Internet Intranet Extranet Tech 104 SPFN 204 SETC 104 Monday

Internet/Intranet/Extranet Tech 104, SPFN 204, SETC 104 Monday, September 25, 2000 3: 00 -4: 00 PM In. Sight Conference Philadelphia, PA September 23 -27, 2000 Fred Henning Sr. Technology Analyst Alexian Brothers Medical Center Elk Grove, IL

Alexian Brothers Health System • Alexian Brothers Medical Center, Elk Grove, IL • St Alexis Medical Center, Hoffman Estates, IL • Alexian Brothers Behavioral Health Hospital, Hoffman Estates, IL • Retirement Communities & Nursing Homes Milwaukee, WI Signal Mountain & Chattanooga, TN St Louis, MO • Alexian Brothers Health Providers (managed care) • Bonaventure Medical Foundation (phy. offices) • ‘Alexian Field’, etc.

Alexian Brothers Medical Center The Alexian Brothers 700 year old worldwide religious congregation ABMC Elk Grove 450 licensed beds 800 + physicians 2500 + employees Elk Grove Village Chicago suburb western boundary of O’Hare airport population 35, 000 5000 + industrial occupancies work force of 90, 000

This is NOT about www. alexian. org the Alexian Brothers Home Page

How many of us have a baby page?

This is what was promised? • understand that an organizations’ use of the Internet can be more than – e-mail – baby pictures • Internet technology – can be a cost-effective solution to many problems • highlight – various technologies – identify their potential – identify HIPAA issues • reality check - not just the hype – resources – costs

1992 - 50 WWW sites

In Less Than 6 Months • October 96 TIMES • HBOC showing a Desktop Demo Microsoft Healthcare Users Conference • HBOC showing a browser view of Physician View • Micro. Script showing automated legacy application data to/from ‘home page’ • February 97 - HIMSS the web & ‘home page’ is everywhere

Getting Started with Intranets: formulating a strategy Health Care Internet Symposium 1997 Tampa, FL March 16 -18, 1997 Fred Henning Sr. Technology Analyst Alexian Brothers Medical Center

‘The’ Internet is more then WWW • We are really talking about the public internet. (There are two Internets) • Most of the time we are talking about a portion of the internet that understands HTML and can present graphics using software known as a ‘browser’. This part of the internet is known as the ‘world wide web’. (www. somename. com)

Internet - Reasons 1 • Marketing º º º keep up with the Jones's everyone else is doing it the doctors want it my peers expect it corporate management asks “Where is our home page”?

Internet - Reasons 2 • Business º customers are asking for information º competitive edge º clients require it · · patients physicians vendors etc. · · JCAHO State reduce training costs efficiencies of Hyper Links º other library facilities safety - codes federal standards

Internet - Reasons 3 + • Recruiting Physicians • Technology – video conference – IP telephony – Physician / Staff • Browser access to applications • Etc.

Vocabulary Internet: A grouping of Resources and network. S 1970 > Arpa. Net, US DOD, Telephone lines 56 k Original internet is what we are using the original Universities and DOD are using a 100 megabit + network tcp/ip: transmission control protocol / internet protocol r-login: remote login finger: ‘finger the suspect’, find out who is the person or personal information attached to a userid (login name) usenet: Users Network, Discussion groups Archie: What ftp site has the file you want Gopher: Menu system to find text information Veronica: search all menus on all gopher sites Jughead: search specific menus on specific gopher sites mosaic: Marc Andreessen (national center for supercomputer applications, university of illinois), imbedded graphics, multimedia applications, color - links change when used (Netscape) webcrawler search engine (Yahoo) telnet: port 23 e-mail: SMTP (simple mail transfer protocol), MIME multipurpose internet mail extensions ftp: File Transfer Protocol www: port 80 URL: www. fredhenning. com, fred@fredhenning. com domain name: . com, . gov, . org, . ie (Ireland) = top level domains Hypertext: HTML, the code used to format text on the screen Hyperlink: an imbedded path to a new location, in the document, another document or another URL

Hypertext Markup Language the Universal Language of the WWW

This is sample text!

This is a sample image with motion!

View of test. htm Http: //www. Site. Name. com/Some. Path/face. htm

Do you need a Web Master? • Marketing - yes º someone that can produce nice graphics! • Technology - someone!! º understand how to get information to/from all of the various systems and present it via a browser º fancy - may slow things down

Accessible Data: An original goal from 1990 & my ‘mantra’ • make data accessible to ° ° all users to / from all systems in a user friendly format and the data must be timely

Taking Control of Your DATA: Provide More Data to Users Use SQL, Data Streams (NEON) & other tools download, manipulate, upload Re-format the Data into HTML Use ASP and JAVA to give users control

What are the BIG Issues? • In real estate it’s – location, location ! • With the Internet it’s – Bandwidth, bandwidth & more bandwidth !

They sell you bits but you need bytes! • Almost everything except communications bandwidth is stated in bytes. • Your RAM is 64 megabytes • your hard drive is 2. 5 gigabytes • your MODEM is 56 k - 56, 000 bits/sec or 56, 000/8 = 7, 000 bytes/sec

Bits & bytes: Our test. htm page was 1 Kb (1000 bytes) the face. gif was 2 kb (2000 bytes) how long to send the page at 56 k 1000 + 2000 = 3000 bytes 3000 * 8 = 24, 000 bits 24, 000 / 56, 000* = less than 1/2 second a highly compressed photo (. jpg 90 dpi) may be 30, 000 bytes and take 30000 * 8 = 240, 000 bits / 56, 000* = 4+ seconds * highly unlikely you can get 56 k data transfer rate PBX limitations!

Bandwidth: • T 1 = 1, 540, 000 bits/sec Max!! • U. S. - 24, 56 Kb voice channels • 56 Kb = 56, 000 bits/sec • (56, 000/8 = 7000 bytes (characters) sec) • analog telephone - 6000 bits/sec • in our tests with transcriptionists - 18, 000 bps was required for just one way on a digital line • NTSC Television - 5, 000 bits/sec • Resolution, color depth, audio quality • compression, CODEX

Topics: • Internet – Choosing an ISP – Security – why does it appear slow to users – being a policeman

Internet Connection: AT&T/IBM Global HBOCvan Internet 56 k telco line Focal Network Elron Internet Manager DSU/CSU Router ISP DSU/CSU 28115 Switch A router DNS Servers Boot P server tunnel TC Concentrator SMTP Internet Mail Server Isolation Firewall T 1 telco line : 80 ABHS Intranet, Syn. Quest CBT Fwd Advantage FAX Server MS-SQL Silver Stream Server 500 Park, Itasca Hanover Park Elk Crossing Local COs

The Firewall, Security's First Line of Defense Fire. Wall - Isolation Systems (Shiva/Intel) proprietary operating system Individual circuit cards with their own CPUs and Memory for various functions capable of 10, 000 Internet users VPN function occurs within the Firewall System capable of 1024 VPN connections 3 levels of encryption complexity Password, Certificate and/or Token security

Alexian Brothers of Illinois, Intranet/Extranet North Wimmer Pavilion Bldg Brock Plaza Niehoff Pavilion Woodlands office complex Bensenville OH BMF Wood Dale Hanover Park BMF, OH Hospital Elk Grove ABHS BMF, OH St Alexis ABMC ABHP BMF Acct. , PFA Marketing I. S. staff Itasca Hoffman Est Data Center ABBHH BMF, MH/A Schaumburg OH Digital/isdn isp other Internet hbocvan Mt Prospect Clinic analog P. S. N Physicians

What Clouds are in your Sky? Those direct connect circuits are not direct! PSN AT&T Frame Relay 56 k Business partners Ameritech Frame Relay UUNet Ameritech Networks 56 k T-3 AT&T - IBM Global HBOCVAN Old copper DS 3 Fiber ISP T-1 Alexian Brothers Data Center Saven

What about Internet speed! Do you think you need more then a T-1? My PC Local Telco ISP’s Internet connection UUNet, MCI, etc Web page ISP My ISP Local Telco Web page server

HTCIA: The day of the Security Officer issuing passwords and file access is over !

Our Portal:

Internet Access Login:

Policy Status ! • strictly enforced • looking at one • should have one • lawsuits from offensive e-mail • scandal - porn (chat rooms) • costs - productivity, systems, resources

Administrative Policy:

How to get Administration involved! So they won’t review your Internet policies! Examples: Medical Library Materials Management Human Resources Division VPs The gets out!

Looking for Bad Words !

SEX

Internet Management System Switch Concentrator NT PC Elron Internet Manager firewall Router ISP Internet LAN / Intranet

The Hidden Costs: • • Finding & saving music watching streaming video sending & receiving personal e-mail sharing jokes, pictures via e-mail Network Bandwidth Storage & Backup Security & PC Maintenance

What does Internet Access Cost? Point Cast Example ! 150 user 1/2 have Point Cast turned on 1/2 of those actually read* it for 10 minutes a day. I. E. 37. 5 users @ 10 min/day 5 days/week. 37. 5(users)x 5(days)x 10(minutes)=1875(minutes/week) 1875(minutes)/60(minutes/hour)=31. 25(hours/week) 31. 25(hours)x$15. 00(dollars/hour rate)=$468. 75(cost/week) $468. 75($/week)x 50(weeks)=$23, 437. 50(dollars/year) * or are distracted from their work

Bill G said I could ! Who took over my PC? I set up a Power Point on the Intranet site I was viewing it and came to a slide with animation. My PC went out over the internet to Microsoft and downloaded an Active. X component to allow me to view the animation. How is the Internet Security Set on user PCs? Using Microsoft Word and all of a sudden the PC goes of to the Microsoft site for an update of the functionality you are using What about Real Audio/Video

Where did all the disk space go? When you use the internet you accumulate all types of interesting artifacts, pages, components, beans, etc.

Issues Access to e-mail Pornography unauthorized e-mail encryption liability issues breaches of confidentiality productivity loss - personal e-mail and internet usage large e-mail attachments - web graphics/downloads spam and spoof attacks Virus Trojan horse worms malicious Java and Active. X code archiving - long time because of music, graphics, etc

E-Mail • Using the first of the Internet ‘Killer Apps’ – ACD (Communication’s Reports) – PFA Insurance Book (bad debt) – payment & adjustment data (to vendors) • is it Internet Accessible (can you send/receive from home? ) • is it ‘Browser’ enabled mail ? (do you need a client or just go to a ‘web page’)

Provide a Browser View of Your World: • HBOC is not the only way to provide a browser view of your information • Other vendors – on site solutions – ASP solutions • Roll your own

A Browser View! • Three tier solution º you get to keep your investment in • reliable CPUs and applications • do something to reduce the LAN traffic ° consider reducing your investment in. . . • hardware • PC support • LAN Administration

A Browser View! continued • What’s up front? º the browser is now the de facto standard user interface - not Windows • What’s behind? automating the conversion of the present screens, reports, etc. to a browser compatible format

Browser: Vendor Implementation NT tcp/ip UNIX CPU Object Server OLE automation Server application Object Driver active server pages MUMPS Programs Object Definitions MUMPS data Internet or Intranet with Browsers Internet Server

HBOC’s Clinical Browser

Browser Terminal Emulators aren't enough! Heads down users should have all of the flexibility a custom application environment provides. users of information shouldn’t need to know how to navigate each application in order to get the data they need

Browser - Virtual User html presentation: tcp/i p Browser request Applications any number on any number of servers middleware conversions

Where do I get the Data? • Departmental Printers can be an answer! • ADT Data Stream • Lab, Rad, Pharmacy, etc. Orders Data Streams • Lab Results Data Stream • Bar Code & label printer streams • ‘any systems’ audit/results output

Screen Scraping / VB Example Alexian Brothers Financial Account Revision Processor Fri Aug 20, 1999 16: 14 Account Name FC Type Admit Disch Balance Loc A 99162 -00 NNN ABCDEFG, FIRST PO M/H 06/11/99 06/18/99 $349. 99 AR 1 Total Charges 2 Total Adj 3 Total Payments 4 Refunds? 5 Exp? $7, 234. 35 $3, 734. 35$3, 150. 01 No No 6 Ins Liability 7 Ins Adj 8 Ins Payments 9 Pre-Collection $0. 00 $3, 734. 35$3, 150. 01 10 Pt Liability 11 Patient Adj 12 Pt Payments 13 Last Pt Payment $349. 99 $0. 00 14 Wkfl 15 Schd 16 Schd Type 17 Lst FU Dt Ty Sq 18 FU Hold 300 Custom 07/24/99 D 1 Yes 19 BD Pre-Listed 20 BD Date 21 Agency 22 BD Transfer Amount 23 Social Sec # 24 Birth Date 25 Bill Hld 26 Notes? 27 Adm By 28 Oth Accts 335 -NN-NNNN 05/05/1977 No Yes BAM Yes 29 COB Ins Carrier #Clm LCS Submit. Dt Est Amt Due Amt Pd Dsp Date 1 KVI 1 1 06/26/99 $7, 234. 35 $3, 150. 01 F 08/13/99 2 PPO 1500 PLAN Press NL for Menu, enter code, or '-' for list--

The Browser View of the Data Link to Account Snap. Shot HTML Summary

Browser Issues Is the war over? Netscape or IE more than ideology? • Why do you need to support both? • What version will be your minimum standard? • You are expected to have it on your desktop – RF Registration in ER, manage access points

ASP-1 (Scheduling. com):

ASP-2:

ASP-3:

ASP-4:

Intranet: using internet technology internally • You should be able to leverage your internet and intranet – webmaster – data bases – programming • to produce actual cost savings processes

Using the Intranet for Training:

CBT, On-line & Other Resources:

Synquest Main Menu:

Who can have a Home Page (site) ? departments, staff, MD

Personal Home Pages? My. Site

Is the Internet the way to: • • • Place telephone calls ? Teleconference ? Video surveillance ? Monitor systems ? Monitor alarms ?

No Guarantees with the Internet! • TCP/IP – not true serial communications • send • receive abcdefg acdbgf – no guaranteed delivery - collisions • what do you do about them? • applications must do the ‘hand shaking’

IP Telephony • The buzz is IP Telephony • The reality is - as always – bandwidth, quality, continuity of flow • What is available – Telephony cards in Routers • 2 analog ports, FAX, voice • T 1/fractional T 1 port(s) – ATM vs. . Frame Relay - cloud • PC to PC • PC to PSN • PSN to PSN via the Internet

Video Vocabulary • Words you need to understand – resolution • 640 x 480 or greater • 320 x 240 or less – frame rate • 30 frames/sec (60 fields/sec) • less than 30 frames/sec • field sequential vs interlaced – compression

Is there a Standard? Audio or Video – compatibility ! ! • • • NTSC CU See Me Real Audio - Video Microsoft IEEE Sound. Blaster

Sample of Video link to a video

VPN Issues • What Browser • What applications – is their a Browser view? • Controlling the need for client side software at the remote users site • guests with their own VPN software

Virtual Private Network User PC looks as if is actually attached to the LAN Locally, any software requirements for a local PC would apply To view e-mail a Group. Wise Client would need to exist on the PC To use Physician View the software would need to be loaded on the PC If an application can be accessed via a Browser then NO Client Software is needed on the PC to have an application Browser enabled normally would require that a NEW module exist on a WEB accessible server

VPN Access PSN Internet ISP’s network T 1 MODEM Dial up networking encryption Firewall VPN client VPN key PC ABMC LAN Tunnel Http server Silver Stream MS-iis MS-SQL

When is it Safe? Basic Security Concept physical security is primary place the document in a safe lock the safe don’t share the password don’t leave the password accessible LOCK the Door!

How does this apply? • Physical security is primary • place the document in a safe • lock the safe • = Encrypt the data – in your data base – on the local PC – in transmission across your network • don’t share the password • don’t leave the password accessible – use a continually changing KEY – control the Encryption KEY

How do you Lock the Door? Firewall in bound - out bound trusted sites VPN password, certificates, tokens Frame Relay, ATM, Dedicated Circuits (fiber, copper) part of the public network Ameritech, Southwestern Bell part of a private network AT&T, IBM Global, HBOCVAN Can I use the Internet ?

theory If 1000 cpus tried 1000 characters/sec how long would it take to crack the code? 40 bit key 30. 5 years 56 bit key 228 years 128 bit key 1. 07 x 1024 years

40 bits = 40/8 (bits/byte) = 5 character 56 bits = 56/8 = 7 characters 128 bits = 128/8 = 16 characters in competition, 128 bits encryption of plain text has been broken in hours!! Patters in plain text can be found! Would you expect to find IBM in a document sent from IBM or Alexian in a document from Alexian Brothers, (7 & 8 letter words following one another, etc. ? )

Fred Henning Sr. Technology Analyst Alexian Brothers Medical Center 800 Biesterfield Elk Grove Village, IL 60007 847 -981 -3667 847 -956 -5435 (FAX) henningf@abeg. hbocvan. com fred@fredhenning. com www. fredhenning. com