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  • Hello everyone. Today I will talk about a distributed healthcare system based on the SOA. My name is Firat and my colleagues are from University of California, Santa Barbara. Gengxin Miao, Louise Moser and Micheal Melliar-Smith. Healthcare is crucial subject in all of our lives. Every clinic have their own policies, different procedures and quality of healthcare service. Due to these variety of requirements, development of distributed healthcare service is difficult. In this presentation, I will provide use of SOA to overcome some of these difficulties.
  • My presentation will start with motivation and our key contributions. Later I will move into our system architecture, and discuss different modules namely Clinic, Pharmacy and patient modules. Later, I will discuss some related work in this area, and our conclusions. Finally, I will discuss possible future works and go to discussion.
  • Human beings in all lines of work make errors. Errors can be prevented by designing systems that make it hard for people to do the wrong thing and easy for people to do the right thing. These are facts from USA, which indicates how it is critic to make errors in healthcare field. Incorrect prescription results in wrong treatments even deaths.
  • Development current healthcare systems starts in a field where different levels of difficulty exists. To start with, management of personal data. The patient record belongs the patient, however this results in situation that change of clinic results in loss of information from one clinic to another when there is no interoperable platform. Standardization of data format is another problem and healthcare organizations are working on it, such as electronic prescription. Extraction and analysis of the patient information provides valuable information to clinic members, however it is not possible to federate different patient records on different clinic systems. Last but not least, security and privacy of patient records is another difficulty current healthcare systems face. These show that, there is need for improved healthcare quality. Ease access to healthcare and healthcare information, keeping privacy of patient in mind. Most importantly, having these healthcare system, reduce human errors, the cost of delivery of healthcare in long term.
  • Now I will discuss common healthcare delivery practice. When we have a healthcare problem, we need to make appointment with the doctor/secretary with a phone call or visit to the clinic. Later, we spend some of our valuable time to visit doctor and take examination. Some of these examinations we believe could be done at home, by medical devices and consultation to physician is necessary, for the physician needs to have official record. Once finished the examination, the doctor writes prescription, usually lookup medication name, or prescribe the one that they know, and give written prescription to patient. Patient takes this prescription to their favorite pharmacy and wait for the prescription to be fulfilled. Keeping these difficulties in mind, now I will move to our contribution and architecture. Once medication is complete, patient might ask for refill of their physician allowed refills in that time period. Patient makes call to the pharmacy and arrange refill. ------------------------------------------- Here, there are possible points that could be included in a healthcare system. Patient should be able to make/view appointments online. The physician should write the prescription electronically, and submit to pharmacy directly other than including the patient between physician and patient. Wrong interpretation of medication could lead in wrong prescription of the patient. Moreover, physician has the knowledge of medicals they know, and usually prescribe same medication related for a specific illness. There are many alternatives, possible better medications than a physician will prescribe. And, accurate information could be provided in case the doctor had knowledge about specific illness.
  • Our SOA based distributed healthcare system aims to provide support for physicians, pharmacists, patients and electronic devices/current applications. Our system reduces human errors for the communication between system users is electronic, away from possible misunderstandings. We keep electronic records of patients, and ease access to this healthcare and healthcare information both for patients and healthcare professionals.
  • SOA provides abstraction of information such that details of implementation is hidden and platform independent, open for future development models, modifications. Encapsulation of information eases modification of services without effecting service consumers. Modular design of SOA components, makes implementation of applications easy. Moreover, software reuse, reduces effort and time to develop systems based on SOA. Our SOA architecture is based on the figure below that we have service functionality shown in middle, and service management and quality of service on left and right respectively. Service functionality consists f 3 layers, Web service Interface on the top. Service coordinator controls flow of messages. Bottom layer is healthcare services that provide functionality to our healthcare system. Service Management and Quality of service components are generic to every SOA architecture and we will not focus on details of these component.
  • Healthcare enforces security and privacy of patient’s data. We use session based authentication to login our system and check session information. We also have content based authorization where access to patient’s data is granted to authorized users and request/approval needed to grant future access to this data.
  • In Britain, they are developing single healthcare system that everybody must use. Modules that we have developed for our system can be grouped into 3 different categories where sometimes we have cross-functionality between components. This enables separation of concerns and ease development. Use of policies in SOA architecture provides diverse implementations of the same code framework. As we discussed, healthcare requirements for each clinic differs and custom development of these applications makes it difficult for the deployment of the system. We believe policy based architecture is helpful in this respect. Interoperability is another important issue in most of today’s information systems. SOA based on web services provides a platform where interoperability between different hardware/software systems is possible. With these features, it is possible to develop existing SOA systems without interrupting existing architecture and provides innovation of new design approaches.
  • I will first discuss our clinic module. Important Clinic module services are addition of notes associated with the patient’s healthcare records. We enable physicians to monitor patient’s data. Currently, each patient is associated with a family care physician, in case a patient’s diagnosis cannot be made, the physician can refer to another physician that is expert in the diagnosis field. Important patient services are availability of schedule of appointment. Receive patient data readings from medical monitoring devices, and deliver notifications to patients when necessary.
  • In this slide I show clinic module which consists of patient/clinic web services. Patient uses the website we have developed, which uses the patient web services as the backend. Devices that cannot use web site interface, uses web service which provides clean definition how to make function calls, create necessary objects. Applications developed, uses web service and we will discuss applications we have developed and possible future applications that might use it. On the other hand, the clinicians/devices uses same structure, with a web site front end, and web service as backend. I will note how and when we use pharmacy web service through clinic module.
  • Web service is for stand-alone applications. We have developed physician application that shows appointment calendar. We enabled this application with speech-enabled software for prescription preparation. Another application is, blood pressure monitor which transmit data readings from patient to healthcare system using Bluetooth connection via our client application. We will have demo for client web site after our presentation.
  • Speech-enabled user interface, gives convenient working environment for physicians who need to write prescriptions into our system. However, using such small devices, usage of keyboard is not convenient. Speech enabled application listens for user input, modify/create necessary data and provide feedback to user. We will have chance to demo this application as well.
  • The physician application and OQO machine looks like the picture on your right. Physician can select patient, select medication/dosage/frequency, select pharmacy, and submit to our system. Later clinic module transmits to corresponding pharmacy web service.
  • Our system employs, Consistent Data Replication protocol that we have designed. This protocol uses Atom syndication technology to synchronize information on different databases. We believe this functionality is necessary in healthcare field because sometimes physicians are in working environments where internet connection is not available, therefore local copy of the original database is needed for the physician’s usage. We designed and implemented a cdr protocol which we applied to our system. It could be applied to many other applications for data replication purpose.
  • Pharmacy module receives prescriptions from clinic module. We aim to provide integration with existing applications into our system using web service approach as the interface. Pharmacist can view outstanding prescriptions, process them and update their status. Patients can request renewal for a prescription and necessary notifications are provided to physician and patient.
  • This is the pharmacy module, that includes patient web service and pharmacy web service with their web cite front-ends.
  • Pharmacy module is accepts e-prescriptions from physicians, update the status and notify patient/physician. Patient website enables patient to check status, request refills.
  • We have evaluated latency of requests for new prescription arrivals. It should be noted that usually, requests are for renewals other than new prescription requests. Having that in mind, we have analyzed reception of 0.1,0.2,0.5,1,2 and 3 prescriptions per second with 1-6 medicines in that prescriptions. The more medication items in a prescription, the bigger request size. As expected, the latency increases with the improvement of the arrival rate. Even for 3 prescription per second case, the system performs in reasonable latencies.
  • Presentation

    1. 1. A Distributed e-Healthcare System Based on the Service Oriented Architecture Firat Kart, G. Miao, L. E. Moser, P. M. Melliar-Smith University of California, Santa Barbara SCC Contest Salt Lake City, July 2007
    2. 2. Outline <ul><li>Motivation </li></ul><ul><li>Key Contribution </li></ul><ul><li>e-Healthcare System Architecture </li></ul><ul><ul><li>Clinic Module </li></ul></ul><ul><ul><li>Pharmacy Module </li></ul></ul><ul><ul><li>Patient Module </li></ul></ul><ul><li>Related Work </li></ul><ul><li>Conclusion </li></ul><ul><li>Future Work </li></ul>Firat Kart SCC Contest 2007
    3. 3. Motivation <ul><li>Healthcare is life-critical work </li></ul><ul><ul><li>7,000 deaths per year in the USA are due to incorrect prescriptions ( Colorado State Board of Pharmacy News ) </li></ul></ul><ul><ul><li>5% of 3 billion prescriptions per year are incorrect ( The Washington Post ) </li></ul></ul>Firat Kart SCC Contest 2007 “ Human beings, in all lines of work, make errors. Errors can be prevented by designing systems that make it hard for people to do the wrong thing and easy for people to do the right thing.” (US Institute of Medicine)
    4. 4. Status of Current Healthcare <ul><li>Difficulties </li></ul><ul><ul><li>Management of personal data </li></ul></ul><ul><ul><li>Standardization of data formats </li></ul></ul><ul><ul><li>Extraction / analysis of content-based knowledge </li></ul></ul><ul><ul><li>Federation of different healthcare databases </li></ul></ul><ul><ul><li>Security and privacy of healthcare information </li></ul></ul><ul><li>Needs </li></ul><ul><ul><li>Improve the quality of healthcare </li></ul></ul><ul><ul><li>Ease access to healthcare and healthcare information </li></ul></ul><ul><ul><li>Reduce the cost of delivery of healthcare </li></ul></ul>Firat Kart SCC Contest 2007
    5. 5. Common Healthcare Delivery Practice Firat Kart SCC Contest 2007
    6. 6. Key Contribution <ul><li>Distributed e-healthcare system based on SOA that aims to </li></ul><ul><ul><li>Provide support for physicians, nurses, pharmacists, patients and medical monitoring devices </li></ul></ul><ul><ul><li>Reduce human errors </li></ul></ul><ul><ul><li>Maintain electronic healthcare records </li></ul></ul><ul><ul><li>Ease access to healthcare and healthcare information </li></ul></ul><ul><ul><ul><li>For healthcare professionals and patients </li></ul></ul></ul>Firat Kart SCC Contest 2007
    7. 7. e-Healthcare System Architecture <ul><li>Service Oriented Architecture (SOA) </li></ul><ul><ul><li>P rov ides abstraction, encapsulation, modularization and software reuse </li></ul></ul><ul><ul><li>Underlying implementation is free to change </li></ul></ul><ul><li>SOA is particularly appropriate for healthcare </li></ul>Firat Kart SCC Contest 2007
    8. 8. Security and Privacy <ul><li>Session-based authentication </li></ul><ul><ul><li>Web sites require login </li></ul></ul><ul><ul><li>Session information is checked </li></ul></ul><ul><li>Content-based authorization </li></ul><ul><ul><li>Authorized users can access patient’s data records </li></ul></ul><ul><ul><li>Authorization is requested for access to patient’s data </li></ul></ul>Firat Kart SCC Contest 2007
    9. 9. e-Healthcare System Architecture <ul><li>Clinic, Pharmacy and Patient Modules </li></ul><ul><ul><li>Separation of concerns </li></ul></ul><ul><ul><ul><li>Different modules require different expertise </li></ul></ul></ul><ul><ul><ul><li>Different styles of user interfaces </li></ul></ul></ul><ul><ul><li>Diverse implementations </li></ul></ul><ul><ul><ul><li>Custom deployments with different policies </li></ul></ul></ul><ul><ul><ul><li>Allow competition and innovation </li></ul></ul></ul><ul><ul><li>Interoperability </li></ul></ul><ul><ul><ul><li>Different hardware such as mobile devices </li></ul></ul></ul><ul><ul><li>Growth, evolution and innovation in the future </li></ul></ul>Firat Kart SCC Contest 2007
    10. 10. Clinic Module <ul><li>Clinical Staff Services </li></ul><ul><ul><li>Add patient data / notes </li></ul></ul><ul><ul><li>Monitor patient data </li></ul></ul><ul><ul><li>Make referrals to other physicians </li></ul></ul><ul><li>Patient Services </li></ul><ul><ul><li>Make appointments </li></ul></ul><ul><ul><li>Receive patient data from medical monitoring devices </li></ul></ul><ul><ul><li>Deliver notifications </li></ul></ul>Firat Kart SCC Contest 2007
    11. 11. Clinic Module Firat Kart SCC Contest 2007
    12. 12. Clinic Module <ul><li>Web Service interface for stand-alone applications </li></ul><ul><ul><li>Physician application </li></ul></ul><ul><ul><ul><li>Appointment calendar </li></ul></ul></ul><ul><ul><ul><li>For each appointment </li></ul></ul></ul><ul><ul><ul><ul><li>Patient data (history) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Prescription items, etc. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Referrals to other physician </li></ul></ul></ul></ul><ul><ul><ul><li>Speech-enabled software for ease of use </li></ul></ul></ul><ul><ul><li>Patient monitoring devices </li></ul></ul><ul><ul><ul><li>Blood pressure monitor </li></ul></ul></ul><ul><li>Web site for patients </li></ul>Firat Kart SCC Contest 2007
    13. 13. Multi-Modal User Interface <ul><li>Interactive communication for healthcare professionals </li></ul><ul><ul><li>High-quality display </li></ul></ul><ul><ul><ul><li>Better for lists </li></ul></ul></ul><ul><ul><li>Keyboard </li></ul></ul><ul><ul><ul><li>User input </li></ul></ul></ul><ul><ul><li>Speech recognition </li></ul></ul><ul><ul><ul><li>Ease input to devices </li></ul></ul></ul><ul><ul><li>Speech synthesis </li></ul></ul><ul><ul><ul><li>Provide feedback </li></ul></ul></ul>Firat Kart SCC Contest 2007
    14. 14. Multi-Modal User Interface <ul><li>Example application </li></ul><ul><ul><li>Preparation of prescriptions </li></ul></ul><ul><ul><ul><li>Select patient </li></ul></ul></ul><ul><ul><ul><li>Select medication, dosage, frequency, etc </li></ul></ul></ul><ul><ul><ul><li>Select pharmacy </li></ul></ul></ul><ul><ul><ul><li>Submit prescription electronically to pharmacy </li></ul></ul></ul>Firat Kart SCC Contest 2007
    15. 15. Synchronizing Information <ul><li>Mobile Device Clinic Web Service </li></ul><ul><ul><li>Consistent Data Replication Protocol </li></ul></ul><ul><ul><li>Based on the Atom Syndication Technology </li></ul></ul>Firat Kart SCC Contest 2007
    16. 16. Pharmacy Module <ul><li>Pharmacy Services </li></ul><ul><ul><li>Integrate with current medical devices </li></ul></ul><ul><ul><li>Receive / view / fill prescriptions </li></ul></ul><ul><li>Patient Services </li></ul><ul><ul><li>Enable renewals of prescriptions </li></ul></ul><ul><ul><li>Provide notifications </li></ul></ul>Firat Kart SCC Contest 2007
    17. 17. Pharmacy Module Firat Kart SCC Contest 2007
    18. 18. Pharmacy Module <ul><li>Pharmacy applications </li></ul><ul><ul><li>Integrate with Web Services interface </li></ul></ul><ul><ul><ul><li>Read existing e-prescriptions sent by physicians </li></ul></ul></ul><ul><ul><ul><li>Update status of e-prescriptions </li></ul></ul></ul><ul><ul><ul><li>Notify physician and patient of status changes </li></ul></ul></ul><ul><li>Web site for patients </li></ul><ul><ul><li>Check prescription status </li></ul></ul><ul><ul><li>Request refills of medications </li></ul></ul>Firat Kart SCC Contest 2007
    19. 19. Patient Module <ul><li>Access to Web sites </li></ul><ul><ul><li>Clinic Web site </li></ul></ul><ul><ul><ul><li>View / make appointment </li></ul></ul></ul><ul><ul><ul><li>Register patient devices </li></ul></ul></ul><ul><ul><ul><li>View patient data </li></ul></ul></ul><ul><ul><li>Pharmacy Web site </li></ul></ul><ul><ul><ul><li>View status of prescriptions </li></ul></ul></ul><ul><ul><ul><li>Request refill </li></ul></ul></ul><ul><li>Integration with patient monitoring devices </li></ul><ul><ul><li>Blood pressure monitor, weight scale, pill box etc </li></ul></ul>Firat Kart SCC Contest 2007
    20. 20. Patient Module Firat Kart SCC Contest 2007
    21. 21. Medical Monitoring Devices <ul><li>A&D blood pressure monitor </li></ul><ul><ul><li>Transmit readings using Bluetooth </li></ul></ul><ul><ul><li>Client application receives data </li></ul></ul>Firat Kart SCC Contest 2007
    22. 22. Medical Monitoring Devices <ul><li>Blood pressure history </li></ul>Firat Kart SCC Contest 2007
    23. 23. Implementation <ul><li>Web Servers and Web Services are deployed on 3 GHz computers with 2 GB memory </li></ul><ul><li>Client applications are deployed on 2 GHz computers with 2 GB memory </li></ul><ul><li>For the PDA we used the OQO device </li></ul><ul><ul><li>A full-featured 3” x 5” personal computer </li></ul></ul><ul><ul><li>Powered by a 1 GHz Transmeta Crusoe processor </li></ul></ul><ul><ul><li>Features a 800 x 480 resolution screen </li></ul></ul><ul><ul><li>Uses WiFi to communicate with other computers </li></ul></ul>Firat Kart SCC Contest 2007
    24. 24. Performance Evaluation <ul><li>Latency of requests </li></ul><ul><ul><li>Different rates of new prescription arrivals </li></ul></ul><ul><ul><ul><li>0.1, 0.2, 0.5, 1, 2 and 3 prescriptions per second </li></ul></ul></ul>Firat Kart SCC Contest 2007
    25. 25. Related Work <ul><li>Architectures </li></ul><ul><ul><li>Beyer, et al., Process-oriented architecture for healthcare network </li></ul></ul><ul><ul><li>Taylor, et al., SOA for health research data network </li></ul></ul><ul><ul><li>Omar and Talen-Bendiab, Sensor and actuator framework </li></ul></ul><ul><li>Workflow </li></ul><ul><ul><li>Song, et al., Computer-aided healthcare workflow </li></ul></ul><ul><ul><li>Ardissono, et al. , Healthcare workflow as a BPEL process </li></ul></ul><ul><li>Records and databases </li></ul><ul><ul><li>Bourke, Strategy and architecture of healthcare information systems </li></ul></ul><ul><ul><li>Tsiknakis, et al., Health telematic services based on digital libraries </li></ul></ul><ul><ul><li>Dick, et al., Computer-based patient records </li></ul></ul><ul><li>Commercial Web sites and products </li></ul><ul><ul><li>Web sites (Aurora, Medseek) </li></ul></ul><ul><ul><li>Prescription software (Epocrates) </li></ul></ul><ul><ul><li>Monitoring devices (A&D, MedSignals) </li></ul></ul>Firat Kart SCC Contest 2007
    26. 26. Conclusion <ul><li>SOA based e-healthcare system </li></ul><ul><ul><li>Supports healthcare professionals </li></ul></ul><ul><ul><ul><li>Fewer human errors </li></ul></ul></ul><ul><ul><ul><li>Electronic healthcare history </li></ul></ul></ul><ul><ul><li>Facilitates communication between healthcare professionals and patients </li></ul></ul><ul><ul><li>Improves presentation / delivery of healthcare </li></ul></ul>Firat Kart SCC Contest 2007
    27. 27. Future Work <ul><li>Incorporation of other kinds of medical devices (e.g., e-pillboxes, weight scales) </li></ul><ul><li>Integration with applications provided by pharmaceutical companies </li></ul><ul><ul><li>Improved and accurate medical information </li></ul></ul><ul><ul><li>Awareness of new medications and accurate information </li></ul></ul><ul><li>Collaboration with healthcare professionals </li></ul>Firat Kart SCC Contest 2007
    28. 28. Questions ? Firat Kart SCC Contest 2007 謝謝 Thank You ! Merci Grazie Gracias ﺷﻜﺮﺍﹰ 谢谢 Danke ありがとう 너를 감사하십시요 вы Teşekkürler ! धन्यवाद