TripleA
ANYPLACE ANYWHERE ANYTIME

M - ALWAYS ON - Occasionally Connected Magic

 

Occasionally Connected

Systems fail - that's just the way it is. AAA is more robust however. AAA is built on an architecture called 'Occasionally Connected' and an engineering concept called 'State Machine replication in distributed computing' - We don't just 'interpret text' we manipulate objects and re-align their effect in time. This allows us to give tasks\jobs\workflow a given 'state' at specific points in time. The data model we then use to control these processes can be updated, modified or added to by any of the group members when they are connected but also when they are not. Their additions or changes are then propagated to the other group members in the correct order as and when they synch.

Efficiency and Compression

AAA is extremely efficient in how it works. Internally, we use techniques such as 'Binary Coded Decimal' and we only transmit the 'delta' of changes you make. If for example you only change a patients age, only the change of age is transmitted and not the entire patient record. We also don't use JSON to again increase the efficiency. On top of this, we then compress the data with an advanced compression algorithm which further reduces the data 'packet' size. Try zipping a pure text file and you can get an idea of the compression ratios we achieve. Most AAA data packets are measured in bytes and not kilobytes. As an example of data size, a fully populated patient record (excluding image and multimedia data) with 5,000 'actions' or tasks each of which are again fully populated is transmitted as a compressed packet in about 30 kilobytes.

Smart Transmission

For every packet we then transmit, each and every one is 'transacted' and the system is resilient to duplicate data as each transaction is uniquely identifiable. If data is ever transmitted twice, the system knows this and ignores the duplicate.

Image, video and other patient attachments are also transmitted intelligently. If you have a 500Mb video file, AAA won't even attempt to transmit the file over 2G or 3G. It will wait till you have 4G or Wi-Fi.

 Loosely coupled and Highly fault tolerant

Our architecture also embraces a design goal of a 'loosely coupled' system in that a failure in any part of the system won't bring the rest of it crashing to it's knees or just plain dead. If our (georedundant) Azure storage fails, the data packets stay on the devices. If our (always-On, replicated) Azure databases fail, the data stays on our Azure storage until the servers come back on-line. The result is a highly reliable, fault tolerant system that is device independent. It rebuilds and reconfigures itself wherever it is installed and when any part of it fails, the preceding component is built to handle the failure. Everything is 'Transacted'. 

 

Occasionally connected works Anywhere

You don't need a connection to the web, Wi-Fi,2G, 3G - that means the top of Mt Everest, the Gobi desert, airplanes, helicopters, Ambulances, EMR shielded rooms, basements, Mars and Pluto. When we say 'Anywhere' we mean it.

 

AAA Works in disaster zones

Where there is no connectivity, Medics can record patient ailments, treatments and take their GPS position. When you connect again, all that data is made available to the rest of your team with the patients GPS location. Even if you change the model by adding a new type of task, that change is propagated to every member of your group in a way that ensures all the object changes needed to complete the task are made as well. The model and the logic it needs are delivered at the same time and in the correct order.

A paramedic in an ambulance that was in an area of no connectivity could for example take vitals, administer medications, take images, video, patient notes and observations. AAA will continually attempt to send this data until it is successful. The phone or device will automatically find the best available connection be it 2g,3g,4g or Wi-Fi as soon as it becomes available. Everything you do before you had a connection and everything you do when you are connected is recorded and transmitted to your group as soon as it can be.

 

It's a modern world and  I.T. failures rarely happen - Right ?

Well, not as modern as you would think and when it does happen you'll probably find that nobody has a pen either.

Here is a major UK hospital that had a power outage on 22nd July 2016 

The point to note is 'During the incident staff were unable to access IT systems which were temporarily unavailable'. Had AAA been available, every action that happened to every patient could have been recorded electronically. No entering ward names \ beds etc. As AAA builds the entire hospital automatically in seconds. Every instruction given by a doctor, medication administered, patient relocation would have been electronically recorded and could have been electronically input when the main system recovered.

A few shutdown by power outages in the last few months and we have not even looked at the outages that happen because of the I.T. systems themselves.

Royal Stoke University Hospital - 22 July 2016

Northwick Park Hospital 04th January 2016

Royal Berkshire Hospital 31 July 2015

Arrow Park Hospital 5th March 2015

Royal Free Hospital London - System Crash

 

Some large hospitals employ over 10,000 people. These people create a lot of data each and every shift and as we know, sometimes their I.T. systems fail. The cost of training these people for what to do in the event of a failure is significant. The effects of any of them not knowing what to do or doing it incorrectly does not bear thinking about. Many UK hospitals measure their 'un-keyed' data in 'Yards' - 100's of yards ! The reality is that this data will never be keyed - it's just 'missing'. A large hospital group in the USA had it's $1bn system operating in 7 hospitals go down. Sutter Health That's a lot of re-keying. AAA would not have been a total solution in that scenario but it would have eliminated all the scribbled notes and re-keying.

 

      
When connected, you can see waiting uploads and downloads - Synching happens automatically. We even have a live tile that works in the background.
With no connection, AAA just saves up your work and transmits it when it does manage to connect or you choose to. Everything is 'Transacted'

 

 

Let's consider a few AAA scenarios where we put occasionally connected technology to use :-

1) Your phone fails \ won't start \ you drop it in the ocean and it's lost.

With AAA just get another phone, in fact any phone or device, download the app, log in and all your group data will be re-built on your new device. You are good to go. Ubiquitous means we don't care which device. In a couple of years it could be your fridge or your shirt.

 

2) Your phone fails \ won't start \ you drop it in the ocean and it's lost AND the Azure cloud is down AND\OR your ISP is down AND\OR your Wi-Fi is unavailable.

Find another member of your group and from their device you will be able to see all your outstanding tasks and respond to them and treat your patients. Yes, you will have to share the device but no data will be lost and you won't be scribbling notes onto bits of paper.

When Azure is back up and you have a new device, all the data is again restored and no re-keying data from paper records was needed. Additionally no action was needed by us. AAA automatically detected it could make connections again and just carried on as normal.

As long as one device of any group member is running, AAA will continue to work and restore the data later.

The major difference here is that with any conventional system if either the cloud, your ISP or your Wi-Fi was down, NOBODY COULD WORK and everyone would have to revert to paper and the data re-entered at a later date.

 

3) If the system is down, how do we stop people performing the same tasks more than once ?

With a current conventional system, you will have to take a note of what your have done and leave some form of notification with the patient. With the current release of AAA, you would still have to leave some form of notification with the patient but for a future release of AAA we are planning an NFC patient bracelet that will record patient treatments and can be scanned by any offline AAA device. In any event, AAA aligns all transaction with UTC time and it will always deliver the latest version of an event.

 

AAA Keeps on Working - Always On means Always ON.

ANYWHERE means ANYWHERE