Using Microsoft Indigo Services: Building blocks to build robust distributed systems based on...

Using Microsoft Indigo Services: Building blocks to build robust distributed systems based on Service Oriented Architecture

Using Microsoft Indigo Services: Building blocks to build robust distributed systems based on Service Oriented Architecture

Professor Furrukh KhanDepartment of AnesthesiologyDepartment of Electrical and Computer EngineeringDepartment of Computer Science and Engineering

The Ohio State University

Professor Furrukh KhanDepartment of AnesthesiologyDepartment of Electrical and Computer EngineeringDepartment of Computer Science and Engineering

The Ohio State University

OSU BuckeyesOSU Buckeyes

Team: College of EngineeringTeam: College of EngineeringFurrukh Khan, Prof., ECE, CSE, Anesthesiology

Sarat C. Subramaniam, Ph. D., ECE

Shantanu Bharadwaj, Ph. D. Student, ECE

Carlos L. del Río, Ph. D. Student, ECE

Sriram Seshadri, Ph.D. student, ECE

Geoff Carr, Masters Student, ECE

Sudhir Subramanian, Masters Student, ECE

Jilani Sarmad Syed, Masters Student, ECE

Agustina Siswandari, Masters Student, ECE

Steven J. Dalley, Undergrad Student, ECE

Furrukh Khan, Prof., ECE, CSE, Anesthesiology

Sarat C. Subramaniam, Ph. D., ECE

Shantanu Bharadwaj, Ph. D. Student, ECE

Carlos L. del Río, Ph. D. Student, ECE

Sriram Seshadri, Ph.D. student, ECE

Geoff Carr, Masters Student, ECE

Sudhir Subramanian, Masters Student, ECE

Jilani Sarmad Syed, Masters Student, ECE

Agustina Siswandari, Masters Student, ECE

Steven J. Dalley, Undergrad Student, ECE

Team: College of MedicineTeam: College of Medicine

Dr. Michael Howie, Prof., Chair Anesthesiology

Dr. Nicholas Teteris, Prof., Director of ORs

Dr. Luis Lopez, Prof., Director of Anesthesia

Dr. Sergio Bergese, Faculty, Anesthesia

Lynda R. Petty, RN, Director of Perioperative Services, OSU Med Ctr.

Diane Nagel, RN, Nurse Manager, Perioperative Services, OSU Med Ctr.

John O'Brien, Quality Control Manager, Materials Manager, OSU Med Ctr.

Dr. Michael Howie, Prof., Chair Anesthesiology

Dr. Nicholas Teteris, Prof., Director of ORs

Dr. Luis Lopez, Prof., Director of Anesthesia

Dr. Sergio Bergese, Faculty, Anesthesia

Lynda R. Petty, RN, Director of Perioperative Services, OSU Med Ctr.

Diane Nagel, RN, Nurse Manager, Perioperative Services, OSU Med Ctr.

John O'Brien, Quality Control Manager, Materials Manager, OSU Med Ctr.

It all started with It all started with Microsoft Research

2002 Request for Proposal

Global Web Services (GXA)

“Real time monitoring, recording, and replay of vital clinical information on Smart Devices,

Tablet PCs, Laptops, and Desktop PCs”

Special Thanks:Dan Fay, MSRGautam Reddy, Academic Developer Relations

Microsoft Research

2002 Request for Proposal

Global Web Services (GXA)

“Real time monitoring, recording, and replay of vital clinical information on Smart Devices,

Tablet PCs, Laptops, and Desktop PCs”

Special Thanks:Dan Fay, MSRGautam Reddy, Academic Developer Relations

Success StorySuccess StoryMSN

Microsoft Case Study

Exec. Circle

Magazine

Network World

Microsoft Business Article

News in

Engineering

Electronic Medical RecordElectronic Medical Record

The Quality Interagency Coordination Task Force in its 2000 report to the President highlighted the unacceptable high rate of errors in health care Recommended Electronic Medical Record Factor limiting the impact of electronic medical records: lack of a cohesive approach towards standardization, security, data entry, integration, policy

The Quality Interagency Coordination Task Force in its 2000 report to the President highlighted the unacceptable high rate of errors in health care Recommended Electronic Medical Record Factor limiting the impact of electronic medical records: lack of a cohesive approach towards standardization, security, data entry, integration, policy

OSU Medical CenterOSU Medical Center

James Cancer Research CenterJames Cancer Research Center

OSU Medical CenterOSU Medical Center

New Richard M. Ross Heart HospitalNew Richard M. Ross Heart Hospital

Highly RankedHighly RankedState of the ArtState of the Art

Wireless ConnectivityWireless Connectivity50+ Operating Rooms50+ Operating Rooms

Heart Transplant Procedure Heart Transplant Procedure

ECHOECHO

Infusion PumpsInfusion Pumps Vital SignsVital SignsMonitorMonitor

TransducersTransducersECG, BP, CO etc.ECG, BP, CO etc.

Medication CartMedication Cart

AnesthesiologistAnesthesiologist

ResidentResidentAnesthesiologistAnesthesiologist

Anesthesia RecordAnesthesia Record

Domain AnalysisDomain Analysis

Team spent four months in the OR complex

Documented comprehensive workflow

Developed empathy, trust and friendship

Formed a med center teamadministrators, anesthesiologistsnurse managers, equipment & quality managers, medical students

Conducted extensive interviews

Followed patients, forms, nurses, doctors, equipment

Studied and documented all the systems used in the OR complex

Team spent four months in the OR complex

Documented comprehensive workflow

Developed empathy, trust and friendship

Formed a med center teamadministrators, anesthesiologistsnurse managers, equipment & quality managers, medical students

Conducted extensive interviews

Followed patients, forms, nurses, doctors, equipment

Studied and documented all the systems used in the OR complex

Existing ShortcomingsExisting ShortcomingsVital Signs monitoring constrained to OR complex

Vital signs data collection lacks fine granularity

Paper based anesthesia/patient record

Hard to mine/correlate valuable data

Hard to use data for educational use

Hard to track patients

Hard to track equipment

Manual Medication Entry

Vital Signs monitoring constrained to OR complex

Vital signs data collection lacks fine granularity

Paper based anesthesia/patient record

Hard to mine/correlate valuable data

Hard to use data for educational use

Hard to track patients

Hard to track equipment

Manual Medication Entry

Concept of Medical ActionsConcept of Medical Actions

Vital Signs Actions

Medication Actions

Position ActionsPatient Position Actions

Monitor Position Actions

Radiology Actions

Other Actions

Vital Signs Actions

Medication Actions

Position ActionsPatient Position Actions

Monitor Position Actions

Radiology Actions

Other Actions

Anything of medical relevance that happens Anything of medical relevance that happens to a patient, OR, equipment etc. is a to a patient, OR, equipment etc. is a medical action.medical action.

Concept of RecordsConcept of Records

Patient Record: Collection of all the actions associated with a patient

Anesthesia Record: Collection of Vital Sign Actions

OR Record: Collection of all the actions associated with an OR

Equipment Record: Collection of all the actions associated with an equipment

Patient Record: Collection of all the actions associated with a patient

Anesthesia Record: Collection of Vital Sign Actions

OR Record: Collection of all the actions associated with an OR

Equipment Record: Collection of all the actions associated with an equipment

Collection of actions form recordsCollection of actions form records

03/03/05 12:12:34 03/03/05 12:18:34

[OR Track]Location Action

(Monitor In)

[OR Track]Location Action

(Patient In)

[OR Eye]Vital Signs

Action

[OR Med]Medication

Action

Time Line

Medical Actions

EMR – collection of Medical Actions

GoalsGoalsImprove operational efficiencyAutomate recording of vital signs dataBetter correlation between medication and vital signs dataBetter tracking of patients and equipmentSecurely display vital signs data on mobile devices carried by health care workers and medical studentsUse existing standards based technologies whenever possible

Don’t reinvent the wheel

Improve operational efficiencyAutomate recording of vital signs dataBetter correlation between medication and vital signs dataBetter tracking of patients and equipmentSecurely display vital signs data on mobile devices carried by health care workers and medical studentsUse existing standards based technologies whenever possible

Don’t reinvent the wheel

High level RequirementsHigh level Requirements

Loosely Coupledallow easy plugging of future sub systems

Secureseparate business logic and security policy

High Availability

Scalable and Maintainable

Should allow inter hospital collaboration (enterprise integration)

Standards based, platform agnostic

Federated not centrally controlled

Self healing

Loosely Coupledallow easy plugging of future sub systems

Secureseparate business logic and security policy

High Availability

Scalable and Maintainable

Should allow inter hospital collaboration (enterprise integration)

Standards based, platform agnostic

Federated not centrally controlled

Self healing

OR-Star Suite ArchitectureOR-Star Suite Architecture

WiFi TrackWiFi Track

Wrist Band Wrist Band value value added added

servicesservices

ORORMedicationMedication

ORORPharmacyPharmacy

OR OR EyeEye

OR OR TrackTrack

OR OR Wrist Band Wrist Band

OR1OR1 OR2OR2 OR50OR50……

ORORMonitor Monitor

ProductionProduction

UnderUnderConstructionConstruction

PlannedPlanned

ClientsClientsLaptopsLaptops

PPCsPPCsFlat Panel DisplaysFlat Panel Displays

USB USB Locate Locate

OR Eye High Level ViewOR Eye High Level View

OR EyeOR EyeSmartSmartClient Client

OR EyeOR EyeDesktopDesktopClient Client

Brand x Brand x MonitorMonitor

ss

OR EyeOR EyeRecordeRecorde

rr ActionActionBucketBucketServiceService

MedicatioMedicationn

RecorderRecorder

ActionActionBucketBucket

Type XType XActionActionBucketBucket

Brand yBrand yMonitorMonitor

ss

OR EyeOR EyeServiceService

OR OR Schedule/Schedule/Or TrackOr Track

PharmacPharmacyy

PPC OR PPC OR Eye Eye

ServiceService


RecordeRecorderr

Secure Compound ServiceSecure Compound Service

Secure Compound ServiceSecure Compound Service

routerrouter

routerrouter

placeholderplaceholder

placeholderplaceholder

PatientPatientss

Wireless networkWireless network

OR Eye High Level ViewOR Eye High Level View

Loosely coupled, scalable, available, multi threaded, lease based self healing

OR EyeOR EyeSmartSmartClient Client

OR EyeOR EyeDesktopDesktopClient Client

Brand x Brand x MonitorsMonitors


rr ActionActionBucketBucketServiceService


OR OR EyeEye

ServicServicee

PPC PPC OR Eye OR Eye ServiceService


RecordeRecorderr

Data Queues Data Queues (one per monitor)(one per monitor)View Lease QueueView Lease Queue

Thread Lease QueueThread Lease Queue

MSMQMSMQ

Windows ServiceWindows Service

Record Lease Queues Record Lease Queues (one per monitor)(one per monitor)

Thread Lease QueueThread Lease Queue

MSMQMSMQ

Windows ServiceWindows Service

WS-Secure ConversationWS-Secure Conversation

WSEWSEWeb Web

ServiceService

WS-SecurityWS-SecurityWS-TrustWS-TrustWS-PolicyWS-Policy

WS-SecureConversationWS-SecureConversation

UNT, SCT (Username Token, Secure Context Token)UNT, SCT (Username Token, Secure Context Token)ClientClient

WSEWSE

WSE Secure ConversationWSE Secure Conversation

Separation of business logic and security policySeparation of business logic and security policy

ClientClient

STSSTSSecure Token Secure Token

ServiceService

Web ServiceWeb Service(business logic)(business logic)

web.configweb.config

receivereceivepolicypolicy

(declarative (declarative security security policy)policy)

Send policySend policy

Server tokenServer tokencertificatecertificate

certificate storecertificate store

UserNameTokenManagerUserNameTokenManager

.NET class.NET class

Override method Override method for authenticationfor authentication

Active Active directorydirectory

STS only acceptsSTS only acceptsmessages signed messages signed

by a username by a username tokentoken

or by X509v3or by X509v3Service acceptsService accepts

messages signedmessages signedand encryptedand encrypted

by using a SCT by using a SCT issuedissued

by this STSby this STS

XMLXML

XMLXML

XMLXMLXMLXML

app.configapp.config

Benefits of using WSE 2.0Benefits of using WSE 2.0

In our last project we spent 80% of our time dealing with security.

In our current WSE 2.0 based project we spent only about 4% of our time on security

Separation of business logic and infrastructure logic

In our last project we spent 80% of our time dealing with security.

In our current WSE 2.0 based project we spent only about 4% of our time on security

Separation of business logic and infrastructure logic

OR Eye Desktop ClientOR Eye Desktop Client

Time LineTime LineTime LineTime Line

Medication ActionMedication ActionMedication ActionMedication ActionVital Signs ActionVital Signs ActionVital Signs ActionVital Signs Action

Archive ModeArchive ModeArchive ModeArchive Mode

Privacy ModePrivacy ModePrivacy ModePrivacy ModePatient IDsPatient IDsPatient IDsPatient IDs

Current ShortcomingsCurrent ShortcomingsData Models - XML Schema – Complex No versioning of the XML SchemasSchemas not published in XML WSDL, passed to clients out of the bandErrors explicitly converted to SAOP faults, mixed with business logicPseudo RM (at least once, ordered) implementation mixed with business logicAbsence of typeless routers at the message layer to enhance scalability, load balancing Complexity of multiple models and tools (MSMQ, Enterprise Services, state management, XML tools)Steep training curve

Data Models - XML Schema – Complex No versioning of the XML SchemasSchemas not published in XML WSDL, passed to clients out of the bandErrors explicitly converted to SAOP faults, mixed with business logicPseudo RM (at least once, ordered) implementation mixed with business logicAbsence of typeless routers at the message layer to enhance scalability, load balancing Complexity of multiple models and tools (MSMQ, Enterprise Services, state management, XML tools)Steep training curve

Indigo (CTP) “mini” OR EyeIndigo (CTP) “mini” OR Eye

OR Eye OR Eye ClientClient

Brand Brand Name Name

MonitorsMonitors


rr

RecordingRecordingServiceService


OR OR EyeEye

ServicServicee

X509/X509 TCPX509/X509 TCP

Typeless RouterTypeless Router

UNT/X509 HTTP

UNT/X509 HTTP

UNT/X509 HTTPUNT/X509 HTTP

End to End RMEnd to End RM

SSLSSL SSLSSL

X509/X

509 TC

PX

509/X509 T

CP

DBDB

Areas of Impact - IndigoAreas of Impact - IndigoCLR Data Contracts: No need to develop/maintain two separate models -> CLR types and XML.Data contracts are published in WSDLInbuilt versioning (v1->v2, v2->v1) Custom Faults (decoupled from business Published in WSDLEase of implementing type less routers (scalability, load balancing, maintenance) Inbuilt end-end RM, WS Reliable Messaging (exactly-once, in order, transport neutral)Inbuilt distributed atomic transactions, WS-Atomic TransactionsEnhanced performance

CLR Data Contracts: No need to develop/maintain two separate models -> CLR types and XML.Data contracts are published in WSDLInbuilt versioning (v1->v2, v2->v1) Custom Faults (decoupled from business Published in WSDLEase of implementing type less routers (scalability, load balancing, maintenance) Inbuilt end-end RM, WS Reliable Messaging (exactly-once, in order, transport neutral)Inbuilt distributed atomic transactions, WS-Atomic TransactionsEnhanced performance

Vital Signs Data ContractVital Signs Data Contract

[DataContract]public class VitalSigns{

[DataMember]string patientID;

[DataMember ]string monitorName;

[DataMember]char hospitalCode;

[DataMember]int locationNum;

[DataMember]DateTime createDateTime;

[DataMember]float heartRate;

[DataMember]float respRate;

[DataMember]float pvcCount;

}

[DataContract]public class VitalSigns{

[DataMember]string patientID;

[DataMember ]string monitorName;

[DataMember]char hospitalCode;

[DataMember]int locationNum;

[DataMember]DateTime createDateTime;

[DataMember]float heartRate;

[DataMember]float respRate;

[DataMember]float pvcCount;

}

Vital Signs XML SchemaVital Signs XML Schema<xs:element name="VitalSigns"> <xs:complexType> <xs:all> <xs:element name="Patient_ID" minOccurs="1" maxOccurs="1" > <xs:simpleType> <xs:restriction base="xs:string"> <xs:pattern value="[0-9][0-9][0-9]-[0-9][0-9]-[0-9][0-9][0-9][0-9]"/> </xs:restriction> </xs:simpleType> </xs:element> <xs:element name="Monitor_ID" type="xs:string" minOccurs="1" maxOccurs="1"/> <xs:element name="OR_ID" type="xs:string" minOccurs="1" maxOccurs="1"/> <xs:element name="TimeStamp" type="xs:dateTime" minOccurs="1" maxOccurs="1" /> <xs:element name="HeartRate" type="xs:float"/> <xs:element name="PVCCount" type="xs:float"/> <xs:element name="RespiratoryRate" type="xs:float"/> </xs:all> <xs:attribute name="isStale" type="xs:boolean" use="required" /> </xs:complexType></xs:element>

<xs:element name="VitalSigns"> <xs:complexType> <xs:all> <xs:element name="Patient_ID" minOccurs="1" maxOccurs="1" > <xs:simpleType> <xs:restriction base="xs:string"> <xs:pattern value="[0-9][0-9][0-9]-[0-9][0-9]-[0-9][0-9][0-9][0-9]"/> </xs:restriction> </xs:simpleType> </xs:element> <xs:element name="Monitor_ID" type="xs:string" minOccurs="1" maxOccurs="1"/> <xs:element name="OR_ID" type="xs:string" minOccurs="1" maxOccurs="1"/> <xs:element name="TimeStamp" type="xs:dateTime" minOccurs="1" maxOccurs="1" /> <xs:element name="HeartRate" type="xs:float"/> <xs:element name="PVCCount" type="xs:float"/> <xs:element name="RespiratoryRate" type="xs:float"/> </xs:all> <xs:attribute name="isStale" type="xs:boolean" use="required" /> </xs:complexType></xs:element>

Scalability trough IndigoScalability trough Indigo


Brand-X Brand-X MonitorsMonitors

Brand-Y Brand-Y MonitorsMonitors

Business logic: 30 msBusiness logic: 30 ms

Asks for vital signsAsks for vital signsEvery 30 sec.Every 30 sec.

WSE 2.0 70 msWSE 2.0 70 msIndigo 17 msIndigo 17 ms

Typed redirecting serviceTyped redirecting service(bottle neck)(bottle neck)

Max Clients:Max Clients:WSE 2.0 300WSE 2.0 300Indigo 638Indigo 638


Brand-X Brand-X MonitorsMonitors

OR OR EyeEye

ServicServicee

Brand-Y Brand-Y MonitorsMonitors

Indigo 17 msIndigo 17 ms

Typeless Indigo router serviceTypeless Indigo router service

Max Clients Max Clients Indigo 638Indigo 638

Max Clients Max Clients Indigo 638Indigo 638

Secure ConversationSecure Conversation

Secure Conversation

Secure Conversation

WiFi tracking – Big PictureWiFi tracking – Big Picture

Mote Island(Scattered Imotes2)

Existing WiFi infrastructure

OR Desk Patient TrackerMobile Pocket PC

Servers

Mobile Tablet PC

Mote Island(Scattered Imotes2)

OR

OR

OR

OR

room

room

room

room

Benefits of our system forthe OSU med centerBenefits of our system forthe OSU med center

Improved patient care

Less prone to mistakes

More realistic training

Better research

More research dollars

Better operational efficiencyMore efficient billing

Improved auditing

Better use of resources

Improved patient care

Less prone to mistakes

More realistic training

Better research

More research dollars

Better operational efficiencyMore efficient billing

Improved auditing

Better use of resources

Using Microsoft Indigo Services: Building blocks to build robust distributed systems based on...

Documents

Transcript of Using Microsoft Indigo Services: Building blocks to build robust distributed systems based on...