© R. A. LaMora 2004 Towards an Open-Architecture, [sort-of] Open-Source Software System for Modern...

© R. A. LaMora 2004

Towards an Open-Architecture,

[sort-of] Open-Source

Software System for Modern Hospitals

Andrew LaMora

Surgery for Engineers 2004

A Crazy Idea:


Hospital Care: “THE” Problem

Much (most?) error is due to “system” failure

System: (my definition) The body of procedures employed by humans and computers in cooperation that minimizes error and maximizes expected results for a patient, from check-in to check-out.

Some System Pressure (and Failure) Points:

• Patients under management

• Administration of prescription drugs

• Distinctions in surgical preparation

Measure of success: how well/poorly a system reacts to load and complexity pressure against it.


… and System Pressure is Increasing:

• More patients• More doctors• More specialties requiring specialized equipment

– Additional procedures performed via MIS– Additional tools added to MIS suites

• Advances in wireless– Patient/Doctor Proximity devices– PDAs

• Advances in Automation/AI– Nursebot ‘Pearl’


Reasons for Failure: Unnecessary Pressure from Current Systems Design

• Decentralized Administration

• Disparate Technologies

• Isolated Vendors (non-cooperative)

• Vague Maintenance Ownership• “who’s calling Oracle???”

• “Rube-Goldberg” effect between humans and computer systems


For Instance…

BillingPharmacyRadiology

PayrollFile Server

Oracle

Microsoft

Informix

White Plains

PeopleSoft


For Instance…


PayrollFile Server

Where does the PDA go?


For Instance…


PayrollFile Server

On its own convenient system, of

course!


How do you add ‘Pearl’?

NurseBot Pearl

(CMU Robotics Institute)


A Solution

“Open Agreements Openly Arrived At”- Woodrow Wilson

(take 2)

Open-Architecture, (mostly) Open-Source

Open Architecture:• XML• CORBA• SOAP

Open Source:• Linux• MySql• VTK


Open Source: Benefits

Tangible:– Broad programmer base; easy familiarization– Rigorous peer review of code– Nightly update builds– Rigorous automatic testing– Potentially many more developers than would be otherwise affordable– Homogenous software and system needs

Intangible:– Collective experience by default– Rich featurization for no extra cost


Open Architecture: Benefits

Tangible:– Broad vendor support– Extensive user-group support– New devices can afford to address the general case– Vendors must provide standard APIs, but are not required to disclose source code– System Blend complexity greatly reduced– Job management greatly simplified


Benefits of Homogenous Technologies

• Less error due to apples talking to oranges• Less dependence on vendors to provide integration

interfaces• Elimination of Rube-Goldberg: affordable solutions

can be developed in-house• Addition of next-generation medical devices greatly

simplified• Systems may still be easily modified to meet specific

technical or procedural needs.• SIGNIFICANTLY LESS COST


This…


PayrollFile Server

On its own convenient system, of

course!


Becomes This:

Radiology Pharmacy Billing Payroll

Closed-source 3rd party vendors expose functionality via standardized, well-defined APIs


Closer View: Glue for Integration;beyond shoestring and chewing gum

• HiPyir Glue: High-level, Python-based Integration Resource

• What it does:– Provides a “scripting” language overlay to compiled code via

“wrappers” provided by the vendor– Provides an extremely powerful, object orientated, natively

networked programming language to write both new programs and systems integration code.

How do you bring so many systems together?


Microscopic View: IRE

C++ Robot Control Library C++ Numerical Library C++ Vector/Matrix Libraries

MFC Windows Application

(Including Edit boxes, Dialog

boxes, buttons, etc)

How a typical ERC/CISST robot application may appear today…

No scripting!

No Command Line Interaction!


IRE: Implementation

C++ Robot Control Library C++ Numerical Library C++ Vector/Matrix Libraries

MFC Windows Application

(Including Edit boxes, Dialog

boxes, buttons, etc)

…and how it would appear with IREWe can script whole programs!

We can interact with running MFC applications at the command line!

And we might be able to do other things too.

SWIG Class Wrapper

Python Workspace

SWIG Class Wrapper

SWIG Class Wrapper

Object

Registry


Take-Home Message

• Open architecture paradigms provide clear instructions and designs for multi-modal systems integration

• Open source programs are now as stabile and capable as commercial applications, and are subject to rigorous testing

• Most of the needs of the modern hospital can be solved better with open source solutions than the current methods

• If coupled with a well designed integration environment, the open solutions together still permit vendors to protect key source code, but simplify integration, maintenance, and development.


Questions?

© R. A. LaMora 2004 Towards an Open-Architecture, [sort-of] Open-Source Software System for Modern...

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