May 15, 2001 Achieving a High Degree of Data Reliability PHI Data Reliability

May 15, Reliability Components  Availability –Where needed –When needed –How needed –(Only) to whom needed  Correctness –Latest information –Right patient –New information is quickly forwarded; passes sanity checks –Appropriate action is easily taken

May 15, It’s the Whole System… Data Reliability is a function of ALL of the components in the entire delivery chain.

May 15, Component Reliability  Access device  Transmission  Infrastructure: internal and external  Technology hardware and software  Change management  Maintenance procedures  People

May 15, Access Device  Functional –Operating correctly –Help Desk support –“Loaner” devices available  User is familiar with application –Training program –Easily upgraded –KISS

May 15, Transmission  Network is available –Internal –External  Network engines function correctly –Protocol error-checking routines –Encryption/authentication functions –Biometric tolerances are reasonable  Speed and throughput match application needs

May 15, Infrastructure  Power availability and distribution  Conditioning: cooling, heating  Access control to premises along entire delivery chain  Resistant structures and engineering  Life support functions

May 15, Technology  Fault-tolerance and redundancy  Alternate routing  MTBF and MTTR  Software testing and implementation process  Effective data and software safety processes: –Backup –Recovery –Restoration

May 15, Technology Change Management  Emergency fix vs. Scheduled change  Process oversight: change methodology –Specification and design –Unit testing; interface testing –Certification –Parallel testing –Documentation  Scheduling

May 15, Ongoing Maintenance Procedures  Infrastructure –Monitoring –Testing –Scheduled activity –Competence –Engineering  Technology Hardware –Monitoring –Spare parts inventory –Capacity management

May 15, People  Right person for the job  Correct levels of compensation  Screening and clearances  Monitoring and auditing  Signed confidentiality statements  Surveillance and spot checks  Sensitivity to behavior changes  Enforcement, enforcement, enforcement

May 15, Complexity Complicates….  Number of interfaces –Communications –Software –Platforms  Number of players/organizations  Vendor contracts/management  Change testing/scheduling  Capacity management  Operational maintenance contracts/management

May 15, Wireless Implications  PDA wireless devices may be a good answer to point-of-service PHI access –Small, portable: assists in viewing privacy –Some clinician familiarity –Easy to restrict access  Challenges: –Biometric authentication; encryption; non-repudiation –Administration of access privileges in remote population –Potential routing complexity

May 15, Countermeasures  Single Points of Failure in Delivery Chain: –Analysis and identification –Fault tolerance –Redundancy  High-reliability infrastructure engineering and maintenance  Respect of detailed technology methodology for change management: hardware and software  “Sanity-checking” AI engines