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Virginia Telehealth Network Infrastructure Work Group  White Paper Consensus Conference: "Developing a Vision and Str...
Infrastructure Work Group (IWG) <ul><li>Examine current Telehealth capabilities in Virginia  </li></ul><ul><li>Identify cu...
Infrastructure Work Group Members <ul><li>Kathy Wibberly, Virginia Department of Health </li></ul><ul><li>Steve Gillis, Te...
Site Survey Responding Organizations <ul><li>Blue Ridge Regional Medical Center </li></ul><ul><li>Buchanan General Hospita...
Site Survey Findings
Telehealth Services <ul><li>Most respondents that have Telehealth/ Telemedicine currently use video over ISDN for video co...
Sites  Pound Norfolk Wise Cedar Bluffs Abington Wytheville Coving- ton Blacksburg Martinsville South Boston Lynchburg Farm...
Networks are Isolated VCU  VDH UVA Dept. of Corrections VT/VCOM VDMHMRSAS/CSB Others
Hard to Generalize- But Capacity is  Already Constrained at Some Network Sites  *   <ul><li>Applications </li></ul><ul><ul...
Issues  <ul><li>Service quality </li></ul><ul><li>Cost </li></ul><ul><li>Scheduling of remote consultations </li></ul><ul>...
Example: Current Process to Establish Video Conference
Note on Video Quality <ul><li>To ensure video quality Industry standard is Quality of Service (QoS) Protocol* </li></ul><u...
Respondents Future Plans <ul><li>Increased use of Telehealth/Telemedicine applications </li></ul><ul><li>Increased use of ...
Optimal Virginia Telehealth Network Hospitals Home patients VCU VDH  UVA Dept. of Corrections Virginia  Telehealth Network...
Future Network Functional Requirements (Optimal) <ul><li>Ensure video quality  </li></ul><ul><li>Ability to support bandwi...
Optimal Technologies & Services <ul><li>IP based video conferencing using  QoS </li></ul><ul><li>Multipoint conferencing c...
Options <ul><li>Status Quo </li></ul><ul><li>Integrate existing networks </li></ul><ul><li>Build a new network </li></ul>
Status Quo <ul><li>Pros </li></ul><ul><ul><li>Least effort </li></ul></ul><ul><li>Cons </li></ul><ul><ul><li>Bandwidth con...
Integration <ul><li>Pros </li></ul><ul><ul><li>All networks can communicate with each other </li></ul></ul><ul><ul><li>Not...
For an Integrated Network to Succeed <ul><li>All participating network administrators/IT departments MUST: </li></ul><ul><...
New Network  <ul><li>Pros </li></ul><ul><ul><li>Centralized technology/ policy coordination </li></ul></ul><ul><ul><ul><li...
Next Step <ul><li>Detailed requirements analysis to support network envisioned by strategic plan. </li></ul><ul><ul><li>De...
Questions? <ul><li>Steve Gillis </li></ul><ul><li>(703) 869-3085 </li></ul><ul><li>[email_address] </li></ul><ul><li>Techn...
Technical Annex (TeleHealth Solutions Group, LLC) <ul><li>Requirements </li></ul><ul><ul><li>Network Requirements </li></u...
TeleHealth/Telemedicine Network Technical Requirements <ul><ul><li>Services </li></ul></ul><ul><ul><ul><li>VoD (Video on D...
Technology Requirements <ul><li>Transmit IP using MPLS with IPv6 protocol  </li></ul><ul><li>Control Latency and Jitter th...
Equipment and Capacity Requirements
Required Video Components <ul><li>Video Terminals (Stations)  (At Remote site Location) </li></ul><ul><li>Gatekeeper  (At ...
Video Equipment Requirements <ul><li>Network Standard </li></ul><ul><ul><li>H.323 </li></ul></ul><ul><li>Video Standards <...
Remote Site Router/LAN switches  Requirements <ul><li>Support Video traffic </li></ul><ul><li>Support QoS services </li></...
Video Capacity Planning Metrics* <ul><li>Video data rate + 20% = Bandwidth required </li></ul><ul><li>No more than 33% of ...
Capacity Examples for Video 11,250kbps 32 x 384kbps 48 x 256kbps 96 x 128kbps DS-3 (45mbps) 384kbps 1 x 384kbps 1 x 256kbp...
Network Design
Currently Sites in Virginia Connect Using IP over ATM   Gatekeeper proxy DATA Switch Gatekeeper proxy Regional Site Headqu...
IPv6 with MPLS is becoming Industry Standard  Customer Edge  Access: Type 1, 2 3 Private IP Edge Router Private IP Core Ac...
Technology Review and Comparison
IP over ATM Issues <ul><li>IP over ATM has the potential to create bottlenecks leading into the core resulting from the la...
Comparison between IP and MPLS <ul><li>IP forwarding (for Video) lacks path control and deterministic resiliency as with M...
Network Cost Efficiencies and Simplification Realized in MPLS Network Network Cost Efficiencies and Simplification MPLS Ne...
<ul><li>Better Quality of service </li></ul><ul><li>Better security services through VPNs </li></ul><ul><li>Moves data pac...
Why QoS? <ul><li>Controls Latency sensitive data such as Video and Voice </li></ul><ul><li>Admission control – bandwidth c...
Optimized Queuing Using QoS 1 1 Video Traffic 2 2 LAN Traffic 3 3 3 Internet Traffic 2 3 2 1 1 Transmit ring
HIPAA  <ul><li>Code of Federal Regulations – 21 CFR-11 </li></ul><ul><li>21 CFR-11 took effect on 08/20/1997 and was inten...
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Virginia Telehealth Network Infrastructure Work Group

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Virginia Telehealth Network Infrastructure Work Group

  1. 1. Virginia Telehealth Network Infrastructure Work Group White Paper Consensus Conference: &quot;Developing a Vision and Strategic Plan for Telehealth in Virginia” May 26, 2005
  2. 2. Infrastructure Work Group (IWG) <ul><li>Examine current Telehealth capabilities in Virginia </li></ul><ul><li>Identify current issues and future requirements </li></ul><ul><ul><li>VA Telehealth site survey ( Fall ’03) </li></ul></ul><ul><li>Present options to the Committee </li></ul><ul><li>Facilitate next steps </li></ul>
  3. 3. Infrastructure Work Group Members <ul><li>Kathy Wibberly, Virginia Department of Health </li></ul><ul><li>Steve Gillis, Telehealth Solutions Group, LLC </li></ul><ul><li>David Heise, Telehealth Solutions Group, LLC </li></ul><ul><li>John Hughes, Virginia Department of Health </li></ul><ul><li>Debbie Justis, VCU Health System </li></ul><ul><li>John Lawson, Virginia Tech </li></ul><ul><li>Mary Claire O’Hara, VA DMHMRSAS </li></ul><ul><li>Dixie Tooke-Rawlins, Edward Via VA College of Osteopathic Medicine </li></ul>
  4. 4. Site Survey Responding Organizations <ul><li>Blue Ridge Regional Medical Center </li></ul><ul><li>Buchanan General Hospital </li></ul><ul><li>Edward Via VA College of Osteopathic Medicine </li></ul><ul><li>Lewis-Gale Medical Center </li></ul><ul><li>Louisvile Medical Center </li></ul><ul><li>Montgomery Regional Hospital </li></ul><ul><li>Norton Community Hospital </li></ul><ul><li>Pulaski Community Hospital </li></ul><ul><li>Sentara Home Care Services </li></ul><ul><li>VCU Health System </li></ul><ul><li>VCU Medical School </li></ul><ul><li>VDH </li></ul><ul><li>VDMHMRSAS </li></ul><ul><li>VA Primary Care Association </li></ul><ul><li>VA Medical Center Salem </li></ul><ul><li>UVA </li></ul><ul><li>Wythe County Community Hospital </li></ul>
  5. 5. Site Survey Findings
  6. 6. Telehealth Services <ul><li>Most respondents that have Telehealth/ Telemedicine currently use video over ISDN for video conferencing </li></ul><ul><ul><li>Several of the larger networks use video conferencing over IP without Quality of Service (QoS) which could cause quality issues </li></ul></ul><ul><li>Several sites use satellite broadcast for Tele-education and training </li></ul><ul><li>75% have Telemedicine (band-width intensive clinical) applications </li></ul><ul><li>50% inter-connect with other networks </li></ul><ul><ul><li>Several larger institutions connect nationally and internationally </li></ul></ul><ul><li>50% use multi –party bridging </li></ul>.
  7. 7. Sites Pound Norfolk Wise Cedar Bluffs Abington Wytheville Coving- ton Blacksburg Martinsville South Boston Lynchburg Farmville Williamsburg Newport News Portsmouth Petersburg Richmond Fredericksburg Alexandria Culpepper Leesburg Winchester Fairfax Harrisonburg Charlottesville Staunton Pennington Gap Big Stone Gap Norton Clintwood Gate City Grundy Vansant Tazewell Saltville Dungannon Konnarock St. Paul Marion Bland Bastion Pulaski (2) Salem Pearsburg Blacksville Lebannon Radford Christianburg Floyd Stuart Galax Hillsville Clifton Forge Hot Springs Monterey Low Moor New Castle Laurel Fork Craigsville Danville Troy Madison Heights Goochland Powhatan Dillwyn Blackstone Boydton Catawba Warrenton Manassas Mitchells Burkeville Bowling Green Colonial Beach Jarratt Dahlgren Arlington Falls Church Warsaw Aylett Glen Allen Ashland Tappanahanock St Stephens Church Chesapeake Heathsville Suffolk Callao Hayes Cheriton Accomac Franktown Hampton Virginia Beach Kilmarnock Saluda Charles City Vinton Chesterfield Montross Olney Hartfield Lancaster Nassawadox (17) (2) (2) (2) (2) (3) (2) (4) (3) 2-H (2) Belle Haven Roanoke Bristol Front Royal (2) (11) (3) (2) Woodstock Lexington Newport News U.V.A. Community Service Board V.D.H. D.O.C. RAHCE EVTN VA Dept. of Mental Health (VDMHMRSAS) VCU. VT/VCOM X= hub = point of presence (POP) X X
  8. 8. Networks are Isolated VCU VDH UVA Dept. of Corrections VT/VCOM VDMHMRSAS/CSB Others
  9. 9. Hard to Generalize- But Capacity is Already Constrained at Some Network Sites * <ul><li>Applications </li></ul><ul><ul><li>2 Video channels (384kbps) </li></ul></ul><ul><ul><li>Internet/Email channel (256k) </li></ul></ul><ul><ul><li>Web application (256kbps) </li></ul></ul><ul><ul><li>T1 local loop (1536kbps usable bandwidth) </li></ul></ul>* Chesterfield VDH site survey
  10. 10. Issues <ul><li>Service quality </li></ul><ul><li>Cost </li></ul><ul><li>Scheduling of remote consultations </li></ul><ul><li>Training </li></ul><ul><li>Needs of remote location not always met </li></ul><ul><li>New services implemented too slowly </li></ul>
  11. 11. Example: Current Process to Establish Video Conference
  12. 12. Note on Video Quality <ul><li>To ensure video quality Industry standard is Quality of Service (QoS) Protocol* </li></ul><ul><ul><li>Controls network congestion through bandwidth management </li></ul></ul><ul><li>Video over IP without QoS is not reliable. Network congestion degrades quality (latency and jitter) </li></ul><ul><ul><li>*s ee technical annex for information on QoS </li></ul></ul>
  13. 13. Respondents Future Plans <ul><li>Increased use of Telehealth/Telemedicine applications </li></ul><ul><li>Increased use of clinical Tele-Education </li></ul><ul><li>Increased connectivity within networks in Virginia and nationally. </li></ul><ul><li>Increased home health monitoring </li></ul>
  14. 14. Optimal Virginia Telehealth Network Hospitals Home patients VCU VDH UVA Dept. of Corrections Virginia Telehealth Network Provider offices Other Networks VT/VCOM VDMHMRSAS/CSB EMS- Satellite Geriatric facilities
  15. 15. Future Network Functional Requirements (Optimal) <ul><li>Ensure video quality </li></ul><ul><li>Ability to support bandwidth intensive video and data applications </li></ul><ul><li>Support private users </li></ul><ul><li>Open Network (standards based) </li></ul><ul><li>Sustainable </li></ul>
  16. 16. Optimal Technologies & Services <ul><li>IP based video conferencing using QoS </li></ul><ul><li>Multipoint conferencing capabilities </li></ul><ul><li>Data Collaboration </li></ul><ul><li>Store & Forward, Streaming Media & Broadcast Video </li></ul><ul><li>VPN and LAN capability (PC Based) </li></ul><ul><li>Ability to interface via any local access method (ex. ISDN, ATM. Frame Relay, Internet, Private line and DSL). </li></ul><ul><li>Emergency response capability </li></ul><ul><li>Open network interoperability </li></ul><ul><li>Compliant with HIPAA /HL7 </li></ul>
  17. 17. Options <ul><li>Status Quo </li></ul><ul><li>Integrate existing networks </li></ul><ul><li>Build a new network </li></ul>
  18. 18. Status Quo <ul><li>Pros </li></ul><ul><ul><li>Least effort </li></ul></ul><ul><li>Cons </li></ul><ul><ul><li>Bandwidth congestion </li></ul></ul><ul><ul><li>Networks do not communicate seamlessly </li></ul></ul><ul><ul><li>Limited exchange of data </li></ul></ul><ul><ul><li>High administrative overhead </li></ul></ul><ul><ul><li>New technology adoption difficult </li></ul></ul><ul><ul><li>Many needy communities and organizations will remain underserved </li></ul></ul><ul><ul><li>Does not support identified future plans </li></ul></ul>
  19. 19. Integration <ul><li>Pros </li></ul><ul><ul><li>All networks can communicate with each other </li></ul></ul><ul><ul><li>Not as expensive as a new network </li></ul></ul><ul><ul><li>MAY! be implemented in less time than new network </li></ul></ul><ul><li>Cons </li></ul><ul><ul><li>Coordination </li></ul></ul><ul><ul><ul><li>Technology Standards </li></ul></ul></ul><ul><ul><ul><ul><li>Ex. IP </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Ex. Video </li></ul></ul></ul></ul><ul><ul><ul><li>Security Policy </li></ul></ul></ul><ul><ul><ul><li>Firewalls/VPN </li></ul></ul></ul><ul><ul><ul><li>IT Policy </li></ul></ul></ul><ul><ul><li>No central governance for infrastructure maintenance </li></ul></ul><ul><ul><ul><li>New technology adoption is difficult </li></ul></ul></ul><ul><ul><li>Biggest stakeholders have the most clout </li></ul></ul><ul><ul><li>Many needy communities and organizations remain underserved </li></ul></ul><ul><ul><li>Re-imbursement for network services difficult </li></ul></ul><ul><ul><li>Security issues </li></ul></ul>
  20. 20. For an Integrated Network to Succeed <ul><li>All participating network administrators/IT departments MUST: </li></ul><ul><li>Open their networks to all potential public and private users!!! </li></ul>
  21. 21. New Network <ul><li>Pros </li></ul><ul><ul><li>Centralized technology/ policy coordination </li></ul></ul><ul><ul><ul><li>New Technologies can be adopted </li></ul></ul></ul><ul><ul><li>All Networks communicate together </li></ul></ul><ul><ul><li>most flexible </li></ul></ul><ul><ul><li>Volume discounts </li></ul></ul><ul><ul><li>All stakeholders are equal </li></ul></ul><ul><ul><li>Facilitate service to underserved communities and organizations </li></ul></ul><ul><ul><li>Billing and support available </li></ul></ul><ul><ul><li>Security can be implemented </li></ul></ul><ul><li>Cons </li></ul><ul><ul><li>Most expensive to implement </li></ul></ul>
  22. 22. Next Step <ul><li>Detailed requirements analysis to support network envisioned by strategic plan. </li></ul><ul><ul><li>Define revenue streams, cost savings and sustainability. </li></ul></ul>
  23. 23. Questions? <ul><li>Steve Gillis </li></ul><ul><li>(703) 869-3085 </li></ul><ul><li>[email_address] </li></ul><ul><li>Technical Annex: </li></ul><ul><li>David Heise </li></ul><ul><li>(703) 477-5456 </li></ul><ul><li>[email_address] </li></ul>
  24. 24. Technical Annex (TeleHealth Solutions Group, LLC) <ul><li>Requirements </li></ul><ul><ul><li>Network Requirements </li></ul></ul><ul><ul><li>Equipment & Capacity Requirements </li></ul></ul><ul><li>Network Design ( Current vs. Optimal) </li></ul><ul><ul><li>IP over ATM </li></ul></ul><ul><ul><li>MPLS </li></ul></ul><ul><li>Technology Review and Comparison </li></ul><ul><ul><li>IP over ATM vs. MPLS </li></ul></ul><ul><ul><li>Why IPv6 </li></ul></ul><ul><ul><li>Why QoS </li></ul></ul><ul><li>HIPPA </li></ul><ul><li>Site Survey </li></ul>
  25. 25. TeleHealth/Telemedicine Network Technical Requirements <ul><ul><li>Services </li></ul></ul><ul><ul><ul><li>VoD (Video on Demand) </li></ul></ul></ul><ul><ul><ul><li>Data Collaboration </li></ul></ul></ul><ul><ul><ul><li>Streaming Media </li></ul></ul></ul><ul><ul><ul><li>Multicast capability (unicast & webcasting) </li></ul></ul></ul><ul><ul><li>Lowest possible Latency and Jitter for Video & Broadcast services to ensure service quality </li></ul></ul><ul><ul><li>Network Facilities to support these services </li></ul></ul><ul><ul><ul><li>Local Access requirements </li></ul></ul></ul><ul><ul><ul><li>Backbone requirements </li></ul></ul></ul><ul><ul><li>Network security </li></ul></ul><ul><ul><ul><li>Layer 2 VPN Capability </li></ul></ul></ul><ul><ul><ul><li>Firewall </li></ul></ul></ul><ul><ul><ul><li>VPLS (Virtual Private LAN Service) (GigE) </li></ul></ul></ul><ul><ul><ul><li>mVPN (Multicast VPN) </li></ul></ul></ul><ul><ul><li>Network Address Translation </li></ul></ul><ul><ul><li>Secure Email </li></ul></ul>
  26. 26. Technology Requirements <ul><li>Transmit IP using MPLS with IPv6 protocol </li></ul><ul><li>Control Latency and Jitter through QoS & Bandwidth management </li></ul><ul><li>Support the new video standard H.264 </li></ul><ul><li>Translate from ISDN (H.320) to IP (H.323) </li></ul><ul><li>Secure VPN service over the public Internet for local loop DSL service </li></ul><ul><li>Provide Encryption and password security features </li></ul><ul><li>IP Address translations and assignment device to device </li></ul><ul><li>Support multiple local access (ex. ISDN, ATM, Frame Relay, Private Line, & Gig E) </li></ul><ul><li>Vender and Facility provider independent </li></ul><ul><li>Support manageability (use H.323 Beacon) </li></ul>
  27. 27. Equipment and Capacity Requirements
  28. 28. Required Video Components <ul><li>Video Terminals (Stations) (At Remote site Location) </li></ul><ul><li>Gatekeeper (At Hub site location) </li></ul><ul><ul><li>Performs all address resolutions </li></ul></ul><ul><li>Gateway (At Hub site location) </li></ul><ul><ul><li>Provides interoperability between H.323(IP) to H.320 (ISDN) </li></ul></ul><ul><li>Multipoint Conference Unit (MCU) (At Hub site location) </li></ul><ul><li>Proxy (Some times combine with the Gatekeeper) (At Hub site location) </li></ul><ul><ul><li>Call processing agent (QoS) </li></ul></ul>
  29. 29. Video Equipment Requirements <ul><li>Network Standard </li></ul><ul><ul><li>H.323 </li></ul></ul><ul><li>Video Standards </li></ul><ul><ul><li>H.261, All H.263 (To communicate with older units) </li></ul></ul><ul><ul><li>The new H.264 (Same quality video using half the bandwidth) </li></ul></ul><ul><li>Audio Standards </li></ul><ul><ul><li>G.711, G.722 </li></ul></ul><ul><ul><li>G.728 </li></ul></ul><ul><li>Security Features </li></ul><ul><ul><li>Passwords </li></ul></ul><ul><ul><li>Encryption (DES, AES) </li></ul></ul><ul><ul><ul><li>H.233, H.234, H.235V3 </li></ul></ul></ul><ul><li>Data Collaboration </li></ul><ul><li>QoS capabilities </li></ul><ul><li>LAN connection at 100 Mbit </li></ul><ul><li>IPv6 compatible </li></ul>
  30. 30. Remote Site Router/LAN switches Requirements <ul><li>Support Video traffic </li></ul><ul><li>Support QoS services </li></ul><ul><ul><li>RSVP, DiffServ & FPC </li></ul></ul><ul><li>Support IPv6 protocol </li></ul><ul><li>LAN connection minimum speed 100Mbit </li></ul><ul><li>LAN switch supports minimum of two queues </li></ul><ul><li>Pass encryption data </li></ul><ul><li>Password protection </li></ul>
  31. 31. Video Capacity Planning Metrics* <ul><li>Video data rate + 20% = Bandwidth required </li></ul><ul><li>No more than 33% of the link capacity should be used for Video Conferencing </li></ul><ul><li>Video + Date should not exceed 75% of the Link capacity </li></ul>*Cisco recommended for IP Video
  32. 32. Capacity Examples for Video 11,250kbps 32 x 384kbps 48 x 256kbps 96 x 128kbps DS-3 (45mbps) 384kbps 1 x 384kbps 1 x 256kbps 3 x 128kbps T1 (1.544mbps) Signaling overhead Max. amount of Video Speed
  33. 33. Network Design
  34. 34. Currently Sites in Virginia Connect Using IP over ATM Gatekeeper proxy DATA Switch Gatekeeper proxy Regional Site Headquarters Site Gatekeeper proxy Regional Site PSTN ISDN Video Infrastructure Gateway M C U Gatekeeper proxy MCU
  35. 35. IPv6 with MPLS is becoming Industry Standard Customer Edge Access: Type 1, 2 3 Private IP Edge Router Private IP Core Access: Type 1, 2, 3 Customer Edge Private IP Edge Router MPLS (IPv6) IP Core Provider Edge FR, ISDN or ATM FR, ISDN or ATM T1, NxT1, T3, OC3 Provider Edge Video MCU/Gateway Gatekeeper Other MPLS networks (Internet 2) T1, NxT1, T3, OC3
  36. 36. Technology Review and Comparison
  37. 37. IP over ATM Issues <ul><li>IP over ATM has the potential to create bottlenecks leading into the core resulting from the lack of segmentation and reassembly (SAR) functional on OC-48 and faster interfaces. </li></ul><ul><li>IP over ATM results in an inefficient use of network bandwidth due to the traditional ATM cell tax. </li></ul><ul><li>The IP differentiated Services (DiffServ) approach to class of service (CoS) does not map well to existing ATM quality of service (QoS) mechanisms. </li></ul><ul><li>TCP/IP is an inherently inefficient protocol to run over an ATM transport, because the transmission of a single ACK requires not one but two ATM cells. </li></ul>
  38. 38. Comparison between IP and MPLS <ul><li>IP forwarding (for Video) lacks path control and deterministic resiliency as with MLPS services. </li></ul><ul><li>MPLS provides rapid failure recovery across IP routing devices. </li></ul><ul><li>MPLS includes traffic engineering (For performance and high availability), quality of service (QoS), resource optimization and security. </li></ul><ul><li>MPLS can reallocate lower traffic class bandwidth resources to provide video services </li></ul><ul><li>MPLS provides FRR (Fast Reroute) which can provide reroute capability in the range of 50ms, and is similar to SONET/SDH technology. </li></ul><ul><li>MPLS can perform an efficient replication within the network, to eliminate duplication traffic over the same link making efficient use of bandwidth. </li></ul><ul><li>Some of the new QoS features supported by MPLS are RSVP-TE (Resource Reservation Protocol traffic engineering and DiffServ-TE) </li></ul><ul><li>MPLS used by US government today </li></ul>
  39. 39. Network Cost Efficiencies and Simplification Realized in MPLS Network Network Cost Efficiencies and Simplification MPLS Network Any-to-Any IP Connectivity (MPLS) Host #1 Host #2 Traditional Frame Relay, ATM or Private Line Networks Host #1 Host #2
  40. 40. <ul><li>Better Quality of service </li></ul><ul><li>Better security services through VPNs </li></ul><ul><li>Moves data packets across the backbone faster and more efficient </li></ul><ul><li>IPv6 can implement multi-cast in the IP protocol unlike IPv4 </li></ul><ul><li>IPv6 has a new class of service called “any cast” which routes data to and from the nearest host. &quot;Shortest Route” </li></ul><ul><li>IP protocol running on Internet 2 backbone </li></ul>Why IPv6?
  41. 41. Why QoS? <ul><li>Controls Latency sensitive data such as Video and Voice </li></ul><ul><li>Admission control – bandwidth control and policy control </li></ul><ul><li>Resource Allocation – Queuing and scheduling – Traffic flows and traffic classes </li></ul><ul><li>Gatekeepers – Network administer – manages the pool of available bandwidth </li></ul><ul><li>Types: </li></ul><ul><ul><li>IP Precedence </li></ul></ul><ul><ul><li>Differentiated services (Diffserv) </li></ul></ul><ul><ul><li>Integrated services (IntservRSVP) </li></ul></ul><ul><li>QoS must be available all the way to the end equipment </li></ul>
  42. 42. Optimized Queuing Using QoS 1 1 Video Traffic 2 2 LAN Traffic 3 3 3 Internet Traffic 2 3 2 1 1 Transmit ring
  43. 43. HIPAA <ul><li>Code of Federal Regulations – 21 CFR-11 </li></ul><ul><li>21 CFR-11 took effect on 08/20/1997 and was intended to permit the widest possible use of electronic technology </li></ul><ul><li>Part 11 requirements for electronic records </li></ul><ul><li>Section 11.10 and 11.30 define controls for closed and open systems </li></ul>

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