Networks: Standardization, Infrastructure, and Applications (Information Age Economy)


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subject of the information age in as engaging and innovative a way as this author . Strongly recommended for . Preface to the Edition of The Rise of the Network Society xvii applications, is the communication fabric of our lives, for work, for personal .. works they need to rely on a multidimensional infrastructure of. Standardization, Infrastructure, and Applications Kurt Geihs, Wolfgang König, Heidelberg; New York: Physica-Verl., (Information Age Economy) ISBN.

Design Phase Analyzing the IT infrastructure. Transformation phase Transformation to the cloud. Operate phase Secure operation of applications in the cloud. Data encryption Active protection against malicious code. Enterprise Security Highly secure end-to-end application. Mobile Security All-round protection for business processes. Magenta Security Consulting, early detection and response in an emergency. Security consulting IT risk management as part of your IT strategy.

Security engineering Developing highly secure software systems. Mobile Encryption App Encryption of smartphone calls and text messages. Managed Firewall Services for enterprises Protection from online attacks. Security Evaluation and Testing Verified security — recognized worldwide. Magenta Security consulting packages Safety concept with comprehensive approach. Industry Standard Definition of a consistently high quality level. People The human factor is crucial to IT quality. Platforms A harmonized it architecture minimizes downtime.

Processes Process quality is key to high-availability IT services. Our promise of quality. A way out of the crisis with Code Zero. Product Lifecycle Management The right data at the right time in the right context.

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Supply Chain Management Optimal supply chains in production, logistics and service. Smart Factory Smart production step by step. Smart Logistics Intelligent shipping route for goods flows. Dealer Management Systems Structure customer processes efficiently. Systemintegration Sales After Sales Transparent customer informationen across all channels. Next Generation Maintenance Digital transformation in maintenance. Public Safety Improve public safety by deploying state-of-the-art technology. High-performance computing Excellent research requires both connectivity and processing power.

Social welfare and churches ICT for churches and social welfare. Smart road charging systems Smart road charging systems for diverse road types. Electronic records management based on Microsoft SharePoint. Scientific computing Tailored solutions for research and education. Satellic Tolling Platform Automatic data capture road charging according to usage. Dynamic Services for Unified Communications All channels in one surface. The digitized store Connectivity as the strategy for success. Customer Journey Advising customers step by step. Cloud in Retail Cloud technology provides retail with more efficiency.

Findbox Don't search, find instead. Retail Analytics Knowing what customers want. Managed LAN Built-in flexibility. Proximity Marketing The best offer at the right time. Omnichannel Retailing Customer connectivity across all channels. Digital Signage Addressing specific target groups. Predictive maintenance and analytics Predictive operations for streamlined logistics.

Passenger experience Airport operators and service providers can improve the passenger experience by focusing on passenger needs. Airport Management Efficient end-to-end airport management. Public transport Digital transformation of public transport. Postal What predictive delivery can do for courier services.

Logistics Improved management of transportation. Managing multi-site corporate networks is a complex undertaking. Even major telecommunications players do not own and operate their own fully comprehensive worldwide networks. Instead, they have to purchase additional infrastructure resources from third parties. As a result, the provisioning of new services can be slow and laborious. But in fast-moving markets, international businesses require agile data networks. More on the Subject. Data networks are finally catching up with the dynamics of the digital age.

The Internet and World Wide Web provide a framework for communication links, and a few large provider organizations have demonstrated the potential of these technologies. But making them accessible to large populations in a health care community will require experimentation and research Perlin et al. Other issues that must be addressed include ensuring the confidentiality and security of transmissions and health care data.

In the preceding discussion of major components of the NHII, a number of technical impediments to implementation of these systems were identified e. Educational barriers are discussed in Chapter 5. At the present time, several factors severely undercut the returns health care providers might expect to capture on their investments. This lack of connectivity, in turn, has severely limited improvements in efficiency and quality.

Another major barrier is the prevailing reimbursement arrangement for health care services, which does not reimburse care providers differentially on the basis of quality of care. Contrast this with incentives for provider organizations to invest in new diagnostic equipment, such as MRI machines, which begin to generate revenue as soon as they are up and running. Nevertheless, the barriers persist. The committee believes that as conceptual and material progress is made in measuring quality and productivity in health care, significant returns on investment at all levels of the health care system will be demonstrated NRC, ; Triplett, , In addition, many clinicians have a very limited understanding of the potential uses, impacts, and benefits of advanced information systems for the production and delivery of care.

Thus, the benefits of change are not immediately visible, but the costs are. Not surprisingly, then, there has been significant resistance to innovation and changes in work processes and the division of labor among health care professionals. The cultural and organizational factors that have contributed to a rigid division of labor in many areas of health care often impede the introduction and exploitation of tools, technologies, and other innovations that could improve quality and productivity in health care see Bohmer, this volume; Christenson et al.

A critical step toward realizing the National Health Information Infrastructure will be the development and widespread adoption of network standards for health care data and software. Research must focus on standards-related issues concerning the integrity of data, controlled access to data, data security, and the integration of large-scale wireless communications.

There is also a pressing need for low-cost tools for standardizing new and legacy digital data without disrupting clinical work flows. Progress in systems interoperability and data standards is likely to improve remote access to self-care educational tools, patient health records, and health care provider and insurer services scheduling, billing, etc. Cross-sector learning and research on information and communications standards among federal agencies, health care insurers, and health care providers represents a potentially vast source of knowledge and advancement.

The Internet and World Wide Web provide a framework for communication links, but making them accessible to large populations in a health care community to promote communication between patients and health care providers will require experimentation and research, particularly to ensure the confidentiality and security of transmissions of health care data. However, many barriers will have to be overcome before it can be implemented. Many factors have contributed to this deficit: The committee endorses the recommendations made by the Institute of Medicine Committee on Data Standards for Patient Safety, which called for continued development of health care data standards and a significant increase in the technical and material support provided by the federal government for public-private partnerships in this area.

The committee endorses the recommendations of the President's Information Technology Advisory Council that call for: The committee applauds the U.

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Department of Health and Human Services year plan for the creation of the National Health Information Infrastructure and the high priority given to the creation of standards for the complex network necessary for communications among highly dispersed providers and patients. Special attention should be given to issues related to large-scale integration. Funding for research in all of these areas will be critical to moving forward. These initiatives include efforts to reimburse providers for care episodes or other bundling techniques e.

The emerging technologies in wireless communications and microelectronic systems described in this section have the potential to advance the patient-centeredness and quality performance of the health care delivery system and to change the structure of care delivery in the process. Microelectronics promises to be a powerful tool for meeting quality and productivity challenges in health care delivery, provided that resources can be marshaled in a rational way.

The global IP VPN challenge

The microelectronics revolution began in the s with the advent of integrated circuits and has since revolutionized data processing, communications, and control. The number of transistors that can be integrated on a silicon chip the size of a finger-nail has increased from about 2, on the first micro-processor to about ,, today; the speed of these chips has increased more than a thousand-fold. At the same time, the number of bits of memory on a chip has increased by a factor of more than a million, and costs have decreased just as precipitously.

Low-cost disk storage is now approaching a density of more than 40 gigabytes per square inch. In short, the processing and storage of data, the creation of information and knowledge based on those data, and the efficacy of decisions have improved exponentially. In the coming decades, as the number of nurses and physicians decreases, monitoring and diagnostics will have to improve dramatically. Efforts to develop sensors using integrated circuit technology has resulted in microelectro-mechanical systems, which can be combined with microelectronics and wireless interfaces to create wireless integrated microsystems WIMS for use in health care delivery.

In the near future, WIMS will be merged with sensors with embedded microcomputers and minute wireless transceivers a cubic centimeter in size or smaller that operate at power levels of less than 1 milliwatt, consistent with long-term operation fueled by batteries maintained by energy scavenged from the environment Wise, , These new devices could potentially provide continuous monitoring of critical functions, thereby turning every hospital room into an intensive care facility. WIMS devices small enough to be worn comfortably and unobtrusively could communicate with a bedside receiver that communicates, in turn, with monitoring stations and a larger health care facility.

The system just described would go a long way toward meeting the objective of the Leapfrog Group of having an ICU physician present in every hospital at all times Leapfrog Group, WIMS systems are still scarce, and their performance is limited, but they are emerging. Blood oximeters, heart rate monitors, and temperature sensors could all be components of WIMS; swallowable capsules for viewing the digestive tract are already in use Fireman, ; Pelletier, ; Pennazio et al. Wearable devices that monitor blood pressure hypertension , breathing patterns sleep apnea , and other variables will certainly be available in the near future see Budinger in this volume.

The major challenges to their use are interfaces with the body itself. Swallowable capsules for all kinds of internal viewing and measurements could significantly improve diagnoses of a variety of conditions and thus could improve the quality of health care. DNA analysis chips will bring advances in genetics into the hospital, and even the local doctor's office Burns et al. However, the impact of these developments on costs will be indirect.

In addition, privacy issues must be addressed before they can be widely used. WIMS for health care are expected to be technically feasible in the coming decade, but to reduce costs, they must be part of a complete system. Bedside receivers and wearable monitors might be technical triumphs, but they could also lead to economic disaster for the company that produces them unless they fit into a larger system.

A similar situation has existed for at least 20 years in the process-control industry. Although prototypes of sophisticated sensors have been produced, they are still not widely used because controllers that can exploit their features have not yet been developed. In the transportation industry, the entire control system of the automobile engine had to be redesigned to take advantage of microprocessors and electronic sensing. Comparable redesigning of the health care system will be necessary at every level to take advantage of WIMS.

The application of WIMS technologies in the hospital promises to significantly improve the quality and patient-centeredness of inpatient and ambulatory care. The potential impact of WIMS on home care and the quality of life for senior citizens and chronically ill patients is even greater Whitten et al. Moving WIMS technology into the home is being seriously considered by makers of home communications equipment.

With properly integrated home-based WIMS systems, patients could be monitored on a continuous basis and care professionals alerted automatically when events merit attention. Continuous or at least more frequent home monitoring of the health status of elderly and chronic care patients could notify clinicians of the need for timely therapeutic interventions that could avoid hospitalizations and shorten hospital stays, thus reducing the costs associated with the care of the patient over time see Budinger in this volume.

Moreover, home-based WIMS could facilitate safe home environments and the activities of daily living that are so important for the health of the elderly and chronically ill. The main technical problems in the development of WIMS are largely related to reliable interfaces between sensors and the body and ensuring that sensors are capable of differentiating between instrumentation artifacts and physiological events. WIMS may also have therapeutic uses. The development of wireless implantable microsystems has been the subject of research for 40 years or more, but, to date, few devices have been developed besides pacemakers.

Pacemakers have become increasingly sophisticated electronically, but their interfaces with the body are primarily via electrodes. Nevertheless, they have set the stage for the emergence of new devices in the coming decade. For example, cardiovascular catheters have been used for diagnosing cardiac conditions for many years, and pressure sensors small enough to be mounted directly on catheters have existed for some time Chau and Wise, ; Ji et al.

In fact, catheter-based electronics for improving diagnostic capabilities are long overdue. Another example is stents, which are widely used for treating coronary occlusions and now have chemical coatings to prevent re-stenosis. In the near future, stents may also be used as platforms for instrumentation, such as wireless sensors for monitoring blood pressure or blood flow that could be activated by a radio frequency wand positioned over the chest.

Significant challenges remain involving range, accuracy, and size, but such systems may be feasible soon Collins, ; DeHennis and Wise, ; Stangel et al. Wireless sensors could also be used in intracranial, intraocular glaucoma , and intra-arterial applications.

Building a Better Delivery System: A New Engineering/Health Care Partnership.

Miniature biocompatible packages that can exist for many decades in the body are also being developed for long-term use in chronic conditions Ziaie et al. WIMS could also have a dramatic impact on the treatment of conditions involving the central nervous system. More than 90, cochlear implants are in use worldwide today, enabling many profoundly deaf and severely hearing-impaired individuals to function normally in a hearing world House and Berliner, ; Spelman, Even though their performance is still limited and there is some opposition to them in the deaf community, these devices may render most kinds of deafness treatable disorders in the next two decades.

In the United States alone, more than 2 million people are profoundly deaf, and 20 million are severely hearing impaired.

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There is considerable interest in treating other neurological disorders using WIMS. Visual prostheses have recently received considerable attention but are still at a very early stage of development Lui, The same is true of prostheses for severe epilepsy and paralysis. For example, an implanted electrode array might detect the onset of an epileptic seizure and provide local electrical stimulation or drug delivery to prevent the spread of the seizure. Functional neuromuscular stimulation FNS is being used to help quadriplegics stand and even walk, and the use of dense electrode arrays to capture control signals directly from the motor cortex has recently enabled primates to control robotic arms Chapin et al.

Combining FNS with cortical control could lead to at least limited closed-loop activation of paralyzed limbs Wise et al. And the use of deep brain stimulation in the subthalamic nucleus to eliminate the manifestations of Parkinson's disease has yielded impressive results and is now approved for human use Limousin et al.

Although all of these devices are still at a relatively early stage of development Table , some are gaining acceptance now, and many could be in wide use in the next 20 years, which could substantially impact the quality of health care and the costs of rehabilitation. Microsystems implemented as wearable and implantable devices connected to clinical information systems through wireless communications could provide diagnostic data and deliver therapeutic agents for the treatment of a variety of chronic conditions.

In fact, WIMS could potentially restructure care delivery in the hospital. There is no question that microdevices can and will significantly improve the daily lives of many people. The barriers to the realization of this vision are significant, however. For patients to take on greater control and responsibility for their own care, they will have to be educated or able to educate themselves. In addition, patients must continue to have access to trusted sources of advice and counsel.

THE CENTRALITY OF INFORMATION TO HEALTH CARE DELIVERY

Support Center Support Center. Information and Communications Systems: Future-proof networks Standardized and harmonized networks. Transformation phase Transformation to the cloud. Engineering research should be focused on defining an architecture capable of incorporating data from microsystems into the wider health care network and developing interface standards and protocols to implement this larger network. However, many barriers will have to be overcome before it can be implemented.

Changes in the division of labor between patients and care teams implicit in the self-care model will also have a profound impact on the roles, work processes, and division of labor among members of the patient's care team. Resistance to change, especially if roles, authority, and jobs are threatened, may arise among care professionals and organizations that deliver services both within and outside of hospital setting e.

Current reimbursement systems may also present barriers if care providers are not reimbursed for e-visits, patient modules, remote care services, and so on. The implications of the self-care model for the health care industry are profoundly disruptive. The move toward self-care could be considered threatening to businesses e. The current complex mix of professional licensing, regulation, liability law, and other constructs established to ensure the health care safety and reliability also pose barriers.

The current hierarchical culture and rigid division of labor in the health care profession could make the reallocation of responsibilities and changes in the roles of care team members extremely contentious. Wireless integrated microsystems could have an enormous beneficial impact on the quality and cost of health care, especially home health care. Microsystems implemented as wearable and implantable devices connected to clinical information systems through wireless communications could provide diagnostic data and deliver therapeutic agents for the treatment of a variety of chronic conditions, thereby improving the quality of life for senior citizens and chronically ill patients.

The use of wireless integrated microsystems technologies in hospitals and clinics promises significant improvements in the quality and patient-centeredness of inpatient and ambulatory care. Microdevices that could provide continuous monitoring of critical functions could turn every hospital room into an intensive care facility. Wireless integrated microsystems for health care are expected to be technically feasible in the coming decade, but to reduce costs, they must be part of a complete system.

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Significant cultural and organizational barriers will have to be overcome for the full benefit of WIMS to be realized. Public- and private-sector support for research on the development of very small, low-power, biocompatible devices will be essential for improving health care delivery. Engineering research should be focused on defining an architecture capable of incorporating data from microsystems into the wider health care network and developing interface standards and protocols to implement this larger network.

Microsystems research should be focused on the following areas:. Timely, accurate information is critical to the efficient operation of large dispersed systems. Although the health care system has been slow to recognize this, efforts are now under way to rectify the situation.

SMART SD-WAN

But it is imperative that research, development, demonstration, and training be expanded and accelerated. Putting together a system that can make use of information microtechnology, nanotechnology, and biotechnology and ensure that applications are widely available and affordable will require coordination at the national level among device manufacturers, clinicians, and hospital systems.

However, unless the approach is coordinated, the impact of new technologies could improve health care for a few but increase costs for everyone else and move the overall system even farther away from providing patient-centered care. Turn recording back on. National Center for Biotechnology Information , U.

In its preliminary blueprint for NHIN, the Interoperability Consortium stresses that the NHIN must be part of an agenda for the comprehensive transformation of health care delivery: Patient Level At the patient level, progress toward an NHII would greatly empower individual patients to assume a much more active, controlling role in decision making and in implementing their own health care i.

Organizational Level At the level of the organization, steps toward an NHII would greatly facilitate the capture, integration, and analysis of clinical, administrative, and financial data for measuring and improving the quality, patient-centeredness, and efficiency of health care. Environmental Level The NHII would lead to significant improvements on the environmental level of the health care delivery system. Health Care Data Standards and Technical Infrastructure If health care data are standardized, they become understandable to all users.

Data interchange formats are standard formats for electronically encoding data elements including sequencing and error handling. Interchange standards can also include document architectures for structuring data elements as they are exchanged and information models that define relationships among data elements in a message.

Knowledge representation refers to standard methods of electronically representing medical literature, clinical guidelines, and other information required for computerized decision support. Core Clinical Applications Clinical information systems provide a mechanism for sharing data collected from various sources e. Computerized Physician Order Entry Systems Using CPOE systems for entering orders for tests, drugs, and other procedures has led to reductions in transcription errors, which have led to demonstrable improvements in patient safety. Digital Sources of Evidence and Knowledge Another key component of the health information infrastructure, digital sources of evidence—including bibliographic references, evidence-based clinical guidelines, and comparative databases—is essential for evidence-based practice.

Decision-Support Tools The standardization of health care data, the development of digital sources of medical evidence and knowledge, and the creation of EHRs will all facilitate the use of decision-support tools, which are key components of clinical information systems. Research and development in the following areas should be supported: Making Every Room an Intensive Care Unit In the coming decades, as the number of nurses and physicians decreases, monitoring and diagnostics will have to improve dramatically. Advancing Patient Self-Care The application of WIMS technologies in the hospital promises to significantly improve the quality and patient-centeredness of inpatient and ambulatory care.

Barriers Microsystems implemented as wearable and implantable devices connected to clinical information systems through wireless communications could provide diagnostic data and deliver therapeutic agents for the treatment of a variety of chronic conditions. Microsystems research should be focused on the following areas: American Medical Informatics Association; Physician Order Entry in U. PMC ] [ PubMed: An informatics infrastructure is essential for evidence-based practice. Journal of the American Medical Informatics Association.

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