Increasing Interoperability, what is the Impact on Reliability? Illustrated with Health care examples

Transcription

1 Illustrated with Health care examples by Gerrit Muller University of South-Eastern Norway-NISE Abstract In all domains the amount of interoperability between systems is increasing. The individual systems tend to be developed and evolve independently. The consequence is that the end-to-end reliability depends on the quality of interoperation of the involved systems. We will discuss the relationship between interoperability and reliability. This will be illustrated by examples from the health care domain. appendix case analysis appendix physical - virtual Distribution interoperability why and where This article or presentation is written as part of the Gaudí project. The Gaudí project philosophy is to improve by obtaining frequent feedback. Frequent feedback is pursued by an open creation process. This document is published as intermediate or nearly mature version to get feedback. Further distribution is allowed as long as the document remains complete and unchanged. status: planned health care case process reference model data and semantics reflection on interoperability

2 From Comp.Risks Dominican fined $25,000 for removing wrong person's appendix <...snip...> The mistake occurred Nov. 14 when two female patients were scheduled for computed tomography, or CT scans, according to the state report.the first patient underwent an appendectomy that very evening because of the CT results. But the surgery was unnecessary. The next day, a radiologist discovered the patient's CT scan was actually that of a second patient. Hospital staff told state inspectors that the technologist had trouble starting the required intravenous line for the first patient and took her out of the CT scan room to complete that task. However, the patient's information had already been entered into the computer system for the CT scan. After the second patient's scan was completed, a radiology technician noted the error, removed the first patient's information and entered information on the second patient. When the first patient's information was deleted from the computer in the scan room, it was not deleted from the computer system used by the radiologist. "This was due to an incompatibility of the software between the two systems," the state report said. <...snip...> from Santa Cruz Sentinel 2 Gerrit Muller IIIRwrongAppendix

3 Figure Of Contents TM appendix case analysis appendix physical - virtual interoperability why and where health care case process reference model data and semantics reflection on interoperability 3 Gerrit Muller IIIRlogo

4 Physical and Virtual World Views standards & legislation DICOM HL7 HIPAA virtual world information product specification 1 product specification 2 product specification 3 CT scanner instantiation 1 instantiation 2 instantiation 3 =? =? =? physical world reality 4 Gerrit Muller IIIRvirtualities

5 Adding Dynamics; the Time Dimension virtual world information product specification 1 standards & legislation product specification 2 product specification 3 specification and design ~ months physical world instantiation 1 instantiation 2 instantiation 3 =? =? =? reality time run-time ~ seconds 5 Gerrit Muller IIIRvirtualitiesDynamic

6 Example: the Appendix Case patient 1 enters CT leaves CT due to problems patient 2 enters CT leaves CT operator handle pat 1 enter name pat 1 handle pat 1 handle pat 2 image handle pat 2 change name to pat 2 time local database name = pat 1 name = pat 2 archive name = pat 1 6 Gerrit Muller IIIRappendixDynamics

7 Figure Of Contents TM appendix case analysis appendix physical - virtual interoperability why and where health care case process reference model data and semantics reflection on interoperability 7 Gerrit Muller IIIRlogoWhyWhere

8 Interoperability is happening everywhere defense health care traffic control entertainment telecommunication administration manufacturing et cetera #ships, #tanks, #planes, #weapons, #soldiers,... #hospitals, #clinical departments, #physicians, #pathologies, #patients,... et cetera et cetera 8 Gerrit Muller IIIRdomains

9 Interoperability Requires Standards human factors interoperability "extremely challenging" data semantics application protocols connectivity data syntax protocols formats, tags e.g. TCP/IP "only engineering" physical media, interfaces cables, connectors,... 9 Gerrit Muller IIIRstandards

10 Challenge... stakeholder A operator stakeholder B radiologist stakeholder C patient system 1 CT scanner system 4 viewer stakeholder E surgeon system 3 RIS system 2 archive system 5 operating theater stakeholder D admin system 5 PC End-to-end performance "emerges" from performance of interoperating systems and humans 10 Gerrit Muller IIIRproblemStatement

11 Reliability Suffers from Poor Interoperability Any mismatch in connectivity or interoperability shows up first as functionality or performance problem and then as intermittent reliability (or safety, security, availability) problem 11 Gerrit Muller IIIRreliability

12 Figure Of Contents TM appendix case analysis appendix physical - virtual interoperability why and where health care case process reference model data and semantics reflection on interoperability 12 Gerrit Muller IIIRlogoHealthCare

13 Health Care Work Flow family doctor consult request report referring physician findings request report nurse, operator interaction radiology department radiologist film legend patient interaction interaction paper or el. form electronic human interaction intense weak image image film 13 Gerrit Muller MICAFrequestFlow

14 Scopes of Interoperability host acquisition reconstruction display MR scanner other examination rooms workstation storage RIS printer PC beamer radiology department workstation archive HIS LIS PC security admin other clinical departments hospital hospital or other clinical center clinicians at home clinicians away clinical experts suppliers patients away patients at home world 14 Gerrit Muller DYOFscopeOfInteroperability

15 Clinical Process Triggers Data and Semantic Changes richness data changes semantic changes surgery clinical review education clinical value time research treatment planning acquire images prepare diagnosis diagnosis report authorise demonstra- tion archive 15 Gerrit Muller IIIRclinicalInfoFlow

16 Example of Semantic Safety Problem false f(x) contour 10 bits pixel value 8 bits pixel value x 16 Gerrit Muller MITORfalseContouring

17 Example of Data Processing Safety Problem tumor> tumor> URF monitor output: fixed size letters at fixed grid for user readability the font-size was determined "intelligently"; causing a dangerous mismatch between text and image EV output: scaleable fonts in graphics overlay 17 Gerrit Muller MITORfontScaling

18 Innovation and Interoperability high innovation rate global standardization takes more than 5 years cardio analyse CT MRI Siemens ACR/NEMA high interoperability bolus chase cardio vascular GE vascular analyse URF DICOM medical imaging Philips RF legend applications product family vendor world standard 18 Gerrit Muller MICAFinformationLayers

19 Figure Of Contents TM appendix case analysis appendix physical - virtual interoperability why and where health care case process reference model data and semantics reflection on interoperability 19 Gerrit Muller IIIRlogoReflection

20 Many Dimensions of Interoperability integrating multiple applications cilinical analysis clinical support administrative financial workflow based on multiple media, networks DVD+RW memory stick memory cards bluetooth 11a/b/g UTMS in multiple languages cultures USA, UK, China, India, Japan, Korea France, Germany Italy, Mexico and multiple standards Dicom HL7 XML delivered by multiple vendors Philips GE Siemens and multiple releases R5 R6.2 R Gerrit Muller DYOFmultiInteroperability

21 Conclusion many small interoperability faults may create huge reliability problems mission accomplished......but did we execute the right mission? to create reliable end-to-end performance we need to understand the dynamic interoperation of many systems and humans 21 Gerrit Muller IIIRconclusions