.
GUIDELINE 4: HIRE METICULOUS MANAGERS
• Good system administrators meticulously monitor and
manage system and network performance, using out-of-
band tools that do not themselves affect performance.
• They take emergency and disaster planning very seriously;
develop, maintain; and judiciously exercise plans and
procedures for managing emergencies and recovering
from disasters.
GUIDLINE 5: DON’T BE ADVENTUROUS
• For dependability, one should use only proven methods,
tools, technologies, and products that have been in
production, under conditions, and at a scale similar to the
intended environment.
ASSESSING THE HEALTHCARE INDUSTRY

• Healthcare clearly has a need for dependable system

both now and after transformation, as the industry
becomes increasingly dependent on IT in the delivery of
patient care
ANTICIPATING FAILURES

• Medical applications that hosted on PC’s and personal data

assistants (PDAs) have a higher likelihood of failure than
application hosted on server machines that are physically
protected, managed by trained system administrators, and
continuously monitored.
• Computers are increasingly being used in safety critical clinical
applications, and without careful and appropriate attention to
software safety, we can reasonably expect that failures will
contribute to the loss of human life.
ANTICIPATING SUCCESS

• Healthcare organizations definitely expect their software

applications, computer systems, and networks to work.
• Providers assume their systems will work as well as any other
medical equipment despite the fact that many of the software
applications they use are running on the same kind of PC’s that
have failed them at home.
• Healthcare organizations do not foresee tat their business success
may increase their need for processing power and network
capability.
Reference:

• http://karlrufosumatra.blogspot.com/2011/05/electronic-health-record-systems-us.htm