Tag Archives: Medical

HL7 Protocol Enhances Medical Data Transmissions–But Is It Secure?

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In our last blog, we examined how DICOM became the standard format for transmitting files in medical imaging technology. As software developers, we frequently find ourselves working in the medical technology field navigating new formats and devices which require specialized attention.

This week, we will jump into one of the standards all medical technology developers should understand: the HL7 protocol.

The HL7 protocol is a set of international standards for the transfer of clinical and administrative data between hospital information systems. It refers to a number of flexible standards, guidelines, and methodologies by which various healthcare systems communicate with each other. HL7 connects a family of technologies, providing a universal framework for the interoperability of healthcare data and software.

Founded in 1987, Health Level Seven International (HL7) is a non-profit, ANSI-accredited standards developing organization that manages updates of the HL7 protocol. With over 1,600 members from over 50 countries, HL7 International represents brain trust incorporating the expertise of healthcare providers, government stakeholders, payers, pharmaceutical companies, vendors/suppliers, and consulting firms.

HL7 has primary and secondary standards. The primary standards are the most popular and integral for system integrations, interoperability, and compliance. Primary standards include the following:

  • Version 2.x Messaging Standard–an interoperability specification for health and medical transactions
  • Version 3 Messaging Standard–an interoperability specification for health and medical transactions
  • Clinical Document Architecture (CDA)–an exchange model for clinical documents, based on HL7 Version 3
  • Continuity of Care Document (CCD)–a US specification for the exchange of medical summaries, based on CDA.
  • Structured Product Labeling (SPL)–the published information that accompanies a medicine based on HL7 Version 3
  • Clinical Context Object Workgroup (CCOW)–an interoperability specification for the visual integration of user applications

While HL7 may enjoy employment worldwide, it’s also the subject of controversy due to underlying security issues. Researchers from the University of California conducted an experiment to simulate an HL7 cyber attack in 2019, which revealed a number of encryption and authentication vulnerabilities. By simulating a main-in-the-middle (MITM) attack, the experiment proved a bad actor could potentially modify medical lab results, which may result in any number of catastrophic medical miscues—from misdiagnosis to prescription of ineffective medications and more.

As software developers, we advise employing advanced security technology to protect patient data. Medical professionals are urged to consider the following additional safety protocols:

  • A strictly enforced password policy with multi-factor authentication
  • Third-party applications which offer encrypted and authenticated messaging
  • Network segmentation, virtual LAN, and firewall controls

While HL7 provides unparalleled interoperability for health care data, it does not provide ample security given the level of sensitivity of medical data—transmissions are unauthenticated and unvalidated and subject to security vulnerabilities. Additional security measures can help medical providers retain that interoperability across systems while protecting themselves and their patients from having their data exploited.

HOW DICOM BECAME THE STANDARD IN MEDICAL IMAGING TECHNOLOGY

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Building applications for medical technology projects often requires extra attention from software developers. From adhering to security and privacy standards to learning new technologies and working with specialized file formats—developers coming in fresh must do a fair amount of due diligence to get acclimated in the space. Passing sensitive information between systems requires adherence to extra security measures—standards like HIPAA (Health Insurance Portability and Accountability Act) are designed to protect the security of health information.

When dealing with medical images and data, one international standard rises above the rest: DICOM. There are hundreds of thousands of medical imaging devices in use—and DICOM has emerged as the most widely used healthcare messaging standards and file formats in the world. Billions of DICOM images are currently employed for clinical care.

What is DICOM?

DICOM stands for Digital Imaging and Communications in Medicine. It’s the international file format and communications standard for medical images and related information, implemented in nearly every radiology, cardiology, imaging, and radiotherapy devices such as X-rays, CT scans, MRI, ultrasound, and more. It’s also finding increasing adoption in fields such as ophthalmology and dentistry.

DICOM groups information into data sets. Similar to how JPEGs often include embedded tags to identify or describe the image, DICOM files include patient ID to ensure that the image retains the necessary identification and is never separated from it. The bulk of images are single frames, but the attribute can also contain multiple frames, allowing for storage of Cineloops.

The History of DICOM

DICOM was developed by the American College of Radiology (ACR) and the National Electrical Manufacturer’s Association (NEMA) in the 1980s. Technologies such as CT scans and other advanced imaging technologies made it evident that computing would play an increasingly major role in the future of clinical work. The ACR and NEMA sought a standard method for transferring images and associated information between devices from different vendors.

The first standard covering point-to-point image communication was created in 1985 and initially titled ACR-NEMA 300. A second version was subsequently released in 1988, finding increased adoption among vendors. The first large-scale deployment of ACR-NEMA 300 was in 1992 by the U.S. Army and Air Force. In 1993, the third iteration of the standard was released—and it was officially named DICOM. While the latest version of DICOM is still 3.0, it has received constant maintenance and updates since 1993.

Why Is DICOM Important?

DICOM enables the interoperability of systems used to manage workflows as well as produce, store, share, display, query, process, retrieve and print medical images. By conforming to a common standard, DICOM enables medical professionals to share data between thousands of different medical imaging devices across the world. Physicians use DICOM to access images and reports to diagnose and interpret information from any number of devices.

DICOM creates a universal format for physicians to access medical imaging files, enabling high-performance review whenever images are viewed. In addition, it ensures that patient and image-specific information is properly stored by employing an internal tag system.

DICOM has few disadvantages. Some pathologists perceive the header tags to be a major flaw. Some tags are optional, while others are mandatory. The additional tags can lead to inconsistency or incorrect data. It also makes DICOM files 5% larger than their .tiff counterparts.

The Future

The future of DICOM remains bright. While no file format or communications standard is perfect, DICOM offers unparalleled cross-vendor interoperability. Any application developer working in the medical technology field would be wise to take the time to comprehensively understand it in order to optimize their projects.

How 5G Will Enable the Next Generation of Healthcare

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In the past month, we’ve explored 5G, or fifth generation cellular technology, and how 5G will shape the future. In this piece, we’ll spotlight the many ways in which 5G will revolutionize the healthcare industry.

DATA TRANSMISSION

Many medical machines like MRIs and other imaging machines generate very large files that must then be sent to specialists for review. When operating on a network with low bandwidth, the transmission can take a long time or not send successfully. This means patients must wait even longer for treatment, inhibiting the efficiency of healthcare providers. 5G networks will vastly surpass current network speeds, enabling healthcare providers to quickly and reliably transport huge data files, allowing patients and doctors to get results fast.

EXPANDING TELEMEDICINE

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A study by Market Research Future showed that the future of telemedicine is bright—an annual growth rate of 16.5% is expected from 2017 to 2023. 5G is among the primary reasons for that level of growth. In order to support the real-time high-quality video necessary for telemedicine to be effective, hospitals and healthcare providers will need 5G networks that can reliably provide high-speed connections. Telemedicine will result in higher quality healthcare in rural areas and increased access to specialists around the world. Additionally, 5G will enable growth in AR, adding a new dimension to the quality of telemedicine.

REMOTE MONITORING AND WEARABLES

It’s no secret that 5G will enable incredible innovation in the IoT space. One of the ways in which IoT will enable more personalized healthcare involves wearables. According to Anthem, 86% of doctors say wearables increase patient engagement with their own health and wearables are expected to reduce hospital costs by 16% in the next five years.

Wearables like Fitbit track health information that can be vital for doctors to monitor patient health and offer preventative care. While the impact may initially be negligible, as technology advances and more applications for gathering data through wearables emerge, 5G will enable the high-speed, low-latency, data-intensive transfers necessary to take health-focused wearables to the next level. Doctors with increased access to patient information and data will be able to monitor and ultimately predict potential risks to patient health and enact preventative measures to get ahead of health issues.

Companies like CommandWear are creating wearable technology that helps save lives by enabling first responders to be more efficient and more conveniently communicate with their teams.

ARTIFICIAL INTELLIGENCE

In the future, artificial intelligence will analyze data to determine potential diagnoses and help determine the best treatment for a patient. The large amounts of data needed for real-time rapid machine learning requires ultra-reliable and high-bandwidth networks—the type of networks only 5G can offer.

One potential use case for AI in healthcare will be Health Management Systems. Picture a system that combines the Internet of Things with cloud computing and big data technology to fully exploit health status change information. Through data-mining, potential diseases can be screened and alarmed in advance. Health Management Systems will gradually receive mass adoption as 5G enables the data-transmission speeds necessary for machine learning to operate in the cloud and develop algorithms to predict future outcomes.

MAJOR PLAYERS

Right now, the major players who serve to benefit from 5G are the telecom companies developing technology that will enable mass adoption. Companies like Huawei Technologies, Nokia, Ericsson, Qualcomm, Verizon, AT&T, and Cisco Systems are investing massive sums of money into research and development and patenting various technologies, some of which will no doubt become the cornerstones of the future of healthcare.

Qualcomm recently hosted a contest to create a tricoder—a real life device based on a machine in the Star Trek TV movie franchise. Tricoders are portable medical devices that would enable patients to diagnose 13 conditions and continuously monitor five vital signs.

For a full list of major players in the 5G game, check out this awesome list from GreyB.

CONCLUSION

With human lives at stake, healthcare is the sector in which 5G could have the most transformative impact on our society. As the Qualcomm Tricoder contest shows, we are gradually building toward the society previously only dreamed about in sci-fi fiction–and 5G will help pave the way.