VladimirVolma_CS635_IP3.docx - Running Head HEALTHCARE...

This preview shows page 1 out of 30 pages.

Unformatted text preview: Running Head: HEALTHCARE NETWORK INFRASTRUCURE Computer Networking (CS635) Healthcare Network Infrastructure Vladimir Volma November 21th, 2018 1 Running Head: HEALTHCARE NETWORK INFRASTRUCURE 2 Table of Contents Week 1: Distributed Network Requirements Analysis............................................................................3 Week 2: Communication Protocols Analysis and Recommendations....................................................7 Week 3: Network Traffic Analysis and Recommendations...................................................................11 Week 4: Network Design and Architecture............................................................................................16 Week 5: Future Needs Analysis and Recommendations.......................................................................17 Running Head: HEALTHCARE NETWORK INFRASTRUCURE 3 Week 1: Distributed Network Requirements Analysis Due to the constant importance of information sharing, distributed networks have become one of the adopted forms of network infrastructure. In the healthcare industry, this method of networking is playing a major role. Healthcare is known to be a very complex system that involve dependents or independent entities working together. A distributed network is the model of networking that allows the healthcare industry to deliver proper care to its subscribers by means of distribution of the system the many entities. This includes hospitals, outpatient centers, medical laboratories, nursing homes, health, and healthcare insurances. Center for Vein Treatment, CVT, is an outpatient medical center that specializes in varicose vein treatment. As a healthcare institution, the company has the necessity to share data with different dependent and independent entities. The company has over 50 locations statewide, and all of them are interconnected with each other. The company has a headquarter that provide a multitude of clinical and non-clinical support to the clinics. The need to have a distributed network is relevant to the good functioning of the company. With a distributed network, CVT can use one electronic health records across the network generate, save, store, and share clinical data; use a common Picture Archiving and Communication System (PACS); perform a standard access control management (authentication); submit electronic medical claims on behalf of the company or via the clinical support center; and submit electronic prescription to pharmaceutical organizations using automated system. Center for Vein Treatment uses an electronic health record platform name NextGen. This application allows the company to generate, store, and retrieve medical data. NextGen has many built-in features that provide scheduling, billing, clinical, business analysis features. As CVT has Running Head: HEALTHCARE NETWORK INFRASTRUCURE 4 many locations, it is a necessity that all of them need to have the ability to share information with each other. A distributed network is the perfect infrastructure to be implemented to spread data across all the clinic using the NextGen. In other terms, the functionality of sharing clinical data among all the clinics using NextGen can be ensured with a distributed system. A distributed network provides the technical foundation necessary to make medical record more efficient in term of security, reliability, and accessibility(Chueh 7 Barnett, n.d) (See the figure below for a Running Head: HEALTHCARE NETWORK INFRASTRUCURE 5 sample of NextGen interface). Ultrasound imaging is an important aspect of services offered by CVT. The business heavily relies on vascular technologist conducting ultrasound study. After each ultrasound exam, Running Head: HEALTHCARE NETWORK INFRASTRUCURE 6 the vascular technology technologist to complete a report and save images on a picture archiving and communication system (PACS). Despite that CVR has multiple locations, all of them must work as on entity. Senior personal need to be able to pool ultrasound study performed at any location from the headquarter or other location for auditing purposes. More importantly, the radiologists reading the ultrasound studies are on remote sites. They need to have access to the PACS wherever they are. Thus, having a distributed network is a critical functionality that the company needs to allow authorized users to access the ultrasound studies from any location. The larger is an organization, the harder it is to implement a standardized access control. Because CVT must meet some State and Federal guidelines in term of patient’s confidentiality and privacy, establishing access control is a primary responsibility. Each clinic has a team composed of different skilled health professionals, and each member of the team need a specific authentication level. As the company has many locations and share a common electronic health record application, it is essential to have a common access control management. Conventional authentication would not be a good option to control all the clinics. A distributed network access control (DNAC), a specific type of distributed network, is the best mean to control the system and monitor the different personals of the company. “Distributed Network Access offers distinct advantages over conventional firewalls and VPNs in the area of policy management and distribution, customized user trust and performance scalability” (Boen, Dent, Chan & Tjia, n.d) To provide patients an optimal care, Center for Vein Treatment must cooperate with other entities. After diagnosing patients with vein disease, claims must be submitted from CVT to insurance companies. After completing treatment, patients sometimes need prescriptions drugs or prescriptions to buy medical graded compression socks. While some medical claims order Running Head: HEALTHCARE NETWORK INFRASTRUCURE prescriptions can be submitted at the clinics, but the follow-ups are done at the company clinical center. There is a special team at the clinical center (Headquarter) to review to review the claims and the prescription orders and assure everything is accurate. For the clinical support center to assist the different clinics, a network ensuring reliable and safe electronic internal and external communication is necessary. A distributed network can provide a reliable and safe communication channel for clinical purposes. The single data communication network system needed to assure the functionalities of submitting electronic medical claims and prescription orders is possible with a distributed network. 7 Running Head: HEALTHCARE NETWORK INFRASTRUCURE 8 Week 2: Communication Protocols Analysis and Recommendations An Electronic health record system, A Picture Archiving and Communication System (PACS), a standard access control management system (authentication), an electronic medical claim submission system, and an electronic prescription order system were previously defined as five functionalities essential to the good functioning of the Center for Vein Treatment. If these functionalities are said to be achievable with the adoption of a distributed network, there are some specific protocols that must be implemented into the network infrastructure to establish them. Safety of Medical Data and Web-based Applications Most of the applications used by Center for Vein Treatment are internet-based. Data that are generated on these applications are saved on a secured server that may be located outside of the network, and they are accessible using the internet. The user interface for these applications resembles as a regular webpage or a personalized web-page. An internet connection is needed for these applications to work. Moreover, the connection must be secured to ensure the confidentiality, integrity as well as the availability of the data. Thus, the first and foremost network protocol should be one that provides a safe median for safe cyber trafficking. HTTPS is one of the network protocol that provides applications web-page user interface and a safe median for data trafficking. Data/File Sharing In their practice, the clinics share file between each other. Electronic health records and many other clinical data are shared among the clinics. As the company also share data with Running Head: HEALTHCARE NETWORK INFRASTRUCURE 9 entities such as healthcare insurances (medical claims) and pharmacy (Prescription order), a network protocol is necessary to ensure the sharing of clinical data. This protocol must also guarantee the safety of the clinical data because the confidentiality, integrity, and availability of the document is a top priority. SFTP is a great option as a secure file transport protocol to safely share clinical data with internal and external entities. This protocol goes beyond transporting file safely. It also enhances the authentication of the applications used by the company. “SFTP also protects against password sniffing and man-in-the-middle attacks. It protects the integrity of the data using encryption and cryptographic hash functions and authenticates both the server and the user” (SFTP – SSH Secure File Transfer Protocol, 2018). Medical Imaging Medical imaging is a major component of the Center for Vein Treatment. Ultrasound images are taken, reviewed, and stored for clinical purposes. After each exam, pictures must be transferred from the ultrasound machines to a picture archiving and communication system (PACS) for further analysis by the radiologist at remote locations. The exam also must be saved for auditing. A protocol needs to be implemented into the network to ensure the reliable and safe transfer of the images into the picture archiving and communication system. DICOM is the most known protocol used in the healthcare industry to manage medical imaging across the many types of networks, including the distributed network. HTTPS Protocol Hyper Text Transfer Protocol Secure is a modified version of HTTP that offer a best safe median for web trafficking. This protocol can be implemented in the network of the company to Running Head: HEALTHCARE NETWORK INFRASTRUCURE 10 provide a safe interface to the web-based application used to generate, modify, and store clinical data or electronic medical records. “HTTPS is configured and supported by default in most web browsers and initiates a secure connection automatically if the accessed web servers request secure connection” (Hypertext Transport Protocol Secure, n.d). To encrypt data when using the web-based applications, a secure socket layer (SSL) or transport layer security (TLS) need to be implemented into the server. SSL encryption or TLS encryption can guarantee the confidentiality and integrity of the data from the web-based application used by the company. The figure below demonstrates how an SSL encryption can be configurated. SFTP Protocol One of the most important aspects of healthcare is the ability to share information in a safe manner. In their daily practice, numerous clinical data are shared between the many locations of CVT. SFTP (SSH File Transfer Protocol) is a protocol that provides the appropriate Running Head: HEALTHCARE NETWORK INFRASTRUCURE 11 means for a safe and reliable sharing of data. The file can be better managed, transferred, and accessed. SFTP protocol requires a client-server model of distributed networking. This protocol is said to be firewall friendly, and a single port is sufficient to set it up (port 22 by default). To implement this protocol, a connection must be made to an SSH server. The figure below demonstrates a sample setup flow of an SSH connection. DICOM Protocol Digital Imaging and Communications in Medicine, DICOM, is the most common protocol used to handle, store, print, and transfer diagnostic medical imaging. This includes Xray, Ultrasound, MRI, and CT Scans. DICOM provides five main imaging properties: network image management, network image interpretation management, network print management, imaging procedure management, off-line storage media management (Bidgood, Horii, Prior, & Van Syckle, n.d). With DICOM protocol, a server for storage and an electric outlet. Running Head: HEALTHCARE NETWORK INFRASTRUCURE 12 To be efficient, the network model plays an essential role. More importantly, the protocol implement into the network are crucial. While there are multiple other protocols necessary to the good functioning of the company; HTTPS, SFTP, and DICOM are the primary ones. . Running Head: HEALTHCARE NETWORK INFRASTRUCURE 13 Week 3: Network Traffic Analysis and Recommendations Different factors need to be taken into perspective analyzing the network traffic flow of center for Vein Treatment. The different types of data need to be estimated individually in to come up with an average bandwidth necessary for the good functioning of the network during its peak traffic flow as well as during its normal data flow traffic. Data flow such as emails, graphics files, and electronic health records are to be analyzed to make the proper network bandwidth estimates, determines peak traffic and level, identify issues to prevent traffic congestions, and make recommendations. Email and SharePoint Bandwidth Estimation For emailing purposes, Center for Vein Treatment utilizes a cloud-based system though outlook. This cloud system provides provide more than emailing assistance, but it also includes document sharing supports, scheduling, and storage features as one package name SharePoint. Outlook and SharePoint are both developed by Microsoft. The tables below list the requirement established by Microsoft Online Office 365 Network to estimate bandwidth for emailing. document sharing, and files storing purposes. The following tables present the message and bandwidth usage for light, medium, heavy and very heavy e-mail traffic. These data will later be used to estimate network traffic and the Running Head: HEALTHCARE NETWORK INFRASTRUCURE 14 necessary bandwidth. In reference to these tables, it is important to mention that most of the communication between the personals of the company is done on site. Only a minimal amount of personals use email messing(Outlook) and data sharing and storing (Sharepoint) heavily in the company. Thus, the message bandwidth usages of the company would fall into the light category for normal data traffic and heavy category for peak data traffic. For a total of 250 users on a 12 hours shift per day basis, the necessary bandwidth for emailing purposes would be the following: Running Head: HEALTHCARE NETWORK INFRASTRUCURE 15 (250 light users × (1,300 KB/user ÷ day)) ÷ (12 hr/day × 3600 sec/hr) = 7.5KB/sec. For a peak traffic, the necessary bandwidth would be as follow: (250 medium users × (5,200 KB/user ÷ day)) ÷ (12 hr/day × 3600 sec/hr) = 30.9KB/sec. In regard to SharePoint, it takes 100 KB for an average interaction (page load), and an average user would generate approximatively 36 interactions (page loads) per hour. It is also said 10 percent of SharePoint will be active at the same time. The network bits per second for an average user would be the following: (100,000 bytes/load × 8 bits/byte × 36 loads/hr) ÷ 3600 seconds/hr = 8000 bits per second. For a total of 250 SharePoint users, the total required bandwidth is the following: 250 x 8,000 bits/sec or 2000 kilobits/sec. Graphics Files Bandwidth Estimation As previously mentioned, ultrasound imaging plays an important role in the healthcare services offered by Center for Vein Treatment. It is important to have a network with the capacity to handle the many the graphics files (Ultrasound imaging files). Each ultrasound image consists of 512 x 512 pixels and 8 bits or 1 byte per pixel of intensity information. Each ultrasound exam has an average of 50 images, and up to 15 studies are performed per day (Keep in mind that each clinic opens 12/hr per dar, four time a week). The network bandwidth (NB) for graphics files alone can be calculated using the following formula: NB= ((frame size x number of pixel per frame x number of study per day) / the time work per day) Running Head: HEALTHCARE NETWORK INFRASTRUCURE 16 =>NB=((512x512 x 8 x 50) / (12hr x 3600 sec) =>NB=2.4 kb/sec (Necessary bandwidth for one clinic) For all the clinic, Center for Vein Treatment the necessary network bandwidth for the Picture archiving and communication system would be 2.4 x 50 =120 kilobits/sec or 15 kilobytes/sec. Electronic Health Records Bandwidth Estimation Because the company uses a web-based electronic health record, it may be a challenge to estimate the necessary bandwidth. The best way to calculate the network bandwidth for the HER system is to evaluate the clinic size using the number of physicians and use the required network bandwidth in relation to the size of the company. Center for Vein Treatment has a total of 50 locations, but each physician is assigned to two clinics which operate on a different schedule. Thus, the company has 25 physicians to manage all the clinics. According to The Federal Communications Commission, 25 Mbps is the minimum bandwidth required for a healthcare institution composed of 5-25 physicians (What is the recommended bandwidth for different types of health care providers?, 2013). Taking into consideration the requirement of the FCC in term of bandwidth, an estimate of 25 Mbps is needed to properly process the electronic health record data traffic. In peak traffic times, the recommended network bandwidth can be up to 50Mbps. Factors of Network Congestion All the pre-listed numbers are just estimates. There are times that the network may receive too many requests and fail to process all the request in a timely manner despite having sufficient bandwidth in reference to its size. Broadcast storms are manageable but inevitable. It Running Head: HEALTHCARE NETWORK INFRASTRUCURE 17 may be one reason causing CVT’s network may become congested. Another reason may be outdated hardware. The company tries to use the latest technology to build a reliable and secure network, but there is no network that is eternally reliable and safe. “Data transmitted through outdated switches, routers, servers, and Internet exchanges can cause bottlenecks. If the hardware is not optimal, this creates a bottleneck for the transmission of data. The result is network congestion” (Rivenes, 2016). Poor network configuration and management can also be a contributing factor to network congestion. If a network is not properly managed and configured, some break-down it system may take place and cause the network to lose its ability to process requests. Overall, Broadcast storms, outdated hardware, and poor network management and configuration are some of the issues that can produce congestion in the company’s network. Network Congestion Prevention and Recommendations As preventive methods, proper network management and configuration is recommended. In order to keep the network running smooth, the network administrator of the company needs to be on top of his game maintaining the network. Software updates and server maintenance are some means to properly maintain and configure a network. Another way to prevent network congestion to perform the necessary hardware updates. The best way to do so is by having the updated technology (Switch, router, or firewall). Broadcast storms can be prevented using backpressure routing technique. This method helps to re-route the incoming request exceeding the capacity of the network in order to prevent traffic congestion. “As the throughput of a network reaches capacity, rather than continuing to send data over that network route, you can choose a different path. This is the concept of backpressure routing” (Rivenes, 2016) Running Head: HEALTHCARE NETWORK INFRASTRUCURE 18 Determining a network bandwidth to ensure proper data traffic, and identifying the different issues that can affect a network in term of data flow are some effective ways to prevent and control a network traffic ...
View Full Document

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture