KTD Consultants

We are a Network Consulting Team called KTD. We have been asked to implement a system in a new multi-specialty medical practice. In this practice, they will have ultrasound imaging, MRI, EKG, and other diagnostic modalities that are digitally read on a computer screen. They would also like to include an Electronic Medical Record system such as AllScripts, EPIC, or NexGen that will need to be accessible to all employees and doctors. This will be a new satellite office for an existing office that is ten miles away.
What we plan to cover in this paper will be the specifications it will take to get this office’s network up, running, and able to support the equipment, software, and databases they are trying to implement, while also giving them the ability to communicate with their Main office. We will also have to ensure that what we create is very secure, and follows all HIPPA requirements for the network and data storage. We will go over the networks design including topology, Network Interface Cards (NICs), network operating system (NOS), cabling, where will the companies devices be located (servers, hubs or switches, printers, firewalls and routers, modems etc.), and how many users will they have. We will also discuss security measures such as, backup processes, and power it will take to sustain this network and its devices. For security we will discuss Virus protection, user passwords, firewalls, data encryption, and what physical security measures may need to be used. When designing the backup plan we will discuss capacity, how it will be done, can it sustain growth, frequency, and how and where it will be stored (on campus, off campus, or both). And lastly we will discuss the source of power and ventilation it will take to sustain the company’s new network.
Network Design Introduction

When designing a network many things have to be taken into consideration such as cost, business needs, hardware/software, and deadlines before the network infrastructure designing can begin. In this business case, we have assessed and gathered the appropriate business requirements to design the network. Because this network is being designed for a medical facility, we have taken into consideration which topology, hardware, software, and cabling/environment that would be ideal to handle the medical facilities needs such as MRIs, ultrasounds, along with having a large database for medical records.
Topology
The topology that is the best approach in this business case would be a star topology. It will have a central connection for all of the computers on the network. A star topology offers great fault tolerance. If an unexpected failure were to occur, like a cable going bad the other components can still communicate; which is a necessity due to importance of having the medical facility network up and running at all times. It also makes it easy to replace a bad cable which will not interfere with the functioning of the network. Performance is another reason why a star topology best suites this design. According to Alphonse (2011), this topology type gives a better performance than any other network topology as there is no clogging of nodes. In order to communicate between any two devices only two links and three devices are involved to prevent confusion. The star topology is also easily expandable which will allow accommodate additional users or workloads in the future.

Hardware
The switch is the connectivity point of the Ethernet network. The devices connect to the switch through the use of twisted pair cabling, one for each device. The switch will only forward the data to the port of the destination device. It can accomplish this by learning the MAC address. Because we want to be able to expand the medical facility network we included routers into the design. A router can create a larger network by joining two segments. In addition, the design has redundant routers for fault tolerance capabilities.
A server is vital in the network infrastructure design. A server will share resources over the network and the client is one that accesses shared resources (Toshmo, Tittel, & Johnson, 2007). The client server model is the most widely used without question which is why it was included into the design. It allows for centralized network management of all network services, security, backup, and user management.
The medical facility needs maximum data availability and they have the available funds to have database cluster implemented in the network. The clustering allows the database servers to group for the purpose of fault tolerance and load balancing. The clear advantage of clustering is that it offers the highest fault tolerance. It also offers data availability, increased performance, failover capabilities, and scalability.
The VLAN in this design is used for network segmentation, which will greatly increase the network’s performance. It can remove potential bottlenecks and can even increase security. Because the medical facility is a three story building in which the employees are spread over three floors the VLAN can enable all the employees to be combined and access network resources as if they were connected on the same physical segment.
The EqualLogic (EQL) SAN will allow the medical facility network to have consolidated networked storage in a self-managing iSCSI that is cost efficient and easy to use, regardless of the size of the network. It can automate difficult tasks and enable rapid storage provisioning. By going with the EqualLogic option it will keep costs down for storage acquisition and daily operations.
Since wireless is a common requirement in business and in the case of the medical facility it was included in the network design. Because the network is large and spans three floors, more than one wireless access point is needed.
Software
When determining which operating systems would be best for the servers and desktop machines Microsoft Windows Server 2008 R2, Microsoft SQL Server, and Windows 7 were the most optimal choices for the medical facility. Microsoft Windows Server 2008 R2 provides several features such as virtualization, management, web, and scalability. Virtualization was vastly improved in Windows Server 2008 R2 by allowing the ability to support client desktop virtualization. In addition, it adds more capabilities for live migration and dynamic disk allocation.
Windows SQL Server offers a distinct advantage over any other database software. It is reliable which makes Windows SQL server a great choice for the medical facility. With SQL clients do not interact with the tables but rather the intelligent data manager on the server. This reads and writes data from the table. What this means is that if the network was to fail the underlying tables are not compromised. The database can continue to run without any issues.
Windows 7 provides a user-friendly interface but yet delivers strong performance, security, compatibility, decreased startup time, and remote access features.
Another important application that is necessary for the medical facility is EPIC. EPIC is interactive software that will support all of the functions related to patient care, including registration, and scheduling (Adam 2011). EPIC software is easy to implement within the network and is user friendly. Overall, EPIC will help the medical facility to reduce cost and assist in expediting patient treatment.
Cabling / Environment
Cabling is a very important part of the network, it is imperative that structured cabling be planned and installed properly. In order to have a successful implementation a structured cabling network needs to involve the three items: a server room, horizontal cabling, and the work area. The idea here is that the individual PC’s cabling will run to the server room. Because we need to follow a standard with structured cabling, CAT-5e is the best choice for the medical facility. CAT-5e is a twisted pair cable for carrying signals and according to Wallace (2012), CAT-5e can carry data at the rate of 1Gbps and offers reduced crosstalk. There are two different types of twisted pair cabling that are used today unshielded twisted pair and shielded twisted pair. However, for this network we are using unshielded twisted pair. Unshielded twisted pair can come into two types: solid core or stranded core. The wires in a solid core unshielded twisted pair use a single solid wire whereas the stranded core is a bundle of tiny wires. Because we are using horizontal cabling we need to use solid core. The horizontal cabling will go through the walls and ceilings providing a safe place for the cables to reside so that they do not get damaged from users in the environment.
Network Addressing
The facility will have three floors. The first floor will be the receptionist, administrators, billing, and medical records. The second floor will consist of the server room, diagnostic department, and viewing stations for all diagnostic machines in the facility. The third floor will house all of our diagnostic modalities. Each floor will have a firewall, router, a switch, and a wireless access point, with the main router located on the second floor. Each floor will have its on broadcasting address as follows:
1st floor 192.162.30.34
2nd floor 192.162.30.74
3rd floor 192.162.30.127

Server Room
It will be advised that the equipment room for this facility to be located on the second floor in the central hallway. The only personnel with access to this room will be the electrical engineer, bio med manager and IT staff. This room will have a hand print entry that will also require an employee number. The hospitals security levels will need to be high, therefore protecting this equipment will be vital to the layout of the network. The second floor was chosen because it will cover both upper and lower levels of the building evenly. This will also give the proper personnel easier access to the equipment.
The equipment room will house the main server, switch and routers for all floors. The telecommunications closet will be located on the back wall behind the equipment room and will be connected with backbone cabling using fiber optic cables. While the rest of the building will use CAT 5e cabling, the cable connection between the equipment room and telecommunications closet will need virtually no interruption or static.
Since this facility will be running many imaging devices that will need to be networked to a central reading station, it will be advised that the reading station also be located in a central location providing access to the diagnostics department. The diagnostic department is also located on the second floor therefore the cabling can be ran through the ceiling from the equipment room providing less travel and less chance of breakage.
Security
The ventilation system will need to be closely cared for in the equipment room as well as the telecommunication closets so the servers do not overheat and become damaged (Tomsho, Tittel, & Johnson, 2007). It will be advised to implement an environment controlled cooling system in these areas. It will be further advised to have a system to check periodically around the clock that the room remains at a steady temperature. This will also give the proper personnel easier access to the equipment.
The physical security of equipment will rely much on locking entryways to administration offices as well as locking down PC’s. As stated, the equipment room will be accessed by only those given privilege and only by handprint access and employee ID. There will also be security cameras located in every hallway. There will be additional cameras located inside of the equipment room and telecommunication closet. A timer will be installed to calculate the time of entry as well as the time of departure. A work ticket will need to be stored in the central database regarding the reason for access.
In a medical facility there are virtually thousands of medical files being networked from departments to referring doctors and from doctors to specialists via fax, email and internet. Documents must be protected from malicious behavior and therefore security is one of the most imperative phases of a network design of this magnitude. Part of developing a security system is to first appoint administrators who will be privileged to enter any shared file on the network such as accounting, medical records, and database manipulation.
Protocols will need to be written to and adhered to not only by the rules of the medical facility but also to the highest courts of the United States. HIPAA (Heath Insurance Portability and Accountability Act) this act protects patient information to the highest degree. It requires all medical staff to attend a yearly meeting to update any changes in the law. Also, it requires all staff to properly hide patient information in public areas where others may see. This includes medical personnel from looking in a medical chart of a patient of which they are not caring for, regardless of relationship. HIPAA has its own set of security rules that will have to enforce when implementing the new HER. Those rules include but are not limited to encryption coding, protection of equipment such as PC’s, hard drives or any other data server that holds patient information, and also the assignment of a HIPAA compliance officer who will strictly enforce these rules (HIPAA Guidlines, 2012). All of the latest EHR’s available have HIPAA standards and guidelines built in (HIPAA Guidlines, 2012). With encryption technology the data on the server will be protected as it travels across the internet or within the company walls (Tomsho, et. al, 2007). By encrypting the data hackers will not be able to see the data in text form; this can also be done on the backup systems. IPSec is an extention to the IP address that will communicate with other devices ensuring that the identity of the receiving system can be authenticated, if it cannot be, it will send a warning box alerting the sender (HIPAA Guidlines, 2012). Another option is Virtual Private Networks (VPNs). VPNs will allow data that is public to be seen as if it were private. This allows the users to access internet files that are encapsulated and given the IP protocol (Tomsho, Tittel, & Johnson, 2007). “When this method is used it appears as a point-to-point connection between the client and the server” (Tomsho, Tittel, & Johnson, 2007, p. 381). User passwords will be necessesary to log into the OS as well as any additional running applications. Window Server 2008 R2 will require a log in of each user from a specific PC that will load a personal desktop as well as other applications such as Allscripts (EHR), Prosolv (Digital Reading Station). Having password protection is one way to ensure that only appointed users are accessing necessary records. Each employee will have allowance to access what is vital to their workstation. For instance, the accounting department will not be privy to medial records and MRI techs will not be allowed in financial records. This ensures that each station will be accountable for their own computer workstations. Futhermore, it will be required that each person logged in, must log off before leaving their workstation. This eliminates abuse such as accessing medical records that do not pertain to their daily work load (Tomsho, Tittel, & Johnson, 2007). Firewalls are a hardware or software device that will inspect internet sites before allowing the user access (Tomsho, Tittel, & Johnson, 2007). Protocols will need to be put in place with strict guidelines as to who is allowed to access internet sites and which sites are appropriate. Not only does this prevent employees from accessing possible infected websites, it also stops usage of bandwidth that may slow down other processes (Tomsho, et. al., 2007). For this company firewalls will be installed between the LAN in the main office and WAN the satellite offices in the area.
Backup
It is important to have a routine for backing up files, and this is especially important for patient medical records. Backup procedures are important in case of system failure. Medical files and records must be backed up frequently. Backups will be made to tapes. Tapes will be stored in a secure vault away from the facility and will be in an encrypted state. Data backups will be done in stages. There will be a nightly backup procedure, a weekly backup procedure, a monthly backup procedure, and an annual backup procedure. The nightly backups will be held for 2 weeks, weekly backups held for 4 months, monthly backups will be held for 2 years, and annual backups will be held for a minimum of 7 years. Each tape will be securely destroyed once expired.
Power Supply This medical facility will need to have an Uninterruptable Power Supply (UPS) as well as a standby generator, which will allow them to sustain power until any contingency plans can be put in place. The power supply will be attached to each computer, all diagnostic modalities the practice may have in use, routers, firewalls, and switches. In the case of power failure, the UPS will allow the business to continue running until any standby generators have a chance to power on.
Conclusion
Johnson, Tittel, & Tomsho (2007) states that, “networking involves connecting computers and other electronic devices for the purpose of sharing information and resources and for communication” (p. 2). The proposed network design for the medical facility allows for proper security, high availability, high performance, manageability, and scalability. The plan supports the current needs of the facility, and is also positioned to support growth and any future requirements. The entire design from beginning to end has been given great thought as to what would be best for this facility to allow it to function with minimal interruption in order to readily service there patients, and communicate within the facility and beyond. Everything from the topology, hardware/software, security measures put in place, down to the backup process, etc. is important for this facility to be successful. It all has to flow in a manner that staff at this facility are comfortable with knowing that there environment is reliable to function on a day to day basis. I believe that the design we have created meets all needs to get this facilities network up and running.

Interview Questions
1. How many people will be using the network? 50-100
2. How will the users interact with the system? Billing, Electronic Medical Records, and Diagnostics
3. How many on-site computers and devices will be connected to the network? As of right now 50-60
4. Will any users need to access the network remotely (from home or other office sites)? We are a satellite office, so users in our main office may need remote access.
5. Which server based applications (databases, email, etc.) do you plan to run on the network? We will need to have Epic which is an electronic medical records system and of course email and Diagnostic software for our ultrasound machines, CT, and MRI machines.
6. What are your plans for expansion in the future? We are a medical facility so room for expansion is important
7. Do you already have an area for the server? Yes, there is an equipment room on the second floor that will be used.
8. Are there any special security requirements we need to know about? Yes, security has to comply with HIPPA. Because we have sensitive patient information security should be at a high level.
9. Will you have someone who will be maintaining the network once it is implemented? Yes, there is an IT group located at our main office that will be maintaining all IT needs once the installation is complete. They will also be the contact throughout the installation process.
Network Design

Network Design Continued
References
ADAM (2011). EPIC. Retrieved from http://emr-matrix.org/2011/04/epic/
Alphonse, M. (2011). Star Topology. Retrieved from http://www.buzzle.com/articles/star-topology.html
HIPAA Guidlines. (2012). HIPAA Security Rules. Retrieved from HIPAA Guildelines: http://www.hipaaguidelines101.com/hipaa-security.htm
Johnson, D., Tittel, E., & Tomsho, G. (2007). Guide to Networking Essentials (5th ed.). Boston: Thomson Course Technology.
Wallace, K. (2012). Network+. Indianapolis: Pearson Education Inc.