Princess Sumaya University for Technology

The King Hussein School for Computing Sciences

Course 13768: Health information systems

Topic 2: Computer and Network Architectures

Dr. Rafat Hammad

Acknowledgements: Most of these slides have been prepared by Robert Hoyt, Elmer V Bernstam, and William Hersh
and adopted for our course. Additional slides have been added from the mentioned references in the syllabus

Learning Objectives

After viewing the presentation, viewers should be able to:

∗ Describe the basic components of computing
∗ Discuss the Internet and World Wide Web
∗ Understand the importance of networks in the field of
medicine
∗ Compare and contrast wired and wireless local area networks
(LANs)
∗ Describe the newest wireless broadband networks and their
significance

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 Computers

∗ Types:
∗ Microcomputer
∗ Minicomputer
∗ Personal computer (PC) (Desktop)
∗ Supercomputer: mainframe enterprise level
∗ Laptop
∗ Server: robust in terms of speed and memory
∗ Mobile
∗ smartphone
∗ tablet 3

Computers and Data

∗ Computers recognize the binary digit (bit): 0 and 1

∗ Bits represent everything in a computer: text, images, etc.
∗ 8 bits is a byte which can have 256 combinations
∗ Text is represented by 7 bit alphanumeric combinations
(ASCII). For more text characters Unicode is used. For
example, 16 bit UTF means 16 bit
∗ Images are represented by pixels. Each black/white pixel
is 1 bit. Images are “memory hogs”, compared to text
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 Converting Between Bits and
Bytes

Computer Hardware

∗ Central processing unit (CPU): where the computer chip

resides and is related to data processing speed
∗ Memory: random access memory (RAM) is the working
memory that is lost when the computer is turned off.
∗ Auxiliary storage: active storage is where data is stored
that is needed continuously. Archival storage can refer to
tape, hard disks, optical drives or cloud
∗ Input and Output devices: keyboards, mouse, monitors,
etc.
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 Computer Software

∗ Software programs instructs the hardware what to

do
∗ Application Programming Interfaces (APIs) are a
common way now for computers to react with other
programs or apps
∗ Operating systems provide a standardized way for
software programs to perform tasks

Programming Languages for

Computing

∗ C, C++, C# – used in many modern applications

∗ MUMPS – used in many early medical applications, now
renamed to M and with many modern enhancements
∗ BASIC – common in early days of PCs
∗ Python – originated as “scripting” languages for Unix and
Web, but achieving larger-scale use, e.g., in machine learning
applications
∗ Java – attempt to create standard language for Web
applications
∗ JavaScript – scripting language for Web browsers
∗ R – emerging important language for statistics and data
analytics
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 Open Source Software

∗ Source code is free and shareable. Examples are Linux,

Apache, Mozilla, OpenOffice, etc.
∗ Resources for open source software in healthcare:
∗ https://sourceforge.net/directory/business-
enterprise/enterprise/medhealth
∗ https://en.wikipedia.org/wiki/List_of_open-
source_health_software
∗ Online Registry of Biomedical Informatics Tools (ORBIT) –
https://orbit.nlm.nih.gov/
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Database Systems

∗ Spreadsheets are considered flat files or one

dimensional; unlike relational databases which link
tables together for more robust storage and queries
∗ A database management system (DBMS) is a program
that manages the database
∗ Most common language to query the database is
structured query language (SQL)
∗ There is a trend towards non-relational database
systems, like NoSQL for large “big data”

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 SQL Database Schema

∗ Note the primary key (Employee ID = 1) in the first

table is linked to the second table (Salary)

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The Internet and World Wide Web

∗ The Internet is the largest and arguably most important large

scale international network
∗ The Internet is a global “network-of-networks” using the
Telecommunications Protocol/Internet Protocol stack (TCP/IP)
as the communications standard. The TCP/IP stack allows for
layering of different standards and technologies based on the
participants in an exchange and the payload being exchanged
∗ The Internet began in the late 1960 as a network known as
Advanced Research Projects Agency Network (ARPANET)
capable of tying together universities and research
organizations securely 12

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 The Internet and World Wide Web

∗ The World Wide Web (WWW) operates on top of the Internet

and was created by Tim Berners-Lee in 1989
∗ The WWW introduced the web browser, a software program
that allows for connection to web servers over the Internet
using Hypertext Transfer Protocol (HTTP)
∗ Web pages are written using Hypertext Markup Language
(HTML), an implementation of a markup language, or method
for defining formatting of text in a document, which has
become synonymous with the Web
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The Internet and World Wide Web

∗ Achieving interoperability on the Internet depends on global

use of standards
∗ Standards exist for the exchange of data, such as HTTP; the
format of data, such as HTML, and the transport of data, such
as TCP/IP
∗ In a TCP/IP network, each device (host) must have an Internet
Protocol (IP) address. IP addresses can be distributed
amongst different tiers of lower layer networks, or “sub-
networks”
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 The Internet and World Wide Web

∗ In order for addressing to function properly in the presence of a

sub-network, the machine must both have an IP address and a
routing prefix or “subnet mask” (example: IP address of
192.168.10.1 and subnet mask of 255.254.254.0) in order for it to
be considered properly addressable by other network nodes
∗ Two versions of IP addressing exists today, IP version 4 (IPv4)
which has been around for more than 40 years
∗ IP version 6 (IPv6) is being used to phase out IPv4 before the
complete depletion of assignable addresses brings the growth
of the Internet to a complete halt
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The Internet and World Wide Web

∗ It is useful to think of the Internet as comprised of

two main components, protocols and hardware
∗ Each machine addressable on a network is known as a
node
∗ Computers connect to the internet through an
Internet Service Provider (ISP) such as Bell South or
AT&T

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 The Internet and World Wide Web

∗ An electronic request for an IP address is sent via the network

link provided by the one’s ISP to a DNS server
∗ The DNS server then matches the requested domain name
and responds with an IP address
∗ The browser is now capable of sending an HTTP GET request
(again routed through one’s ISP provided link) to the IP
address returned from the DNS request
∗ The browser can now render and display the document
defined by the HTML response on the user’s screen
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The Internet and World Wide Web

∗ A message must be sent using small packets of information

that can arrive via different routes, useful when there is web
congestion, and are reassembled back at one’s computer
∗ All traffic sent using TCP/IP (such as phone calls over the
internet (VoIP) and email) are sent using packets
∗ A router is a node which directs the packets on the Internet.
The role of ordering these packets and making sure that they
make it to their intended recipient in the proper structure is
one of the jobs of TCP/IP
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 The Internet and World Wide Web

∗ The Uniform Resource Locator (URL) is a specified address to a

specific resource (e.g. http://www.google.com); the first part
of the URL is the protocol identifier and the rest is the resource
name
∗ The protocol identifier and the resource name are separated by
a colon and two forward slashes. As an example,
http://uwf.edu/uwfmain/about describes HTTP as the
protocol,“uwf.edu” as the server to which the HTTP request
will be made, and “/uwfmain/about” as the path to the
resource being requested. The most common domains end in
.com, .edu, .org, .net, .mil, .gov and .int
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How the Internet Works

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 Web Services

∗ Prior to the advent of the Internet, disparate businesses and

health care entities were not able to easily exchange data;
instead data resided on a local PC or server
∗ Now, much of what we do is “is in the cloud”
∗ Web services are task specific applications which are deployed
in a platform independent manner via a series of transactions
to and from other web-aware applications/services over a
network (such as the Internet)
∗ Web services can be broken down into two categories:
RESTful services and SOA services
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RESTful Services

∗ Representational State Transfer (or RESTful) services are

lightweight services which use existing Internet infrastructure
and World Wide Web (WWW) concepts as their backbone
∗ REST is an architecture, not a standard with endless possibilities
as to how REST can be applied to act as a service bus
∗ Communication with a RESTful service is a relatively quick
process and can utilize any existing content standard for
packaging its messaging. Most commonly, a RESTful service
will use XML or JavaScript Object Notation (JSON) for this
content delivery 22

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 RESTful Services

∗ Operation Types (GET, DELETE, POST, PUT). These HTTP

methods can provide four different points of access to a
RESTful service. If a URI or URL identifies an object, the
HTTP operation type defines an accessor method to that
object (e.g. GET a list, POST an update, PUT a new record,
DELETE a purged record)
∗ MIME Type (Multipurpose Internet Mail Extensions) is a
means of communicating the content type used within a
message transferred over the Internet. Typically, in a
RESTful service, this would be XML or JSON, but it could be
any other type 23

RESTful Operations

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 Service Oriented Architecture (SOA)
Web Services

∗ SOA is based on SOAP, a protocol standard for interacting

with web services
∗ These services require a set of standards for content and a
service oriented architecture (SOA) stack, a collection of
services
∗ The most common standards used in web services
transactions are HTTP, as the internet protocol, with XML as
the delivery language

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Service Oriented Architecture (SOA)

Web Services

∗ SOAP (Simple Object Access Protocol): a communication protocol

between applications. It is a XML-based platform neutral format for
the invocation and response of web services functions over a
network
∗ WSDL (Web Services Description Language): a XML document used
to describe and locate web services. A WSDL can inform a calling
application as to the functionality available from a given service, as
well as the structure and types of function arguments and
responses
∗ UDDI (Universal Description, Discovery and Integration): a directory
for storing information about web services, described by WSDL.
UDDI utilizes the SOAP protocol for providing access to WSDL
documents necessary for interacting
26 with services indexed

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 SOA Web Services

∗ UDDI provides the service registry (like the yellow pages) and
WSDL describes the services and the requirements for their
interaction
∗ A service requester seeking a web service would search a
service directory for a function that meets a need using a
structured language
∗ Once the service provider is located, a SOAP message can be
sent back and forth between the service requester and service
provider (next slide)
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SOA Web Services

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 The Open Systems Interconnection
(OSI) Model

∗ A conceptual model
was created in 1984
to help understand
network
architectures
∗ It divides computer-
to-computer
communication into
seven layers known
as the OSI Stack 29

The OSI Model Layers

∗ Application. This is the layer where applications access

network services. Examples: software for database access,
email and file transfer and the Internet protocols FTP, HTTP
and SMTP
∗ Presentation. This layer translates (formats) the data for the
application layer for the network. Examples: data
encryption and compression
∗ Session. This layer establishes, maintains and terminates
“sessions” between computers
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 The OSI Model Layers

∗ Transport. This layers deals with error recognition and

recovery and handles message size issues and can send
receipt acknowledgments. The Internet protocol related to
this is TCP
∗ Network. This layer is involved with message control,
switching and routing. It translates logical addresses into
physical addresses
∗ Data link. This layer packages data from the physical layer
into frames (special packets) and is responsible for error free
from transfer from one computer (node) to another
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The OSI Model Layers

∗ Physical. This layer deals with the unstructured raw

data stream from the other layers. Specifically, it
encodes data and decides whether the bits will be
sent via a digital or analog mode and decides if the
bits will be transmitted as electrical or optical signals.
This layer is involved with communication with
devices. Examples: USB, Bluetooth and RS-232

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 Networks

∗ A network is a group of computers that are linked together in

order to share information
∗ A network can share patient information as well as provide
internet access for multiple users
∗ Networks can be small, connecting just several computers in
a clinician’s office or very large, connecting computers in an
entire organization in multiple locations
∗ There are several ways to access the internet: dial-up modem,
wireless fidelity (WiFi), a Digital Subscription Line (DSL),
3G/4G telecommunication, cable modem or T1 lines
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Data Transfer Rates

Transmission method Theoretical max speed Typical speed range
Dial-up modem 56 Kbps 56 Kbps
DSL 6 Mbps 1.5-8Mbps downlink/128 Kbps uplink
Cable modem 30 Mbps 3-15 Mbps downlink/1-3 Mbps uplink
Wired Ethernet (Cat 5) 1000 Mbps 100 Mbps
Fiber optic cable 100 Gbps 2.5-40 Gbps
T-1 line 1.5 Mbps 1-1.5 Mbps
Wireless 802.11g 54 Mbps 1-20 Mbps
Wireless 802.11n 300 Mbps 40-115 Mbps
WiMax 70 Mbps 54-70 Mbps
LTE 60 Mbps 8-12 Mbps
Bluetooth 24 Mbps 1-24 Mbps
3G 2.4 Mbps 144-384 kbps
4G 100 Mbps 10-70 Mbps
Satellite 34
10 Mbps 10 Mbps

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 Data Transfer Affected By:

∗ Bandwidth is the size of the pipe to transmit packets (a formatted

data unit carried by a packet mode computer network)
∗ Packet loss is an issue because packets may rarely fail to reach their
destination. The IP Transmission Control Protocol (TCP) makes sure
a packet reaches its destination or re-sends it. The User Datagram
Protocol (UDP) does not guarantee delivery and is used with, for
example, live streaming video
∗ End-to-end delay is the latency or delay in receiving a packet. With
fiber optics the latency is minimal
∗ Jitter is the random variation in packet delay and reflects Internet
spikes in activity 35

Network Types

∗ Networks are named based on connection method,

as well as configuration or size. As an example, a
network can be connected by fiber optic cable,
Ethernet or wireless. Networks can also be described
by different configurations or topologies. They can
be connected to a common backbone or bus, in a star
configuration using a central hub or a ring
configuration

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 Personal Area Networks (PANs)

∗ A PAN is a close proximity network designed to link phones,

computers, PDAs, etc. The most common technology to create
a wireless personal area network or WPAN is Bluetooth (BT)
∗ BT is designed to wirelessly connect an assortment of devices
at a maximum distance of about 300 feet with the most recent
Bluetooth devices (version 5.0). It does have the advantages
of not requiring much power and connecting automatically. It
operates in the 2.4 MHz frequency range
∗ The most common application of Bluetooth today is as a
wireless headset to connect to a mobile phone but wearable
technology (e.g. fitness devices)
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is a close second

Personal Area Networks (PANs)

∗ Bluetooth can be used to wirelessly connect computers to

keyboards, mice, printers, PDAs and smartphones
∗ Security must be enabled due to the fact that even though
the transmission range is short, hackers have taken advantage
of this common frequency
∗ Bluetooth Smart or Low Energy 5.0 requires less power, has
better battery life and is less expensive. The frequency is the
same but the range is less (about 50 meters)

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 Personal Area Networks (PANs)

∗ PANs can also use other standards: Infrared to connect

devices using the IrDA standard, ZigBee networks, Wireless
USB and a body area networks (BANs)
∗ A wireless body area network (WBAN) is also known as a body
sensor network which is gaining importance in healthcare
∗ Another wireless sensor network protocol known as ANT™ is
available for ultra-low power applications. The proprietary
network operates on the 2.4 GHz ISM band

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Local Area Networks (LANs)

∗ LANs generally refer to linked computers in an office,

hospital, home or close proximity situation
∗ A typical network consists of nodes (computers,
printers, etc.), a connecting technology (wired or
wireless) and specialized equipment such as hubs,
routers and switches
∗ LANs can be wired or wireless

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 Wired LANs

∗ To connect several computers in a home or office scenario, a

hub or a network switch is needed
∗ Routers direct messages between networks and the Internet;
whereas, switches connect computers to one another and
prevent delay
∗ Unlike Hubs that share bandwidth, switches operate at full
bandwidth. Switches are like traffic cops that direct
simultaneous messages in the right direction

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Wired LANs

∗ To handle larger enterprise demands Gigabit Ethernet LANs

are available that are based on copper or fiber optics. Cat5e
or Cat6 cables are necessary
∗ Greater bandwidth is necessary for many hospital systems
that now have multiple IT systems, an electronic medical
record and picture archiving and communication systems
(PACS)
∗ Typical LAN shown on next slide

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 Typical Wired LAN Schema

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Wired LANs

∗ Phone lines can connect a computer to the internet by using

a dial-up modem. The downside is that the connection is
relatively slow
∗ Digital subscription lines (DSL) also use standard phone lines
that have additional capacity (bandwidth) and are much
faster network connection than dial up
∗ DSL also has the advantage over modems of being able to
access the internet and use the telephone at the same time

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 Wired LANs

∗ Power lines are another option using standard power

outlets to create a network. PowerPacket® is
inexpensive to install and claims data transfer speeds of
14 Mbps
∗ Ethernet is a network protocol and most networks are
connected by fiber or twisted-pair/copper wire
connections. Ethernet networks are faster, less
expensive and more secure than wireless networks. The
most common Ethernet cable is category 5 (Cat 5, 5e)
unshielded twisted pair (UTP)
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Wireless LANs

∗ Wireless networks are based on the Institute of Electrical and

Electronics Engineers (IEEE) 802.11 standard and operate in
the 900 MHz, 2.4 GHz and 5 GHz frequencies
∗ Wireless networks have become much cheaper and easier to
install so many offices and hospitals have opted to go wireless
∗ This allows laptop/tablet PCs and smartphones in exam and
patient rooms to be connected to the local network or
internet without the limitations of hardwiring but it does
require a wireless router and access points
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 Wireless LANs

∗ 802.11ac is the newest standard that can operate at speeds up

to 900 Mbps with a frequency of 2.4 and 5 GHz
∗ The network router is usually connected to the Internet by an
Ethernet cable to DSL or a cable modem. Security must be
established using an encryption scheme such as WiFi Protected
Access II (WAP2) encryption
∗ Each device on a network has a unique address (MAC) and
routers can have security lists which only allow known devices
or MACSs into the network
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Wireless LAN (WLAN)

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 Global Area Networks (GANs)

∗ GANs are networks that connect other networks and have an

unlimited geographic area. The problem with broadband
technology is that it is expensive and the problem with WiFi is
that it may result in spotty coverage
∗ These shortcomings created an initiative known as Worldwide
Interoperability for Microwave Access (WiMax), using the
IEEE 802.16 standard
∗ This 4G network is about 10 times faster than 3G and has
greater capacity which is equally important
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Global Area Networks (GANs)

∗ The goal is to be faster than standard WiFi and reach greater

distances, such that it might replace broadband services and
permit widespread wireless access to the internet by PCs or
phones
∗ The introduction of one 4G network (WiMax) was so slow that
major carriers adopted Long Term Evolution (LTE) WiFi
∗ Operating in the 700 MHz range it has maximum download
rates of 100 Mbps and upload rates of 50 Mpbs
∗ There will be a slow roll out of 5 G in 2018
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 Virtual Private Networks (VPNs)

∗ In this case the home computer is the client and is attached to

the network at work by communicating with a VPN server
associated with that network
∗ The Internet can serve as the means of connection with VPN
working over both wired and wireless LANs
∗ “Tunneling protocols” encrypt data by the sender and
decrypt it at the receiver’s end via a secure tunnel. In
addition, the sender’s and receiver’s network addresses can
be encrypted
∗ A physician at home may use a VPN to access the work EHR
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Virtual Private Networks (VPNs)

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 Conclusions

∗ Informaticians need to understand computer and network

technologies
∗ Clinicians and IT staff must have an excellent
understanding of office networks and the related required
security
∗ Wireless networks have become attractive due to faster
speeds and lower costs
∗ Wireless broadband has arrived to provide faster Internet
access for all
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