For well over 10-15 years, the battles between 'open' vs. 'closed' solutions have raged. It started with free and 'open source' software (FOSS) solutions, then moved on to 'open standards', 'open access', 'open data', 'open architecture', ... It started in the technology sector, then spread into education, healthcare, manufacturing, government and just about every other component of the public and private sector. It became more than just about technology, it became a broad, global movement that supports the adoption of 'open culture' and 'open societies' around the world. Many individuals, corporations, and countries will continue to battle and fight against the 'open movement' for years to come, not recognizing that the war is over - all 'closed' systems will succumb to 'open solutions' as we move into the future. - Peter Groen |
COSI 'Open' Health
Collaboration, Open Solutions, and Innovation in Healthcare - All about open source Health IT systems, open access health information, open data, open standards, etc.
Monday, March 9, 2015
Last COSI 'Open' Health Information & Technology Blog
After more than 5 years, this is the last COSI 'Open' Health Information & Technology Technology
blog. We will, however, continue to maintain the associated COSI 'Open'
Health Information & Technology web site. We thank the thousands of visitors that took the
time to visit the site and read our blogs over the years.
Tuesday, November 4, 2014
Overview of 'Open' Software Defined Networking (SDN) for Business Managers
If
you don't understand what Software Defined Networking (SDN) is, don't
worry about it. When asked, only 10% of 450 information technology
(IT) specialists at a recent Network World event raised their
hands and said they understood what it was all about.
Obviously,
if you’re in IT you will definitely want to know about the topic of
Software Defined Networking (SDN).
For business managers in most corporations, not so much. However,
this article attempts to provide a high level overview of the topic
for managers so they don't get lost when the IT staff inevitably
starts talking about SDN and why the organization needs to invest in
it.
Software Defined Networking (SDN) is a relatively new approach for managing and operation large scale telecommunication networks. SDN involves decoupling control of the network from the physical infrastructure. It allows network administrators in your data center to better manage your telecommunication networking resources that often consist of equipment from multiple vendors. |
Background
Sometime
in the
year 2000, the Gartner Group recognized the emergence of programmable
networks as the next big thing for the Internet. There
was a growing
mismatch between market requirements and network capabilities. In
response, the industry started
creating
the Software
Defined Networking (SDN) architecture and associated 'open'
networking standards.
The
growth
of mobile devices, server virtualization, cloud services, and
the emergence of the Internet of Things (IoT)
are among the trends driving the telecommunication
industry to
reexamine traditional networking
architectures. Many conventional networks are hierarchical, built
with tiers of Ethernet switches arranged in a tree structure. This
design made sense when client-server computing was dominant, but that
architecture
is ill-suited to meet
the dynamic
computing, storage, and
communication
needs of today's
enterprise
data centers and
telecommunication
networks.
'Open'
SDN Technology & Solutions
Open
source
software
now plays
a permanent role in the world
of enterprise
IT systems.
Gartner forecasts that open source technology will be included in 85%
of all commercial software packages by 2015 and 95% of mainstream IT
organizations will use
a range of
open source
software components.
Currently,
one of the
fastest growing segments within the
world of open
source
software is
Software
Defined Networking (SDN).
The SDN market is projected to
surge from $360M
to $3.52B by
2018.
The Open
Networking Foundation
(OFN) was founded back in 2011 to champion the cause of 'Open
Standards' and Software Defined Networking (SDN). In addition to
promoting SDN, it also supports the popular OpenFlow
specification and communications interface for creating 'open' SDN
solutions. Its board members include Microsoft, Yahoo, Facebook,
Goldman Sachs, Google, Verizon and Deutsche Telecom.
SDN
Benefits
The
tangible benefits of transitioning to software defined networking are
many. They range from better management control of an organization's
telecommunication networks to significant reductions in operational
costs over time. Next generation SDN solutions are not only designed
to handle the many new technologies and infrastructure requirements
associated with the cloud and the Internet of Things (IoT), but they
provide a foundation for massive scalability to meet the future needs
of organizations well into the 21st century.
Other
benefits include more vendor independence, transitioning away from
expensive proprietary solutions, as well as increased flexibility and
agility needed to innovate and meet future needs that have yet to be
determined. In addition increased network performance will also
translate into better service to network users - business customers.
According
to Amin Vahdat, a Principle Engineer at Google, "The
biggest advantage is being able to get better utilization out of our
existing lines." Currently,
the state-of-the-art in the
industry is to run lines at 30% to 40% utilization. With
SDN, organizations should be able
to run wide area lines at close to 100% utilization.
Conclusion & Recommendations
In traditional data centers, network services have been provided by specific physical devices such as routers, switches, and firewalls. Each of these physical boxes was expensive, complex, physical fixture located in a large data center. All that will change when the network is no longer restricted by the hardware, but lies in the software. The trend is unmistakable. In the future, more and more network infrastructure and services will rely on 'open' standards-based software defined networking (SDN).
If
your organization uses large telecommunications networks, better pay
attention and plan on funding the your data centers acquisition and
transition to the use of software defined networking (SDN)
solutions. This applies to organizations in healthcare, education,
manufacturing, retail, government and almost every other industry.
Selected
Links
OpenDaylight
- An
open-source platform for network programmability to enable
Software
Defined Networking (SDN)
and create a solid foundation for Network Functions
Virtualization (NFV).
OpenFlow
- Managed
by the Open Networking Foundation, it
is an
open source communications interface between the control and
forwarding layers within an SDN architecture.
Open
Platform for NFV
Project
- A
carrier-grade, integrated, open source reference platform
intended to accelerate the introduction of new NFV
and SDN products
and services.
Open
Networking Foundaion (ONF) -
Dedicated to the promotion and adoption of Software Defined
Networking (SDN) through open standards development.
OpenStack
- Software
designed to control
large pools of compute, storage, and networking resources
throughout a data center
Project
Floodlight -
One of the world’s leading open source software-defined
networking (SDN) community.
SDN
Central
-
One
of the
leading centralized source of news and resources for network
functions virtualization (NFV)
and software
defined networking (SDN).
|
Wednesday, October 29, 2014
Ebola in the US: Short on Accountable 'Open' Information, Effective Systems Planning and Decision Making
The
CDC issued new guidelines for workers in U.S. hospitals who care for
Ebola patients. Even when they follow all recommended guidelines for
wearing personal protective gear, they “might not realized they
have been exposed.” Statement from CDC, Washington Post October
28, 2014
By
Marc Wine
This
personal blog relays some of my experiences and efforts related to
helping produce a robust and integrated biosurveillance capability
for the nation with connections to international disease surveillance
systems, in order to provide early warning and ongoing
characterization of disease outbreaks like Ebola.
Events
in the present Ebola crisis prompt unease that the United States
deployment of Web based, standardized population health and
biosurveillance information services is fragmented, incomplete and
insufficient, prompting me to write this blog.
The
United States has made significant progress in public health and
medical preparedness since the 9/11 terrorist attacks; yet, poorly
interconnected information systems add to our vulnerability to
planning and response to viruses like Ebola or enviro virus EV-D68
that threaten the health of large populations.
Today,
a gap exists between information technology specialists and public
health programmatic or scientific personnel. Overall, their
intergovernmental attention to interoperable data management for
meeting the challenges of notifiable disease
reporting, outbreak detection, emergency response, program
evaluation, and public communications in relation to syndromic
disease outbreaks, is divided by lack of program collaboration and
timely, accurate data sharing.
The
will of the nation’s public health decision-makers has been divided
between federal, state and local politics that prevent connecting
content, analysis and integrated electronic health information
systems from every hospital, clinic, county, state and federal
departments of health with the people.
Today,
the Ebola outbreak that began in West Africa, killing over
5,000 people so far, moved from Texas Health Presbyterian Hospital in
Dallas to the Washington, D.C. area with the transfer and now
released Nina Pham the first nurse diagnosed with Ebola after caring
for now deceased Ebola patient Thomas Eric Duncan, to the situations
in New York with Ebola diagnosed Craig Spenser and quarantined Kaci
Hickox in New Jersey plus the dozen U.S, military personnel
quarantined in Vicenza, Italy following their mission in West Africa.
My
sympathies are deep for the people and families stricken by the
virus; further, my empathy is heightened for all people who are
missing the promise of security and protection from not having a
deployed and interoperable nationwide information system for the
continuous predictive analysis and communications in the common
handling of critical disease and public health threats.
What
we do see are the results of the gaps and dangers of the unfulfilled
policies of the National
Strategy for Biosurveillance (The White House July 2012).
My
own observations of the wide-scale implementation of electronic
health information systems for surveillance show challenges, barriers
and missed opportunities suggesting the U.S. failure to fully harness
the laws and comprehensive systems of early warning of health
threats and early detection of deadly disease events, including
bootstrapping comprehensive and unremitting education especially
among health care workers.
Situational
awareness in real-time, that ought to have enabled the more
appropriate response behavior of the health systems workers in
Dallas, Texas for example, remain uncoordinated with federal and
global signs of the Ebola crisis. Governments around the globe have
stalled, unwilling to recognize this outbreak as the humanitarian,
information and resources crisis it is. Even though, we knew about
Ebola at least since the 1976 Sudan outbreak, the U.S. is looking
months into the future before any efficacious vaccine may be
expected.
Looking
back, beginning within about three months of the 9/11 attacks,
Veterans Health Administration (VHA) Under Secretary of Health Dr.
Jonathan Perlin requested that the VA Federal Interagency Health IT
Sharing (HITS) program to demonstrate within 90-days the capability
for VA to exchange the data of all VA ambulatory lab results
system-wide with CDC’s Office of Public Health Informatics in near
real-time.
The
first goal of the initiative was to electronically exchange the data
from VA to CDC plus create algorithms for analyzing the lab test
results for flagging any evidence of atypical diseases or syndromic
incidences; supporting the monitoring and detection or population
disease or biosurveillance outbreaks. The outlier lab tests of
unusual and unexplained results would be exchanged back to VA
end-users for considering potential bioterrorist or syndromic disease
events.
Then
working on the mission to plan with the CDC associate director for
health informatics, we helped deliver on the Undersecretary’s
request for the development of a data exchange and analysis
demonstration between VA labs and CDC. Accordingly, It marked the
first time VA was to share lab data electronically on a wide-scale
with CDC for public health disease monitoring. Although, it was not
until about a year later that the VA and CDC could show the initial
capability of how to cleanly exchange electronic disease surveillance
data, initially via an over-night batch processing solution.
Eventually,
this evolved as a part of today’s BioSense
2.0 that provides a mechanism to collect and share information on
emergency department visits, hospitalizations, and other health
related data from multiple sources, including VA, the Department of
Defense (DoD), and civilian hospitals from around the country.
In
2002, I discovered that VA clinical researcher Dr. Sylvain DeLisle of
the VA Medical Center Baltimore was awarded CDC’s first grant to
mine VA’s VistA
electronic health record (EHR) system for the purpose of
identifying evidence of influenza-like symptoms that may be
indicative of serious population health threats. Dr. Delisle’s
results, gained from applying his methodology used to optimize VA’s
VistA electronic health record (EHR) data, evaluated the performance
of an automated text classifier for syndromic surveillance.
This
VA data mining automatically processed VistA health record source
documents, patient diagnostics, and was used for informing decisions
regarding electronic textual data sources for potential applications
with computerized biosurveillance systems. In other words, Dr.
DeLisle’s analytic method would automatically flag certain patient
diagnostics for potential unexplained disease incidence.
My
reaction immediately and vigorously was to help promote Dr. Delisle’s
surveillance methodology as an innovative direction toward advancing
'open' solutions, that would be used for generating decision support
and knowledge. The analysis of existing patient information could be
used to inform the public and health care workers about high
potential, critical disease outbreaks across health systems that can
be predicted accurately from patients’ electronic health records.
The
vision I held then, was that semantically accurate disease predictive
analytics can be combined with online learning modules that would be
able to inform health workers in real-time how to apply precautions
and procedures for emergency response to threatening outbreaks. Now,
in the era of Ebola and enviro viruses, it still looks as if the
nation’s health system is not there, despite the development of
policies and capabilities based on billions of dollars invested over
at least a decade-and-a-half.
It
appears that CDC Director Thomas Frieden’s answers to questions
about Dallas health worker’s lacking a clear understanding about
how to handle Ebola is not his part of his responsibility; yet, it
represents another view that U.S. leadership with population health
and biosurveillance systems is sadly lagging behind policies, plans
and political commitments dating at least back to 9/11.
In
2007, my experience working within the Department of Defense (DoD),
Telemedicine and Advanced Technology Research Center (TATRC), proved
again that the U.S. was planning but not working effectively to
produce and deploy an interoperable and integrated data sharing and
decision support system for the public’s protection and health care
worker’s knowledge of future pandemic or bioterrorist diseases like
Ebola.
In
the report, “CDC’s
Vision for Public Health Surveillance in the 21st
Century,”
CDC authors emphasized, “…federal, state, and local agencies and
health departments have failed to obtain access to desired
administrative or survey data…” in relation to collaborating
Information from disparate sources or programs that can display
patterns of disease that individual program data cannot.
At
TATRC the deputy director assigned me to serve as “the
belly-button” for promoting innovative
health information technology solutions that would be used for
managing biosuveillance in educating, informing and analyzing
real-time bioterrorist or syndromic disease events. There,
I set out to accomplish three goals:
- analyze the alignment of the rules and regulations governing how and why population health data are collected and released,
- coordinate planning for innovations generating the processes to put the data into a form that can be shared across the Web and between DoD, VA and CDC and
Then
Associate
Director for Science, National Center for Public Health Informatics
at CDC Dr, Tom Savel visited TATRC, and we agreed to work together on
identifying gaps of interoperability between CDC, DoD and VA public
health data surveillance systems.
There
was no existing useful sharing involving all three of the federal
government’s disease surveillance systems across CDC, VA and DoD.
My work entailed bringing together managers and leaders of the
federal disease surveillance systems from, DoD, VA and CDC for
mapping ways to address the policy and technical barriers to cross
government data communications about potentially deadly disease
outbreaks.
The
lesson I learned from facilitating collaborative
efforts to meet the needs of public health surveillance programs
through collaboration, innovation and open data solutions was that no
common standards for communicating, interpreting and educating people
from top-to-bottom across the nation were operating; moreover, the
efforts just to get the different departments talking to one another
proved arduous.
Earlier
in 2006, I was invited to attend a small meeting at The White House
Executive Office Building where I saw presented the first
model for rapid identification of “conditions favorable” for
Ebola epidemics using satellite imagery.
As
it turned out, this was somewhat related to innovation projects with
the TATRC portfolio that I was promoting in 2008. The most forceful
realization of this initial disease information satellite project was
the possibility of connecting a global biosurveillance system
seamlessly to hospitals in America using information technology so
that patients would not be seen by American healthcare workers
without access to immediate situational awareness of what that
patient might have been exposed to while traveling overseas.
With
the history, benefits and opportunities that CDC Director Dr. Frieden
has behind him, not to overlook the nation’s high priority
commitments to systematically inform its health workers and people of
the granular details and data about Ebola fully and in advance, how
can he not accept responsibility for what happened with Ebola in the
Dallas hospital and the incidences involving the subsequent illnesses
and gaps overall?
Indeed,
an apparent breakdown in the nation’s ability to use electronic
health information systems for providing disease surveillance, share
open data with interoperability, including situational knowledge in
real-time from hospitals across cities and towns, to counties and
states, to federal decision-makers and global leaders is contributing
to fundamental weaknesses in our global preparedness for future
epidemics, which given the interconnectedness of modern life, will
likely occur.
Not
only does today’s call for answers to the problem of being ready
and smart about Ebola cry out for open solutions across all boarders,
but my own experience speaking within the Washington, D.C. and global
community about the substantial need to be ready with health
information systems, shows how little we listen and take action
successfully when it comes to national and global governments
collaborating effectively.
For
example, in 2008 after I was invited to organize and moderate a
meeting of top disease surveillance leaders from the U.S. and Canada,
including DoD, VA and Canada’s public health departments, hosted at
the Canadian Embassy, I became curiously intrigued at the slow pace
that America moved with global partners in response to the laws and
demands for implementing a reality-based integrated population health
disease information network, including virtual reality programs for
educating health professionals that CDC itself promoted.
Still,
the goal that is evasive in the midst of the Ebola outbreak in the
U.S., is that all data potentially relevant to
public health surveillance would be harmonized across data systems,
interoperable, and easily accessed by the maximum number of users in
as timely a manner while protecting confidentiality and privacy of
respondents.
More
recently, in 2013, I was invited to meet again with CDC officials.
This time the initial request was for me to organize a meeting with
the CDC public health Community Guide directors and The White House
Chief Technology Officer (CTO).
The purpose of the talks and was for enhancing the planning and
design of a nationwide public health decision support system that
would generate usable knowledge, from the federal level with
secondary epidemiological and population health research, and deliver
it in real-time to all state and local levels of public health
directors for their use in planning and preventing serious disease or
other public health threats.
On
the one hand, the success of my talks with the CDC officials about
how to design an infrastructure for an advanced health information
decision support system, one that would responsively handle knowledge
sharing about an Ebola outbreak for example, in an extreme instance,
was noted by their appreciation for learning how to proceed. On
the other hand, I am substantially more concerned today than ever
before in my experiences that far too few have stepped up in advance
to provide the resources and services including technical expertise
and political will that are so desperately needed to fight Ebola at
every level.
Final
Observations & Recommendations
These
are selected observations and recommendations for working urgently
towards a more responsible network for filling the gaps of systems
interoperability, plus sharing health and disease information.
The
job of deploying a comprehensive disease surveillance information
system is unfinished.
Today,
this presents the nation with a critical imbalance from having to
react lesser prepared than it could have, as did health workers
handling Ebola in Dallas, to benefiting from having an open and
uniform infrastructure for surveillance information and knowledge for
all.
By
identifying, sharing and integrating diverse information sources and
expert analysis, collectively we will be more likely to identify
trends signaling an incident, analyzing prevalence and better able to
answer key questions that President Obama and Dr. Frieden have
stumbled into.
Recommendations:
- Pursue more 'open' biosurveillance activities that purposefully mix and match efforts and the sharing of information between and among Federal, State, local, tribal, territorial, private, nongovernmental, academic, and other national enterprise participants.
- Develop connections through collaborative international biosurveillance activities that will accelerate effective response to domestic and international incidents.
- Ensure the nationwide, vertical top-to-bottom 'open source' distribution of a cloud-based data integration platform supporting collection and integration of biosurveillance of information from a variety of governmental and other sources, including social media and news reports.
- The president and CDC director should be held immediately accountable for comprehensive disease security and data sharing through the elimination of differences in coding, formatting, definitions, and methods that differ substantially or in the ways data are stored in incompatible formats.
- Directors of the states departments of public health should be held accountable for limiting sharing disease surveillance data by the lack of user-friendly data dissemination tools or adequate and detailed documentation and distribution.
- The White House and Congress should lead a review of all funding steams and mechanisms the affect how disease surveillance data are collected. All data, analytics and systems deemed to be essential for public health safety, security and learning should be considered open source for the purposes of national security and disease protection.
- Data-use agreements should be shared widely to provide models for others interested in sharing data; data sharing should be promoted by developing supportive funding mechanisms, devoting resources, fostering partnerships and centralizing support; and methods and procedures should require open standardized across datasets.
- The White House and CDC should immediately re-commit their agencies and departments to assessing the utility of having surveillance data directly flow into information systems that support public health interventions and information elements or standards that facilitate this linkage of surveillance to action and improving access to and use of information produced by a surveillance system for workers in the field and health-care providers.
- Public health and hospital electronic health records (EHR) systems should accelerate their capacity to process both structured and unstructured data access and standardized interpretations faster than HHS ONC Meaningful Use Stage 2 and 3 criteria would require.
- Concerns related to disease managements best practices, data quality, data standardization, process automation, work flow design, and system validation all need to be addressed. The need to use new and legacy systems in parallel for a period must be considered and planned for, including the challenging process of transitioning users off legacy systems. Therefore, emergency federal, state and local resources should be made available immediately and effectively in order to establish accountability among all the nation’s hospital networks for identifying and handling Ebola plus other population-level disease threats.
Finally,
the future Learning Health System Governance and Policy Framework
that is being planned with leadership from the University of Michigan
Department of Health Informatics should include the real-time,
anywhere, anytime decision-support that the people around the globe
will demand in relation to public health events.
References
for More Information:
- National Strategy for Biosurveillance, The White House July 31, 2012 http://www.whitehouse.gov/the-press-office/2012/08/01/national-strategy-biosurveillance
- Homeland Security Presidential Directive HSPD-2, Public Health and Medical Preparedness http://fas.org/irp/offdocs/nspd/hspd-21.htm
- Public Health Surveillance in the United States: Evolution and Challenges, CDC July 27, 2012 http://www.cdc.gov/mmwr/preview/mmwrhtml/su6103a2.htm?s_cid=su6103a2_x
- Ebola Outbreak A Test for Data Mining and Analytics, Information Week Health Care, October 16, 2014 http://www.informationweek.com/healthcare/analytics/ebola-outbreak-a-test-for-data-mining-analytics/d/d-id/1316666
- Collected articles on 'open' biosurveillance solutions and activities posted in Open Health News (OHN).
Marc
Wine is a senior health systems and health information technology
adviser in Washington, D.C. and co-author of the benchmark book,
Medical
Informatics 20/20: Quality and Electronic Health Records through
Collaboration, Open Solutions and Innovation, ( Jones and
Bartlett 2007)
Labels:
Biosurveillance,
disease surveillance,
Ebola,
EHR Systems
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