Service Delivery für ehealth Applications

Transcription

1 Service Delivery für ehealth Applications Martin Staemmler University of Applied Sciences Stralsund, Germany

2 Contents Service Delivery for e-health Applications e-health Service Lifecycle Organisation and Governance Service Delivery based on a multi-layer approach Results and Discussion Summary

3 e-health Service Lifecycle e-health Service Lifecycle need, idea, proposal grant/financial support call for tender, contracts months... year plan, development implementation, customization time limited warranty What is required, what has to be provided? e-health service deceased routine operation sustainable operation continuous service years - adapt to new user needs, train users - maintain, update systems, change management - provide services (SLA, hotline, central / on-site support,...) time but not only IT-services what about organisation and governance

4 e-health structures Organisation and Governance point-to-point Images / reports bilateral: low organisational / governance demands hub-to-spoke multilateral: - potential domination at the hub - limited spoke spoke cooperation extending the view: scaling it up

5 Organisation and Governance e-health structures multiple clusters cluster 1 - cluster reflect local / regional service provision / cooperation - cluster cluster cooperation gets difficult, potential competition - s at cluster borders face a problem - overall higher cost - maintenance and administration per cluster - interoperability cluster 2 cluster 3 assigning responsibilities in a multi-layer approach

6 Multi-layer Approach layer contents example related to teleradiology e-health structures organisation, medical, clinical weekend or night shift, business process cooperation remotely controlled exams 3LGM² - Three Layer Graph-based Meta-Model (Winter et. al. 2003) domain enterprise function, second opinion, referral, entity types online consultation logical tool application DICOM and Web-Services components for image / report handling physical tool infrastructure IT-systems, server, network components IT-layers as conceived by the 3LGM² amendment: organisational / business process layer

7 From theory to practise The challange: State-wide e-health services for - teleradiology - second opinion - emergency consultation - remotely controlled examination - teleconsultation Wismar Nordwest- Mecklenburg Schwerin Parchim Ludwigslust Mecklenburg Vorpommern - lowest population density in Germany (71 persons/km² on average) - low number of s at a distance (ca. 50 km) Rostock Bad Doberan Güstrow Müritz Demmin Rügen Stralsund Nordvorpommern Greifswald Mecklenburg-Vorpommern Neubrandenburg Mecklenburg- Strelitz Ostvorpommern Uecker- Randow Objectives: - sustainable e-health services (for at least 3 years) - accessible for s and practises - extensible for further services - compliant to regulations and data protection laws grant of the Ministry for Social Affairs and Health, taken by the Institut für Angewandte Informatik an der FH-Stralsund

8 The concept IT-view - centralized infrastructure shared by all low cost - hub-to-spoke topology - data transfer (DICOM / Web) infrastructure - - single interface to each cooperation view - s with equal rights - mutual cooperation - change in cooperation easily accomplished

9 The implementation physical tool layer redundant provider connection Access Router 1 Access Router 2 Switch 1 Layer 2 Switch 2 Layer 2 Vmware ESX-1 Host Vmware ESX-2 Host Controller A Controller B iscsi SAN Legend network: storage, HW-virtualization, remote maintenance Vmware VC-Center infrastructure for high-availibility redundant network connection and HW secure connection to s (VPN based)

10 The implementation logical tool layer redundant provider connection Access Access Router 1 site-to-site VPN-tunnel Switch 1 Layer 2 DICOM-Services and -Objects Access Access Switch 2 http access to pseudonymized data Legend network: virtual machines, applications Vmware ESX-1 Host Vmware ESX-2 Host Vmware VC-Center DICOM Forward virtuelle Pseudonymization Maschinen DICOM Webserver Controller A Controller B Vol A iscsi SAN Vol B DICOM Forward ( infrastructure ) Pseudonymisation (de-identify DICOM objects) DICOM Webserver (DICOM / JPEG access via Internet)

11 The implementation domain layer Infrastructure clinical services - second opinion - emergency consultation - remotely controlled examination è services for business process support in addition services for surveillance and business continuity

12 The implementation domain domain - surveillance services using Nagios: infrastruture network level ( critical ) and application level ( warning ) - quality control compliant to DIN : Java application TR-DIN for transfer times of reference data sets 350s 300s days è services for infrastructural surveillance end-to-end quality control average 303s 223 kbyte/s 1784 kbit/s

13 The implementation business processes - contracts and agreements - fees for second opinion and consultation - fees for remotely controlled examinations - support for regulatory approval with - data and IT security analysis - risk analyis and mitigation plan - contractual framework for - data management by third parties - service level agreement - hotline, training - contractual framework for - data management by third parties provider provider è level assignment: business process s IT-layers contracted provider

14 The results sucessful operation sind 6/ s / 2 practises - ca images / month - ca image series / month - > 100 GByte / month - multiple changes in coopera- tion and partnership difficulties and problems - technological (HW failure) - application (transfer syntax) - marketing, establishing new Nordwest- Mecklenburg Ludwigslust Grevesmühlen Wismar Schwerin Hagenow Parchim Ludwigslust cooperation scenarios, state-wide coverage Rostock Bad Doberan Güstrow Teterow Güstrow Waren Plau am See Stralsund Nordvorpommern Müritz Demmin Neustrelitz Rügen Greifswald Mecklenburg- Strelitz Karlsburg Ostvorpommern Neubrandenburg Uecker- Randow

15 Conclusion - 4 layer approach allows for different assignment of repsonsibilities - central infrastructure assures scalibility - an independent service provisioning for the IT-layers guarantees - equal rights and access for each partner - cost-effective operation, maintainance, hotline and training - reduction of efforts for regulatory approval / - s are releaved from keeping up multiple separate connections - improved access to healthcare services for patients Outlook - comparable approach for nation-wide cooperation for managing trauma patients (emeergency consultation, second opinion, transfer decision) - up to 800 s organized in 55 so-called trauma networks - pilots starting end of October routine operation from January 2012

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