Going eXtreme for Healthcare

Going Extreme for Health Care

Koen Vanderkimpen@koenvdk

Dirk Deridder@dirkderidder

When Security, Performance, Scalability, and Availabilityall want to be the star of the show

09/04/23

Smals

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Dirk Deridder

Koen Vanderkimpen

Preferred ICT Partner of Social Security and Health CareInstitutions in Belgium

Smals Research Team

Dedicated to introducing innovative IT in e-GovernmentAnd solving clients' more abstract problems

1.5 years @ Smals, specializing in OO, software develop-ment, version control; implemented first demo of the PCS

1 year @ Smals, specializing in dynamic programming languages, software architecture, Agile and XTP

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What Follows

1. The Project: which challenges?2. Security: Novel Approach using threshold

encryption3. Conflicting Challenges in a High-Risk Project4. Extreme Transaction Processing5. Conclusions6. Questions

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Mission:

« Build a highly secure platform to exchange Patient Data between Healthcare actors within

Flanders/Be/EU/… »

1. The Project: A Primary Care Safe (PCS)

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The "PCS manifesto":• Security, Privacy, Confidentiality• 24/7 always-on• Generic, Multi-Purpose, Shared

Thoroughly Patient-Centric Vision

• Ready for Growing Data & Usage

• Performant (4s response time)

Some NFR's…

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Functionality

• PUT(a file, or part of it)

• GET• DELETE

Patient File

Medication

Parameters

Allergies

Journal

…

Anti-DiabeticalAnti-Aids

Blood Pressure

Heart Condition

Other

Pulse

Entries

Entry1

Entry2…

(Versioning)

(Fine-Grained DataModel)

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(for Flanders)• Patients: 6.5 million• Users (medical professionals): 51000• File accesses per day/user: 7.2• Starting file size: 50K (towards 5M)

Some Figures

What if?• All of Belgium joins in?• Patients get access?• Mobile usage develops?

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2. PCS – Novel Security Architecture

• "end-user eyes only"• "distributed trust"

File

(Only Encrypted Messages)

Alice Bob

PCSDokters OrgGov (ehealth)

host & control control

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Symmetric Encryption

Message

Secret key Encrypted Message

Alice Bob

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Assymmetric Encryption (Public Key)

Public KeyPrivate Key

= +

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Primary Care Safe - PCS

Bob

PCS

Dokters.Org

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Threshold Encryption (Public Key)

• Main Idea: a minimum number (= the threshold) of people needed to decrypt

1

2

1

2Public Key

Bob

Marc

Alice

Partial Decryption

Combination

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Primary Care Safe - PCS

Dr. Bob

PCSDokters OrgGov (ehealth)

1

2

1 2

1

2

Patent Pending!

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Fine-Grained Access Control

Patient File

Medication

Parameters

Allergies

Journal

…

Anti-DiabeticalAnti-Aids

Blood Pressure

Heart Condition

Other

Pulse

Entries

Entry1

Entry2…

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• Exchange Platform for Medical Data• Eventually for 6500000 patients (all of

Flanders) – A few 1000 to startGrowing data (e.g. lifetime biometrics)

• For many different applications• Provided by the Government• Security + Fine-grained Access

3. Roundup: Primary Care Safe (PCS)

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Availability

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Availability

Scalability

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Availability

Scalability

Flexibility

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Availability

Scalability

Flexibility Security

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Availability

Scalability Performance

Flexibility Security

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Security

Availability

Scalability Performance

Flexibility

Challenge: Reconciling the NFR's

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4. How to approach this?

• Programming language? Java @ Smals

• Software Architecture? N-Tier & SOA @ Smals

• Development approach? EUP @ Smals

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?Will this work

Sure, but more geared towards « conventional » projects

Actually we weren’t « sure » so we investigated further …

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XTP versus Traditional N-Tier Solution?

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Business Processing Tier

Web Tier

Load Balancer

Database Tier

Primary

Primary

Primary

Backup

Backup

Backup

Primary

Primary

Backup

Backup

xx

Messaging Tier

Primary

Backup

Availability?

Scalability?

Elasticity?

Performance?

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Looking for inspiration…

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• Social Media• Stock exchange• Investment banks• Telecommunications• Retail Business• Web-commerce• Internet media• Factory automation• Aerospace industry• Online gaming• Big Data analysis• …

• Large number of users • High volume of requests• Very demanding availability (24/7)• Peak loads are a moving target• Challenging performance expectation• …

Some of our NFR’s are « easy » compared to their day-2-day operation

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Extreme Transaction Processing

« An application style aimed at supporting

the design, development, deployment,

management and maintenance of

distributed TP applications

characterized by exceptionally demanding

performance, scalability, availability,

security, manageability,

and dependability requirements »

Everything we need « in a box »?25

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Let’s get this « XTP solution in-a-box »!

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Hypertable

BigTable

NoSQL

DevOps

MongoDB

MemcacheDB

Cassandra

CouchDB

Voldemort

Map/ReduceHadoop

Grid Computing

Space Based Architecture

Event Driven Architecture

Shared Nothing Architecture

Partitioning TerracottaAkka

Erlang

Actor Model

Scala

AmbientTalkNode.js

…

Async Flows

In-memory DBMaster/Worker

Task Execution

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Today’s main focus: Support offered by an XTP middleware Platform

• Several solutions exist MaatG G Platform, GigaSpaces XAP, Appistry, Tibco

ActiveSpaces, Paremus Service Fabric, …• Currently establishing a position as CEAP’s / EAP’s

Good match with « cloud » requirements Fine-grained elastic scalability, Continuous availability & Non-stop operations Consistent performance

Still require additional work on multitenancy, billing, self provisioning, …

Not intrinsic to XTP (can be enablers) Traditional application servers will not meet future needs to

move to the cloud « … dinosaurs tiptoeing through a meteor storm… »

[M. Gualtieri, Forrester 2011]

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XTP Platform characteristics enabling Extreme Availability

• Let it crash principle• Zero downtime failover management

Automated failover without side-effects E.g., handover from primary to backup with no manual intervention,

even between datacenters Automated self-healing without side-effects

E.g., creation of new backup nodes after failover with no manual intervention

Automated replication management E.g., keeping primaries/backups consistent, redo queues, …

• Transparent for client applications The client is unaware of « who » handles the request and is only

interested in getting a result Shield-off all complexity involved in guaranteeing high availability

• Application virtualisation and overall automation are key!

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Availability

Availability

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XTP Platform characteristics enabling Extreme Performance

• Improve response time by not moving data around Focus on data/processing affinity

Routing of requests to the location of the data Do not separate tiers physically

Work with an in-memory data grid Cf. caching, but not as an after-the-fact optimisation strategy Persistency as a service, not involved in servicing live requests

• Increase throughput Asynchronous processing flows

Give back control asap Make requests self-contained so they can

served by any « workers » that are available Work with a processing grid

Execute (parts of) requests in « parallel » Avoid relying on external systems Enforce strict internal / external SLA’s

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Performance

Performance

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XTP Platform characteristics enabling Extreme Scalability

• Principle of horizontal scaling Increase capacity by adding resources « on the fly » in an

automated fashion Elastic scaling, so capacity can be taken away easily Location-unaware applications

Transparent for client applications as well Capacity planning vs capacity management

• Application virtualisation and overall automation are key!

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HORIZONTAL SCALING

Scalability

Scalability

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Concrete XTP Platform XAP: Characteristics

• Space Based Architecture Based on Tuple Spaces [Gelernter & Carriero]

Cf JavaSpaces, but a lot more Technology arena: Java, Jini, JMS, Spring, Hibernate, … Data + Processing+ Messaging Grids

• SLA-driven application containers• Excellent enabler for implementing XTP

architectures Allowing you to focus on the « difficult part » by taking

care of the « hard part »

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ServerServer

ProgramProgram

MemoryMemory

ServerServer

ProgramProgram

MemoryMemory


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ServerServer

ProgramProgram

MemoryMemory


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ServerServer

Space

ProgramProgram

MemoryMemory

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ServerServer

ProgramProgram

MemoryMemory

Processing UnitProcessing UnitProcessing UnitProcessing Unit

Space

ProgramProgram

MemoryMemory

ProgramProgram

MemoryMemory


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ServerServer

ProgramProgram

MemoryMemory

ServerServer ServerServer

Processing UnitProcessing UnitProcessing UnitProcessing Unit

Space

ProgramProgram

MemoryMemory

ProgramProgram

MemoryMemory


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ServerServer

ProgramProgram

MemoryMemory

ServerServer ServerServer ServerServer

Processing UnitProcessing Unit Processing UnitProcessing Unit Processing UnitProcessing Unit

Space

ProgramProgram

MemoryMemory

ProgramProgram

MemoryMemory

ProgramProgram

MemoryMemory


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ServerServer

ProgramProgram

MemoryMemory



Space

ProgramProgram

MemoryMemory

ProgramProgram

MemoryMemory

ProgramProgram

MemoryMemory


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ServerServer

ProgramProgram

MemoryMemory

ServerServer ServerServer


Space

ProgramProgram

MemoryMemory

ProgramProgram

MemoryMemory

ProgramProgram

MemoryMemory


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ServerServer

ProgramProgram

MemoryMemory



Space

ProgramProgram

MemoryMemory

ProgramProgram

MemoryMemory

ProgramProgram

MemoryMemory


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Lots of flexibility and support « out of the box »for realizing an(y) XTP solution

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XTP versus Traditional N-Tier Solution?

BusinessProcessing Units

(Data + Processing + Messaging)

AA BB CC

AA BB CC

AA BB CC

Web Processing

Units

Load Balancer

Persistencyas a Service

Persistencyas a Service

Database

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Conclusions

• XTP is not just a technology or style of programming Impacts software architecture, development process, … An integrated approach / vision is required! Having an XTP platform is only a first step Think outside the traditional box

• Demands disciplined application of development practices Not only functional testing: NFR’s ! Automation is fundamental

• Updating applications with no downtime is an additional challenge Requires « next-release strategy » XTP platforms provide « patterns » to handle this

• Problems can still happen, be prepared! Cf. Recent Amazon / Microsoft /… outages (if the best fail, expect…)

• ROI analysis is absolutely necessary Not every application calls for a platinum-approach

But it never hurts to think about it ! Maximum ROI = Availability + Scalability + Performance

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09/04/23

Going Extreme for Health Care

Koen Vanderkimpen@koenvdk

Dirk Deridder@dirkderidder

When Security, Performance, Scalability, and Availabilityall want to be the star of the show

Q&A

Going eXtreme for Healthcare

Technology

Transcript of Going eXtreme for Healthcare