Florida National UniversityHSA-6197 Health Information System and Electronic Health Records: Assignment Week 3
Case Study: Chapters 5 and 6.
Objective: The students will complete a Case study assignments that give the opportunity to synthesize
and apply the thoughts learned in this and previous coursework to examine a real-world scenario. This
scenario will illustrate through example the practical importance and implications of various roles and
functions of a Health Care Administrator. The investigative trainings will advance students’
understanding and ability to think critically about practice management and Electronic Health Records.
As a result of this assignment, students will be better able to understand, analyze and evaluate good
quality and performance by all institutional employees
ASSIGNMENT GUIDELINES (10%):
Students will critically measure the readings from Chapters 5 and 6 in your textbook. This
assignment is planned to help you examination, evaluation, and apply the readings and strategies
to your Health Care organization.
You need to read the article (in the additional weekly reading resources localize in the Syllabus
and also in the Lectures link) assigned for week 4 and develop a 3-4 page paper reproducing
your understanding and capability to apply the readings to your Health Care organization. Each
paper must be typewritten with 12-point font and double-spaced with standard margins. Follow
APA style 7th edition format when referring to the selected articles and include a reference page.
EACH PAPER SHOULD INCLUDE THE FOLLOWING:
1. Introduction (25%) Provide a brief synopsis of the meaning (not a description) of each
Chapter and articles you read, in your own words that will apply to the case study presented.
2. Your Critique (50%)
Case Studies
Doctors, Nurses Overcome Workplace Hierarchies to Improve Patient Experience Scores in
Phoenix ER
Doctors and nurses have worked together for centuries, saving and prolonging countless lives in
healthcare facilities around the world. And as in so many other professions featuring rich and
deep-rooted histories, hierarchies created long ago have been assumed by modern-day
caregivers.
So it was no surprise when emergency medicine leaders in Phoenix, AZ, initially struggled in
trying to improve their medical facility’s patient experience scores. But by focusing on the heart
of the matter, and successfully selling a culture of quality to staff, they helped employees
overcome social norms to achieve success for the organization and, most importantly, the patient
Banner Health, a nonprofit healthcare provider, encompasses 24 acute-care hospitals and
healthcare facilities in seven states (Alaska, Arizona, California, Colorado, Nebraska, Nevada,
and Wyoming) while employing more than 36,000 individuals. Located in Phoenix, Banner
Good Samaritan Medical Center is a Level One trauma hospital that provides services to more
than 60,000 patients annually.
The Emergency Physician Insurance Program (EPIP) is a partnership between Banner Health,
Emergency Professional Services, North Valley Emergency Services, and Progressive Medical
Associates. EPIP, established in 2003, addresses challenges involving malpractice coverage,
while reducing the cost of malpractice coverage and overall risk found in five Banner Health
emergency departments.
Understanding the importance of positive patient experiences, EPIP created staff leadership
groups, or vision teams, that sought to achieve better patient interactions, communications, and
outcomes while also decreasing risk of malpractice. A vision team composed of Banner Health
physicians in Arizona was tasked with studying how staff could improve patient experience
scores and reduce litigation risks.
Dr. Moneesh Bhow, medical director at Banner Good Samaritan Emergency Department, and the
rest of the Patient Experience Vision Team, began a near two-year process of digging into the
patient survey data. But Bhow quickly recognized an integral piece to the puzzle was missing
from the physician-only vision team: nurses. At Good Samaritan, like many medical facilities,
Bhow said a culture exists that creates a sort of separation between doctors and nurses.
Gretchen Dallman, a nurse manager within the emergency department, agreed that motivating
the two sides to work together and create positive experiences was a cultural change that was not
going to be easy or happen overnight.
Using the define, measure, analyze, improve, and control (DMAIC) approach and Pareto analysis
of patient experience data, team leaders learned:
•
Part of the problem was the lag time from when the patient left the facility to when staff
received feedback through mailed surveys.
•
Many unhappy patients, regardless of the care they received, felt there was a lack of
communication between doctors and nurses.
To address these issues, the patient experience team implemented the following process
improvements:
Created a realtime, point-of-service survey program to improve the reaction capabilities for the
staff to make meaningful strides in helping unhappy or distressed patients.
Moved doctor-nurse conversations to the bedside.
Introduced “story time” within preshift meetings, during which staff members shared tales of
patient care victories, large and small.
Beyond the data collection and analysis, the patient experience team also focused on the
emotional side of the equation, specifically as relates to staff. A major focal point of the
improvement project was centered on engaging the clinician. A culture change had to take place,
Dallman said, so the vision team turned its scope away from the patients and onto themselves.
As a result of process improvements, patients are now 89 percent less likely to file a complaint
when a physician or nurse addresses any concerns prior to discharge, which ultimately helps curb
the risk of litigation.
CASE STUDY CHALLENGE
1. Students should be asked to read the case and discuss all procedures done and suggest a
solution program.
3. Conclusion (15%)
Briefly summarize your thoughts & conclusion to your critique of the case study and provide a
possible outcome for the patient positive experience. How did these articles and Chapters
influence your opinions about check-in procedures and Office visit?
Evaluation will be based on how clearly you respond to the above, in particular:
a) The clarity with which you critique the case study;
b) The depth, scope, and organization of your paper; and,
c) Your conclusions, including a description of the impact of these Case study on any Health
Care Setting and the marketing projects.
ASSIGNMENT RUBRICS
Assignments Guidelines
1 Points
10%
Introduction
2.5 Points
25%
Your Case Study Critique
6 Points
50%
Conclusion
1.5 Points
15%
Total
11 points
100%
ASSIGNMENT GRADING SYSTEM
A
90% – 100%
B+
85% – 89%
B
80% – 84%
C+
75% – 79%
C
70% – 74%
D
60% – 69%
F
50% – 59% Or less.
Dr. Gisela Llamas
Chapter 5:
HIS Tactical
Planning
Introduction
• Once the organization’s HIS Strategic Plan is
complete, the tactical level of work is ready to be
started
• All initiatives in a healthcare organization involve
HIS
• During the planning processes, the aligned
organizational and HIS strategies can be
articulated as detailed tactical HIS plans
– HIS initiatives, project descriptions, capital/
operating budgets, staffing plans, and metrics
HIS Planning
HIS Planning Hierarchy: Strategic stages and
planning techniques
HIS Planning
• Guiding principles
– At the outset of work to implement the HIS strategic
Plan, guiding principles must be developed and
agreed upon
• Statements about the things the group agrees on at a
principles and high level of thinking
• Statements the group goes back to as it struggles with
decisions priorities, habits, inertia, or methods
– Status quo holds organizations back
– Process works best with facilitation by someone not
part of the organization and its culture
HIS Planning
• Steps in developing guiding principles
– Development begins with talk about common
denominator and shared values
– Discussions are broad and interdisciplinary
– Include representation from every sector
– Four broad steps to creating guiding principles
• Step 1: Articulate the organization’s values
• Step 2: Document the current state
• Step 3: Develop the guiding principles
• Step 4: Apply the guiding principles
HIS Planning
• HIS-related guiding principles
– Some HIS-related principles
• Integration over interfacing for enterprise systems
• Say no to silos
• Manage the vendor; don’t let the vendor manage you
• Transparency is required in all matters
• Use inter-disciplinary decision making processes
• Adhere to standards; be compliant
• Picking a vendor is not a strategy
• Be thorough in definition of principles
HIS Plans and Projects Follow the
HIS Strategic Plan
• HIS Strategic Plan is broken down into Strategic
Initiatives
– Link strategy and actionable projects
– Projects consist of numerous projects that comprise
the initiative
– When creating the Strategic HIS portfolio, remember
need for balance and relentless connection to
organizational strategic business plan
HIS Plans and Projects Follow the
HIS Strategic Plan
• HIS and technology strategy: architecture builds
a strong house
– Once an architectural plan is devised and approved,
“construction” commences
– First step is preparing land and laying a good
foundation
– Systems and networks rely on a strong
infrastructure – the “electronic highway” that
carries data, images, voice, and information traffic
between users and technology
HIS Plans and Projects Follow the
HIS Strategic Plan
• HIS and technology strategy: architecture builds a
strong house
– Adequate infrastructure must be in place/maintained) to
support data comm, software, devices, and hardware
– Must be reliable; nothing is more important
– If a system supporting a clinical function goes down, patients’
lives can hang in the balance
– HIS and technology plans and budgets must be practical,
realistic, rooted in good stewardship
– Cardinal rule: Understand and approve total effort and costs
to build and maintain all needed systems before the first
projects are approved and under way
HIS Plans and Projects Follow the
HIS Strategic Plan
• Balanced application portfolio
– Bottom-line principle: No essential part can be left out
– Systems in all four quadrants must be considered and built
into the plan
– Major categories of HIS
• Clinical care
• Institutional business
• Clinical intelligence and quality
• Business intelligence and management
• Infrastructure
– Balanced HIS and technology plan and portfolio address
needs of all these areas
HIS Plans and Projects Follow the
HIS Strategic Plan
• Staffing plan
– The HIS and technology plan must identify IT staffing
and talent needed to design, build, and support
systems and end users
– Software vendors/consultants cannot provide all
necessary services
– Must have in-house experts who know both the
technology and the organization’s people, culture,
and processes
– Interdisciplinary collaboration on teams and groups
HIS Plans and Projects Follow the
HIS Strategic Plan
• Data plan
– Becomes as active a part of managing HIS and
technology as keeping the systems and devices up and
running
– Establishes principles and policies to manage and
steward data
– Must have data standards, data dictionary, and data
model/map
– Data ownership is important part of data stewardship
– Responsibility for quality and consistency is with end
users
HIS Plans and Projects Follow the
HIS Strategic Plan
• Data plan
– Data structures: methods and formats used to organize
data in a computer (records, files, arrays)
– Data dictionary: dictionary or database that contains
data about the data elements (AKA metadata)
– Data model: map or visual representation showing the
way data are organized according to relationship with
one another and key elements of a process or function
– Updates are another key part
– Patches may be needed to correct problems introduced
by updates
HIS Planning Tools and Techniques
HIS Plan Techniques and Tools
HIS Planning Tools and Techniques
• HIS Planning Framework: an aligned,
architectural approach
– Planned HI must support all business and clinical
strategies
– Good HIS plan advances the organization’s
performance
• Reduces costs and waste, improves revenues, enhances
service, improves quality of care, increases patient,
employee, and provider satisfaction
– When the HIS strategies and systems support the
organization in doing these things, they are aligned
HIS Planning Tools and Techniques
• HIS Planning Framework: an aligned,
architectural approach
– Systematic approach is necessary to achieve all, not
just some, of these things
– Without an effective, aligned HIS plan, the
organization can cease to exist
– Includes both top-down and bottom-up
perspectives to create a realistic, comprehensive,
pragmatic, forward-thinking plan
– ”Everything touches everything”
HIS Planning Tools and Techniques
HIS Planning Framework with examples of software applications in each quadrant
Modified from Jay McCutcheon’s Systems Planning Framework.
HIS Planning Tools and Techniques
• The HIS Business Plan
– Closely linked to the HIS Planning Framework
– Straightforward way to organize and design an application
portfolio
– Provides a non-technical, visual tool to help with education
and communication about HIS and the planning process
HIS Planning Tools and Techniques
• The HIS Business Plan standard format
– Executive summary
– Introduction of the project
– Organizational need
– Information and systems capabilities requirements
– Interdisciplinary involvement
– Expected financial requirements, five-year- capital, and
operating budgets
– Expected staffing requirements
– Implementation plan
– Project Summary, needed approvals, next steps
HIS Planning Tools and Techniques
• Capital and operational budgets for HIS
– Good budgeting begins with policies
– HIS planning and budgeting deserves dedicated staff and
attention
– HIS Strategic Plan keeps HIS knitted into the financial fabric of
the organization
– HIS Strategic Initiatives typically funded through capital
budgets
– Items classified as capital expenditures according to
Generally Accepted Accounting Principles (GAAP) quality to
be funded out of capital budget
– Budget line items are funded from the operating budget
HIS Planning Tools and Techniques
• HIS project five-year cost estimate and template
– Five-year cost estimate is one of the most
informative and revealing exercises in HIS planning
– Best way to avoid cost over-runs
• Software license fees (the “cost” of a new system)
• Software maintenance
• Hardware and devices plus maintenance
• Implementation and training costs
• List of all start-up and one-time capital costs/operating
expenses with annual increases for inflation/ wages
HIS Planning Tools and Techniques
• HIS contracting guidelines
– Tie directly into, “Manage th4e vendor; don’t let the vendor
manage you”
– Steps for any HIS project involving selection of a vendor or
renewal of a contract
• Conduct detailed due diligence on finalist vendors
• Negotiate agreement(s)
• Create and send contractual guidelines to finalist vendors
– Healthcare organizations should never sign the standard
agreement of the software vendor
– Agreement must include be based on a milestone payment
structure (working system, accomplishment of milestones)
HIS Planning Tools and Techniques
Five-Year Cost Estimate Template
HIS Governance: Policies,
Leadership, and Decision Rights
• Issues of change and the need for governance
– HIS and technology planning and implementation are highly
disruptive
– Shift in expectations creates stress in organizations
– Organization must prepare itself for structured guidance
through these decisions
– Governance: the process of thoughtful, balanced decision
making for projects and arbitration of issues that arise
– HIS governance focuses on 1) stewardship of organizational
and HIS resources on behalf of stakeholders and 2)
protection of the organization from excessive risk
– Governance structure must specify decision rights
HIS Governance: Policies,
Leadership, and Decision Rights
• Issues of change and the need for governance
– HIS governance occurs at the board level and within
executive management and committee structures
– Highly interdisciplinary because it touches every
corner of the organization
– Effective governance serves four purposes
• Provides assurance that the HIS and technology plans
align with strategic goals of the organization
• Protects the organization from taking on too much risk
• Ensures adequate personnel resources and skill sets
• Ensures the job is getting done properly in a timely
fashion
HIS Governance: Policies,
Leadership, and Decision Rights
• HIS steering committee
– In addition to board of trustees (not-for profit) or board of
directors (for-profit)
– Interdisciplinary and enterprise-wide
– Consists of leaders from management, medical staff, nursing,
finance, HR, strategy and marketing, ancillary clinical
departments, revenue cycle, facilities, supply chain, and
other disciplines
– Typically chaired by CIO (or person in lead IT position); COO
may serve or co-serve
– Committee’s purpose is to develop, oversee, and enforce
adherence to guiding HIS principles and make evaluations
and decisions
HIS Governance: Policies,
Leadership, and Decision Rights
• Governance within and outside organizations
– Only when HIS efforts are well planned, governed,
and implemented within organizations can a
national HIS and technology strategy hope to
succeed between and among organizations
– External drivers are exerting considerable pressure
on healthcare organizations to develop and
implement advanced HIS and technology plans
• Government regulations (HIPAA, HITECH Act)
• Consumer expectations
• General societal progress
HIS Governance: Policies,
Leadership, and Decision Rights
• Governance policies
– Policy: staffing initiatives
• HIS projects require staffing by different disciplines
• Organizational policies must be in place for HIS staffing
• Backfilling for roles pulled from regular duties, e.g., for
training prior implementation
– Policy project management
• HIS project management is a key component of successful
HIS projects and initiatives
• Policies must be in place to require proper leadership and
methodology for HIS project management
• Program management also needs policies
HIS Governance: Policies,
Leadership, and Decision Rights
• HIS governance: leadership
– HIS leadership occurs throughout organizations, at all levels,
among all disciplines, using evolving technologies
– Leadership roles are required from health care’s knowledge
workers
– Leadership in HIS and technology for organizations includes
management responsibilities, policy, and governance
programs
– Effective HIS leadership comes from a variety of arenas
• Organizational
• Governmental/presidential
• Clinical/business
HIS Governance: Policies,
Leadership, and Decision Rights
• HIS leadership
– Role of chief information officer (CIO)
• HIS vision and plans
• HIS budget and costs
• Assures security of information
• Engaging externally with others in the community
regarding local or regional HIS initiatives
• Sets up, runs, and retires steering committees
• Collaborates with subject matter experts
• Should report to the CEO
HIS Governance: Policies,
Leadership, and Decision Rights
• HIS leadership
– Roles of chief medical information officer (CMIO)
• Respected physician who engages physicians and nurses,
sees things from their perspective
• Typically reports to the CIO and may practice medicine on
a part-time basis
• Helps translate process of using computers
• Runs physician discussions, Q&A sessions, and workshops
• Leads physician advisory groups for clinical HIS projects
• Researches external sources about system use
• Engage other physicians in projects
• Aid in detecting and resolving clinical and strategic issues
HIS Governance: Policies,
Leadership, and Decision Rights
• HIS leadership
– Nursing informatics and role of the chief nurse
executive (chief nursing officer, or CNO)
– Significant percentage of clinicians who will interact
with the EHR system will be nursing professionals
– Nurses must support the EHR implementation for it
to succeed
– Graduate degrees in nursing informatics are
becoming increasingly available
HIS Governance: Policies,
Leadership, and Decision Rights
• HIS leadership
– Role of chief executive officer
• CEO must engage in HIS planning as part of the overall
strategic planning and management process
• Most important thing a CEO can do for the HIS and
technology agenda is to actively participate in the HIS
planning process and place HIS on the executive
management team’s agenda on a regular basis
• CEO-CIO working partnership is key to success of HIS and
technology investments, plans, and implementations
HIS Governance: Policies,
Leadership, and Decision Rights
• HIS leadership
– Role of department managers
• Managers of departments and key functions play key role
• Managers and directors are key participants on steering
committees, task forces, process redesign initiatives, and
implementation of new HIS
• Influence the way staff members who are asked to work
and participate in HIS implementation feel about the
changes they are being asked to help define and
implement
• Support and lead staff members “into the fray”
HIS Governance: Policies,
Leadership, and Decision Rights
• HIS leadership
– Clinical leadership and medical staff leadership
• Clinical and medical staff departments are necessary to
provide care processes provided by the organization
• Medical staff leadership can reach majority of the
physicians providing care
– Quality and safety leadership
• Those responsible for measuring and assuring quality of
care should help define data elements needed to
populate those measure
• Quality and effectiveness measures should be seamlessly
woven into the fabric of workflows and processes
Case Example: Failure to
Communicate
• Background
• The challenges needing a solution
• The solution
HIS Governance: Policies,
Leadership, and Decision Rights
• HIS leadership
– Change management leadership
• Change management determines the ability of healthcare
workers and organizations to successfully meet their goals
to adapt to forces in their environment
• It is the carefully planned move from a current way of
doing work/caring for patients to new ways
• Requires strong leadership, commitment to addressing
details, involvement of knowledge workers from clinical
and business domains, and will to pursue implementation
while the organization continues its work of caring for
people
Case Example: The Role and
Importance of Chief Quality
Officers
• Background
• The challenges needing a solution
• The solution
Communication Tools for HIS Plans
and Projects
• All reaches of the organization must be included
in comprehensive, clear, inviting description of
the goals, process, and components
– Elements, timing, and expectations should be clear
– The size of the initiatives and organization dictate
the extensiveness or simplicity of the
communication strategy
– For major projects, monthly newsletters can focus
solely on the project
– Task requires true communication specialists
Lessons Learned in HIS Planning
• Create a HIS culture of learning
• Transparency is key
• Strive for good communication
• Remember history
• Put a value on interdisciplinary balance, fairness and
collaboration
• Help keep vendors in their proper place
• Establish good, milestone-driven vendor contracts
• Count on collaboration
Summary
• Tools and techniques for implementing the HIS
Strategic Plan
– High-level HIS architecture using HIS Planning Framework
– HIS Business Plan template
– Five-year cost estimate template
– Capital and operating budgets
– Contracting guidelines
– Policies to establishing governance and decision rights
– Communication tools for HIS plans and projects
Chapter 6:
Application
Systems and
Technology
Introduction
• Applications and technology are needed to
support Health Information Systems (HIS)
– Applications involve an understanding of the
Software Development Life Cycle (SDLC),
programming languages, clinical and business
applications, integration, and databases.
– Technology includes infrastructure, networks,
servers, desktops, data centers, mobile and cloud
computing, and many other areas
HIS Applications
• Programming languages
• Databases
• Vendor applications
– Commercial off-the-shelf (COTS)
– Best-of-breed
HIS Applications
• Software Development Life Cycle (SDLC)
methodology stages
– Conceptual planning
– Planning and requirements definition
– Design
– Development and Testing
– Implementation
– Operations and Maintenance
– Disposition
HIS Applications
Software Development Life Cycle
HIS Applications
• Application interfaces
– Can bridge disparate systems
– Create silos
– Difficult and complex to maintain
• Application integration
– Allows data to be shared between disparate
systems
– Uses a common data elements and database
Clinical Applications
• A clinical application is defined as any system
that supports clinical care (e.g., electronic
health record systems), ancillary clinical
support processes (e.g., laboratory testing,
radiology), clinicians (e.g., computerized
physician order entry, clinical decision
support) and patient flow (e.g., registration,
scheduling).
Clinical Applications
• Types of clinical applications
– Electronic health records (EHRs)
– Clinical information systems (CISs)
– Laboratory information systems (LISs)
– Pharmacy information systems (PISs)
– Medication administration records (MARs)
– Computerized physician order entry (CPOE)
Clinical Applications
• Types of clinical applications
– Radiology information systems (RISs)
– Medical imaging systems (MISs)
– Picture archive communications systems (PACSs)
– Outpatient systems
– Personal health records (PHRs)
– Long-term care systems (LTC)
• Figure 6.x summarizes the key CIS applications
Clinical Applications
Healthcare Provider Technology Adoption Map
Data from IDC Health Insights, Nov 15, 2010.
Administrative Applications
• Administrative and financial applications
– Enterprise resources planning (ERP) systems
– Customer resource management (CRM) systems
– Supply chain management (SCM) systems
• Other applications
– Home health care
Case Example: A Ticket to Ride
• Background
• Problem that needed to be solved
• The solution
• Results of the pilot
Technology
• Robust data communications is needed to
support HIS applications
• Two key areas of technology for supporting
voice and data
– Telecommunications
– Networking
Telecommunications and Networking
• Telecommunications
– The electrical transmission of data among
systems, whether through analog, digital, or
wireless media
• Data communications networks components
– Server
– Client
– Circuit
Types of Networks
• Four types of networks
– Local area networks (LANs)
– Backbone networks (BNs)
– Metropolitan area networks (MANs)
– Wide area networks (WANs)
• Two classifications of networks
– Intranets
– Extranets
Network Models
• Open systems interconnection (OSI) model
• Internet model
• The Seven Layers of the OSI Model
– Physical layer
– Data link layer
– Network layer
– Transport layer
– Session layer
– Presentation layer
– Application layer
Network Models
• The four layers of the Internet model
– Network group layer
– Internet group layer
– Transport group layer
– Application group layer
• Understand how the various layers function
when a user sends an email message to
another user
Network Models
(a). The seven layers of the OSI model and (b). The four layers of the Internet model.
Data from Hitchcock (May 8, 2008). OSI Reference Model: Layer 1 Hardware. http://www.windowsnetworking.com/articles-tutorials/common/OSI-Reference-ModelLayer1-hardware.html. Accessed March 10, 2014.
Local Area Networks
• Two primary uses of LANs
– Information sharing
– Resource sharing
• Important LAN components
– Network interface cards (NICs)
– Copper and fiber-optic cables
– Switches, hubs, patch panels
– intermediate distribution frames (IDFs)
– main distribution frames (MDFs)
– virtual local area networks (VLANs)
Wireless LANs
• Wireless local area networks (WLANs)
– Fast-growing network technology
• WLAN components
– wireless access points (WAPs)
– radio frequencies (RFs)
– power-over-Ethernet (POE) switches
• WLAN benefits and challenges
Wide Area Networks
• Wide area networks (WANs)
– Connect users on LANs to other LANs or other
WANs
– Largest WAN today is Internet
– Bandwidth is key
• Types of WAN circuits
– T1 lines
– asynchronous transfer mode (ATM) lines
– multiprotocol label switching (MPLS) circuits
Wireless Wide Area Networks
• Wireless wide area networks (WWANs)
– Provide service to large geographic areas called cells
– Also called broadband or cellular networks
• Three families of WWANs
– GSM and UMTS
– CDMA One, CDMA2000, and WCDMA
– WiMAX and LTE (3G, 4G, 5G, etc.)
• Distributed antennae system (DAS)
– Useful for increasing in-building RF coverage
Storage Area Networks
• Storage area networks (SANs)
– are dedicated back-end computer systems
designed to efficiently and cost-effectively store
and transfer a healthcare organization’s server
data
• Two types of SANs
– Fiber channel (FC) SANs
– Network attached storage (NAS)
Storage Area Networks
• Redundant array of independent drives (RAID)
configurations
– RAID 1 (mirrored disks)
– RAID 5 (with or without a hot spare)
– RAID 10
• SAN protocols
– Ethernet (also referred to as IP)
– Fiber Channel
– Fiber Channel over Ethernet (FCoE)
– Internet Small Computer System Interface (iSCSI)
Voice and Communications
• Voice technologies
– Voice over Internet Protocol (VoIP)
– Voice over wireless local area network (VoWLAN)
• Unified communications (UC) technologies
– Instant messaging and presence
– VoIP and VoWLAN
– Video and web conferencing
– Digital signage and wayfinding
– Internet Protocol (IP) television (IPTV)
Voice and Communications
VoWLAN Protocol
Data Centers and Cloud Computing
• Three important data center trends
– Co-location or leased facilities
– Data center consolidation
– Cloud computing or hosted infrastructure
• Types of cloud computing in health care
– Infrastructure-as-a-service (IaaS)
– Platform-as-a-service (PaaS)
– Software-as-a-service (SaaS)
– EMR-as-a-service (EaaS)
Data Centers and Cloud Computing
• Data center facilities critical components
– Electricity or utility power
– Power distribution units (PDUs)
– Remote power panels (RPPs)
– Generators
– Uninterruptable power supply (UPS) or flywheeldriven continuous power source (CPS) systems
– Heating, ventilating, and air-conditioning (HVAC)
systems
Data Centers and Cloud Computing
Cloud Computing Components
Data from Venture Beat News. Cloud 101: What the heck do IaaS, PaaS and SaaS companies do? http://venturebeat.com/2011/11/14/cloudiaas-paas-saas/. Accessed March 10, 2014.
Data Centers and Cloud Computing
• Data center facilities critical components
– Computer room handlers (CRAH)
– Chillers
– Fire suppression systems
– Very early smoke detection apparatus (VESDA)
– Emergency power off (EPO) switch
– Branch circuit monitoring system (BCMS)
– Data center management system (DCMS)
Data Centers and Cloud Computing
Data Center Management Systems Components
Emerging Cloud Technologies
• Software Defined Networking (SDN)
• Network Functions Virtualization (NFV)
• Hyper Converged Infrastructure (HCI)
Business Continuity and Disaster
Recovery
• Business continuity (BC)
– Describes the processes and steps a healthcare
organization puts in place to ensure that its
essential business functions will continue during
and after a disaster
• Disaster recovery (DR)
– Comprises the planning, process, policy, and
procedures undertaken to prevent interruption of
mission critical IT services, and to reestablish full
IT functioning as swiftly and smoothly as possible.
Business Continuity and Disaster
Recovery
• Elements of BC plan (BCP) and DR plan (DRP)
– BCP and DRP assessment
– Recovery time objectives (RTOs)
– Recovery point objectives (RPOs)
• Backup systems
– Tape-based backup systems (DLT or LTO)
– Disk-based backup systems
– Virtual tape libraries (VTLs)
Business Continuity and Disaster
Recovery
• Redundancy within the data center
– Applications, servers, storage, and the network
– Clustering and load balancing
• Redundancy between the data centers
– Cold sites
– Tepid sites
– Warm sites
– Hot sites
Server Computing
• Servers
– Are specialized computers that are designed to
process or “serve” computing requests, such as
requests for database information, application
processing, or file transfers and storage
• Server components
– Central processing units (CPUs)
– Random access memory (RAM)
– Input/output (I/O) and internal bus systems
– Keyboard, video, and mouse over IP (KVMoIP)
– Access to storage, network, and backup systems
Server Computing
Data Center Class Servers
Courtesy of James W. Brady.
Server Computing
• Physical server types
– Rack mounted and blade servers
– Appliances
• Virtual server elements
– Hypervisors or virtual machine monitors (VMMs)
– Virtual machines (VMs)
– Logical partition arrays (LPARs)
• Server classifications
– Test, development, and production servers
Server Computing
Diagram of a Virtualized Server
Data from Nash Networks, Inc. (2009). Virtualization: A small business perspective. Executive Summary.
http://www.nashnetworks.ca/virtualization-a-small-business-perspective.htm
Infrastructure Servers
• Important infrastructure servers
– Dynamic Host Configuration Protocol (DHCP)
servers
– Domain Name System (DNS) servers
– Active Directory (AD) servers
– Identity and access management (IAM) servers
– Enterprise monitoring servers
Infrastructure Servers
• Important infrastructure servers
– Integration servers
– Systems management servers
– Database servers
– Enterprise web content management (EWCM)
servers
– Application virtualization servers
Client Computing
• Client computing
– Describes the computers and devices used by end
users
– Categorized as either stationary or mobile devices
• Stationary computers include
– All-in-one (AIO) computers
– Wall-mounted computers
– Thin- and zero-client computers
– Electronic tracking board systems
Client Computing
• Mobile computers include
– Workstations on Wheels (WOWs)
– Laptops
– Tablets
– Smartphones
• Miscellaneous client devices and peripherals
include
– Bar-code scanners, signature pads, printers, document
scanners, and identification (ID) badge and access
control systems.
Client Computing
• Important client computing technologies
– Printing
– Electronic document management (EDM)
– ID badge and access control systems
– Virtual desktop infrastructure (VDI), including
nonpersistent and persistent desktops
– Single sign-on (SSO) and “tap ‘n go”
Mobile Computing
• Emergence of mHealth and Bring Your Own
Device (BYOD) in health care
• Steps to develop a mobile computing strategy
– Identify the key stakeholders
– Create policies, procedures, and an end-user
acceptance agreement
– Understand regulatory, legal, and compliance
requirements
– Develop mobile management strategies
– Define the technical architecture
Information Security
• HIS data security
– Defines how users and computer systems should
behave to reduce risk to the organization
– Protects valuable assets from financial and
reputational loss
– A security program with updated policies and
corresponding controls needs to be in place
Information Security
• Important information security technologies
– Traditional and Next Generation (NG) firewalls
– Virtual private networks (VPNs)
– Data loss prevention (DLP)
– Encryption (at-rest and in-transit)
– Multi-factor authentication
– Security information event management (SIEM)
– System hardening, vulnerability assessments, and
penetration testing
– Managed security services
Summary
• HIS applications are critical for delivery of
quality patient care
• A robust technical infrastructure,
encompassing client, server, network, and
data center technologies is needed to support
HIS applications
• Healthcare is leveraging advances in mobile
and cloud technologies to provide secure
access to HIS applications