Presentation on theme: "Point of Care Data Networking"— Presentation transcript:
1 Point of Care Data Networking by Kevin Breneman and Keith EnsorofWellspan Networking and TelecommunicationsWe will be presenting the NUTS & BOLTS of NETWORKING POC devices to the KEYPOC group..We will be presenting a view from a FUNCTIONAL COMMUNICATIONS level as we in Wellspan Networking see the system.We view the METER as a small COMPUTER or PDA like a BLACKBERRY or PALM PILOTWe won’t be discussing patient comfort, operator use, or strip chemistry, we will concentrate on meter to host communications.Our DESIRE is to explain in detail how the test data gets from the patient Point of Care to the hospital LIS and BILLING SYSTEMs and to present the TERMS and TECHNOLOGY involved.We hope to present NETWORKING KNOWLEDGE to help you better INSTALL & MAINTAIN your own POC DATA COLLECTION SYSTEM(s)Disclaimer: we are not endorsing or condemning the LIFESCAN system and iSTAT systems. We are only using them as examples in our presentation as they are the systems we are familiar with.Questions will be accepted and welcomed at any time during the presentation.Keith EnsorKevin Breneman
2 GOAL = connectivity METER to HOST communications Paperless read and results reporting of patient testingA single source of truth that is reliably copied verbatim to whoever needs the dataPopulate other systems with the collected dataEliminate hand written transposing errorsImprove efficiency of existing available staffRevenue recovery for services renderedWhat are we TRYING to ACCOMPLISH?
3 GOAL = convenience for caregivers A good system willbe preferred over a manual systemreturn more info then a manual systemsimplify an otherwise tedious taskIntegrate easily with other hospital systemsAllow moderate degrees of customizationPatient id format matching and checkingInclusion of desired extra fieldsElimination of unwanted field requestsInclude security controls and honor patient privacyMANUAL should NEVER be better then an installed automated system!MORE DATA plus higher DATA integrityIntegrity example: TIME of TEST is not what caregiver wrote down but what the ACTUAL TIME of the test was!CUSTOMIZING:PATIENT ID NUMBER FIELD CONTROL LENGTH, LEADING CHARACTER, QUICK CHECKPATIENT ID vs TESTER BADGE NUMBERCould you include a new field like a scan of the ROOM NUMBER?Could some one unskilled pick up a meter and EXTRACT PATIENT INFO, CORRUPT recorded tests, ADD bogus tests?
4 Wellspan Glucose System Components 1st Level Lifescan meterLifescan IR docking stationLantronix mss100 terminal serverHouse wiring / interconnectCatalyst 5500 Ethernet switchdecreasing user exposureWe’ll be presenting the system at TWO levels.FIRST LEVEL…..equipment exposed to the userAll this equipment within 300 feet of the DOCK locationFailure causes:Drops, liquids, physical damageUnexplained damage: the dog ate itTheft and abuseUnauthorized, inexperienced repair attempts by uneducated “helpers”
5 Other “hidden” components 2nd Level Core network componentsi.e. core or distribution routerWAN links to annex’s (wan=wide area network i.e. across a phone company circuit)Lifescan Windows server, Lifescan WorkstationQDXI / CLOVERLEAF interface engineCerner interfaced Lab Info SystemEclipsys interfaced registration / billing systemOther systemsLOW user exposure2nd LEVELMID and UPPER Level equipmentKEY for the actual DATA INTEGRATIONLOW failure rate ….. Less human exposureFailure causes at this levelLOSS of UTILITY POWERSOFTWARE CHANGESOVER ZEALOUS NETWORK ENGINEERS!
6 Point of Care Data Networking Glucose Testing Docking Station ComponentsThe components you’ll see most around the hospitalThese are also the items with the highest human exposure and therefore will be the items requiring the most service and attention.FIRST LEVEL USER EXPOSED:ELEMENTS of a LIFESCAN system you’d see at a nursing station or DOCKING location.GOOD: COMPACT SMALL EQUIPMENT, WALL MOUNTABLE, MODULAR CABLING, LED power status indicators on DOCK and LantronixBAD: AC adapters, battery powered meter, replicates existing Networking equipment already ownedBAD: A potential problem area I see here is the union connector for the AC adapter for the DOCKWellspan UPDATED from REGAL to NEW BRAND AC adaptor for LANTONIXTip: -UPGRADE AC brick if you have Lantronix REGAL’s-Tape power couplers
7 Wellspan Glucose System Components 3126Lifescan meterHandheld, self powered, Lifescan glucose meter “mini”-computerTouch screen user interface Input/OutputStrip sensor i/o portBar code reader i/o portIR (infra red) communications i/o portDuplicate "earphone” communications i/o portBattery poweredIs it RUGGED….Can you DROP IT?SAFE case….no metal, no glass, all plasticno shock or telemetry equip hazard. No RF interferenceNice if you can operate with ONE HANDCLEAR BRIGHT HIGH CONTRAST DISPLAY (backlit?)AUTOSHUT OFF after xx seconds of no use? Battery Savings.LOW BATTERY indication BEFORE you TEST & waste a strip or sample a patient.SAFE LASER….do not look into the LASER with your REMAINING EYE!BELT CLIP, HOLSTER, CART?Can it be CLEANED and STERILIZED?Can you afford to replace it?Can an unauthorized person use it elsewhere?POINT OUT I or O or BOTHScanner reads symbology CODE 128 (and others) TURN OFF DECODE of UNUSED symbologiesSet scanner rules / FILTERS for length, prefix, whatever you can. AVOID scan of nurse BADGE for PATIENT IDBADGE and ARMBAND print quality should be EXCELLENT. Scanning should work FIRST TIME.547Tip: turn off scanner decode of unused bar code symbologies
8 Wellspan Glucose System Components Lifescan meter dockIR portoptical / infrared transceiverrj11 presentation serial data communications connectorMeter “present” triggerIt’s wall mountable so DO IT!Make cords custom length and consider custom color. The red cable connects a to b , the blue cable connects c to d EASY SUPPORT!If an AC outlet is not within reach of the provided cord have one installed. Don’t use extension cords. Added failure pointConsider locking clamps for AC adaptors so the CAN’T be unplugged.FACT: Only when docked is a meter available for data upload download.-meter updates to flash memory-meter programming changesAC power adapterTip: consider clamp locks for AC adaptors
9 Wellspan Glucose System Components Lantronix terminal serverStatus LED’sUTP rj45 Ethernet presentationAC power adapter connectIt’s wall mountable so DO IT!Tout that this is a low cost commonly available device….. Good equipment despite use of AC adaptor.Uses common industry standard connections, RJ11 serial/(phone) cable, RS232 modular adaptor, rj45 network cableFirst real networking item that communications staff would typically take ownership of.We should NOT have purchased as we already own a big brother of this unit with 48 ports and a network interface.30 $300 eachUsing our OWN would have cut CLUTTER at the nursing station as well as incorporated a more robust, secure device.LABEL it with its location, ip address, and hostname with a permanent label. We like the Brother PTOUCH labeling. Cheap, neat , lasting. CLOSE look shows this to be hostname 6east“PINGable” device which aids in troubleshootingTry this FIRST when you know it is working as your pc may be denied access to ping the LANTRONIXRS232 standard “db25” presentation serial data communications connector with rj11 adapterTip: ECHO test if it’s alive and on-line.from your desktop pc issue the command: ping
10 Wellspan Glucose System Components House wiring / interconnectA reliable cable plant is key to a successful installationHouse wiring may be used for Ethernet, serial, or telephone connectionsBasically it’s nothing more then a “quality” extension cord for your wiring needsLearn your institutions wiring identification scheme. It’ll may help you locate devices.Report problems by connection id informationAt Wellspan the first three digits indicate the central wiring closet where the cable terminates and the remaining digits are the sequence number or patch location for that cable.Consider custom length cords. Bundling can be done but exact length cables stay out of the wayStatus LED’sTip:Look closely and see the wall plate is numbered , AND ,A typical modern cable plant will server a 300’ radius area around a central communications closet.The area covered however is typically only 2 dimensional and does NOT CROSS FLOORS verticallyA well planned cable plant can accommodate, telephone, ethernet, serial data, intercom, misc low voltage sensors and usesEXTENDS the facilities of the secure communications closet to the “desktop”.Equipment in the secured communications closet is usually of higher quality, lower cost/port, and includes redundancy capabilitiesExample: comm closet term server has 48 ports instead of one like the lantronixExample: catalyst switch has dual power supplies (UPS fed) and hot-swappable componentsRJ45 jack presentation will allow the insertion of an RJ11 plug. GOOD and BADReferred to in the industry as STRUCTURED WIRING.Structured house wiring. UTPUnshielded Twisted Pair with rj45 jack presentationUTP rj45 network cable
11 Wellspan Glucose System Components MID level network connectivityNetwork switch with fiber uplinktelephone portsNetwork portsA typical WIRING CLOSET. Sometimes referred to as an IDF (intermediate distribution frame)We call this one IDF 66CATALYST SWITCH is our first interest….note RJ45 jacks on the chassis cards. THEY are EXTENDED to the wall plate via the structured wiring.WIRING:40 station runs per DESTINATION tray:RUNS are sequentially numbered. This idf appears to have 12 trays (12 * 40=480 wall jacks)SOURCE trays:Network ports and telephone extensions. Varying special requirements.The closet should be neat, secure, and be equipped with a simple local access device, telephone and a variety of POWER optionsUtilityHouse Emergency powerUPS backup power for smooth transitions.NOTE DUAL plugs on the Catalyst switch. Accepts TWO power sources!minutes to this pointHouse wiringWellspan network closet 0666th flr main bldg
12 Wellspan Glucose System Components Tip: check the path.from your desktop pc issue the command: tracertTop level network connectivityCORE RouterCore layerDistribution Router #1Hospital 6th flr idf 66 meter locationDistribution layerDistribution Router #2Modern Networks employ and Access, Distribution, and CORE layerFew controls in the Access layer….Make a “local” call to anyone….in fact it’s like a party line in some casesDistribution layer offers access control and modularization. Think “long distance” and appropriate charges and checks.Core layer provides high tier direction but primarily offers high capacity linking so “calls are never blocked”U.S. telephone system is VERY much like DATA NETWORK routing.Routing in an ip network is analogous to the use of AREA CODES for U.S. phone calls.Every telephone company couldn’t manage every phone number but they can forward it “upstream”.The distribution router is the first upper tier to “reroute” a call, the CORE router is the know it all that has EVERY area code is.A non-existent AREA CODE call may actually have to be processed by the CORE before you get a “wrong number” reply.Introduce concept of HOP COUNTTHREE HOPS from meter to Lifescan Server/WorkstationUSE of tracert commandRouting introduces deterministic, repeatable, reliable transport.Core and distribution components provide a backbone or expressway for network traffic.Access layer7th flr & POC dept idf 79 LIFESCAN Server locationHospital Data Center idf 159 Cerner LIS location
13 Other “hidden” components 2nd Level Core network componentsi.e. core or distribution routerWAN links to annex’sLifescan Windows NT serverQDXI / CLOVERLEAF interface engineCerner mainframe interfaced Lab Info SystemEclipsys mainframe interfaced billing systemLifescan Workstation and iSTAT CDSThat Catalyst in the 6th floor wiring closet is ONLY the ACCESS switch for devices within 300 feet of it.Other SYSTEMS on OTHER network switches would include:QDXI / CLOVERLEAF interface engine…eliminate a full mesh between interfaces systems. Creates a HUB and SPOKE instead.Cerner interfaced Lab Info System.. An interface on Cerner connects directly to Cloverleaf which then connects to the Lifescan W/SEclipsys interfaced billing system. SAME as CERNEROther systemsCERNERQDXIEclipsys
14 Point of Care Data Networking A typical glucose meter to LIS (lab info system) configurationComponentsMeterDocking stationEthernet / Terminal serverEthernet transport inter-networkhub, switch, routerGlucose System ServerLab Information SystemOther involved information systemsGlucose Meter Bw/IR linkingPOC dockEthernet Terminal ServerEthernet Area RouterFOCUS now on BLOCK LEVEL DATA FLOWFIRST on a block level from 10,000 feet up……WHAT ARE THE COMPONENTSEthernet HubEthernet SwitchGlucose Server &Data CollectorLab Info SystemSUPER DOOPER HOST
15 Point of Care Data Networking A typical glucose meter to LIS (lab info system) configurationGlucose Meter Aw/IR linkingRouter interfaces 1,2,3,4 join FOUR tcp/ip networks.Without the router we can not segment traffic.With the router we can have local traffic stay local & impart network access controlsWhen a router is used each host must have knowledge that it needs to use the router for destinations not on its own subnet.Host AAAEthernet Terminal Server 1POC dockEthernet HubEthernet Switch #1Laser AGlucose Meter Bw/IR linkingSubnet 1POC dockEthernet Terminal Server 2Ethernet Area/Core Router124Subnet 2FLOW EXAMPLE METER A to LIS. NOTE LINK SPEEDS…..First IDENTIFY ROUTER and that METERS are on NETWORK 1Meter IR to DOCKDOCK serial/rs232 to term server LOW SPEED, LOW PAYLOADTerm server ethernet to switch or hub HIGH SPEED, UP to HIGH PAYLOAD.Ethernet switch to distribution router for forwarding to destination (other area code) using the gateway declared on the terminal serverin this case TERMINAL SERVER GATEWAY ADDRESS = network address of ROUTER INTERFACE 1Core down to DESTINATION area code router interface 3 for processing by Lifescan W/SAnd so on to ……….interface 2 to cloverleafDESPITE LIS and Registration being in same “area code” they had to go “LONG DISTANCE” to use the interface engineSWITCH vs HUB…HOST A to LASER A concurrent with our transmission….hub allows ONLY ONE at a time.HUB = Hotel with one phone line and all rooms on that party line. One inter-room call at a timeSWITCH = Think of a skilled switchboard operator with a pile of patch cords managing multiple inter-room calls in a hotel.Ethernet Switch #23System to System Interface engine (Cloverleaf)Subnet 4Subnet 3Ethernet Switch #4Ethernet Switch #3serial linksRegistration SystemLab Info SystemUTP linksGlucose Server &Data CollectorFiber links
16 Wellspan Glucose System Components Ethernet Area/Core Router352&41Ethernet Area/Core Router67Ethernet Switch #1Ethernet Switch #3Ethernet Terminal ServerGlucose Server &Data CollectorThe 10,000 foot block view overlaying the technical networking components.Introduce TRUNK concept where TWO router interfaces can be delivered to one physical switch with virtual capabilitiesNetwork 2 and 4 are really two area codes owned by the same telephone company and are both multiplexed on a single physical connection.These are called Vlans or Virtual LansRecall final step or LAB to CLOVERLEAF to REGISTRATION flow using VLANSDATA CENTER is where this often happens first because of high host concentrationLike a big city split by a river and needing two area codes to effect efficient call routingWE’LL be coming back to this one!!!Ethernet SwitchGlucose Meter Bw/IR linkingEthernet Switch (#2 & #4)w/ VIRTUAL capabilityPOC dockEthernet Terminal ServerInterface engine (Cloverleaf)Glucose Meter Bw/IR linkingLab Info SystemRegistration SystemPOC dock
17 Point of Care Data Networking iSTAT Testing Wellspan Components iSTAT ReadingiSTAT meter = lifescan meteriSTAT IR docking station = lifescan docking stationCOBOX terminal server=lantronix terminal serverCisco Catalyst Ethernet switchCisco distribution routeriSTAT Windows serverCDS-Central Data Station = Lifescan workstationTIME FOR A BREATHER….!!Compare istat components to equivalent Lifescan components…..Equipment is identical from a networking persons perspectiveiSTAT did not include mounting capabilities or were not usedREMEMBER THAT….Uses AC adaptorsSESSION BREAK BETWEEN SLIDE 17 and 24Scripted CDS to Cerner interfaceCloverleaf NOT used!!!! NON - HL7Likely Low Cost but LOW TECH….only works to Cerner. Un-expandableLooks like a user logged in on the system. Subject to Cerner changes!!uses a VT420 dumb terminal style of login and script to upload dataNOT interfaced to Eclipsys interfaced billing/registration system
18 Component Functions Glucose meter a limited function computer with i/o capabilities for:display and keyboard / bar code reader inputtest strip subsystem and inputOptical communications port to transfer data base field type data.Inputoperator lists / badgesDatabase type field parametersOutputPatient idPatient test numberTimePatient test result valueDEVICE Technical specificsIR communications typically at 9600 bpsIR tops out at 4 megabits/secIR has its own protocolThe meter is a pretty sophisticated computer!!!Multi function, multi i/o, touch screen!SESSION BREAK BETWEEN SLIDE 17 and 24
19 Docking Station IR (infra-red) linking to meter Physical and/or Optical connection to meterMay be passive or may provide expanded communications features absent in the meter to offer serial RS-232 communications to existing hospital owned standards based Networking devices like a hospital owned Ethernet terminal server.The data stream from the meter/dock is like a single file row of marbles coming down a tube in sporadic pacing.References to the docks data port may include the terms serial, asynchronous, com port, rs232 port, rs485 port.Adds reliability and automation to the UPLOAD processProvides AC line power for communicationsTriggering magnet in DOCK causes meter to automatically initiate upload sequence w/o user interventionProvides industry standard serial communications link.RS232, serial, asynchronous, DTE device, comm port, (all are used as terms to refer to such a connection)Small payload - Slow speed communicationsSESSION BREAK BETWEEN SLIDE 17 and 24
20 Asynchronous Ethernet Terminal server A conversion device or communications converter to allow the connection of slow speed low cost devices to high speed Ethernet networks. (marbles to envelopes)Meter and dock speak asynchronously typically at only 9600 bits/second or about (9600/8) 1200 characters per second.Serial communication is typically referenced by bits or single charactersEthernet by contrast speaks at 106 bits/second or about (106/8) 1,250,000 characters per second with typical modern networks NOW using fast Ethernet 107 and gigabit 108 bit rates.Ethernet communication is typically referenced by packets of dataTerminal servers most often emulate the original DEC Digital Equipment Corporation (now HP) DECserver200.They allowed the connection of multiple terminals to a single box which could then communicate on a base band ethernet backbone.This saved the need to run a wire from the host computer to each and every dumb terminal or printer.Aggregates serial stream data into a data packet or DATAGRAMS for forwarding as a “packet” on a high speed data network.PACKET is multiple characters i.e packet 1=“The quick brown fox”, packet 2=“jumped over the lazy”, packet 3=“dog .<FF>”SPEED consideration and INTEGRATION onto a common backbone is the advantage.SESSION BREAK BETWEEN SLIDE 17 and 24
21 Ethernet terminal server (cont) The job of the terminal server is to “package” the async data into a larger package for efficient transport on a high speed network. i.e. Japanese subway “stuffers”.The data stream on the Ethernet side of the term server would be analogous to when a train comes by with open box cars and you fill each boxcar without the train stopping in a “clocked” loading fashion such that each boxcar represents a data packet from the terminal server. Many cars will leave only partially filled and sometime 2 or 3 cars may be needed for one big packet that has to be split up because it’s too big or takes to long to get in the current passing boxcar!One box car or packet may contain multiple individual threads between several meters on a common terminal server origination or source to a common destination such as the LIS host offering multiple threads to accommodate communications with each connected meter.Once a data stream begins from the meter the term server starts packetization.The train starts rollin !Every x milliseconds a box car door slams shut and data continues to be loaded in the next boxcarEach boxcar has a source address of the server it came from (the city) and the home sending it.Communication closet terminal servers can support more then one slow speed device concurrently.i.e. 48 docking stations on ONE terminal serverAll docking stations can send at the same time and the term server manages the source identification by labeling each data stream with “tagging” information included in the ethernet packet.SESSION BREAK BETWEEN SLIDE 17 and 24
22 Cloverleaf (QDXI) interfacing and HL7 An interfacing program executing on the LIS receives the inbound testing information but at Wellspan the meter actually first sends to the Lifescan server (Lifescan Workstation) which then sends to an interface engine which then sends to Cerner (the LIS) via HL7 data exchange protocol. [HL7 = health layer seven]The advantage is that an enterprise hub and spoke interfacing plan can be adopted saving per host interface ports and resources.Consider this example “6 host hospital enterprise”full mesh interfacing…………..interfaces=n(n-1)/2 or 6(5)/2 =15hub-and-spoke interfacing…..interfaces=n(1) or 6(1) = 6A hospital with only 20 hosts would take 180 interfaces versus 20 interfacesA Lab Info system like CERNER would likely require the addition of a communications software moduleThe module is typically a programming collaboration between the LIS vendor and in the in this case LIFESCANSuch modules written well require considerable development time and are costly but rewardingdata feed input originating from the meter is integrated into the LIS as if entered manually by a user transposing data from written test results.USE of integration protocols like HL7 have reduced the cost of such ventures by using a standard based syntax.A huge benefit of using HL7 is that perhaps a single HL7 software module can be purchased for your LIS instead of one for each communications partnering requirement.BENEFITS of an INTEGRATED INTERFACE ENGINEREDUCED interface processesREDUCED LINK COUNTSESSION BREAK BETWEEN SLIDE 17 and 24221313Hub and SpokeFull MeshversusQDXI646455
23 LIS Laboratory Information System The LIS is the eventual receiver of the collected test data. The LIS (Cerner) receives the data via the HL7 data exchange protocol from Cloverleaf interface engine.A communications application module purchased for the LIS must be running and “listening” for this inbound data stream.The Cloverleaf and the LIS being Ethernet capable devices exchange packets (boxcars) filled with Lifescan transaction data that has been aggregated by the Lifescan Workstation.TCP / IP protocols job is to direct and route those data packets to the appropriate software communications endpoint on the LIS host.This endpoint is often called the listener, the interface socket, or host virtual port.TCP/IP protocol is the networking protocol that carries the ethernet packet stream whether it bePackets from the terminal server carrying the raw meter dataPackets to or from the Cloverleaf engine carrying HL7 transactions dataTCP/IP is where the data gets it “state, city, and street” address we spoke of earlierSESSION BREAK BETWEEN SLIDE 17 and 24
24 …that old black magic…. DATA NETWORKING The part we just skipped is Networking's specialty and what puts bread on the table for Keith and Kevin !!!!!What really happens when my glucose meter begins to upload data to the network.How does the meter data actually make it to the LIS host?What keeps the data from getting all jumbled together when 5 meters all upload concurrently?SESSION BREAK BEFORE THIS SLIDE (#24)
25 MAC and IP addressing MAC addressing Every Ethernet device EVER made has a globally unique MAC or media access control Ethernet address assignment. This assignment is burned into the chip set of each and EVERY Ethernet communications port of any device that can be Ethernet attached.In our example the terminal server would have one and the LIS host would have one.A MAC address is 48 bits long and is almost always written and represented in the computer world in hexadecimal.281,474,976,710,656 = possibilitiesexampleb-01-af-19 hexbinary equiv8,796,814,552,857 decimal equivMAC media access control addressMy house will always be at latitude and Latitude: N, Longitude: no matter what they name your street or who lives in it.The mac address might be considered synonymous to my homes latitude and longitudeLeft part of the number manufacturer (left 24 bits or left 3 bytes)Right part is to be equivalent to the device serial number (right 24 bits or right 3 bytes)
26 IP addressing Example: 192.168.236.104 Every Ethernet device added to a tcp/ip network needs to get an assigned IP address. This assignment is typically awarded by your institutions network guru or IP address administrator.In our example the terminal server would be assigned an ip address so it could talk to other tcp/ip systems on your network. An ip address is a 32 bit number typically expressed in decimal format. The left portion of the assignment reflects the network (think area code) that the host is enrolled in and the right portion of the assignment reflects the host number in that network. (think your 7 digit phone number)An IP address is 32 bits long and is represented in the computer world in decimal using what is called dotted decimal notation.Example:Above in binary isFull decimal value would be 3,232,296,040 but this reference is not used as the dotted decimal notation more easily shows network enrollment32 bits = 4,294,967,296 possibitliesPrivate REUSABLE addressing ranges:thru first dot boundary (/24 bit)thru second dot boundary (/16 bit)thru (/8 bit)IP address is an address awarded to a device independent of its mac address.The left side of the “address” reflects the network you belong to….the right side reflects your individual host or house identifierThink left side = zip code, right side = street numberUnlike the mac address the network/host boundary can be shifted.A town with lots of short streets may want to use more digits for networksA town with only one or two really long streets may want to use more digits for host or house identifiersDEPLETION OF AVAILABLE #’swe are on a course to soon deplete all available 4 BILLION addressesSchemes were introduced in the early 90’s to avoid and defer thisintroduction of address translationIntroduction of a reusable block for internal addressingthru first dot boundary (/24 bit)thru second dot boundary (/16 bit)thru (/8 bit)
27 IP addressing/subnet masking Example:Above in binary is:MaskThe above 32 bit mask allows 224 bits for network and 28 bits for host numbersMASK ValueTypical masks are :allows last byte to be all host numbers 28 = 255 (actually 256-1)allows last 2 bytes to be for host numbers 216 = 65,535allows last 3 bytes to be for host numbers 224 = 16,777,215BUT they can be on a NON-classful boundaryCUSTOM mask exampleallows only the last HALF of last byte to be host numbers 24 = 15Every host in a tcp/ip network needs an ip address, a mask, and a gatewayMask indicates where the network / host boundary marker is.The mask is the masking tape that tapes over the COMMON NETWORK PART of the address that is not important when talking within your network.The MASK is the second requirement when giving a device an IP address assignment.VALUE THAT SETS THE BOUNDARYThe left side of the “address” reflects the network you belong to….the right side reflects your individual host or house identifierWHY SHIFT THE BOUNDARY??A town with lots of short streets may want to use more digits for networksA town with only one or two really long streets may want to use more digits for host or house identifiersThe reason I show and 1 less for each network mask is because an all 1’s number like 255 is considered unusable for a hostThis is because an all 1’s address is a BROADCAST address that all hosts receive and process.
28 IP addressing/gateway Network portionHost portionExample:Above in binary is:Gateway:Above in binary is:MaskThe gateway address will always be a similar ip address to yours & in your local network.The gateway address you use will always be the ip address of a router interface.Your “GATEWAY” to the rest of the IP world.You talk to it. It talks to the next level on your behalf.The address you enter on your host for the GATEWAY will always be an address on YOUR network. It is who you DEFAULT to for getting beyond your network.“long distance” to another area code.Hence the name “default gateway”An ARP address resolution protocol table in your pc maps host ip addresses you talk to, to that device’s MAC address. Devices really talk MAC to MAC!!!The last part of giving a device an IP address assignment is to give it the address it uses to go out of its home networkIf the DESTINATION host you are seeking to talk to is NOT on your network you initiate a connection to your networks GATEWAY.The GATEWAY is a routerThe GATEWAY will know where to forward the message to and if it doesn’t it will forward it up to a tier that does.If there is no response or no known destination (or it’s down) you will get back an “unreachable” messageEach router gateway encountered between you and your destination is referred to as a HOP.Your PC has a relational table called an ARP table that maps a destination ip address to a MAC address.If LOCAL it is the actual MAC address ---- If “long distance” it is the MAC address of the gateway router.If you can’t ping a Lantronix terminal server….see if you can ping it’s GATEWAY address.If you can the network is probably OK.If you can’t the router could be down.Tip: ECHO test the gateway. If it’s not alive then that net will be unable to talk outside of its own “area code”.from your desktop pc issue the command: ping
29 IP addressing / dhcp or permanent (static) The ip address can also be awarded by machine from a pool of predefined available addresses. This technique is called DHCP or Dynamic Host Control Protocol. This works great for devices that join and leave networks and works well if no one needs to access your host. DHCP can be setup to award you a temporary ip address, your correct mask and your assigned gateway.A pc workstation works fine with a temporary dhcp address but a pc SERVER would almost always need to receive a permanently assigned address so other computers would know what to connect to.The addressing typically used by POC system component will likely always be static addressing because like a server the addressing is permanently awarded per device so that other systems can find the POC system components using the same address each time.Good static address example is which really isGood dhcp example is your office pc which only makes OUTGOING connections so it doesn’t really matter if you use a different address tomorrow. You could still for example get to google.com!IP addresses originally were all static and you always used the same oneDevices like laptop and portable computers however dictated a need for dynamic addressing.If you were a summer visitor to a small town in New England in your Airstream RV trailer and wanted to receive mail there over summer vacationyou’d use the network number (zip code) but you’d probably get a box number from a pool of available p.o. boxes at the local post office.You may have trouble receiving mail because no one will know you have this temporary address until they get notification from you or a friend.When you move your RV to Florida to a new location for the winter season you’d inherit a new address in a Florida zip code and a new P.O. box. The p.o box might even be the same number you had in New England but to the world it is different because the zip code makes it globally unique.This is how DHCP works. You inherit from the local authority a temporary address so you can send and receive communicationsNEW ENGLAND pool example FLORIDA pool exampleIf this were the scheme in use (last “octet” = po box) the network/host boundary would be at the /24 bit point (after the third decimal point)
30 Wellspan Glucose System Networking Here’s that picture again.Lets look at the Flow from LIFESCAN WORKSTATION to the METER to PULL data…..Glucose ServerData CollectorIP:Gateway:Mask:Ethernet Terminal ServerIP:Gateway:Mask:Glucose Meter Bw/IR linkingPOC dock
31 Socket Communications Socket communications is how the I.T. world refers to endpoints.Two systems that are ETHERNET capable will use socket to socket communications for each “flow”Meter A on term server 1 to the Lifescan Workstation would use a socket pair.Meter B on term server 2 to the Lifescan Workstation would use a socket pair.At least one endpoint must use an exclusive ip address or socket number to differentiate between the two flows. (reference slide 15)Connect to your LIS host and then to an Internet sites on your work pc and then click start and run and in the dos window that opens type netstat –a on your pc. It will show you an nice example of socket to socket communicationsexample: pc to googleExample pc to CERNER via telnetIP addresses are associated to MAC addresses at some point along the flow path…..An ARP table or address resolution protocol table manages this for you.Typically one on your pc for hosts in your zip codeAnother one on the upstream router for how to get to other zip codesBring out the concept of source and destination addressingIntroduce concept of my daughter at my house in my zip code writing to her boyfriend in another zip code at another house where he is the 3rd of 4 children. SOCKET COMMUNICATIONSSocket type/capabilitiesOne host to a listener allowing one connection per socket…..POC term serverOne host to a listener allowing multiple connections per socket….telnetUse floppy copy orig > copy as an example of data flow.Tip:
32 Sockets that receive connections are called “Listeners” because they are “at the ready” to receive an inbound connection.Are often called “services” or service sockets because they are typically tied via software to an application function like:telnet, or ftp, or webserverCustom receiver application like Glucose meter data collection.The boyfriend on the receiving end is the listener socket…… Aren’t they always…ha-haThe boyfriend may be programmed to receive and accept letters from many girlfriends i.e. telnet and ftpThe boyfriend may be programmed to only accept one girlfriend input at a time i.e. single input like a Glucose listener.
33 Application to Socket communications The application can however be coordinated with an initiating socket with the other endpoint being the listener. Printing is an example of such a reverse direction of socket communications because the printer is listening for a connection for its next print job.A listener may allow only ONE connection at a time or it may allow multiple concurrent connections.THE computer with the endpoint that INITIATES the communications is NOT the listener.Web server = example of multithreaded listenerIf the terminal server is the listener end = example of single thread listener.A busy listener will tell the end trying to connect to it that it is already busy or it may even allow a degree of queuing whereby it accepts a second, third or fourth connection but it may put that flow in a hold or stacking pattern till it can process the current “on deck” request.
34 Application to Socket communications Click RUN, then click START then enter command (win98) or cmd (winxp) and in the dos window enter netstat –a at the prompt to view all the current socket connections on a pc. Here’s a partial clip from our Lifescan server.Tip:Active ConnectionsProto Local Address Foreign Address StateTCP lfs_datalink: : LISTENINGTCP lfs_datalink: : LISTENINGTCP lfs_datalink: : LISTENING...TCP lfs_datalink: : LISTENINGTCP lfs_datalink: : LISTENINGTCP lfs_datalink:nbsession : LISTENINGTCP lfs_datalink: : ESTABLISHEDTCP lfs_datalink: : ESTABLISHEDTCP lfs_datalink: : ESTABLISHEDTCP lfs_datalink: :telnet TIME_WAITTCP lfs_datalink: : ESTABLISHEDTCP lfs_datalink: :telnet TIME_WAITProtocol = tcpLocal address is the hostname of the LIFESCAN workstationAfter the COLON in the Local Address is the socket number ON the LIFESCAN w/SForeign address is the host name or address of the other end of the connectionAFTER the COLON in the Foreign Address field is the socket number endpoint on the distant hostState tells you what it’s doing:LISTENING: the software that receives on this socket started up the listener and it is runningESTABLISHED: the socket (could be a LISTENER) is connected to the listed host:socketTIME WAIT: the socket was in use but was torn down and is in HOLD mode so it is not reused accidentallyFIN WAIT & CLOSE WAIT: one end closed and is waiting on ACK from the other…… could indicate problems or connection losses.netstat –a is a harmless command to view connection status. It can be executed at any time on any pc w/o impact.
35 Wireless adoption Current capabilities Future Wirelessly connect the terminal serversFutureDirect real time or “hot spot” wireless linking for each meterWould help eliminate those times when no one remembers to dock and upload the days work from a meter.Wireless Meter tracking…. Where did I lay meter icu01???Wireless daily audit of transactions w/o docking.Meter peds06 did not report for 24 hours so the server will “look” for it and potentially alarm / a system manager if missing.Automated updates…. All meters will be software upgraded to now accept an additional bar code format for the new to be adopted patient id system.Or all meters will be upgraded to Lifescan operating system version 6.12 from 5.83First wireless generation will be nothing more then wireless docking stations….easy to do and can even be done with your current cabled terminal servers by front ending them with a wireless bridge adaptor.Giving a term server a wireless connection may have unseen benefits like helping to keep the dock station neat because it could be on it’s own cart instead of competing for precious counter space at the nursing station.
36 What can POC users do to make for an optimal Network deployment at their institution? Establish clear installation locations that are not overcrowded with other nursing functions.Name everything with a short, lower case, meaningful name during the design phase and stick with it.Too many devices here!! A horrid wire mess from msicuWhere’s Waldo?Find the istat meter dock!!!!..????The lifescan doc is on the wall. Note its clean install helps keep it easiest to find but front clutter impacts its accessibility.Compare integrity of Lifescan install (mounted and bundled to wall) with iSTAT install which was just splayed out on the counter.Would you want to troubleshoot and support the Lifescan or the iSTAT install if you had your choice?Recall how I pointed out that iSTAT had no wall mount option and Lifescan difference. Here is the result.
37 What might POC users be asking of POC vendors for future product considerations give thought from a Networking perspective.Does the vendor’s devices allow you to use existing network resources.You may already own terminal servers? Why buy more? We shouldn’t have.Can they use DNS or dynamic DNS for naming simplification and connection destinations? A netstat will then show names instead of addresses!Can the peripheral devices be easily monitored for health status (SNMP, telnet and web access)?Does the system support test and training data collection while the production system is live?
38 Other “BEST” networking practices Neat cable work eliminates problemsLabel devices and document connectionsGive EVERYTHING an enterprise unique nameThink like a hacker when planning the install.Hospitals have been lax on security for too long.If the area is already cluttered don’t expect it to improve with the addition of another computing device. Something gotta go or new space must be allocated.If the installation looks permanent it will be permanent. If it is just splayed out on a counter it’ll be buried in charts and you can be assured of failures. If it didn’t require tools to install it then it won’t require tools to dismantle it and someone will.Consider a semi-annual or regular equipment inspection and be prepared to make repairs and corrections. Time the inspection with your annual review and tout how you’ve assured continued meter reliability. If it breaks you’ll get the blame so why not get the credit.
39 Point of Care Data Networking Thank-youQuestionsKeith EnsorKevin Breneman
40 Point of Care Data Networking EXTRA CREDITKeith EnsorKevin Breneman
41 BEST PRACTICES: DNS Domain Name System What’s DNS have to do with POC networking???Forms a name to IP address relationship that is enterprise wideEnter every ethernet device in your DNS. You would submit to your DNS administrator the official hostname and its assigned ip address. They will add an “A” record to your enterprise DNS so the name can be resolved to an ip addressPromotes good naming conventionsAids dramatically in troubleshootingIs the terminal server in ICU plugged in? The users say they can’t upload?Lookup the ip address of the Lantronix in ICU and find it isSo you do a ping to---- ORIs the terminal server in ICU plugged in? The users say they can’t upload?Ping the server by the enterprise naming convention for Lifescan terminal serversSo you do ping ts-ls-icu01 (names should use only alpha and numerics and the special character “–” for best practice….add 01,02 at the end for when you expand.)What would the name of the terminal server be in pediatricsAny traces or netstat reports will now present the DNS name of the device in the output instead of the IP address. Much more people friendly!!!
42 PING example - successWhat’s a ping display look like when it is successful?
43 PING example - failureWhat’s a ping display look like when it fails?
44 Trace route example (tracert) What’s a tracert display look like?Note tracert (and ping) commands are case sensitive.Two techniques shownStandard trace with name lookuptracertModified trace with resolve of names disabledtracert –d
45 IP version 6 Futures Huge address space 128 bits of addressing capacity3.40 X 1038 available addresses340,282,400,000,000,000,000,000,000,000,000,000,000MAC layer addressing can be auto-extracted into an IP address and address awards can be made from the router w/o a dhcp server.Dynamic but always reserved for your MAC!Return to a net 5 years later and get the SAME address!Integrated encryption already included.Can be made to work with existing IP version 4 networks
46 Wellspan Glucose System Components HL7Health Level Seven is a syntax standard specifically designed by. the healthcare industry to facilitate patient data exchange between computer applications .....Derived from the X12 EDI standard used for HIPPA compliant data transfertake a look at a typical HL7 ADT message. This message is sent when a new patient arrives at the hospital. The patient's demographics are entered into HIS (hospital information system) and then the information is communicated to all the other systems to avoid multiple entries of the patient's demographic information.MSH|^~\&|EPIC|EPICADT|SMS|SMSADT| |CHARRIS|ADT^A04| |D|2.3| EVN|A04| |||CHARRIS PID|| ^^^2^ID 1|454721||DOE^JOHN^^^^|DOE^JOHN^^^^| |M||B|254 E238ST^^EUCLID^OH^44123^USA||(216) |||M|NON| ~ |999-| NK1||CONROY^MARI^^^^|SPO||(216) ||EC||||||||||||||||||||||||||| PV1||O|168 ~219~C~PMA^^^^^^^^^||||277^ALLEN FADZL^BONNIE^^^^|||||||||| || ||||||||||||||||||||||||| ||||||HL7 messages are ASCII messages and the standard requires that they be "human readable". The | (pipe characters) are considered readable
47 Security Planning and Considerations Three A’sAuthenticationMultifactorWho you are = usernameSomething you know = secret passwordSomething you have = key or tokenAuthorizationWhat is allowed now that your in?Not all users should have full accessAccountingWho are you, what did you do, and when did you do it?Audit trailIntrusion analysis
48 Point of Care Data Networking THAT’s ALL FOLKS!!!!REALLY!!!!Keith EnsorKevin Breneman
49 presentation needs What host will provide: Screen and projector setup with VGA input capabilityCable for VGA connect to laptop from projector that can reach presenters laptop locationTable or stand for convenient nearby location of 2 laptops to presenter with space for mouse navigation by presenterExtension cords / outlet for AC power for presenter laptopwhite board or flip chart w/markers of two colorsAccess to conference room 15 to 30 minutes prior to presentation for setupHard copy of the presentation will be provided to each attendee.3/15 POC mtg agenda for the day: registration networking lecture (keith &kev) break networking lecture &questions (keith &kev) lunch & vendor fair barcoding lectureConference chairperson/contact: Beverly McAllister, MS, MT(ASCP)SC Laboratory Operations Manager Ephrata Community Hospital 169 Martin Ave Ephrata, PA Phone: Fax:What presenter(s) will provide:Final version of presentation ed to Bev M. by 3/10/2006Laptop(s) and power point software and presentation fileLaptop mouse and local cablingSpare laptop ready to be used to continue presentation in the event of equipment failure.