Interoperability – Credit Cards As a Model For Health Information Sharing

Isn’t it amazing how we can travel the world and pay for nearly anything with a credit card? This is possible because credit cards are simple: they use a standard device; they are relatively secure; and they use a common data standard. In the world of electronic medical records, we should strive for this same level of interoperability. Just like a credit card, we should be able to use our medical records anywhere in the world, anytime we choose, and maintain personal control over our information at all times.

Credit cards use a standard device to store information; all of the data is encoded onto a magnetic stripe. Since credit cards don’t carry much data, this works well. Medical records, however, are quite complex and sometimes require a substantial amount of storage, especially when including x-rays or other images. Another important difference is that medical records must be constantly updated. Carrying outdated medical records is more dangerous than not having any records at all. Credit cards aren’t designed to have their data added to or changed, they are “read only.” Medical records need a standard device, similar to a credit card, but with the ability to read and write data. USB storage devices are easy to carry, and offer plenty of storage space; and some are even designed to fit in your wallet. Almost every computer built in the past 12 years has a USB port, so they should be nearly as universal as credit card terminals.

Credit cards are relatively secure. The cards are protected by security codes, expiration dates, and encryption when used online. Most people keep their credit cards in a wallet or purse, so they are accessible at all times. Medical records should be used in the same way. Patients should have their data handy at all times. Just like making a purchase, their health information should only be available to physicians they choose. One key difference is that credit card purchase information travels over a network. Sending medical data over networks is where the model fails. There are many reported health data breaches every year, many of which lead to identity theft. Rather than using a network like the banking industry, medical records software should save data in a standard format on a USB drive. Just like with online purchases, encryption can protect sensitive medical data.

Credit cards use a common data standard. Terminals all over the world can read credit cards, regardless of manufacturer. This is possible because of standard data formats. Magnetic stripes have been exactly the same since their introduction in 1975; however almost everything has changed in medicine in the last 35 years. Even though medical technology will continue to evolve, interoperability will require a common way of storing and communicating data. Extensible Markup Language, or XML, is a common way to store and communicate data. It is used everyday by millions of websites and software programs worldwide. There is already a version of XML, known as Health Level 7, or HL7, that is specialized for communicating and storing medical data. Choosing a standard data format is necessary for any interoperable system.

The Solution to Interoperability is SIMPLICITY. Rather than complicated and insecure national health networks, we should look to the credit card as a model for an interoperable health system. First, an interoperable medical records system should use a standard device, like a USB drive. Second, it should be secure, using strong encryption and personal control over the USB drive. Finally, an interoperable system should use a standard format to store and exchange data. The result would be a simple, secure medium that allows individuals complete control over their comprehensive medical information.

Ensure Compatibility and Interoperability of Your Applications

With the effects of recession gradually getting diluted, most enterprises are back to normal at their IT investments and are today focused on empowering their workforce and business processes with latest technologies, new browsers, operating systems, infrastructure, productivity applications, security controls and so on. While updating to latest technologies has become imperative, major challenge lies ahead for enterprises to ensure the compatibility of new applications and technologies with that of legacy devices.

Most enterprises try to postpone their upgrade plans to do away with the compatibility issues. For instance, though enterprises have started deploying Windows 7 in their environments now, the adoption rate has been sluggish during the initial stages. Enterprises were used to Windows XP operating system that offers the compatibility, security, and reliability needed. It is quite essential for enterprises to ensure that their applications or systems continue to function well and much better even after deploying new applications and technologies. Adding to these are several systems in place in today’s enterprises which access functionality and data from various other external applications and devices, which may need to interface with the application at a data, component, user interface, network or operating system level.

Hence, ensuring compatibility between different systems/applications/environments is a must for today’s enterprises. There is a need for enterprises to evaluate the performance of system/application on certain hardware platforms; peripherals like printers and fax machines; underlying operating systems such as Windows, MAC or UNIX; and compatibility with different databases and operating tools. Compatibility testing verifies how applications behave within a particular environment containing disparate operating systems, databases, networking hardware, several servers, browsers, and peripheral devices, while Interoperability testing verifies how several applications work with other applications.

Compatibility & Interoperability Testing (C&I) plays a prominent role in ensuring whether an application under test interacts and functions as expected with other applications. It ensures compatibility of existing data files and other applications as well as whether an application is compatible with several versions of the software. It is aimed at verifying whether the application under test interacts and functions as expected with other software and hardware combinations. C&I testing identifies the defects that might arise while testing on a combination of hardware and software environments, reports failures to the development teams and ensures defects are fixed, while determining the application-readiness for the release. Overall, C&I testing helps in validating the compatibility and interoperability of a set of enterprise-class apps in a combination of complex hardware and software environments, while meeting specific business requirements.

Radio Interoperability Discussed By National Public Safety Telecommunications Council

As almost an aside to the conversations about 10-codes, politics and turf battles as they relate to interoperability, Harlin McEwen, vice chairman of the National Public Safety Telecommunications Council, sounded an ominous note about the lack of radio interoperability among first responders from different agencies and locales.

“You’ve got all these disparate systems – I don’t believe in my heart that’s ever going to be resolved,” he said. “There’s not enough money, and the problem is, what you change this year to bring some compatibility, next year somebody has a newer and better product.”

The problem isn’t the lack of technology from which to choose; in fact, plenty has been done in the interoperability arena in terms of solutions first responders can focus on without reinventing the wheel. The real need is for responders to take rising costs into consideration, as well as the ease of use, and look into forming partnerships with nearby jurisdictions that have already deployed solutions.

Expensive Investment

There are many considerations when procuring a radio system, and cost tops the list. Effective radio communication systems can be expensive, and many agencies and locales can’t afford the investment.

“For many years, radio systems were a pretty simple technology and lasted for a long time,” said Kevin Kearns, executive director of iXP Corp., based in Washington state. “It was not uncommon to see 20-year-old base stations in use, and mobile and portable radios at 10 to 15 years of age. The gear could be repaired by radio technicians as long as the parts were available, and that was typically a long time.”

That, however, has changed dramatically in the last decade.

“Systems are much more complex now and utilize expensive new technologies that have shorter life cycles,” Kearns explained. “Radio systems are looking more and more like IT systems, and some of the core components of the infrastructures have comparable life cycles. That shifts a significant capital expenditure burden on a jurisdiction that may be having a hard time just coming up with adequate funding for personnel and operating costs.”

Though the right technology is a bit of a moving target, it’s important to find out what interoperability investments have already been made, and consider partnering with another agency or locale, said Chris Essid, interoperability coordinator for Virginia. He said it’s critical to coordinate with other locales in the region to ensure that communications systems are interoperable.

“Many times systems are built 100 percent independently – without consideration of partnering with a nearby system that would create a larger footprint at a reduced cost,” he said. “I was in a meeting where a locality was going to build a system, but once they realized the state was building the same kind of system, they let the state use their frequencies in return for being able to become a primary user on the system. This resulted in millions being saved.”

Essid advises agencies to retain internal technical expertise when dealing with the vendors.

“Many times what you need is much different from what you are being sold, and localities can save millions on large systems by having some internal technical expertise to advise them.”

But if a certain project comes to fruition, technology costs could be mitigated.

A Cyren Call

The project in question – a nationwide, public-safety grade broadband network for emergency responders, built by commercial operators and shared with the government – is proposed by the co-founder of Nextel Communications, Morgan O’Brien, now co-founder and chairman of a company called Cyren Call.

The Cyren Call project would take an estimated 10 years to build at approximately $17 billion. It would use a block of 30 MHz in the 700 MHz spectrum band, which is to be auctioned off in 2008. The bill for the project was introduced by Sen. John McCain, R-Ariz., in March, and would put the band spectrum in a public safety broadband trust.

Former Department of Homeland Security (DHS) Secretary Tom Ridge urged the project’s creation, while McEwen said he’s intrigued by the idea, adding that the network wouldn’t be designed to replace traditional land mobile legacy systems, but could tie them together.

“You’d have nationwide, roaming, compatibility,” McEwen said. “And you’d have voice over IP [Internet protocol] backup to your traditional, more reliable voice systems.”

But the project has its critics, including senators, the FCC and telecommunications companies, who want to guard the spectrum and dislike the concept of having Cyren Call managing it.

McEwen said he hasn’t seen a better proposal for a nationwide system, and that it would be a relief to taxpayers, who’d otherwise have to pay for many more local systems. Critics, however, say users will still be on the hook for expensive proprietary handsets. Passage of the bill may be a long shot because Congress has a tendency toward wanting to sell spectrum commercially rather than putting it in a public trust.

Statewide System

In the interim, some states, such as Florida, are building 800 MHz radio systems through which public safety agencies statewide can communicate. Okaloosa County, Fla., is in the process of joining this system, and expects to go online in 2009.

The county is now working with 1970s architecture, but emergency workers, deputies and county workers all operate on different systems. Joining the state system will save the county the $10 million it would have spent to build radio towers. However, there’s still the cost of $600,000 for dispatching consoles, as well as startup costs for radios, which is expected to be $200,000. Sheriff’s deputies are expected to pay more than $500,000 for radio startup.

In Silicon Valley, a group of 30 law enforcement, fire and emergency medical agencies in Santa Clara County is developing a voice/data wireless system that was cited by the DHS as a “Best Practices” model for interoperability.

The system will rely on a microwave network, now being built, that will enable first responders to exchange voice and data. Another part of the area’s interoperability system is the Bay Area Mutual Aid Communications System (called BayMACS), which responders can use to communicate regardless of jurisdictional boundaries.

But because this system exists on a single channel, it would be easily overwhelmed during a catastrophe. The group is looking at a network-based VoIP radio solution to solve the problem.

The Gee Whiz Factor

The very mention of IP-based systems is the cause of many a furrowed brow.

“There are lots of gee whiz technology solutions that could help these folks in various parts of their jobs,” said John Clark, former deputy chief of public safety for the FCC. “But in terms of making sure they have real-time communications that might be the difference between life and death, it has to be with them in the tower, in their hands, on their belt, and it has to be seamlessly usable. In other words, it can’t require them to dial up channel 9; it’s got to be something that just happens.”

Some agencies are operating with legacy equipment that precludes them from considering interoperability with their neighboring agencies and jurisdictions.

“It’s pretty common,” McEwen said. “There are a lot of people around the country having problems because of their systems being old and needing replacement. Little by little they’re getting replaced, but it costs a lot of money to replace them.”

There’s not a lot of incentive, Clark said, for a local agency to break the bank to purchase technology for interoperability’s sake – for a catastrophe that may or may not happen.

“It’s the same problem they had in New Orleans,” he said. “How much money do you want to invest on a category 5 storm that you might not see in your lifetime?”

There’s another issue, McEwen said.

“Unless you have good communications within your agency to do your own job, you’re not going to be really enamored with, ‘How can I improve things to talk to my neighbors.'”

Gateways to Interoperability

Most of the time, Clark said, internal communications are all that’s needed. And interoperability can be achieved – and might have to be achieved – by use of gateway devices, McEwen said, like the Raytheon ACU-1000, which can be deployed quickly to connect disparate systems.

As Kearns said, these communications systems are prestaged and preprogrammed to allow quick deployment, but that takes prior coordination.

“At the strategic level,” he said, “you can utilize larger and more network-centric versions of these gateway technologies to link together dissimilar system infrastructures so that interoperability is essentially permanently in place and users of one system can talk with users on a linked system on a routine basis.”

Florida has used the ACU-1000 and other emergency deployable interoperable communications systems, in numerous situations.

“They are extremely useful,” said Silvia Womack, 911 communications chief of the Okaloosa County Department of Public Safety. “Any county in the state can request its deployment. It also can and has been deployed outside of the state for emergencies such as Hurricane Katrina. They have been used for every type of emergency – tornadoes, hurricanes, conferences, the Super Bowl and even the Space Shuttle retrieval mission.”

Learning From the ‘Amateurs’

Steve Rauter, former deputy chief of the Lisle-Woodridge Fire Department in Chicago and current 911 director, said he wants on-scene, off-network tactical radio solutions for most interoperability needs.

“My issue is in-the-hand tactical interoperability,” he said. “I want the technology in the hand – not at some controller far away or an IP-based system that is fairly brittle.”

There’s a time and place for the IP-based solution, he said, but not in critical, on-scene communications – at least not yet.

“Some of the military IP solutions are starting to come out,” Rauter said. “Those are in essence hardened; they’re encapsulated, meaning they’re not wide open to anybody who wants to smack into them.”

But as far as public safety is concerned, he said, the IP-based system hasn’t arrived yet. “I don’t want to have to wait and reboot my radio before I can go into a fire scene; that just doesn’t make sense to me.”

Some manufacturers sell radio systems and call them IP compatible when they’re really not, Rauter said. “Some of the bigger manufacturers, including some of the biggest, will tell you that they’ve got IP from end to end, which is completely false because the radio is not IP compatible – though they will tell you it is.”

He said public safety officials could take a page or two out of the amateur (ham) radio playbook.

“For at least 35 years, the ham radio community has enjoyed multiband, multimode radios, and we’re trying to migrate some of that technology to public safety,” Rauter said. “Give me a bag of them with some AA batteries, and I can deploy some folks to go do work. The technology lends itself to instantaneous work. You’re going to hear people opposed to that. They’re going to say that you need to bring in a full up trunk radio system to handle large emergencies, and there is some merit to that. But for the most part, for most of the country, a much less expensive methodology could be had.”

He said there are products available now that fill this need. Amateur radio units cost about $300, and it’s rumored that a couple of manufacturers will unveil new, multiband, multimode radios at this year’s International Wireless Communications Expo in Las Vegas.

“One of the manufacturers was talking about a military style or at least a migration from the military, that’s an intra-team radio that’s sometimes known as an MBITER radio that [covers] 30 MHz through 512 [MHz] continuous tuning with digital, analog, wideband, narrow band and encryption,” Rauter said. “That’s a standard-issue handy talky called a PRC-148.”

Read the Label

Some manufacturers are peddling Project-25 compatible systems that are advertised as interoperability solutions. But, Rauter said, it’s not that easy.

“Project 25 does not address the band issues,” he said. “Interoperability has to start with spectrum. Project 25 started out as a digital on-the-air interface, which they were fairly successful in implementing, but some of the manufacturers would put in proprietary options, which would make them nonstandard, meaning you can’t put Brand A on a Brand X system, and this has been a problem.”

Rauter said he’d like to see labels on these systems, much like the food label on a jar of peanut butter that lists exactly what’s in it.

“The manufacturers want to position themselves to be exclusive,” Rauter said. “If you go back 18 years when Project 25 started, it was supposed to reduce the price of radios. They’re not going down, they’re going up.”

Ham Group Ready for Action

The Arlington, Va., Office of Emergency Management will be the beneficiary of 25 amateur (ham) radio volunteers in the case of an incident requiring emergency communications.

The local Radio Amateur Civil Emergency Service (RACES) volunteers graduated from a yearlong course of weekly radio communications exercises and are certified to help the Arlington County government in a crisis.

The volunteers each passed a county-authorized background check and achieved the first level of training required. Continual training and exercises are required to maintain the RACES affiliation.

Ham radio operators have a history of being able to quickly set up radio communications during emergencies when other systems have failed or become overloaded.

IM Provides Redundancy

One of the few reliable means of emergency communications during the aftermath of Hurricane Katrina was instant messaging.

That was not lost on Kentucky, which recently launched a project that will allow all public safety users in the state’s wireless data system to exchange messages from mobile data computers, vehicles or a stationary computer.

The project, KYWINS Messenger, lets first responders communicate when voice communication is unavailable. The program can also quickly broadcast a message to all users within seconds.

The project resulted from a joint effort by the Kentucky Office of Homeland Security, the Justice and Public Safety Cabinet, the Commonwealth Office of Technology and the Center for Rural Development.

New Jersey Mesh

The Lakewood, N.J., Police Department will deploy a 4.9 GHz, broadband mobile mesh network for communication during patrols, surveillance activities, events and tactical operations.

The PacketHop Communications System is a software-based, infrastructure-optional network communications system loaded into the state’s police cruisers and in its command post.

The software converts analog video into digital video and distributes it across the network in real time. It allows police to monitor events from afar and to quickly move resources to where they’re needed and cut down on overtime costs.

The state successfully deployed the system during its Wingstock music festival in September 2006.


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