Emir Prcic wrote:
I will have a centralized server
So, this will be your potential Single Point of Failure (SPF)
(CAT5 will be going horizontaly, and optics verticaly and from building to building)
That has worked well before.
But think of a Hospital Information System (HIS) as a living organism, i.e., a symbiont organism made of hardware, software and people. Organisms typically grow after being born. So, please, start it small and than slowly add people, software and hardware.
More than 80% of all HIS fail not because they are proprietary or open source, but because they fail to acknowledge the human factors. Hospital Administrations will pay the system, Hospital IT personnel will set it up better or worse, but, in the end it will be the real people that will make your success or failure.
Time and again I have seen massive investments in hardware and in software, just to discover latter on that those systems failed their objectives. Equipment becomes obsolete very quickly, software is more robust but will also (eventually) need improvement, but real people will stay long after equipment or software do.
6. Place at least one unpretensious server for each floor, or 1 server for each 30 LTSP workstations (http://www.ltsp.org/), if you have more than 30 wrksts per floor.
I will have max 50 wrksts per floor and I will look more deply into ltsp although they are all windows people.
Windows, hum... thats your time. But if you need reliability, security and easy centralized administration and solid HA Cluster architecture, I am afraid that you will need to look into a flavor of BSD or Linux.
From the strict point of view of the clinical records and patient data confidentiality, just think of the security and peace that a Linux Terminal Server Project (LTSP) terminal will give you:
a) each time you turn it on you will always have the latest software, the latest security patches, the most accurate user data. And all that by just updating a single terminal image in the central server.
b) while using it the user will not have mass data devices to input from , or to store to. All floppy, HD, CD units will be absent. All I/O ports besides keyboard, mouse (or other mouse-like pointer devices) and ethernet card will be disabled... so, no trouble with non authorized USB, RS232 or Parallel devices.
c) once you turn it off, all the sensitive clinical information will be dead, so you need not to worry with hospital liability if some non authorized person grabs a hand on that terminal.
See what is being done here in Portugal: http://danuninho.dhis.org/~halix/
With some luck, Bruno Tavares will give you the project drafts and implementation scripts.
6.1. As SERVER try:
6.1.1. CPU: AMD64 CPU
6.1.2. RAM: 1GB for the server and 100MB for each workstation. It would give 1GB + 3 GB (30x 100MB) for a 30 LTSP workstation setting. If you
are you talking about ltsp server or decentralized application server with ltsp
Think of it as a floor server that will feed 30 linux LTSP workstations, much like if it were the operating system of the workstations. Of course that you will want to install in that server OpenOffice, Mozilla, some secondary domain controller and user validation software.
That way you will keep the uplink free to just download/upload sensitive data (user configuration and preferences, HIS data, etc.). Even if someone grabs your floor server, they will not have much critical data.
6.2. As WORKSTATIONS:
I see the savings (50 workstations without CD, floppy, HD) which I could plug into the ltsp server but what happens when the server crashes??
Some other server, assumes that task?
That server and the switch device for that floor are distinct hardware. Your floor server will be one among 30 or 40 other floor based secondary domain controllers that each report to a higher server (a PDC ?).
So, configure your servers to be able to re-route and accept the logins from people that were previously served by a failed server (when the time comes think of OpenLDAP).
Remember that with LTSP every single computer in your hospital will be able to log any user and make him "at home" as if he were in his own post-it and Disney comics decorated workstation back in is own ward...
50 workstations down, or I have to cluster the ltsp server, plus my IT team
has no expirience in ltsp nor much expirience in linux.
Either you loose time know to learn BSD (or Linux) and the related software tools, and then setup and forget the system;
Or you will be doing (and paying for) the MS paraphernalia: antivirus, antiwarm, update patches, forced software updates just to keep up with... by now I am pretty sure that you know the drill.
6.2.7. If you afford it, go for wall bolted, touch sensitive LCD/TFT screens.don't think I can aford it. what is the price difference???
Here in Portugal for a 15'' screen it is roughly US$ 120 for a CRT screen and US$ 300 for the latest sens. TFT. But these are prices for equipment imported from the far east (Korea, Taiwan, China, etc.)
6.2.8. If you afford it, go for small touchpads instead of mice.good idea and I think they cost about the same as an optical mouse, plus
they are more sanitary.
Ha-han... and they may also be bolted down... as touchpads are cute creatures that like to go out and take a walk outside the hospital...
6.2.9. If you afford it, specify sterilizable membranes (plastic or silicone based) to cover the keyboards.You think those things that you can type through??? Where do I get those?
Taiwan, Thailand or Singapore. See the "Asian Sources - Computer" magazine. The silicone ones cost aprox. US $0,80 each if you by a thousand or more. But there are vinyl and other plastic materials that are even more cheap, although they have not such a good touch.
I don't think that will be a problem. I would like to see a nurse, or a doctors, taking a workstation out of the hospital. We have guards on the doors 24/7 for this kind of stuff.
Do did we, so did we...
I need realibility, but most of the users that have worked on computers (there are those that still type with old mechanical typewriters, and can't stand the electric ones (40-65 years old doctors and nurses)) know windows.
And I am sure that they know linux too. If they ever surfed the web, if they used google, if they browsed Amazon or eBay, I am pretty sure that they used Linux, as those are linux systems.
Now if I come up with a word like linux terminal, they will all think it is a space ship, and start talking about air polution inside the hospital....
You wish! If you only could get all that people talk about some event that you originated, you would have got their initial attention, and that would certainly be half work done! :-)
So, if they use MSoffice... give them Open Office; if they use IE and Outlook... give them Mozilla; and so on.
Treat people like intelligent persons, ear them, work with them in a day-to-day basis and you will be surprised how they will be willing to help you and become valuable elements of change inside your organization.
Just remember: a HIS is a living being made of SW, HW and PEOPLE.
If you just drop in a bunch of Hardware and a brand new software it won't be those people that will change their habits... it will be you who will change to some other institution...
You will need something like:
7.1. NON PROPRIETARY High Availability Clustering.
7.1.3. DHCP (http://www.isc.org/)>
Will this work for windows workstations?
I can see that you are heading to the "hard way".
But, yes. It can be done. You can use Linux + Samba 3 + LDAP to create PDC's to validate windows workstations. See more at
http://www.unav.es/cti/ldap-smb/smb-ldap-3-howto.html
Go for postgreSQL.Isn't CARE2X originaly made with mySQL?
It is man made... so it cannot be perfect. But even that is being changed...
I have a 6 people team and, yes it is an 6-12-24 month project (6 hardware, 12 mo. software and people training, testing, etc. for 1 med. department, 24 mo. whole hospital.
Well I see that someone has already given the subject some thought and that some hard home work has already been done.
Come again, what is the name of your hospital? And in which part of the world is it located?
Again, they have no hardware (none that I can use for this project). They have a couple of PC's and that rounds it up.
Ok, buy 2 servers (it takes two to start ha-clustering), buy 8 dumb workstations and show them some working software. Be evil, show them a sever being disconnect from the wall plug and the other one graciously taking over; show them a working terminal and ask them to destroy valuable data using it: perhaps trying to upload a virus or other malicious code, or sneaking some patient data files into a floppy, or burning a CD with some financial data from the last quarter...
I bet that they will amazed. I have seen it time and again.
THis article is great.... just wat I was looking for.
Oh, you just can't imagine how many more I can point you to.
The thing is, this is all very new for all the personel in the hospital, and I was the one to suggest CARE2X and I want to make it as safe as possible.
What have you done?!?! :-)
I am planing for 3-4 nines and if I organize all of that very good, I just might get 5 nines. I am also planing to put an AC into server room to keep all of that clean and cool, which might prolong disk life.
Ok, I can see that you are trying hard to be very careful.
So, think about "the Single Point of Failure (SPF) concept".
Whenever you think in a big, fast well known brand server, think instead in two reliable twaianese white line ones. If you think in one fiber channel storage or large SCSI disk, think instead in half a dozen, off the shelf, reliable, SATA drives connected in some kind of redundant arrangement. Etc, etc.
Ok, what about the storage capacity for app. server, file server and DB server?
Care2x has a 3 layer architecture based in the web paradigm:
1. I/O layer - user interaction (Input things from user; Output things to user). This movie will be in a workstation near you as the only thing that you need will be a standards complaint web browser.
2. Business code layer - these are the PHP, javascript and other app code that form the body of the Care2x environment.
3. Supporting layer - these are the OS, DBMS (mySQL or postgreSQL), Apache server.
With the layers 1. and 2. you don't need to worry much with, as any hardware (even an old Pentium 1 with 128 MB RAM) will do.
The problem is the layer 3. And being our area of interest an Information System (an HIS), we will need space to store not only data but, more important, information.
Information is important because some friendly and intelligent human being, just spent a fair amount of time to assemble some static and useless data into valuable and (hopefully) structured information.
So, in the absence of a better opinion, information is (again) your single point of failure. So, work it first.
Data and Information tend to be better stored in a Database Management System (DBMS). While we don't have XML DBMS, we need to be pragmatic and use the next best thing, i.e., a Relational DBMS (RDBMS). And that's why we use mySQL or postgreSQL.
Based on what you have reported so far I would agree that a 1 or 2 TB disk storage would be enough for all your information storage needs for the next 2-5 years. I.e., for combined App. server and File server and DB server needs.
> What about backup of DB and File server, what capacity,
> how do I > backup 1-3 TB radiology images, ultrasound movies, or what ever?
You do it on paper, film or magnetic tape.
You do not do it on a computer system. Nobody does it. You just cannot afford it. Nobody can. Even organizations with very deep pockets gave up.
I tend to think of a CAT scan as DATA and of the medical report made by the radiologist about that CAT as INFORMATION.
So I tend to specify:
a) CAT reports to be available in the HIS
b) CAT exam as film or offline mass storage medium
DVD archive rack (those big robot things)???
No hardware setting will be big enough for even the first 3 years... So, give up.
In the future... with holographic DNA hybrid mediums... who knows?
I have included an image of my last server planing. Please coment on it.
I looks reasonable. Please keep in mind that although Care2x is Apache served it is not a web site. It is an live information system continuing needing human input and output. All the information stored is critical in the sense that any error may originate the death of a human being.
The values are not only material or economic, as some human being may the seriously hurt or even decease in consequence of an error in the system.
Best regards,
J. Antas
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