# Presentation: 426580

## 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

**Notes:**
As Moderator, Dixie will introduce this work and PureEdge (using notes from Pat) hand the session over to Tim.  (3:30-3:35)

## Realization of the Vision Brings Risk

**IT Dependency and Value**

**eHealth – Realization of NHIN**

*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)**

**Stage 1: The Family Doctor**
**Minimal use of IT in clinical care**
**“****Departmental” systems**
**Private networks**
**Decision making as an “art”**

## 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, ***DEPENDABILITY****** ***becomes essential for business success, quality care, and patient safety!

## 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

## 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.

## Dependable Architectures Recognize Dependencies

## 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.

## 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.

## Contact Information

## 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