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Case Scenario

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Case Scenario

Five doctors have decided to consolidate their businesses to cut costs and provide better service to their patients. In the new arrangement, each of the existing five offices will remain intact—one office is located in the city center and one each is located in the east, west, north, and south of the city. All the doctors want to be able to see their patients and access patient information at any of the offices. The time of operation of all offices will be from 7 a.m. to 9 p.m., based on the schedule of the doctors.

Since 1986, the offices located in the north and the south have been using an IBM PC/XT and a dot matrix printer with custom software to manage the patient information. These computer systems need to be upgraded, and the data needs to be typed manually into the new computer system.

The office located in the city center is more modern; however, the software and hardware it uses may need to be upgraded to store the new information and meet the needs of additional network connectivity. This office will be the central office, and it will have the maximum activity. This office has a Fedora Core Linux Operating System version 8 on a Dell server and uses TCP/IP to communicate with the existing workstations that have XP sp2. This office has the Medical Manager software operating on the server. This office also has two workstations in the reception area, one workstation in the nurse’s office and one in the supervisor’s office that is shared by the office supervisor and the billing manager.

The offices located in the east and the west also use the Medical Manager software installed on SCO Unix machines with directly attached terminals. These machines are outdated and need to be replaced. However, the cabling in these two offices has recently been updated for the replacement of SCO machines and terminals and the use of TCP/IP on the network. The existing network printers can use TCP/IP for communication.

Billing and management will be centralized and administered from the central office. The main reason for this is that the doctors prefer the existing Medical Manager software operating on the Linux server in the central office. The server is mounted in a rack in the Telecom/IT room, which has no locks. This room is also used for storage.

Growth Expectations

The doctors expect to add four more doctors and nurses to their staff and an office manager to oversee all offices. The doctors are also planning to sponsor internships for new doctors and nurses. They are not sure about the number of interns joining per year; however, according to current estimates, they plan to limit the number of interns to one nurse and one doctor per quarter.

The doctors have concerns and need guidance regarding technology, maintenance, upgrades, and warranties for all equipment. In the future, they are considering the use of wireless personal digital assistants (PDAs) or small tablets for viewing records during a patient visit, Voice over IP phones to reduce the cost of their telephony, and dictation devices to transcribe patient visits.

A consultant representing the doctors approaches you. To the consultant, winning this project and being the doctors’ technology advisor will depend on how well you use the existing offices, equipment, and connectivity for fulfilling the networking requirements.

Security, Disaster Recovery, and Risk Analysis

The doctors are not sure about the security requirements. However, they know they must provide physical security besides complying with the current Health Insurance Portability and Accountability Act (HIPAA) regulations. They also know that good disaster recovery plans as well as good backups are essential. Currently, the only machine backed up is the Linux machine in the central office. A backup to digital tape is performed once a week. After the backup is completed, the office manager stores the tape at home. So far, a situation requiring using a backup tape has not arisen. Therefore, it is not known whether or not this method of backup works.

In addition, each office needs to be able to see patients even if there is no network connectivity between the offices. The doctors would like some redundant connectivity if the connection between a remote office and the central office fails. This connectivity can be between remote offices so that if the primary connection between the central office and a remote office fails, the remote office could communicate with another remote office and utilize its main connection to the central office. The doctors are not sure if the connection should be a T1, DSL, or cable connection.

The doctors would also like to see a plan for a standby server that is updated with the current patient information.

Network Infrastructure Scope

The scope is to create a network infrastructure that connects each remote office to the central office. Currently, there is no connectivity. Each office will have its own local area network (LAN) with an operating speed that will permit data transfer at high speeds with minimum chances of bottlenecks. The doctors need to know if it would be best to store the data used by all offices on a separate LAN or on the existing LAN in the central office. At present, all offices with a network are using static IP addresses. There are no user authentication requirements when the workstations are started. In addition, there is no high-speed Internet access at any office. Each office uses a dial-up modem to connect to the insurance clearing house to process its insurance claims.

The central office needs to have high-speed Internet access to connect to the insurance clearing house as well as to the hospitals. The doctors need to retrieve the hospital information and claims. This information also needs to be printed on a network printer.

Existing Networks

The doctors have purchased three class C addresses, through The existing IP addresses used in the central office are on the network and are to be migrated. All existing network cables are CAT 5e and use RJ45 connections. The serial numbers for the Dell equipment in the central office are 32746072201 to 32746072205.

Office and Building Dimensions

Each remote office building is 92 feet wide and 66 feet long. The height from the floor to the false ceiling is 10 feet. The height from the false ceiling to the roof is another 4 feet. The passageways are 4 feet wide. The rooms are equal in width. In the central office, the print room is 6 feet in length, the storage room is 20 feet in length, and the Telecom/IT room is 16 feet in length.

Requirements for Each Remote Office

• A file or print server
• Two network printers or copiers
• Three workstations at the front desk—one for check-in, one for check-out, and one for appointments
• A workstation for the billing manager
• A workstation for the office supervisor
• A plan to accommodate three more doctors and three more nurses at any one of the remote offices at a given time The other doctors and nurses will be at other remote offices or the central office, depending on the schedule. Each nurse and doctor will require a separate workstation.
• Connections for laptops used by the billing manager and the office manager when visiting a remote office
• Network connectivity provided by routers, firewall, and switches

Requirements for the Central Office

• A Linux server with the Medical Manager software installed to track all patients, demographics, insurance, and bills
• Windows 2003 server for Active Directory, DNS, and DHCP acting as a master
• Network connectivity provided by routers, firewall, and switches
• A Linux-based or Windows-based fax server
• Windows server for QuickBooks, used for business accounting
• A Web server for business advertisements
• E-mail provided by an outside source and accessible through Firefox or Internet Explorer
• One file or print server
• Three network printers or copiers
• Three workstations for billing
• A workstation for the collection agent
• A workstation for the office manager
• Three workstations at the front desk—one for check-in, one for check-out, and one for appointments
• A workstation for the billing manager
• A separate workstation for each nurse—accommodation that can cater to three more nurses at a given time
• A separate workstation for each doctor—accommodation that can cater to three more doctors at a given time
• A workstation for the office supervisor

Software Requirements for Workstations

• Microsoft Office
• Firefox and Internet Explorer
• E-mailing software
• Network connectivity to Medical Manager, others servers, and the Internet
• A minimum of 1 GB of RAM, a hard drive of at least 80 GB, and a Microsoft XP Pro operating system
• A virus scanner and a software firewall for each workstation…...

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