Development of the Utility Tree of Distributed Healthcare

System and Reasoning the Architectural Design.

Abstract -The paper presents the development of the utility tree of distributed healthcare System and

reasoning the architectural design to improve the conventional health care system. The proposed

architectural design of a distributed healthcare software system manages patients’ health records and

assures remote and interactive access to medical services. In order to cover the complex relationships

between different medical concepts (symptoms, diseases, treatment, medication, etc.) and to put the

information (IS) at the core for connecting patients, doctors, nurses, diagnostics, and pathology, and

payment in a ubiquitous manner utility tree analysis from Architectural Trade Off Analysis (ATAM )

has been implemented to make sure that architecture meets the entire health care scenario . In this

system, both real-time and off-line data are feed to the system through on-line medical equipment, bed

side as well as wearable patient monitoring devices, mobile phones, PDAs and computers. These devices

are connected using both wireless and wire line interfaces. Data are also accessed as off-line as well as

real-time from the system through these and other similar devices as well. Therefore the main objective

to build the utility tree is to translate the main requirement into concrete scenarios so that we can come

up with an appropriate distributed architectural design. This solution together with the adoption of

some widely accepted medical standards assure interoperability and transparent data exchange between

various medical applications which will make the current healthcare system ease access to healthcare

and healthcare information, for healthcare professionals and patients and will provide effective and

efficient healthcare services to every patient. To conceive the distributed healthcare service delivery

system Bangladesh’s healthcare system has been taken as an example.

Index Terms -Software architecture, utility tree, ATAM, distributed healthcare system, SOA, database

centric architecture, client server

 I. INTRODUCTION

A. Overview

In Bangladesh, the status of healthcare is similar to the one of many developing as well as developed countries,

medical practitioners in Bangladesh often operate in relative isolation, dealing with diverse health care needs.

Therefore an appropriate Healthcare system is essential to provide proper healthcare service to its bulk
[1]
population . Inoder to fulfill the needs healthcare needs of the mass population a distributed healthcare

software system need to be implemented which will manage patients’ health records and assures remote and

interactive access to medical services .Therefore for a software-intensive system like distributed healthcare

right software architecture is essential, consecutively to meet its functional and quality requirements which

will ultimately govern the real-time performance, reliability, maintainability and other quality attributes.

Architectures are complex and involve many design tradeoffs. Without undertaking a utility tree analysis from

the Architectural Trade Off Analysis (ATAM), one cannot ensure that the architectural decisions has made—

particularly those which affect the achievement of quality attribute such as performance, availability, security,

and modifiability— are advisable ones that appropriately mitigate risks[2].

B. Problems in the healthcare system

It is noted that the highest number of problems (22%) in health sector are related to inadequate number of

physicians, wrong treatment, negligence towards patients, and absence from duty and unwillingness of doctors

to stay at rural areas and small towns. The other problems are related to supplies, equipment, beds etc (21%).

Healthcare is life-critical work in Bangladesh around 7,000 deaths per year are due to incorrect

prescriptions and 5% prescriptions per year are incorrect Some other major problems often discussed also

include lack of ambulance services as well as proper referral services[3]-[6].

C. Deficiencies particularly in the healthcare centers

1. Lack of proper diagnostic facilities

2. Lack of qualified physicians

 3. Improper distribution of diagnostic professionals

4. Professional isolation of Physicians

5. Medical manpower shortage

[7]
6. Post-disastrous medical management

D. Difficulties in the current healthcare system

1. 1.Management of personal data

2. Standardization of data formats

3. Extraction / analysis of content-based knowledge

4. Federation of different healthcare databases

5. Security and privacy of healthcare information

E. The Needs

1. Identify the quality goals clearly by Quality utility tree to improve the quality of healthcare

2. Ease access to healthcare and healthcare information by considering the quality goals for security,

performance, functionality and reliability

3. Considering the usecase scenarios, and growth scenarios to reduce the cost of delivery of healthcar

F. Research Objectives

In this article validation of an architectural decision has been taken in order to overcome the difficulties of

current healthcare system in Bangladesh. In order to do so quality utility tree analysis from adapted ATAM

Framework has been implemented to evaluate and refine the architecture and hence validate it.
 II. LITERATURE REVIEW

A. Literature Review and Defining Scope of Research

Study has been conducted on a number of research papers and available standards to develop a clear concept

of ATAM to implement Quality Utility tree analysis, its role as a risk-mitigation process used early in the

software development life cycle. The .literature review s were conducted on

1. Architectural Concept and analyzing architectural patterns.

2. Architecture Trade-Off Analysis Method(ATAM)

3. Adaptation process of ATAM framework.

4. Verification of adapted ATAM framework [8].

Literature review on the above mentioned terms and issues showed that there is a need for defining a process

of adopting ATAM for the small and medium companies in Bangladesh and verification of the adapted ATAM

framework. Therefore, the research proposed a verification of ATAM adaptation process considering the

existing practice of architectural design [8].

The scope of the research includes:

1. First understand the current health care scenario of Bangladesh

2. Analyze the requirement to identify the quality attributes

3. Prepare the detail operational concept and define the architecture of the project.

4. Apply the adapted Utility tree analysis from ATAM framework to evaluate and refine the

architecture.

5. Validate the adapted Utility tree analysis in terms of relevance and limitations to the real life

practices.

B. Methodology

To validate the architectural decision through ATAM adaptations following work items are generated.

1. Identify the architectural issues.

 2. Address all constraints and uncertainty and figure out the implemented architecture with details

description, inorder to full fill the goal of the software.

3. Figure out the quality goals clearly.

4. Make the final architectural design of the system.

5. The utility recourses identification interims of security, performance, functionality and reliability.

6. Figure out the related information needed to full fill the requirements.

7. Identification of the stakeholders or key informants from whom the information can be gathered.

8. Mapped the information need and key informants and prepared questionnaires.

9. Interviewed the key informants and gather the related information and build the utility tree to

characterize and priorities the specific quality attributes requirements.

10. Proposed tactics achieve these and evaluate benefits as well as liabilities to implement those

tactics through the different architectural patterns.

11. Take appropriate architectural solution according to the validation.

C. The Concept of the Integrated Distributed Healthcare services delivery system

All the modern concepts of medical services are centered on the healthcare consumer, the patient who receives

medical attention or treatment. Recent developments in information technology and communication offer new

opportunities in the implementation of high quality healthcare systems. These technologies assure the support

for better medical data processing, more accurate diagnoses and easier access to medical services. Today a

major request imposed for medical systems is the integration of the different medical applications and services,

regardless of their regional distribution, ownership or specific medical domains. A patient should access

medical services in a uniform and transparent way anytime and anywhere. His/her medical records should

travel seamlessly between medical entities (e.g. general practitioner, hospital, and laboratory) as required by

his/her treatment path. This can be achieved with the intensive use of standards and with the adoption of a

generally accepted terminology. Clearly an ontology-based approach is needed in order to represent entities,

ideas, and events, along with their properties and relations, as a form of knowledge representation about the
medical world. Unlike many other disciplines, medicine has a long standing tradition in structuring its domain

knowledge, e. g. disease taxonomies, medical procedures, anatomical terms and others, in a wide variety of

medical terminologies, thesauri and classification systems. Here in the proposed Integrated Distributed Health

care system, IS is at the core for connecting patients, doctors, nurses, diagnostics, and pathology, and payment

in a ubiquitous manner. In this system, both real-time and off-line data are feed to the system through on-line

medical equipment, bed side as well as wearable patient monitoring devices, mobile phones, PDAs and

computers. These devices are connected using both wireless and wire line interfaces. Data are also accessed as

off-line as well as real-time from the system through these and other similar devices as well.

The over view of the system is shown below:

Figure 1: The over view of the system

The over view of the operational concept

Figure2: operational concept of the system

D. Detailed utility tree of the system

In a big system like distributed health care system, evaluation and constant monitoring is very much required

which will ensures that the offered system satisfies quality, attributes such as operability, usability and

maintainability imposed by the end users . Inorder to built the utility tree we first of all we gather requirement

to establish the this project and figured out the needed information to identify the quality attributes and their

utilities and point out the target stakeholders and key informants who will be related to this .After figuring out

the information needed and key informants mapped the information need and key informants and prepared

questionnaires .After making the questionnaires we interviewed the key informants and gather the related

information and build the utility tree so that we can characterize and priorities the specific quality attributes

requirements .Here we find five quality attributes are Funtionaliy, Relaibility,

Availability,Security,Performace and Portability.The detailed utility tree is showed bellow

 [A]

Figure 3: The detailed utility tree of the system

The above utility tree showed the abstract requirement of the proposed system into concrete scenarios which

helped us to take the appropriate architectural design in effective and efficient manner.

III. THE ARCHITECTURAL DESIGN OF THE SYSTEM

Architecture is chosen because it achieves functional properties (behavioral, performance, security, etc.) and

nonfunctional properties (the ability to support maintenance and evolution, product line building, and low

time-to-market development) that are important to the developer. In order to evaluate architecture against

attributes of significance, it must be possible to express those attributes in a quantitative way. Current

evaluation methods finesse the issue through the use of scenarios; quality attributes are never expressed

directly at all. To see if architecture is maintainable, an architect poses a set of specific change scenarios and

evaluates the architecture against each of those.

 Figure 4: Multilayer Structure of the Distributed Healthcare system

A. Different layers of the architectural design

Presentation layer:

Interfaces of presentation layers are as follows:

1. User controls that will show information

2. User controls that will get information from the user.

Business layer:

Interfaces of business layers are as follows:

1. Business work flows.

 2. Business rules executing by the business work flows.

3. Business rules validation logics

Data Layer:

Interfaces of data layers are as follows:

1. Data retrieval logics.

2. Data manipulation logics

3. Data validation logics.

4. Data representational logics

Service:

Information consuming interface to get information from other service providers.

Interfaces to provide service in the data layer.

B. Layering Architecture

In Distributed Integrated Health care system architecture is defined as taking consideration of our constraints

and the system requirements.

TABLE 1.

THE MAPPING BETWEEN THE ARCHITECTURAL LAYERS WITH ARCHITECTURAL STYLE WITH JUSTIFICATION

SN Architectural Layer Architecture Styles Justification

1 User interface (UI) components Event Driven Architecture EDA is used to interact with

Users action

2 Business Logic and Components Client Server Form the client each

business work flow will

execute to the server to serve

SN Architectural Layer Architecture Styles Justification

certain service to the user.

3 Data Service Client Server This is Client Server

architecture to retrieve and

store data successfully and

quickly.

4 Utility Service Oriented Architecture Here SOA is used to

maintain the communication

easily.

5 Integrity Database Centric Architecture DCA is used to integrate

with other Applications

So, SOA, Client Server, Event driven, Distributed computing based distributed healthcare system will provide

1. Supports healthcare professionals

a. Fewer human errors

b. Electronic healthcare history

2. Facilitates communication between healthcare

3. professionals and patients

4. Improves presentation / delivery of healthcare

IV. CONCLUSION

Evaluation system is necessary for any proposed system, it is very much needed for the projects which are

large and considered to have complex and delegate structures. Our research dealt with developing utility

tree for reasoning of appropriate software architecture for a distributed health care system. The application
 assures interactive and real time data exchange between the main actors of the medical system. Using, bed

side as well as wearable patient monitoring devices, mobile phones, PDAs, computers and widely accepted

medical coding standards the proposed solution solves the interoperability issues between medical entities.

Rules and relations embedded in the medical knowledge based offer support for a better medical decision

and in these ways assure higher quality for medical services. Also the system assures remote access and

patient’s monitoring reducing time and cost needed for medical assistance. This system would be a new

way of delivering health care in a coordinated approach inorder to improve the quality of healthcare, ease

access to healthcare information and to reduce the cost of delivery of healthcare in Bangladesh .The

architecture for efficient management of patients’ health record has been proposed by implementing the

utility tree to obtain software quality from an architectural evaluation point of view.

REFERENCE

[1] e-Health & Learning: the Bangladesh experience

Elena Murelli 1, Theodoros N Arvanitis 2 1 CRATOS Catholic University of Piacenza, Piacenza, Italy, 2 The

University of Birmingham, UK

http://www.hon.ch/Mednet2003/abstracts/992581377.html

[2] http://en.wikipedia.org/wiki/Architecture_Tradeoff_Analysis_Method
[3] Khan, Naila, Health in Bangladesh in the new millennium

[4] Haq, Naimul, Innovative approaches to healthcare and family planning services

[5] Peters, Gordon, Healthcare in Bangladesh: the missing link

[6] Prince, MR, Healthcare in Bangladesh: beyond 2000, The Daily Star, 30. 1. 2001.

[7] Perry, Henry B. (2000). Health for all in Bangladesh. Dhaka: University Press Ltd.

[8]http://www.softwarearchitectures.com/go/Discipline/EvaluatingArchitecture/
ATAM/tabid/67/Default.aspx
[9]http://www.sei.cmu.edu/architecture/ata_method.html