Emerging Role of Content Delivery Networks in Healthcare IT

09Oct09

Yesterday was a busy meeting day for me (9 meetings in 8 hours) and we all know that on days like those your brain can get a little mushy. But my last meeting yesterday was one of the best one’s I’ve had lately because it revealed to me just how important strategic planning can be around technology infrastructure and network decisions; especially as they relate to sharing vast amounts of data with physicians across the country.

Content delivery networks (CDNs) are widely used by companies that understand them. But remarkably many in the trenches of healthcare IT (technologists and legal advisors) either don’t understand how a CDN can improve the user experience, ultimately lower costs, and improve patient care, or worse, fear embracing the use of this type of network because of possible security issues relating to protected health information (PHI).

A content delivery network (CDN) is a system of computers containing copies of data, placed at various points in a network so as to maximize bandwidth for access to the data from clients throughout the network. A client accesses a copy of the data near to the client, as opposed to all clients accessing the same central server, thereby causing a bottleneck near that server.

Imagine the scenario of a radiology imaging company wanting to serve X-ray images of a patient in a secure manner with the patient’s doctor located on the other side of the country. If that company were to place this content in a single data warehouse on the West Coast, and the doctor tries to access that information from the East Coast, common internet traffic may delay the feed significantly enough to make it inconvenient for that doctor to even attempt accessing that image. This can be a real deal breaker if the doctor needs real time access to the image, or needs to interact with that image in any way.

Policy makers in Washington DC are beginning to understand the emerging role of CDNs, even as they strengthen regulations surrounding PHI access. I’m encouraged by their recognition that security is a function of budget and that “Imposing ‘nuclear secrets’ security technology on a small doctor’s office is not feasible.”

John D. Halamka, MD, MS, Chief Information Officer of Beth Israel Deaconess Medical Center, Chief Information Officer at Harvard Medical School, Chairman of the New England Healthcare Exchange Network (NEHEN), Chair of the US Healthcare Information Technology Standards Panel (HITSP)/Co-Chair of the HIT Standards Committee, and a practicing Emergency Physician elaborates on what the HIT Standards Committee is debating as it relates to enhancing security for all stakeholders without creating a heavy implementation burden in his blog posted on October 7, 2009.

He states that:

1. All data moving between organizations must be encrypted over the wire. Data moving in an organization’s data center should be encrypted if open wireless networks could lead to the compromise of data as it is moved inside the organization. There is no need to encrypt the data twice — if an organization implements appropriate secure wireless protocols such as WPA Enterprise, the data can be sent within the organization unencrypted.
2. All data at rest on mobile devices must be encrypted. Encrypting all databases and storage systems within an organization’s data center would create a burden. But ensuring that devices such as laptops and USB drives, which can be stolen, encrypt patient-identified data makes sense and is part of new regulations such as Massachusetts’ data protection law.

As more healthcare information goes digital, delivery of that content will require that the data warehousing model commonly used by healthcare IT change to be decentralized and copied to multiple places for delivery-on-demand.

I have a few predictions:

• Encryption, security policies, and regulatory-compliant data centers will evolve to support this delivery strategy.
• Data hosting will become a commoditized service if Data Centers fail to alter their infrastructure and policies in a way that complies with the HITECH Act, FISMA, PCI Standards, and/or HIPAA standards.
• Healthcare providers and technology suppliers who want to succeed will continue to think outside the traditional box in how they deliver content and will chart new territory in how to marry security policies with best-of-class content delivery.
• Unsuccessful providers and suppliers will bunker down and never let anyone “outside their data center” touch their data. There will be plenty of those in the future, and ironically they’ll begin to see their market share dwindle as the market adopts new ways of accessing PHI without breach incidents.
• Policy makers at the federal level will succeed in creating standards that the industry can live with.
• Content Delivery Networks will play an important role in medical content delivery, especially if CDN providers can provide the security necessary for healthcare IT players to trust healthcare content outside their physical networks.

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PC Die-hard Switches to Mac

06Oct09

I love those Mac commercials. I really do, but I never really thought seriously about switching to Mac.

I put up with the degrading performance over time of my PCs, I was even okay with the occasional rebuild – from scratch – just to get a fresh start. The cost of two days of productivity was always well worth the investment in gained productivity by not having to reboot a few times a day.

No. I never really took the Mac commercials seriously because we develop applications at my company. We can can work with Photoshop or Illustrator with the best of them, but our talents at DirectClarity lie in content management and web applications, so nah, we’ll stick with PC because “we develop applications”.

Imagine my surprise three weeks ago when I was treated to an executive briefing at Cisco World HQ in San Jose where 90% of the brains providing the briefing on everything from Internet security, to how their Unified Computing Platform can help healthcare IT companies comply with the HITECH Act, walked in with their MacBook Pros…

Hmm. My image was shattered. These were geeks of the highest order. Carrying Macs. Mental note to self.

Upon my return to Phoenix I continued along my PC ways until just before a big WebEx with a team of hospital corporate big wigs my PC froze and left me to explain why we had “technical difficulties” in presenting our information.

That was it. Fed up with PC, I found a great deal on a MacBook Pro, loaded Snow Leopard, added my Exchange Server with no issues at all, and installed VMware and then Windows XP on top of it.

Never has a Microsoft product run so smoothly with so few errors.

My Mac just works. That’s all I expect (too bad my PC doesn’t understand that little job requirement).

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The 3 G Project – Part 3

31May09

After researching antenna mounting options for the last couple of weeks, I’ve come up with a hybrid design of sorts.  It will incorporate features of ridgemount and tilt-over designs, and will additionally employ guying for stability.  Aside from the goal of performing well, my secondary requirements are that it causes as little destruction to the roof as possible, and that it not be immediately visible from the main road or the front yard. 

I’m going with the tilt-over design (it will employ a winch for raising and lowering the mast) because I want easy access to the antenna if I need to make changes.  I’d also like to be able to raise and lower the mast without needing anyone else on site to assist.  The ridgemount feature will let me take the advantage of starting my tilt-over at a base height of 18 feet by mounting on the peak of the roof.  That’s more than a third of the way to my goal, which is to have the antenna sit at, or higher than, 50 feet. 

Although I won’t have LOS (line-of-sight) to my target at this distance, getting above the average tree-line altitude will remove as many obstacles from the signal path as possible.  besides, I have a lot better chance of finding a usable signal at 50 feet than I do at 20 or 30.

Before I grabbed my materials and headed for the roofline I decided to check the temperature.

It's going to be warm today

 I guess it could be worse- it could be humid but fortunately it is not- still, the thermometer is reading about 86 and it’s only 10 AM.  Have you ever experienced what it feels like to work on top of a roof with the shingles pouring off heat from the sun?  Good times.

Here’s where the antenna will be mounted.  I’ve picked a spot just behind the satellite dish because it offers a slightly lower tree-line to the north than at any other spot on the roof, plus that location will leave the bulk of the mount invisible from the main road and the front yard.

Finding the right location is important

I kicked this part of the project off by determining the pitch angle of the peak so I can construct a sturdy base.  Since this project is low buck I didn’t use anything facy.  Just a piece of paper and sharpie marker that I traced the angles with.  When I was done it looked like a drawing of the Flux Capacitor.  You movie buffs won’t have to click the link to appreciate that one.

Using a couple pieces of scrap wood, I cut the angles with my trusty Black-n-Decker chop saw and did a test fitting.  I had to modify the angles just a bit, and keep cutting and fitting until I had it right.  it only took a couple of tries.  Once I had the correct angles, building the base was a piece of cake.

Angles are our friends (say 10 times fast)

Now for the fun part.  On each side of the peak. just a few inches before the angle cuts join, I’m going to fit a couple pieces of 2×12’s and angle them up until they sit perfectly level.  These two pieces will form a 12″ rectangular hole that our 4×4 uprights will drop into.  These 4×4 uprights (which will be 6 feet long) will provide the pivot point and lower anchoring point for our mast. (Note the short 4×4’s at each end of the base.  These are extra pieces that I used to initially position the 2×12’s, and they will stay there to provide extra support although when we’re done they will not be visible).

Positioning the 2x12's was so easy! (not)

Notice the orange level on top of one of the supporting 4×4’s?  You have to constantly check for level all the way through a project.  It’s a good rule of thumb to assume that every action you take will knock things out-of-level.  Since the main 4×4 uprights will anchor to the supporting 4×4’s, it stands to reason that if they are level and plumb, so will the main uprights.

My son James starting getting interested at this point and came up to help.

My partner in crime (and son) James III

To further bulk up the base, we’ll add more (shorter) 4×4’s to the bottom of the base running perpindicular to the main uprights.  All of this framing will be hidden once we “skin” the top with a couple of pieces of 2X6, which will add even more structural strength.

At this point I’ve got the main 4×4x6′ uprights in place, and after going through my second battery on the cordless driver and about 100 3″ gold screws connecting everything together, those uprights are so secure I could probably climb them and sit on top.  Down in the base there are a total of 6 4×4’s interconnected with the 2×12 sides for stability.  At this point there are no entries into the roof.  Everything is self supporting, which is exactly what we wanted.  Now lets check for level again!

Checking the main uprights for level - Level is good!

 Almost done for the day.  To finish, we’ll skin around the tops of the supporting 4×4’s to hide the framing and to make it all a little bit stronger.  This will hide the first foot and a half of the uprights, and bring our mast starting altitude to 18 feet.  I also closed the “top” parts of the rectangular hole around the uprights.  We’ll seal those up with silicone and then Thompson’s Waterseal the whole base to keep out the elements, but that will happen later.

Here’s a shot of the base before I skinned the top to hide the shorter 4×4 supports.

The uprights aren't crooked - I wobbled the camera.

Next weekend, before we mount the mast, we’ll add some framing on each side of the 2×12 supports to hold some plywood that we’ll slope down to cover the open distance between the front of the ridgemount and the top of the upright supports.  With that in place we’ll add tar-paper, and then I’ll shingle it (the previous homeowner left boxes and boxes of shingles) so from the ground or the air it will resemble a section of pitched roof.

That’s all for today.  At the rate of progress I’m guessing we’ll go for an initial raising of the mast two weeks from today.  But maybe, just maybe, we’ll get to that next weekend- although I’m in no hurry.  After the work I did today I feel like an old man.  I sure wish I was still in my twenties.

To be continued…

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The 3G Project – Update!

24May09

Today was Recon day.  That’s short for reconnaissance for those unfamiliar with the term.  It’s a military term that means to explore with the objective of gaining information.  And gain information we did!

I’m happy to report that I was wrong about the distance to 3G coverage.  I took my son with me this morning, and after arming ourselves with my Blackjack II mobile phone, the Compass 885 modem, and a laptop (with an AC inverter to keep the battery from running dry) we headed off in search of Mr. 3G and his family of high-bandwidth.

After placing the Blackjack into field test mode I set it to reject signals unless they were carrying WCDMA traffic in the 1900 MHZ band.  I could have chosen 850 MHZ, but I figured 1900 would be in use.  This filtering kept the phone from automtically locking onto what it judged was the best signal (there are several combinations for AT&T – the Blackjack II is a quad-band handset), and I was able to get a more accurate picture of where the 3G coverage umbrella ends.

When in field test mode, the Blackjack rewards the user with a heads up display of all pertinent connection information, including RSSI (Recieved Signal Strength Indicator), transmit and recieve channels (this number can be used to determine the frequency - more on that later), neighboring cell sites standing by to take over if we stray too far, and power output levels.

With all of that information at our fingertips, we (my son and I) hightailed it north looking for signal.  Rejecting all unwanted signals, we were able to find, and hold,  3G coverage at only 9.5 miles from the house.  At that fringe area of reception we placed the Compass 885 into service and were surprised to find out that the service is actually HSPA, not plain-jane 3G.

HSPA is an enhancement over the original 3G standard, and it is the combination of two separate improvements that were made to address upstream (HSUPA) and downstream performance (HSDPA) limits.   That must be why I recorded speeds of up to 2.2 MB today from a SpeakEasy test at DSLreports.com!

The best speeds were actually obtained at the extreme fringe of coverage while the Blackjack was reporting an RSSI of only -102.  The signal is displayed in dBm; lower-powered applications (such as wireless networks) function with signal levels in the negatives.  The closer the reading is to a zero, the better the signal quality. 

The EDGE service I use at home (with no antenna) fluctuates around -74 to 78 dBm, which is a very usable signal.  -102 dBm is basically right at the cusp of “have it” and “don’t have it”.  At -108 the Blackjack was still able to see the signal (on the drive back home) but I would have likely been unable to pass any traffic across the Compass 885.

So we learned today that quality HSPA 3G coverage is only about 9.5 miles away as the crow flies, and we were able to hold it with no special equipment.  I’m encouraged that with the right directional antenna on a high enough mast, it can be caught at my house.  Oh yeah, I said I’d mention more about how the channel number can be used to determine the frequency.

The basic rule of thumb is (thanks to Jim in Virginia over at EVDO Tips and Tweaks)  if the channel number is evenly divisible by 25, you’re getting a 1900 MHZ signal.  But with the Blackjack in field test mode I get to cheat- it lets me lock out all other frequencies, so I knew the coverage I found was on 1900 MHZ.  Now I know enough to plan my antenna setup so it’s optimized for that frequency spectrum.

To be continued (in a couple of weeks…after I get brave enough to try hoisting a 40 foot mast onto the roof)…

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The 3G Project (Or, Can Broadband be Found in the Boonies?)

22May09

My wife and I own a getaway house we are renovating on a 5 acre plot of gorgeous, mother-nature decorated, out-of-the-way land.  I could seriously see myself retiring here 20 years down the road, but right now I’m on a mission.  You see, the  techie in me just can’t quite reconcile the lack of Broadband Internet access with the On-Golden-Pond beauty of the place. 

I figure I spend about 60 to 70 hours a week coming up with software solutions to all kinds of business challenges, so why should this be any different?

Enter Wireless Mobile Broadband.  Simply put, it’s using existing cellular networks to provide Internet access to all those folks on the go.  What you may not know is that the user experience is getting good enough now to seriously consider using it as a fixed location Internet solution.

Without boring you to tears, lets just say there are 3 basic levels, or tiers, of connection speed.  At this stage of the technology, there is a direct relationship between speed and civilization.  Heavily populated metro areas are more likely to have the faster tiers, while those of us out in the sticks (that would be me) have to settle for, well, what we can settle for.

Since I’m the kind of guy that hears “not yet” instead of “can’t be done” I suppose this project was inevitable.  About 45 days ago I bit the bullet and retired the ISDN line.  I had it for two years and it provided a constant-on connection that was about 3 times faster than dialup.  Enough speed to bear the Internet, but just barely.

In it’s place I have a Sierra Wireless 885 Compass (also known as a Mercury LaptopConnect on AT&T Networks).  There’s a cell tower about 3 miles due East of the house, and I have no problem keeping a very solid connection.  It never drops, and most of the time I maintain a full 5-bars of connection strength. 

The 885 is a USB solution that plugs right into any laptop.  As long as you are near an AT&T cell site, you’ll have Internet access.  The only question is, what level of speed will that tower have?  And that brings us to my new project.  My cell tower offers the EDGE service, which is the middle tier, and I see between 180 to 250 Kbps.  Granted, that’s much improved over the ISDN line, but I’m driven to find the holy grail of Wireless Broadband…3G – which can get me into the neighborhood of DSL to cable Internet speeds.

3G coverage, as the crow flies, is about 22 miles from my house in a small town outside of the nearest metro. 

So here’s what I’m going to do:  I’m going to get that signal.  Somehow, someway, I’m going to reel it in from 22 miles away.  And I’m going to document the whole experience (succeed or fail) right here.

To be continued.

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The TPS Report

16Jan09

Your employees don’t usually produce what you expect, but rather what you inspect. The metrics you use to gauge the success of your operation can be critical to your success, but only if you measure the right results.

If you’re selling cars, for example, and your weekly reports measure the number of hot dogs your sales people give away at the Saturday promotional barbeque, then chances are you’ll never know how many cars you’re selling until you’re broke.

If you’re a state agency trying to save money on procurement costs and you write an RFP that measures the number of employees and bidder insurance levels, instead of how much money a system can save, then you might as well be rolling up those $100 dollar bills and smoking them.

If you are Freddie Mac and you measure the gross number of mortgages you provide with no metric in place to monitor who is actually paying those mortgages, you get an 81% increase in foreclosures in 2008.

Yah…have you read the memo about TPS reports? Do you need me to get you another copy of that memo?

If it were not so true in so many companies and government institutions across America it would really be as funny as the comedy Office Space.  But in all reality, it’s not really funny and can cost your company dearly if you don’t measure the right success metrics in your own operation.

Measuring the correct metrics is not rocket science. It just takes a look at the obvious, and if the obvious is not clear ask your employees to help you. You’ll be surprised at how insightful they can be in helping you really understand what it takes to succeed.  Bookmark this on Delicious

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Just Trying to Reconnect

15Jan09

For the second time in a week a judge has ruled that Bernie Madoff doesn’t have to go to the slammer after allegedly attempting to disperse money, jewelry and other assets to his family. He defense attorney claimed that Madoff wasn’t trying to abscond with the goods, but rather use the $173 million in checks found in his desk drawer to “reconnect” with his family members.

I guess people who defraud their investors don’t really need their family until it all hits the fan and the indictments come rolling down the grand jury steps. But alas, Madoff really had a great plan in the wings…screw his investors out of billions, live the high life for a few decades, and then when he needs a little support, toss his ever loyal family members a couple of hundred million bucks. I wonder if any of his “family” members worked for SEC?

And here’s the punch line…as if that weren’t funny enough…the second judge this week bought it!

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Flash issues with Firefox on Mac OS X

14Jan09

Using the parameter “wmode” with a value of “transparent” in the SWf Object and Flash-fix javascript methods of deploying flash in cross-browser applications will cause the flash feature to either not display, or intermittently display with Mac systems running Firefox browsers.

When the “wmode” parameter is removed, the flash feature will reappear.

There is no known workaround at the time of this article.

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What is a good password strength policy and why should I use one?

14Jan09

A typically sound password strength policy should require a mix of Upper and lower case alpha characters OR one of the cases with at least one number, AND a special character, like an exclamation point!

Here are a couple of examples of passwords that would pass the policy referenced above:

• ftff6485! – Meets the requirement with all lower case and numbers, and a special character
• Ecirpmij! – Meets the requirement with upper and lower case, and a special character. 

Regarding password length, the minimum number of characters for a password should be six (6) characters, although the more characters that are used, the stronger the password will be.  Fourteen (14) characters is considered to be normal for the maximum.
 
It may seem a little tedious, but strong passwords virtually eliminate unwanted entry into your system.  The other “gotcha “ is users sharing passwords.

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The Gesture!

14Jan09

A new client engaged DirectClarity to clean up some of the code left behind by a firm that suddenly relocated oversees. After getting to know this new client, we gladly offered our services to help.

Then came the gesture…

 ”Hey Chris, I did some work yesterday for a gentleman that owns a wine import business here in town.  He gave me a case of Malbec that I will never drink.  My fiancé tells me its very good wine.  I am dropping by on Friday to touch base with Katie, so let me know so I can bring a few bottles.”

This simple gesture was all it took to propel ACArizona.com to an esteemed client status!

Thanks Jay!

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