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Diploma in Health Informatics Networks Mark Gleeson gleesoma_at_tcd.ie Distributed Systems Group, Trinity College, Dublin 20.02.2010 – PowerPoint PPT presentation

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Title: Mark Gleeson


1
Diploma in Health Informatics Networks
  • Mark Gleeson
  • gleesoma_at_tcd.ie
  • Distributed Systems Group,
  • Trinity College, Dublin
  • 20.02.2010

2
Objectives
  • Understand some network terminology- enough to be
    able to read further on the topic.
  • Understand some issues of network design.
  • Issues concerning application of networking to
    health.
  • Emphasis on practical aspects

3
Introduction to Networks
  1. Introduction
  2. Network characteristics
  3. Network Software
  4. Network Hardware
  5. Security
  6. Internet and the World Wide Web
  7. Telemedicine

4
Section 1 Introduction - Network Basics
  • In the 20th Century developments include
  • worldwide telephone networks
  • the invention of television and radio
  • the unprecedented growth of the computer
  • launching of communication satellites
  • The convergence of computers and communications
    is very significant.
  • Initially computers were highly centralized,
    usually within a single room.
  • Now lots of small independent computers
    communicating to do a job. These are called
    Computer Networks

5
What is a Computer Network? (1/2)
  • An interconnected collection of computers which
    are
  • Co-operative
  • Co-operative action is required between the
    components
  • Autonomous
  • All components are capable of independent action
  • Any resource is capable of refusing requests
  • Mutually Suspicious
  • Components verify requests

6
What is a Computer Network? (2/2)
  • Any computer connected to a network is known as a
    host.
  • Local host
  • Your own computer
  • Remote host
  • The computer elsewhere you are in contact with
  • There are hardware and software aspects to
    computer networks

7
(Digital) Bandwidth
  • The amount of data per second a communications
    link can carry
  • Typically referred to in bits per second
  • Note 1 byte 8 bits
  • The actual amount of useful data you can send
    will be less than the actual capacity
  • Overheads for
  • Addressing
  • Routing
  • Error detection
  • Medium access

8
Latency / Delay
  • Measure of the delay from sending a piece of data
    or request until it is processed at the
    destination
  • Exceptionally important for
  • Video and audio
  • Voice over IP, Skype, Video conferencing
  • Interactive systems
  • Inquiry based systems patent records
  • Booking systems
  • Needs careful investigation to determine the weak
    points
  • Is it the network or the computer?

9
Section 2 - Network characteristics
  • What Are Networks
  • Network Types and Topologies
  • Communication concepts
  • Basic Message Types

10
What are Networks?
  • Tanenbaums definition
  • "A network is an interconnected collection of
    autonomous computers"

11
Types of Networks
  • Bus-based networks
  • Original Ethernet (802.3)
  • Star-based networks
  • Switched (Modern) Ethernet (802.3ab)
  • Ring-based networks
  • FDDI
  • Token Ring (802.5)
  • Wireless networks
  • WiFi (802.11a/b/g/n), Bluetooth, Hyperlan IrDA,
    WiMax, GSM, EDGE,3G

12
LAN Topologies
13
Types of Networks
  • Classification based on diameter

1 m System
10 m Room
100 m Building
1 km Campus
10 km City
100 km Country
1,000 km Continent
10,000 km Planet
Multi-processor
PAN (Personal Area Networks)
LAN (Local Area Networks)
MAN (Metropolitan Area Networks)
WAN (Wide Area Networks)
The Internet
14
Local-Area Networks (LANs)
Figure is courtesy of B. Forouzan
15
Wide-Area Networks (WANs)
  • Latency
  • Administration/Jurisdiction

Figure is courtesy of B. Forouzan
16
Simplex
Figure is courtesy of B. Forouzan
17
Duplex
Half-Duplex
Full-Duplex
Figure is courtesy of B. Forouzan
18
Point-to-Point Multipoint
Figure is courtesy of B. Forouzan
19
Basic Message Types
  • Three basic message types
  • 1. Unicast - one sender to one receiver

Sender
Receiver
20
Basic Message Types
  • Three basic message types
  • 1. Unicast - one sender and one receiver
  • 2. Broadcast - one sender, everybody receives
  • Broadcast addresses
  • network ID
  • all bits of host ID set
  • e.g. 134.226.255.255

Sender
21
Basic Message Types
  • Three basic message types
  • Unicast - one sender and one receive
  • Broadcast - one sender, everybody receives
  • Multicast - one sender and a group of receivers

Sender
Receivers
22
Section 3 - Network Software
  • Originally hardware matters were the main focus
    when building networks the software was an
    afterthought.
  • Key Network Software concepts
  • Layers
  • Protocols
  • Interfaces
  • Services

23
Layers
  • The idea of introducing layers of software
    reduces the design complexity. It divides the
    large problem into smaller ones.
  • The number, name, contents and function of each
    layer vary from network to network.
  • However for each network the idea is that one
    layer offers something to a second layer without
    the second layer knowing how the first layer is
    implemented.

24
Protocols
  • Provided two networks adhere to the same set of
    layers layer n on one machine can
    (virtually)communicate with layer n on another
    machine.
  • The rules and conventions used in this
    conversation are known as the layer n protocol.
  • A protocol is an agreement between the
    communicating parties as to how the communication
    proceeds.

25
Design Issues for the layers
  • Addressing identifying senders and receivers.
  • Data transfer rules- Simplex, half duplex, Full
    duplex.
  • Error control - Agree on a protocol.
    Implementation of the protocol.
  • Order of the messages
  • Fast sender swamping a slow receiver - feedback
    or an agreed size is required.
  • Length of messages - Too large/too small.
  • Multiplexing - use the channel for multiple
    unrelated conversations.
  • Multiple routes - How to choose the route.
    Physical and logical choices.

26
Reference Models
  • Two reference models are considered
  • The OSI (Open Systems Interconnection) Reference
    Model initiated in the 1970s matured in the late
    1980s and early 1990s
  • TCP/IP initiated through work carried out in the
    late 1960s, matured and adopted in early 1990s

27
Open Systems Interconnetion Model
  • Developed by the International Standards
    Organisation (ISO)
  • The model deals with connecting open systems i.e.
    systems that are open for communication with
    other systems.

28
Network Protocols
  • Common language on the network
  • Define network components interactions
  • Actions/requests
  • Responses
  • Defined in standards
  • ISO Standards
  • IEEE Standards (mainly at physical and mac)
  • ITU Recommendations
  • IETF Request For Comments (RFC)

29
Communication between End-Systems
Figure is courtesy of B. Forouzan
30
Data Link Layer
Figure is courtesy of B. Forouzan
31
Duties of the Data Link Layer
The data link layer is responsible for
transmitting frames from one node to the next on
the same network.
Figure is courtesy of B. Forouzan
32
Packetizing Addressing
  • Packetizing Encapsulating data in frame or cell
    i.e. adding header and trailer
  • Addressing Determining the address of the next
    hop (LANs) or the virtual circuit address (WANs)

Figure is courtesy of B. Forouzan
33
Medium Access Control
  • Control the access to a shared medium to prevent
    conflicts and collisions
  • Aloha
  • CSMA/CD or CSMA/CA

Figure is courtesy of B. Forouzan
34
Analogy Point-to-Point Communication
  • Simple Synchronization

Phone conversation
35
Analogy Shared Medium
  • Synchronisation is more complex

36
Asynchronous Systems
  • Round robin
  • Good if many stations have data to transmit over
    extended period
  • Reservation
  • Good for stream traffic e.g audio, video
  • Contention
  • Good for bursty traffic
  • All stations contend for time
  • Distributed
  • Simple to implement
  • Efficient under moderate load
  • Tend to collapse under heavy load

37
Multiple-Access Protocols
Figure is courtesy of B. Forouzan
38
LAN Technologies - Ethernet
  • Developed by Metcalfe 1972/3 while at Xerox PARC
  • Standards in 1978, 1995, 1998
  • Types of Ethernet
  • Original Ethernet
  • Switched Ethernet
  • Fast Ethernet
  • Gigabit Ethernet
  • Medium Access Control
  • CSMA/CD
  • IEEE 802.2 Logical Link Control

Metcalfes Ethernet sketch
39
Ethernet Addresses The MAC Address
  • A unique 48 bit long number
  • Eg 00A04A211913
  • Types of Addresses
  • Unicast delivered to one station
  • Multicast delivered to a set of stations
  • 01-80-C2-00-00-00 Spanning tree (for bridges)
  • 03-00-00-00-00-01 NETBIOS
  • Broadcast delivered to all stations
  • FF-FF-FF-FF-FF-FF

vendor-specific
40
Full-duplex Switched Ethernet
  • No collisions
  • One line to send
  • One line to transmit

Figure is courtesy of B. Forouzan
41
Switches in Comms Rooms
42
Wireless (1/2)
  • IEEE 802.11 standard of 1997 started the
    revolution with 2Mbps top speed
  • Now on 802.11g with 54Mbps
  • 802.11n to promise 150Mbps
  • Referred by some as Wireless Ethernet
  • Shares significant similarities with original bus
    style Ethernet
  • Reliability and Performance much less than wired
    network
  • Current max speed 54Mbps shared by all on same
    base station
  • Prone to interference and poor reception
  • Speed drops under poor conditions to reduce
    errors
  • Range 100m in open much less in office situation

43
Wireless (2/2)
  • Star like network
  • Your laptop talks to a access point which
    connects to your wired network
  • Laptop which move been access points to keep the
    strongest signal
  • Uses the Industrial, Medical and Scientific Band
  • No licence needed
  • Healthcare staff should be aware this shared use
    and verify before installation that there wont
    be a conflict
  • Advantages
  • No need to install ethernet cabling everywhere
  • Network access everywhere in range

44
The Network Layer
  • The Network Layer is concerned with controlling
    the operation of the subnet. A key design issue
    is determining how packets are routed from source
    to destination. They can be static, dynamic.
  • Example issues to be agreed when building this
    layer
  • Routing mechanisms
  • How is subnet congestion to be dealt with
  • How are costings included- national boundaries
  • Addressing mechanisms.
  • In broadcast networks the network layer may be
    very thin or non-existent.

45
Position of the Network Layer
  • Sends frames through data link layer
  • Accepts data from transport layer

46
Duties of Network Layer
  • Problems the Network Layer needs to address
  • Transfer over networks of various architectures
  • Addressing on a global scale
  • Adjusting to maximum transmission units
  • Hop-to-hop delivery provided by data link layer
  • Transfer of packets between end systems provided
    by network layer

47
Switching in the Internet
  • Connection-oriented communication
  • Connection exists between sender and receiver for
    duration of communication
  • Connection-less communication
  • Data between sender and receiver

48
Yet another Layer ?!?
  • Transport Layer TCP
  • Why should you care?
  • Applications use TCP as main communication
    mechanism
  • HTTP
  • Remote procedure calls (RPC)
  • File Transfer

49
Network Layer vs Transport Layer
Network Layer Transport Layer
Communication between two nodes Communication between processes
Best effort delivery Ordered, guaranteed delivery
Connection-less communication Connection-oriented communication
50
Transport Layer
  • Process-to-Process Delivery

51
IP Addresses Port Numbers
  • IP Addresses determine the host
  • Port Numbers determine the application

52
Communication at Transport Layer
  • Comms at Transport Layer from port to port
  • IP implementation multiplexes depending on
    protocol field in IP header

53
Section 4 - Network Hardware
  • Connecting hosts and networks require hardware
    devices which include..
  • Networking and Internetworking Devices
  • Repeaters
  • Bridges
  • Hubs
  • Switches
  • Routers

54
Networking and Internetworking Devices
  • These devices can be divided into 3 categories
  • Repeaters,
  • Bridges,
  • Routers and Gateways.
  • Repeaters and Bridges are used at the Networking
    of hosts
  • Routers and Gateways are used for Internetworking

55
Repeaters and Bridges
  • Repeaters
  • Operate at the physical layer. They regenerate
    signals.
  • Bridges
  • Operate at the physical and data link layers.
  • They are used to divide a network into segments
    and can control traffic flow and are useful for
    securing the network.
  • They can also regenerate signals.

56
What is a Switch
  • A layer 2 device Data Link Layer
  • Builds a table of the MAC addresses of devices
    attached on each port
  • Store and Forward
  • Switch receives a packet
  • Verifies it is error free
  • Looks at its destination MAC
  • Sends the packet on
  • Cut Through
  • Starts to forward packet once it reads the
    destination address
  • No error checking
  • Improved performance

Photo thanks to Cisco Systems
57
What is a Router
  • A layer 3 device
  • Works at physical, data link and network layers
    e.g. Internet Protocol (IP) level
  • Is a bridge between a number of distinct networks
  • Example your internal network and the internet
    beyond
  • Range from simple devices
  • ADSL router for home users
  • To
  • Extremely complex enterprise level
  • Looks at the destination of each IP packet and
    determines where it would be sent on for its next
    hop
  • Tries to select the best route

58
Example Sizes of Medical Images
59
Uses of Networks in Healthcare?
  • Communicating into/out of and between hospitals
  • Paging Staff
  • Networking instrumentation
  • Maintenance of instrumentation
  • To aid communication
  • Professional to professional.
  • Professional to patient.
  • Patient to patient.
  • Sharing Information of all types

60
Section 5 - Security
  • Secrecy
  • Keeping information out of the hands of
    unauthorised users.
  • Authentication
  • Making sure you are talking to the right person.
  • Data Integrity control
  • Making sure the data is correct.
  • Security effects each layer in the network
    design.

61
No Network Is Secure
  • Original Ethernet
  • Every host on the bus could see and capture every
    transmission made
  • The physical network itself cannot be considered
    to be secure
  • Wires can be tapped
  • Wireless communications available to all within
    range with a suitable receiver
  • Need to trade off the strength of security with
    the practicality of the measures
  • Users when faced with a complex process may
    attempt to undermine the system
  • Sharing of passwords or not logging out

62
Wireless Networks
  • Extremely vulnerable to attack
  • Anyone with a suitable radio can listen
  • IEEE 802.11 originally used a 40 bit WEP key
  • Shared encryption key by all users of the network
  • Later versions supported a 104 bit key
  • Proved to be very easy to crack in both versions
  •  WiFi Protected Access (WPA/WPA2)
  • Based on 802.11i standard
  • EAP extensible Authentication Protocol
  • Authentication framework not a protocol
  • Can integrate with existing authentication
    systems
  • 802.1x

63
  • Best practice in Network Management is to heavily
    restrict access to external users or to block it
    totally
  • Avoid potential security issues
  • Protect from hackers
  • What of legitimate users
  • People who work at other locations
  • Particularly relevant concerns in the Healthcare
    Domain

64
VPN Virtual Private Network
  • Not strictly a security solution
  • Two implementations
  • Connecting you to a remote network
  • A network within a network
  • Allows you to access resources on another network
    as if you where connected directly
  • A secure encrypted tunnel between your computer
    and others on the same network
  • Typically requires a dedicated VPN box on the
    office end network to provide the service

65
VPN - Connecting you to a remote network
  • Ideal for a single user
  • Work from home, on the road, other institution
  • User needs VPN client software
  • Setup can be complex for users
  • Need to implicitly log in to access the network
  • Not transparent
  • Potential security risk if users computer is
    breeched
  • Hacker may have access into network

66
Methods of Attack (1/3)
  • Impersonation
  • Using someone elses password or a terminal that
    is already logged on.
  • Active wire-tapping
  • Connecting a device(authorised/unauthorised) to a
    communication link to obtain access to data
    through the generation of false messages.
  • Passive wire-tapping
  • Monitoring data coming over a communication link.
  • Traffic flow analysis
  • Analysing the frequency of data traffic, seeing
    which data is encrypted and which is not.
  • Eavesdropping
  • interception of information

67
Methods of Attack (2/3)
  • Replay
  • Play back a recording of a communication
  • Routing Table modification
  • Sending messages to the wrong address or multiple
    addresses.
  • Audit Trail Information Modification
  • To cover up an attack.
  • Operational Staff Table Modification
  • To change access rights.
  • Bogus Frame insert
  • Inserting bogus information as a frame.
  • Data Portion Modification
  • Modify the data portion of a message.
  • Viruses

68
Methods of Attack (3/3)
  • Sequencing Information Modification
  • Change the order of the pieces of information.
  • Message Deletion
  • Removing the message completely
  • Protocol Control Information modification
  • To send data to a different location.
  • Misuse of resources
  • Swamping communication lines Denial of service
  • Interruption of power supply
  • Denial of service
  • Malicious physical damage
  • Denial of service
  • Theft
  • Parts of computers or entire computers could be
    stolen. Confidentiality issues arise.

69
Disposal of computer hardware
  • You typically contract a third party to securely
    shred paperwork, but you skip a used computer.
  • Computer can store a virtually unlimited amount
    of data in a easy to search format
  • Serious privacy issues concerning medical records
  • Computer may have no confidential information
    but!
  • Usernames, passwords, security certificates and
    so on for networked information may be stored on
    the computer, thus allowing access
  • Essential the contents of the hard disk be wiped
    not just deleted
  • Most operating systems have the ability to do
    this
  • Or remove hard drive and use a sledgehammer

70
Section 6 - The Internet and the World Wide Web
  • Addressing and Domain Names
  • Who is in charge
  • Relationship between IP address and hostnames
  • Arrangements for .ie domains

71
Internet Addressing and Domain Names
  • To be able to identify a host on the
    internetwork, each host is assigned an address
  • Internet Protocol address.
  • Addresses are assigned in a delegated manner.
  • The Internet Corporation for Assigned Names and
    Numbers (ICANN) has responsibility for Internet
    Protocol (IP) address space allocation
  • ICANN are the top body. They comprise IANA
    http//www.iana.org/

72
Internet Addressing and Domain Names
  • Users are assigned IP addresses by Internet
    service providers (ISPs). ISPs obtain allocations
    of IP addresses from a local Internet registry
    (LIR) or national Internet registry (NIR), or
    from their appropriate Regional Internet Registry
    (RIR)
  • APNIC (Asia Pacific Network Information Centre) -
    Asia/Pacific Region
  • ARIN (American Registry for Internet Numbers) -
    North America and Sub-Sahara Africa
  • LACNIC (Regional Latin-American and Caribbean IP
    Address Registry) Latin America and some
    Caribbean Islands
  • RIPE NCC (Réseaux IP Européens) - Europe, the
    Middle East, Central Asia, and African countries
    located north of the equator

73
Internet Addressing and Domain Names
  • The .org domain is operated by Public Interest
    Registry. It is intended to serve the non
    commercial community, but all are eligible to
    register within .org.
  • The .com domain is intended to serve the
    commercial community.
  • The .gov domain is reserved exclusively for the
    United States Government. It is operated by the
    US General Services Administration.
  • The .edu domain is reserved for postsecondary
    institutions accredited by an agency on the U.S.
    Department of Education's list of Nationally
    Recognized Accrediting Agencies and is registered
    only through Educause.

74
IP and Internet Addressing
  • Currently there are two types of Internet
    Protocol (IP) addresses in active use
  • IP version 4 (IPv4) and IP version 6 (IPv6).
  • IPv4 is still the most commonly used version.
  • IPv4 addresses are 32-bit numbers often expressed
    as 4 octets in "dotted decimal" notation (for
    example, 192.0.32.67).
  • Deployment of the IPv6 protocol began in 1999.
    IPv6 addresses are 128-bit numbers and are
    conventionally expressed using hexadecimal
    strings (for example, 10800008800200C417A).

75
IP Addresses
  • 32-bit number in IPv4
  • 4,294,967,296 addresses
  • IP addresses are unique and universal
  • with some exceptions
  • Dotted decimal notation
  • Bytes of binary notation represented as decimal
    separated by dot
  • Internet hosts have both IP addresses and
    hostnames
  • wilde.cs.tcd.ie 134.226.32.55

76
Mapping Domain Names
  • Hostname - wilde.cs.tcd.ie
  • Internet Address - 134.226.32.55
  • How does a machine translate a fully qualified
    hostname into an IP address?
  • It consults its nearest Domain Name Server (DNS)
  • The local Nameserver knows the mappings for local
    machines and
  • At least one root nameserver which knows all
    nameservers for the top level domains.

77
.ie domains
  • All registrations handled by the IE Domain
    Registry - www.iedr.ie
  • Was based in UCD until 2000, now a independent
    non profit making body
  • You are required to prove a connection to the
    domain name sought
  • 4th Feb 2010
  • Total number of domains 137,661
  • In Jan 1995
  • Total domains 347

78
Section 7 Telemedicine
  • Telemedicine is the rapid access to shared and
    remote medical expertise by means of
    telecommunications and information technologies,
    no matter where the patient or the relevant
    information is located. (CEC 1993)
  • Telemedicine has been defined in General Terms as
    Medicine practiced at a distance and as such,
    it encompasses both diagnosis and treatment, as
    well as medical education. (Journal of
    Telemedicine and Telecare, 1995)

79
Definitions
  • Telemedicine is the delivery of healthcare
    services, where distance is a critical factor, by
    all healthcare professionals using information
    and communications technologies for the exchange
    of valid information for diagnosis, treatment and
    prevention of disease and injuries, research and
    evaluation, and for the continuing education of
    healthcare providers, all in the interests of
    advancing the health of individuals and their
    communities. (World Health Organisation 1998)

80
Telemedicine
  • Many different definitions of Telemedicine. Be
    aware of this.
  • Telemedicine is a process not a technology. Can
    be applied to many different domains.
  • Can be used for patient/clinician,
    patient/patient, clinician/clinician
    communication.
  • Can be used to support training
  • As with all applications of technology,
    appropriateness is the key. The application
    should be clinically driven.

81
Characteristics of Telemedicine systems
  • Interaction style- Real Time, Store and Forward.
  • Data types- Text, Images, Sound, Video
  • Equipment
  • Action Direct Intervention, Advice
  • Patient numbers one patient, multiple patients
  • Duration

82
Some Advantages and Obstacles of Telemedicine
  • Advantages
  • Improved use of resources
  • Continuing professional development
  • Reduces unnecessary patient transfers
  • Facilitates homecare for the elderly and the
    chronically ill
  • Equitable access to care!
  • Links doctors with remote centres of excellence
  • Wireless links can be used in cases of lack of
    infrastructure
  • Obstacles
  • Patient and professional dissatisfaction in some
    specialities
  • Lack of standards
  • Security issues
  • Legal and ethical implications
  • Equipment failure
  • Lack of protocols of care for these new types of
    interactions.

83
History
  • Pre-electronic telemedicine
  • Accounts from the middle ages of a physician
    examining a patient for plague- the patient and
    the physician were on opposite sides of the
    river.
  • Prescribing by post was practised well before
    national postal systems were in place.
  • Electronic telemedicine
  • Telegraphy- equipment was developed to send an
    X-ray
  • Telephony- voice communication, computer networks
  • Radio- initially by morse code and later by
    voice.
  • Television- closed circuit television, video
    conferencing
  • Wireless communication- use of mobile phone
    technologies and satellites.

84
Research
  • Why is Telemedicine not in widespread use?
  • The technologies exist but the organisational and
    personal problems exist.
  • Lots of funding has been allocated and has been
    spent on projects analysing, testing and
    evaluating technical requirements.
  • More projects/research should be funded to show
    cost-effectiveness and evaluation of new
    Telemedicine applications.

85
Ethical and Legal Issues
  • Some projects in Europe have looked at certain
    aspects of this area (SEISMED, ISHTAR,
    TrustHealth and SIREN). They have mainly been
    concerned with the security and confidentiality.
  • More work needs to be done to research other
    aspects including accountability, responsibility,
    licensure, reimbursement, intellectual property
    rights, changes in consultation and referral
    patterns, defining the owner of patients,
    defining geographical catchment areas.

86
Economics/Evaluation
  • Need to compare the new technology with an
    alternative way of working. What is the system
    costing at the moment?
  • How to asses the cost of the new technology-
    equipment, software, installation, training,
    maintenance, legal, utilisation rates.
  • How do we asses the benefits- people getting
    well, shorter stays in hospital, less time spent
    with the expert, patient not having to travel,
    expertise experienced by the remote healthcare
    professional.
  • Methods are required if economic evaluation is to
    take place. Care should be taken when comparing
    costs across, domains, environments and time.

87
Practice
  • Teleradiology
  • Telepathology
  • Teledermatology
  • Telecardiology
  • Telepsychiatry
  • Teleorthopaedics
  • Surgical Consultations
  • TeleENT
  • Tele-EEG
  • Minor Injuries
  • Mobile Telemedicine
  • Maritime Telemedicine
  • Teleopthamology
  • Home Care
  • Telephone Services
  • Education
  • Telesurgery

88
Using Networks to Provide Equality of Care?
  • Network Infrastructures- Network hardware and
    network software
  • Network users
  • Software applications
  • Legislation
  • Standards
  • Delivering care (need experts on site)

89
Network Infrastructure
  • In order to avail of networked healthcare a
    network infrastructure must be in place.
  • This infrastructure requires an initial
    investment, maintenance investment and investment
    to keep it up to date
  • It is hard to see therefore even at the
    technology end how equality of care can be
    achieved.

90
Network Users
  • In various countries, regions and hospitals
    different levels of technical skill exist.
  • If we assume that all places have the same
    network infrastructure it still doesnt allow us
    achieve equality of care

91
Software applications
  • On top of the network infrastructure software
    applications.
  • Depending on economics, skill and awareness of
    users differences can exist.
  • Not everyone will be aware of the software
    applications that exist and the implications of
    choosing particular software e.g. from standards
    point of view

92
Legislation
  • Be aware that using networks allows the user to
    bypass physical boundaries thus enabling a
    specialist in Ireland to communicate with a
    patient in England. There are legal implications
    to this that havent been addressed.
  • Equality of care may not be possible due to these
    legalities. The closer you live to the specialist
    the better.

93
Standards
  • In order to have healthcare delivered to all
    areas standards are required.
  • Communication standards
  • Coding standards e.g. for diagnosing,
    prescribing.
  • Data set format standards
  • Semantic standards
  • If all areas do not agree to the standards then
    equality of care is not possible.

94
Experts on site
  • Even if all the infrastructure, software
    applications, standards, legislation and skills
    are equal is it possible to get equality of care?
  • Remember healthcare is ultimately delivered by
    human experts.
  • Technology can only be used to support the
    current processes of healthcare delivery or to
    make new processes possible.
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