Distributed Healthcare Framework Using Patient-Centric Role-Based Security Modelling and Workflow
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Distributed Healthcare Framework using Patient-centric Role-based Security Modelling and Workflow Matthew Symes Submitted in partial fulfilment of the requirements of Napier University for the Degree of Computer Networks and Distributed Systems School of Computing August 2008 Page 1 Authorship Declaration I, Matthew Robert Symes, confirm that this dissertation and the work presented in it are my own achievement. Where I have consulted the published work of others this is always clearly attributed; Where I have quoted from the work of others the source is always given. With the exception of such quotations this dissertation is entirely my own work; I have acknowledged all main sources of help; If my research follows on from previous work or is part of a larger collaborative research pro- ject I have made clear exactly what was done by others and what I have contributed myself; I have read and understand the penalties associated with Academic Misconduct. I also confirm that I have obtained informed consent from all people I have involved in the work in this dissertation following the School's ethical guidelines Signed: Date: Matriculation no: PLEASE NOTE that in signing this page you are aware of the consequences of doing this fraudulently as explained at http://www.napier.ac.uk/ed/plagiarism/homepage.htm Page 2 Data Protection Declaration Under the 1998 Data Protection Act, The University cannot disclose your grade to an unau- thorised person. However, other students benefit from studying dissertations that have their grades attached. Please sign your name below one of the options below to state your preference. The University may make this dissertation, with indicative grade, available to others. The University may make this dissertation available to others, but the grade may not be dis- closed. The University may not make this dissertation available to others. Page 3 Contents CONTENTS 4 FIGURES 6 1. INTRODUCTION 9 1.1. Introduction 9 1.2. Context 9 1.3. Aim and Objectives 10 1.4. Dissertation Structure 11 2. LITERATURE REVIEW 12 2.1. Introduction 12 2.2. NHS IT Strategies 12 2.2.1. Information Management &Technology Strategies 1992, 1998 12 2.2.2. The NHS National Plan 13 2.2.3. eGovernment Interoperability Framework (2000) 13 2.2.4. The National Programme for IT (NPfIT) / NHS Connecting for Health (NHS CFH) 13 2.3. Standards and Protocols 14 2.3.1. Digital Imaging and Communication in Medicine (DICOM) 14 2.3.2. Health Level 7 (HL7) 15 2.3.3. Reference Information Model (RIM) 15 2.3.4. HL7 v3 Messaging 16 2.4. Workflow 16 2.5. Past and Present Implementations of NHS IT standards and strategies 16 2.5.1. NHSnet 16 2.5.2. National electronic Library of Heath (NeLH) 17 2.5.3. NHS Care Record Service (NHS CRS) 17 2.5.4. Indigo 4 Review and tQuest 18 2.5.5. Indigo 4 Keystone 18 2.5.6. BHC Oasis Patient Administration System (PAS) 18 2.5.7. Oasis Medical Solutions 19 2.6. Conclusions 19 3. ANALYSIS 21 3.1. Introduction 21 3.2. MOSS Service Components 21 3.3. MOSS Server Components 22 3.4. MOSS Software Components 22 3.5. Delivery Mechanisms 22 3.6. Business Data Catalogue (BDC) 23 3.7. Search Service and Indexing 25 3.8. .NET 3.x Workflow 26 3.9. My Site 27 3.10. Conclusions 27 4. DESIGN 28 4.1. Introduction 28 4.2. High-level design 28 4.3. Infrastructure Model 29 4.4. Site Structure Model 30 4.5. Site Column Definitions 31 Page 4 4.6. WSS 3.0 List Templates 31 4.7. Data Integration Model 34 4.8. HCP Role Based Security Model 34 4.9. Interface design 36 4.10. Information Targeting Design 37 4.11. Workflow Design 38 4.11.1. Business Process Analysis 38 4.11.2. Finite State Machine (FSM) Model 40 4.12. Conclusions 42 5. IMPLEMENTATION 43 5.1. Introduction 43 5.2. Infrastructure Implementation 43 5.3. Test Users 43 5.4. Disparate data consumption 44 5.4.1. Single Sign-On (SSO) Configuration 44 5.4.2. Disparate Data Source Configuration 44 5.4.3. Account Setup 45 5.4.4. BDC Application Definition File 45 5.4.5. Configuring Profile Import Connections 45 5.4.6. Initial Testing, outcomes and Error Correction 45 5.4.7. Results and Verification 45 5.5. Information Targeting Implementation 46 5.5.1. List Configuration 46 5.5.2. Security Configuration 46 5.5.3. Interface Configuration 47 5.5.4. Testing 47 5.6. Workflow Implementation 48 5.6.1. Tasks and Task Lists 49 5.6.2. Business Process Activities to SharePoint workflow activities 49 5.6.3. SharePoint Workflow Activities 51 5.6.4. Workflow Activation 52 5.6.5. Events and Predicates 52 5.6.6. SetTask State 53 5.6.7. Code Class 54 5.6.8. Verification 55 5.7. Conclusions 57 6. EVALUATION 58 6.1. Introduction 58 6.2. Data Integration 58 6.3. Information Targeting, Security and Relevance 58 6.4. Workflow 59 6.5. Wider Issues 60 6.6. MOSS Boundaries 60 6.7. Patient-Centric 61 6.8. Other Observations 62 7. CONCLUSIONS 63 7.1. Critical analysis 63 7.2. Future work 64 Page 5 Figures Figure 2.1: DICOM Distributed Model and Service Classes 15 Figure 2.2. Example of NHSnet Topology 17 Figure 3.1. Typical request response ASP.NET and WSS 23 Figure 3.2. Business Data Catalogue Architecture 24 Figure 3.3. Business Data Catalogue Meta Data Container Model 24 Figure 3.4 Simplified view of MOSS search and indexing architecture 26 Figure 3.5. High Level Workflow Architecture 27 Figure 4.1 High level design overview 29 Figure 4.2 Basic network topology and MOSS farm infrastructure design 30 Figure 4.3 Site structure design 30 Figure 4.4 Data integration through profile import 34 Figure 4.5 Dynamic security process 35 Figure 4.6 Patient interface design 36 Figure 4.7 Personalised view page design 37 Figure 4.8 The issue of unfocussed data 38 Figure 4.9 Effect of personalised filtering 38 Figure 4.10 Flow diagram of business process 40 Figure 4.11State transition diagram modelled on workflow scenario 42 Figure 5.1 Screen shot showing disparate in "Custom Properties" 46 Figure 5.2 Information targeting interface as seen by Patient01 48 Figure 5.3 Information targeting interface as seen by Surgeon user 48 Figure 5.4 Predicate expressed in .NET 3.0 workflow 52 Figure 5.5 Screen shot of development design surface showing SetTask state 53 Figure 5.6 Workflow activities in the set task state initialisation 54 Figure 5.7 Create task activity implemented method 55 Figure 5.8 Send email activity implemented code 55 Figure 5.9 Screen shot of appointment list after item added to referrals list 56 Figure 5.10 Screen shot of SurgeonSecretary user's My Site showing tasks 56 Figure 5.11 Screen of email sent when task is assigned 56 Tables Table 4.1 Additional site columns 31 Table 4.2 Cardiology results template 33 Table 4.3 Radiology results list design 33 Table 4.4 Generic appointment list template 33 Table 5.1 Server configuration 43 Table 5.2 Disparate database table 44 Table 5.3 Sharepoint groups 47 Table 5.4 FSM events and MOSS workflow activities 50 Page 6 Acknowledgements I would like thank Professor William J. Buchanan (Bill) for providing guidance and being my supervisor, Professor John Kerridge for agreeing to be my second marker, and Napier Uni- versity for providing learning resources. I would also like to thank Napier University and Mi- crosoft for facilitating the Academic Alliance program, without which, this project would not have been possible. In addition, I would like to thank my employer for allowing me the time to complete this project. To my partner I thank for her enduring patience and encouragement. I would also like to thank Dr. Christoph Thuemmler, consultant physician and a Visiting Reader in the School of Computing, for his participation in the evaluation of this project. Thanks also to Liz Binnie who kindly provided transcriptions of recorded interviews used in this document and Jonathan Miles for proof reading. Page 7 Abstract Healthcare professionals are spending less time with patients and more time on administrative duties (Royal College of Nursing, 2008). This is due to a high bureaucratic demand (Brindley, 2007) on the caring process, patient population and longevity (Fougère and Mérette, 1999). A patient-centric system uses gathered information and includes the patient in its functional design (IBM, 2006). Patient-centric requirements have existed in UK healthcare IT since 2000 (Fairway, 2000). Some existing systems cannot be patient-centric. This is be- cause the strategies that shape the requirements for IT systems have changed over time (Mackenzie, 2004); therefore, information technology solutions, built in different times, meet different healthcare requirements. The data created in these differing systems can become disparate and less useful (Singureanu, 2005). Patient information is sensitive; medical health- care professional roles, such as doctors can only access a patient’s health record at appropri- ate times. Other healthcare professionals must ask for a patient’s permission to access their health record whilst other roles in the National Health Service (NHS) are only entitled to non- medical information (Scottish Consumer Council, 2007). This implies that viewing patient data attributes are only permissible by role. The aim of this project is to provide a patient-centric prototype distributed system that can demonstrate approaches to reducing complexity through data and interface integration; in- creasing visibility through relevant role based information targeting; and reducing administra- tive overhead through electronic workflow.