Category Archives: IT

Designing Hospital IT Infrastructure For Promoting Patient Centered Care

patient-centered-careThis is a re-post of discussion I had on .  You can read it here by clicking this link

When designing an IT system for Hospitals, you would have to consider many factors like
1. Who are main users of the systems
2. What are the legal requirements
3. What are regulatory requirements

(img courtesy : )

4. What are security considerations you have to follow
5. Would the users need access to the systems outside hospitals organizational or IT boundaries
6. How will you protect the privacy of the data you would be storing
7. What kind of redundancy do you need and how are you going to replicate the data
8. Will you be needing to integrate with other 3rd party vendors for example EHR providers and if it is then how do you plan to integrate them. Think in terms of integration issues, data migration/replication/access etc.This should also cover the different types of software/databases you or your organization would be using.

9. How many different systems does your hospital have and what kind of data they are creating/accessing/retrieving and in what format.
10.Also think about the regular IT maintenance tasks you have to follow.
11. Think in terms of the HW reliability and backup plans.
12. What kind of latency is tolerated while doing stuff real time for your users. This will help you plan your network issues.
13. Understanding the load/performance issues of your IT depending on the expected usage will help plan on selecting right infrastructure.

Here is how I would approach : I would build a patient journey template . The moment patient wants to visit your hospital to the moment they walk out . Along the process list all the interactions they will have with your staff and what kind of IT infrastructure you need to support them. 

This should also include what your physicians will need to support the patient like clinical decision support systems.

Next, build the template from the physicians  and/or hospital administration point of view.

Also think about how to monitor the patient remotely and how to process real time alerts and what kind of infrastructure you need for that. For example those alerts or data might be passed to hospital nursing station who would then filter and send it to order .

Do this from the point of view of all users of the system (or stakeholders of the system like patients/nurse/physicians/administration) etc and by the time you are done with this exercise you will have around 6-8 templates.

Now keeping all the templates in front of you, comeup with a top-down template that comprises whole system. If there are multiple systems (in the context of IT) doing the same thing, eliminate/simply them keeping price/features/support/security/privacy/compliance in mind.

You might have to iterate multiple times to build something you can go forward.

Next introduce the hardware required to support the IT systems you selected keeping reliability/costs/power in mind. This will give you a decent understanding of what your datacenter will look like . See if the HW system costs and electricity/cooling costs still makes sense. If not revise and make tradeoffs

Next introduce the connectivity part. What components needs to be on what kind of networks. Wireless/Wired etc. Think of network security here. Figure out a strategy on how you will protect against intruders/hackers/breaches etc…

Since you are hospital, you must be using some latest and greatest surgical equipment and many of them are wired and some are wireless or require different protocols. Plan ahead for these and include this as a part of IT development plan.

Use of ipads or tablets is increasing in hospitals. There might be additional devices your staff will be using . Sort of BYOD (bring your own devices) . So think what kind of mobile device management technology you want to use and how it fits in this picture.

There might be many more, but this is pretty broad picture and this is how I would approach if I were to design/develop patient centered hospital.

Few suggestions:
1. Stick few systems and vendors if possible. This will solve interoperability issues
2. Storage plays a key role. So select right database technology and database vendor. I prefer documented oriented databases.
3. I’m really not sure if you can have open access meeting all stringent legal/compliance/privacy/regulatory req. There will be tradeoffs. Ask your startup what you will be loosing or your patients/staff will be loosing and what you will be gaining.
4. How do you plan to have CMS (content management system ) serving both patients and medical staff. You need 2 CMS systems one where patients can access and other only hospital staff/physicians can access.Its very important from legal/security point of view to separate or have them in network boundaries.
5.Since you want state of art, what kind of login access are you planning to have ? Biometric? They come with their own sets of requirements
6. Same with clinical decision support systems. Collect all the requirements each of dept needs.

Would love to know from readers on how they would approach or design an advanced hospital IT infra with patient centered care in mind…

Cisco Valet router or Fon 2.0N

Cisco Valet router or Fon 2.0N :

by kiran on Aug.02, 2010, under General, Technology

Should I buy “ease of setup” Cisco Valet router or “smart router which can get more things done with ease of setup” aka Fon 2.0N .

I’m not writing a PR for Fon 2.0N nor this is a marketing blog for Fonera. I’m working on home automation on a tighet budget and have been looking at various devices and saw the video from cisco valet routers and after reading through the specifications , I had this question: why buy Cisco Valet routers when you can do the same and get more things done for lesser price . I’m talking about the Fon 2.0N router from Fonera . I’m an happy Fon 2.0N user for over 8 months and the setup is a breeze so it should satisfy the networking newbies as well (defaults works as well ) and can create seperate network for outsiders/guests (meaning no need to share you private wireless SSID/WEP keys). So question is why someone should 150$ for just “ease of setup”.. Fon works on opensource and also downloads torrents, converts 3G to Wifi, is media/print server, can handle youtube/picasa/megaupload/rapidshare . It actually serves large audience including newbies/geeks/students/wireless enthusiasts .

check this link from networkworld newsletter where the author tells that linksys E-series routers from cisco itself does all the above with lesser price tag..Even then, Fon 2.0N should be a better choice.

Looks like Cisco is trying to appeal consumers with “ease of setup” as their pitch…but will they succeed or will this be yet another router from cisco…?

What I have to admit is, I liked the product design and from what I have seen, they seem to have avoided the usage of technical terms including “router” :) and they use wireless hot spots/internet access which helps many users though… Since I haven’t tried the router hands-on and my impression was based on the router specs and videos from cisco, I might be wrong as well. If anyone has hands-on experience , let me know or let me know if I’m missing something

4 things that make me still run Windows OS

My windows XP laptop at work started giving me all sort of headaches and so decided to shift  to Linux despite my IT telling me that they dont provide any support for linux based laptops (ofcourse I’m glad that they allowed me to install another OS) . I have been using linux since RHEL 6.0 and I was confident that I will be able to manage . So while I’m cruising through , there are 4 things that  hit me real hard and is making me run windows XP as virtual machine via virtualbox.

1. IMAP Calendar Plugin : There was no good solution to pull microsoft exchange calendar and do a 2-way synchronization.  Evolution was too slow and Thunderbird with lightning extension doesnt solve. After googling around, found davmail which acts as intermediate gateway between your IMAP mail client and microsoft exchange gateway and does 2 way sync etc. But its still not stable/usable in the production/corp environment.

If Canonical/Ubuntu   instead of   working to shift window indicators like min/max/close to left (in lucid lynx 10.04 ), if they spend few more hours and developed a robust calendar plugin, it would have served 90% of the corp users like me  .  I hope they will consider this in their next releases atleast . BTW, I tried Zimbra desktop and its painfully slow. I dont know if its slow because of the Ajax client or someother reason. It does more than what I need :) It pulls my calendar and also our corporate and IT calendars which I dont care and it really floods my calendar with unnecessary stuff. Other clients/extensions dont do this, so it must be zimbra specific.

2. File synchronization : I’m a big fan of  Microsoft Live Mesh (which runs on azure clouds I guess) and they dont have a linux client.  I have done lot of research/googled around looking for a file synchronization sw which is free , gives more storage space/unlimited folders and is truly cross platform, the closest I found is dropbox, but it doesnt serve my purpose (unlimited folders, same storage space as live mesh etc & is FREE).I  have  different folders which I share between my work/home laptops,my parents  & cousins etc and I want to do the same in linux , but it doesnt have one. Crossover/wine neither works with live mesh.

Ubuntu one seemed promising , but they dont have any intentions of developing a windows client ( probably for the same reason microsoft doesnt develop linux client) .

3. Photo editing software :  I have Nikon D90 and I shoot in RAW (NEF). I use ViewNX/CaptureNX2/ColorFx/NoiseNinja and couple of other SW for slideshow etc.  I have a whole workflow setup using these SW. Sadly, none of these have linux version. I wish Nikon recognizes there is decent size of linux users for them to develop linux versions. The closest program is dcraw/GIMP , but there are lotof reason why I cannot shift to them yet (probably will explain in another post). Again, tried Crossover/wine neither works.

4. Office apps :  I prepare powerpoints/Xls all the time and with lot of customers shifting to 2007/2010 version of Microsoft Office, I received and send files with pptx/xlsx extension. There are 2 alternatives I found for handling this in linux. One is openoffice 3.x from Oracle and another  is Softmaker 2010 . While  both can handle docx , only openoffice can handle pptx/xlsx extensions. I wish if Softmaker had this already and its worth every penny to buy their solution. Keep in mind, we never know when Oracle will stop releasing openoffice as free alternative and this makes SoftMaker as the only solution available in linux. I installed their linux2010 beta version and it worked out fine and never had any single issue with the docx or doc/ppt/xls  extensions. My beta expired, but when they make pptx/xlsx, I will revisit their soln, but for now, I have to live with slow,not so attractive looking openoffice (It works though!! so, cant really complain hard)

My friends say this is reason why I have to shift to mac, but sorry!! I dont have budget for buying those pricey macs and later I have to buy all the apps and no free/opensource versions.