InternetIntranetExtranet The Access Revolution INDT 112 SETC 112

Internet/Intranet/Extranet The Access Revolution INDT 112, SETC 112, SECS 112 Wednesday, August 22, 2001 11: 30 – 12: 30 In. Sight Conference San Diego, CA August 18 -22 , 2001 Fred Henning Sr. Technology Analyst Alexian Brothers Medical Center Elk Grove, IL 8. 17. 2001 In. Sight 8. 22, 2001 1

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. 8. 17. 2001 In. Sight 8. 22, 2001 2

Alexian Brothers Medical Center The Alexian Brothers 700 year old worldwide religious congregation ABMC Elk Grove 450 licensed beds 800 + physicians 3000 + employees Elk Grove Village Chicago suburb western boundary of O’Hare airport population 35, 000 5000 + industrial occupancies work force of 90, 000 8. 17. 2001 In. Sight 8. 22, 2001 3

This is NOT about www. alexian. org the Alexian Brothers Home Page 8. 17. 2001 In. Sight 8. 22, 2001 4

The Schedule said this is about: • What is an – Internet – Intranet – Extranet • • Or- What Happened to my LAN & WAN ! use them to expand access to ‘data’ methodologies for implementing Retrieving data Bonus - Internet Technology 8. 17. 2001 In. Sight 8. 22, 2001 5

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, HH 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 8. 17. 2001 hbocvan Mt Prospect Clinic analog P. S. N In. Sight 8. 22, 2001 Business Partners Physicians 6

Internet Connection: AT&T Global HBOCvan Internet user ID ALHS 56 k telco line Router 157. 196. 20. 1 Focal Network Elron Internet Manager DSU/CSU 157. 196. 253. 70 Concentrator Library Proxy Server ISP 28115 Switch Local COs 157. 196. 216. 126 A router Cisco Router 209. 172. 185. 25 209. 172. 185. 26 157. 196. 229. 14 : 80 ABHS Intranet Syn. Quest CBT Fwd Advantage FAX Server MS-SQL 157. 196. 229. 12 alexian. smpt SMTP Internet Mail Server 8. 17. 2001 Isolation Firewall ver 6. 7 157. 196. 20. 2 T 1 telco line DHZA 622375 157. 196. 250. 22 LINUX ftp & www Server DNS Servers 209. 172. 128. 2 209. 172. 128. 8 209. 172. 187. 73 Dial up users www. Alexian. Results. net (Palm Project) www. alexian. net (VPN access test page) 209. 172. 186. 190 In. Sight 8. 22, 2001 7

What Clouds are in your Sky? Those direct connect circuits are not direct! Ameritech Frame Relay PSN AT&T Frame Relay 56 k Business partners UUNet Ameritech Networks 56 k T-3 AT&T - IBM Global HBOCVAN Old copper DS 3 Fiber ISP T-1 Alexian Brothers Data Center 8. 17. 2001 In. Sight 8. 22, 2001 Saven 8

Internet Technology is the Key: • understand an organizations’ use of Internet Technology – e-mail – WWW – etc. • various other technologies – identify their potential – identify HIPAA issues • reality check - not just the hype – resources – costs 8. 17. 2001 In. Sight 8. 22, 2001 9

From Arpa. Net to Internet: 1970 Arpa. Net a few Universities and Government Installations with Large Computers began to be interconnected. 1992 - 50 WWW sites Today 10, 000 8. 17. 2001 In. Sight 8. 22, 2001 10

There must be a reason ! Today there at least 5, 000, 000 pages - Yes, that’s BILLION ! ! pages 4, 400 new sites per day Google is searching almost 1. 5 Billion Pages !! 8. 17. 2001 In. Sight 8. 22, 2001 11

‘The’ Internet is more then WWW • We are really talking about the public internet. (There are two Internets + 3 rd? ) • 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) 8. 17. 2001 In. Sight 8. 22, 2001 12

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 webcrawler search engine (Yahoo, etc. ) 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 8. 17. 2001 In. Sight 8. 22, 2001 13

Internet Topics: • Choosing an ISP • • local phone numbers multiple access to backbone security VPN experience • why does it appear slow to users • Security • being a policeman 8. 17. 2001 In. Sight 8. 22, 2001 14

What is the BIG Issue? • In real estate it’s – location, location ! • With the Internet it’s – Bandwidth, bandwidth & more bandwidth ! 8. 17. 2001 In. Sight 8. 22, 2001 15

Bandwidth: • analog telephone - 6000 bits/sec • in our tests with transcriptionists - 18, 000 bps was required for just one way on a digital line • 56 Kb = 56, 000 bits/sec • (56, 000/8 = 7000 bytes (characters) sec) • T 1 = 1, 540, 000 bits/sec Max!! • U. S. - 24, 56 Kb voice channels • NTSC Television - 5, 000 bits/sec • Resolution, color depth, audio quality • compression, CODEC 8. 17. 2001 In. Sight 8. 22, 2001 16

What about Internet speed! Do you think you need more then a T-1? My PC Local Telco ISP’s Internet connection to Backbone Web page ISP My ISP 8. 17. 2001 Local Telco In. Sight 8. 22, 2001 On site Web page server 17

Our Portal: 8. 17. 2001 In. Sight 8. 22, 2001 18

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 Chat Rooms Spam and spoof attacks (ping to death, etc. ) Virus, Trojan horse, worms malicious Java and Active. X code archiving - long time because of music, graphics, etc 8. 17. 2001 In. Sight 8. 22, 2001 19

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 8. 17. 2001 In. Sight 8. 22, 2001 20

What does Internet Access Cost ? June 2001 data: Average time spent per employee – with Internet access. 22 hours 38 minutes per month. If 500 PCs have Internet access and disregarding the fact that there are 3 shifts IF only 100 employees surfed at the National Average ! 100 x 22. 5 hours @ $21 per hour (wages) = $ 47, 250 / month @ $49 per hour (cost) = $110, 250 / month ! ! 8. 17. 2001 In. Sight 8. 22, 2001 21

Who took over my PC? Bill G said I could ! What about ‘Smart Tags’ taking you to ONLY Microsoft Sites ? ? ? 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. 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 How is the Internet Security Set on user PCs? 8. 17. 2001 In. Sight 8. 22, 2001 22

Where did all the disk space go? When you use the internet you accumulate all types of interesting artifacts, pages, components, beans, etc. 8. 17. 2001 In. Sight 8. 22, 2001 23

Internet Access Login: 8. 17. 2001 In. Sight 8. 22, 2001 24

You Must Login: 8. 17. 2001 In. Sight 8. 22, 2001 25

Policy Status ! • strictly enforced • looking at one • should have one • lawsuits from offensive e-mail • scandal - porn (chat rooms) • costs - productivity, systems, resources 8. 17. 2001 In. Sight 8. 22, 2001 26

Administrative Policy: 8. 17. 2001 In. Sight 8. 22, 2001 27

How to get Administration involved! So they won’t review your Internet policies! Examples: Medical Library Materials Management Human Resources Division VPs The 8. 17. 2001 gets out! In. Sight 8. 22, 2001 28

Internet Management System: Switch Concentrator NT PC Elron Internet Manager firewall LAN / Intranet Router ISP Internet 8. 17. 2001 In. Sight 8. 22, 2001 29

Looking for Bad Words ! 8. 17. 2001 In. Sight 8. 22, 2001 30

SEX! 8. 17. 2001 In. Sight 8. 22, 2001 31

HTCIA: The day of the Security Officer issuing passwords and file access is over ! 8. 17. 2001 In. Sight 8. 22, 2001 32

The Firewall, Security's First Line of Defense Our 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 8. 17. 2001 In. Sight 8. 22, 2001 33

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! 8. 17. 2001 In. Sight 8. 22, 2001 34

How does this apply? a HIPAA issue • 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 8. 17. 2001 In. Sight 8. 22, 2001 35

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 ? 8. 17. 2001 In. Sight 8. 22, 2001 36

VPN Users: • • IR staff after hours access / support Medical Center staff remote access Physician View access Business Partner Access – collection agencies • Store. Com PAX development • Cortex upgrade support • etc. 8. 17. 2001 In. Sight 8. 22, 2001 37

VPN Access Diagram: PSN Internet ISP’s network T 1 Dial up networking, Cable, DSL MODEM Router ? encryption Firewall Http servers LINUX, MS-iis MS-SQL VPN client VPN key 8. 17. 2001 PC ABMC LAN Tunnel In. Sight 8. 22, 2001 38

If you can’t see the Firewall? WWW. alexian. net 8. 17. 2001 In. Sight 8. 22, 2001 39

Intranet, VPN Issues: • What Browser – what version, what plugins • 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 • Security !!! 8. 17. 2001 In. Sight 8. 22, 2001 40

Virtual Private Network Client: 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 (if not using Novell Browser view) To use Physician View the HBOC 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 8. 17. 2001 In. Sight 8. 22, 2001 41

Encryption Theory: 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 8. 17. 2001 In. Sight 8. 22, 2001 42

Encryption Reality: 1. 40 bits = 40/8 (bits/byte) = 5 character 2. 56 bits = 56/8 = 7 characters 3. 128 bits = 128/8 = 16 characters 4. in competition, 128 bits encryption of plain text has been broken in hours!! 5. Patters in plain text can be found! 6. 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. ? ) 8. 17. 2001 In. Sight 8. 22, 2001 43

Using Internet Technology Internally: • You should be able to leverage your internet and intranet – webmaster – data bases – programming • to produce actual cost savings processes 8. 17. 2001 In. Sight 8. 22, 2001 44

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’) 8. 17. 2001 In. Sight 8. 22, 2001 45

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 8. 17. 2001 In. Sight 8. 22, 2001 46

<HTML> Hypertext Markup Language the Universal Language of the WWW <html> <title> test page </title> <body> <font style=“arial” size=+3 color=“blue”> <p><center> This is sample text! </font> </p> <font size=+5 color="red"> <img src=”yelhappy. gif"> This is a sample image with motion! </p></CENTER></font> </body> </html> 8. 17. 2001 In. Sight 8. 22, 2001 47

View of test. htm Http: //www. Site. Name. com/Some. Path/face. htm 8. 17. 2001 In. Sight 8. 22, 2001 48

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 8. 17. 2001 In. Sight 8. 22, 2001 49

An ASP solution 8. 17. 2001 In. Sight 8. 22, 2001 50

Data Conversion & Interfaces, my specialty since 1959: When Tubes were used and a Drum was fast access UNIVAC 1105 Analog 8. 17. 2001 Digital Conversion In. Sight 8. 22, 2001 IBM 7094 GEDA +/- 100 volt Analog Computer UNIVAC 51 1105

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 8. 17. 2001 In. Sight 8. 22, 2001 52

Taking Control of Your DATA: Provide a UNIVERSAL view of Data to Users via Browser Use HL 7, SQL, Data Streams, etc. to download, manipulate, upload Re-format the Data into HTML Use ASP and JAVA to give users control 8. 17. 2001 In. Sight 8. 22, 2001 53

Where do I get the Data? What if HL 7 is not an option? • Even 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 8. 17. 2001 In. Sight 8. 22, 2001 54

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-- 8. 17. 2001 In. Sight 8. 22, 2001 55

The Browser View of the Data Link to Account Snap. Shot HTML Summary Link to VB code 8. 17. 2001 In. Sight 8. 22, 2001 56

A Browser View! • What’s up front? º the browser is 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 8. 17. 2001 In. Sight 8. 22, 2001 57

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 8. 17. 2001 In. Sight 8. 22, 2001 58

Browser - Virtual User html presentation: tcp/i p Browser request middleware conversions Applications any number on any number of servers 8. 17. 2001 In. Sight 8. 22, 2001 59

Active Web View Projects: • integrated web view of data from 3 hospitals • patient web access – billing information, e-mail and electronic payments • • • operations shift notes STAR HL 7 queues monitoring EBO scripting projects Medical Library On Line Station Census 8. 17. 2001 In. Sight 8. 22, 2001 60

Live Census Data ! 8. 17. 2001 In. Sight 8. 22, 2001 61

HL 7 Queues Monitor Web View: 8. 17. 2001 In. Sight 8. 22, 2001 62

EBO Monitor: EBO Process Monitor Start Record End Record This Record % Complete 200 400 25. 00% Account Number Financial Class Balance 99012300123 BO 500. 12 Zero Bal Ct Wrong FC Ct In Follow up Ct Processed OK 1 2 1 46 Start Time Now Average/Min. File Type P 8: 00: 42 AM 8. 17. 2001 8: 13 AM 2. 77 In. Sight 8. 22, 2001 63

Emergency Guidelines: 8. 17. 2001 In. Sight 8. 22, 2001 64

Employee Handbook: 8. 17. 2001 In. Sight 8. 22, 2001 65

Custom Documents: 8. 17. 2001 In. Sight 8. 22, 2001 66

Education & Training: 8. 17. 2001 In. Sight 8. 22, 2001 67

Synquest Main Menu: CBT Produced in House ! 8. 17. 2001 In. Sight 8. 22, 2001 68

Who can have a Home Page (site) ? departments, staff, MD 8. 17. 2001 In. Sight 8. 22, 2001 69

Is the Internet the way to: • • • Place telephone calls ? Teleconference ? Video surveillance ? Monitor systems ? Monitor alarms ? 8. 17. 2001 In. Sight 8. 22, 2001 70

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’ 8. 17. 2001 In. Sight 8. 22, 2001 71

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 • Private Voice & Data Networks (IP only) 8. 17. 2001 In. Sight 8. 22, 2001 72

Video Vocabulary • Words you need to understand – Resolution • • • HDTV 1920 x 1080 (1200) 16: 9 aspect ratio 1024 x 768 xvga 4: 3 aspect ratio 800 x 600 svga 640 x 480 vga 320 x 240 or less – frame rate • 30 frames/sec (60 fields/sec) • less than 30 frames/sec • field sequential vs interlaced – compression 8. 17. 2001 In. Sight 8. 22, 2001 73

Is there a Standard? Audio or Video – compatibility ! ! • • 8. 17. 2001 HDTV NTSC CU See Me Real Audio - Video Microsoft IEEE Sound. Blaster In. Sight 8. 22, 2001 74

Sample of Video link to a video 8. 17. 2001 In. Sight 8. 22, 2001 75

Napster, et. al. : • We freely give unlimited access to our PC and all of it’s data • NSA • CIA • FBI – Carnivore - read e-mail • SETI (shared computing) – looking for intelligent life via radio signals • Pratt & Whitney – United Technology 8. 17. 2001 In. Sight 8. 22, 2001 76

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@henning. com www. fredhenning. com 8. 17. 2001 In. Sight 8. 22, 2001 77