CCTOS:  Network Installations

• Problem:
  • In telemedicine it would be very difficult to go to visit all users on site for installation and maintenance purposes. This is particularly critical in the case of developing regions.  
  • Phones are already largely available in developing regions, where budgets for more complete workstations are very limited.
  • In developing regions power supply and internet are not always continuously available 24 hours a day.
  • Large centralized servers rise potential problems from ethical and political points of views.
    
• Approaches:
  • "Thin client":
    • The user workstation should be as simple as possible.
    • The essential requirement is to be limited to a standard browser as available on most usual OS platforms.  A browser based on full open W3C standards should be required, if possible.
      
    • Although a standard web browser is currently seen as the main technology, we will also have to take account of other devices, as phone devices.
    • In general no options should depend on the client machine, but well on hte user account at the server side.
      
  • Servers:
    • Servers are intended to do all the work.
  • Network configuration:
    • Decentralization:
      • Avoid unnecessary centralization of data bases.  Preference for relatively small regional servers, while a possibility of long distances inter-connexions must be available.  This can be better controlled since it applies to only a small percentage of the patients. Server should be decentralized at regional level in the region were the patients are living.  The degree of decentralization may depend on several factors as where are cluster of frequent transactions expected, where is basic technical maintenance and protection possible.
      • Servers need to be interconnected, in order to get access to remote medical expertise and in case a patient would need care at an other location than his usual region where he is normally living. 
        
      • Confidentiality control is easier when the number of transaction is relatively limited.
        
    • Autonomy:
      • Workstations and servers should include a battery maintaining a stable power for at least some time.
        
      • Server and client could be in the same machine, although this kind of extreme decentralization is only intended for back-up or emergency situations when no communications at all are available.
    • Access to the international Internet is mandatory, even if it use need to be limited due to high costs and porr continuity:
      • Necessary to get support from remote medical expertise, otherwise not available locally. 
        
      • Mandatory for occasional software maintenance.