Norsk Teknisk Audiologisk Foreniging Hørselsentralens Datanettverk. Ralf Greisiger - PDF

Norsk Teknisk Audiologisk Foreniging Hørselsentralens Datanettverk Ralf Greisiger Why having a network? Benefits share information share resources (printer, etc.) backup accessibility of patient

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Norsk Teknisk Audiologisk Foreniging Hørselsentralens Datanettverk Ralf Greisiger Why having a network? Benefits share information share resources (printer, etc.) backup accessibility of patient data maintenance Hørselsentralen Network Cochlear Implant system Brainstem measurements ENG-OAE measurements Hearing aid system Cochlear Implant OP system Middle ear implants / OP Various database Network printers Audiometric system XXXXXXXX XXXXXXXX XXXXXXXX XXXXXXXX CI database patient info (address, birthday, etc.) operation data (side, surgeon, date) system info (implant type, serial number) statistics (implants per year, age distribution, etc.) work scheduler, time table, room organisation test data (speech tests) medical data (etiology, gen info) technical data (speech processor) kommune, fylke, school, kindergarden Address labels, standard letters OP plan, OP waiting list, utredings waiting list, hengere, CI-HA-nett / infrastructure 7x NOAH hearing aid fitting PCs (currently 5) 1x spare NOAH/Otologics middle ear implant fitting PC 4x CI-datamaskiner CI-fitting (currently 3) 1x CI-OP notebook 1x CI-OP spare / presentation notebook 6x Audiometry PCs (currently 4) 3x Visual Reinforcement Unit PCs (planned) 2x ASSR / ERA PC (currently 1) 1x Admin-Test-PC 1x Server 1x Spare Server / Test Server / Backup Server 2x OAE-PCs (not conected yet) 2x ENG-PCs (not conected yet) 4x Network Printer (3x colour / 1x black/white) - 36 Network elements Accessibility CI-HA-nett RH-nett CI-database Audiogram (audiografer) Administration Investigation (leger) CI-HA Server: Dual processor SCSI RAID 1 1GB RAM Software / databases System NOAH hearing aid NOAH Audiometry Cochlear R126 V2.1 Med-El Studio Cochlear NRT Visual Reinforcement Unit ASSR Audera ENG system (balance) OAE system (sceening) CI database HA database Software Database 9 9 soon one database NOAH Hearing Aid NOAH can handle the SW from 95 hearing aid distributer RH & UUS using about different hearing aids NOAH database NOAH Hearing Aid Fitting Room I Fitting Room II Fitting Room III Win 2k Adv. Server Win 2k Prof / Win XP Fitting Room IV Fitting Room V Fitting Room VI NOAH database 2-3 times per year every HA distributer is sending us new modules/fitting SW 15*6*2=180 installations per year (best case) 20*6*3=360 installations per year (worst case) During login the entire client list is retrieved from the database. The time will depend on the number of clients in the database, and the network is also a factor in this. We are looking into changing the database and it will be to a database with same or better performance. We have not yet decided which Database to use. HIMSA statement HIMSA's product manager, Søren Kristensen (November 2004): Is there a solution in development that the modules can be installed in a network setup just at the server and the clients receive the latest fitting module from the server? No I'm sorry; this is a limitation to the current NOAH framework. We are taking this in consideration when discussing next generation of NOAH. There are no plans yet for this, so you should not expect a solution to this issue within the next year at least. Why is the connection to the database much slower if I access the server database than to the local one? Maintenance Solution Support Levels Third level support One of our audiografer can solve easy problems and can do basic installations Second level support One of our audiofysiker (ikke Ole) takes care of problems that are more difficult, as well designs the infrastructure to the departments needs First level support IT-expert from RH IT department Virtual Network Connection Freeware!!! Terminal Services Remote Server local PC Security The minimum! Virus protection patch installation Access control lists Firewalls?! Backups / safety copies Example: worms RH Server farm System with maximum security RH LAN CI-HA LAN Access Control Lists no ip RH LAN CI-HA LAN Stability How to use the system? save and close audiogram / HA fitting after you have finished the patient NOAH / Auricle usage if NOAH is not used within a short time - close it too! best close NOAH whenever you don t use it reboot the PC at least once per day (in the morning or before you go home) if you have any error messages during measurements or fitting - reboot PC and start with a clean system on Fridays or every evening you can shut down the PC make sure the Auricle interface is switched on before the PC starts up in case of doubt - restart PC again close the patient after you have saved an audiogram (don t open an audiogram after you have closed it - close - open patient first) in case nothing works for the Auricle PC - un-plug power cable, put back in and start the PC (extrem emergency procedure!!!) Mobility Wireless? Incompatibility with other medical devices? Do we have a signal? OP6 OP7 OP8 OP9 OP10 OP11 OP5 OP4 OP3 OP2 OP1 Maybe now? OP6 OP7 OP8 OP9 OP10 OP11 OP5 OP4 OP3 OP2 OP1 Worst case What to do if the server or network is down? Single Point of failure X X X X Switch X Redundancy data base overnight safety copy Backup line Switch Server: Dual Processor system 2x power supply 2x HDD (RAID) Backup Service contract; spare server available data base data base data base data base Redundancy copy the database e.g. weekly onto each local workstation use the standalone version if network is down import created data back onto the server use scripts, batch files and task manager for copying files SQL is having open files mdb no probs, but user limited Outsourcing services Clinicians should concentrate on clinical work and should not be occupied with spare part and repair services! Situation now 1. Patient sends damaged speech processor /HA to us 2. We program a spare processor /HA and write a problem report for the HA- CI-company 3. The processor / HA gets send by us to the patient 4. We send the damaged SP / HA to the company 5. After repairing the company sends us new spare processors 1. HA-CI-Patient HA-CI-Company Service Rikshospitalet 2. 5. Situation desired HA-CI-Patient HA-CI-Company Service 1. Patients sents damaged speech processor directly to the HA-CI-Service company 2. HA-CI-Service company delivers speech processor / HA to the patient Economical/service advantage No additional spare processor / HA programming time (and searching for the failure problem) is needed No cost for sending parcels No delivery insurance is needed (SP costs about NOK ) No problems running out of spare processors in stock No additional staff required for service tasks - focusing on actual medical treatment Increase of patient number We have an exponential grow of patients with Cochlear Implant! Soon we are no more able to give required support and service to our patients! Antall Displayed are just patients below 18 years! År Possible Solution Patients coming to Rikshospitalet Patients are regularly coming to RH for fitting adjustments of their speech processors / HA All fitting data is stored on our server In case of programming a spare processor/ha, the HA-CI-Service company is having access to the latest fitting data HA-CI-Service Company RH Server CI-HA Fitting at Rikshospitalet Firewall Solution I RH-net Outside RH LAN PSTN ISDN- Router CI-NOAH-Server Solution II RH-net Outside Firewall RH LAN Internet VPN DMZ CI-NOAH-Server VPN Connection LAN (Rikshospitalet) DMZ Rikshospitalet Secure Server Internet VPN Connection DSL Pix 501 Vendor Worldwide dial in connection via Modem, ISDN, Wireless, ADSL... Logistics Who has ordered what? Order database Need some cables. Great Arne has ordered some data base We are out of spare cables. I need to order some. Future visions Future plans - one database for all CI patients in Norway Hearing Aid Companies Companies: Cochlear Med-El Hospitals: Oslo Stavanger Bergen Trondheim Tromsø Future plans Operation and first fitting at Rikshospitalet Control and standard fittings at remote centers Problem cases at Rikshospital Information exchange by regularly visits and/or video conferences Fjerntilpassing maybe in future the patient connects its device via USB or Bluetooth to the PC and gets reprogrammed over the internet fast cheaper maybe personal contact is required? Future plans II ehealth Patient Authentication for accessing electronic patient file Biometric (fingerprint) ID-chip card etc. Doctor s practise Hospital Electronic Patient File xxxxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxxxxxxxxx Norwegian Cochlear Implant Database Link Electronic Patient File xxxxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxxxxxxxxx Contact Information Rikshospitalet Universitetsklinikk Øre-, nese- og halsavdelingen Hørselssentralen Ralf Greisiger N-0027 Oslo Norge Dir. linje: Telefaks: E-post:
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