Public Trust in Health Information: Foundational Principles for Dependable Systems

1. Public Trust in Health Information: Foundational Principles for Dependable Systems Dixie B. Baker, Ph.D. Vice President for Technology CTO, Enterprise and Infrastructure Solutions Group Presented by Kathleen A. McCormick, Ph.D. Senior Scientist/Vice President SAIC, Health Solutions

2. Realization of the Vision Brings Risk Time RISK • Stage 3: The Digital Doctor • Patient ownership of record • Integrated EMR available anywhere, exchangable across caregivers, minable for syndromic surveillance • Integrated, individualized decision support • Data exchanged over shared, public networks (Internet) • Stage 2: The Bewildered Doctor • “System of systems” through the miracle of integration engines • Electronic clinical data • Electronic administrative transactions with trading partners • General-use decision-making tools (e.g., drug-drug interactions) eHealth – Realization of NHIN • Stage 1: The Family Doctor • Minimal use of IT in clinical care • “Departmental” systems • Private networks • Decision making as an “art” IT Dependency and Value

3. Confronting Risk – Assuring Public Trust • System reliability • Service availability • Information confidentiality • Data integrity • Software safety As provider organizations increase their dependence on information technology in the delivery of clinical care, DEPENDABILITYbecomes essential for business success, quality care, and patient safety!

4. 5 Guidelines for Dependability 1. Architect for dependability. • Architect enterprise systems from the bottom up so that no critical component is dependent upon a component less trustworthy than itself. • Minimize complexity – the simplest design and integration strategy will be the most understandable, maintainable, and recoverable. • Avoid/eliminate single-point failures – distributed architectures can tolerate failure more easily than large, centralized systems. • Incorporate redundancy & fail-over for critical components. • Implement security in depth to protect sensitive information from unauthorized disclosure, critical data from corruption and destruction, and essential services from interruption. From:Baker, D. Dependable Systems for Quality Care. in Saba, VK and McCormick, KA. Essentials of Nursing Informatics, 4th Edition, New York:McGraw-Hill Book Co., in press 2005

5. Dependability Requires Architectural Assurance • Confidence that enterprise systems will: • Deliver services as described in functional specification; • Not exhibit behaviors that are unexpected, malicious, or harmful; and • Be available when they are needed.

6. Safety FUNCTIONAL CAPABILITIES Security FUNCTIONAL CAPABILITIES Dependable Architectures Recognize Dependencies

7. 5 Guidelines for Dependability 2. Expect failures. • Implement application-transparent features to detect faults, failover to redundant components, and recover from infrastructure failures. • Implement application-specific features to handle exceptions in software execution. • Implement features to detect, recover from, and survive malicious attacks while preserving system stability and security. • Design and build safety-critical systems to fail in a safe state. 3. Expect success. • Plan for scalability. • Plan for integration with other systems. • Model use-case scenarios and associated data flows, system loading, and network impact.

8. 5 Guidelines for Dependability 4. Hire meticulous managers (with just a touch of paranoia) to manage your systems and networks. • Use middleware to manage workload. • Use out-of-band tools to monitor and manage system and network performance. • Develop and execute plans and procedures for managing emergencies and recovering from disasters. 5. Don’t be adventurous. • Use proven methods, tools, technologies, and products that have been in production, under conditions and at a scale similar to yours. • Don’t be the first (or second) to adopt a new technology.

9. Contact Information

10. Local Health Solutions • Kathleen A. McCormick, Ph.D. • Senior Scientist/Vice President • SAIC Health Solutions • Falls Church, VA and Rockville, MD • 703 575-7209 • Kathleen.a.mccormick@saic.com