Patton Fuller community Hospital Network Introduction Patton fuller community hospital is a reputable hospital, known as its strict commitment towards the proper application of the (HIPAA) rules, and its adherence to the standard norms being in practice, as well as its homogeneous business model in place that inspires lot of companies. During this paper, we are going to discuss the modality of this business system, strength points as well as the missing areas that should be improved. We also are going to describe what improvement might be adopted to enhance the relationships with outside organizations and global organizations.

Analyze the current business system in place: Who, what, when, how, and why? In a general view, Patton Fuller hospital community is constituted from several departments. The arrangement of these departments is divided in to two sections, the clinical area which encompasses the following departments: Emergency rooms (ERP’s), Operating rooms (OR’s), Pharmacy, labs, Doctor’s offices, Wards, Outpatient examining rooms, and intensive care units (ICU’s). The administrative area for its part circles the following departments: IT department, Admitting/Discharge, Facilities, Human Resources (HR’s), Finance, and hospital senior management.

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Among this formation of multiple departments, we can count individual section of department that remains independent in term of using different standards such as 1000BASE F, such as Radiology section. Regarding the entire network in use within the company, is a 1000BASE T, which supplies 1gigabit of Ethernet connectivity over 5 cables (CAT 6) (Hewlett-packard, 2000. Pg1). The entire hospital beneficiates from a complete power backup system with automatic cutover to a large diesel motor generator set. Individual departments have local UPS.

Also, all patient data files are encrypted for storage using AES, and all access to patient data files requires identification and authentication od each user. In all radiology modalities, the DICOM standard and PACS are standard. Top view In a detailed view, the logical network interconnections allows us to assess the nature of the cable connection used in both areas. The administrative area are assembled via Ethernet cable connection 1000BASE T using CAT 6 cable, while the clinical area is using 1000BASE F using Ethernet single fiber mode.

Both areas are related through a network bridge, allowing thus data flow between the two sections. In order to understand what sort of workstations are in use and what Operating Systems is supported within the hospital, we focused on the administrative segment to assess those elements. We discovered that the workstations in use, OS environments, wireless, data storage capacity are different since the hierarchy level. The executive management has access to all workstations, with an Apple Imac’s 2. GHZ, 2 GB RAM, 500 MB HD, using 2 OS defined in MAC leopard and windows XP, the cited privileges are shorten to HR’s, OPNS, finance senior manager workstations, that beneficiates from the same computer modalities, however in a less storage capacity. Other employees involved in data entry in HR, OPNS, and finance, and have a lower rank within the hospital, has a restricted data access and have a thin client computers, a HP L1706 windows OS model. On the other side of the network, we can count the peripheral 2 B&W laser printers machines, and 1 color laser printer, HP4350 and HP4200 pht. IT data center

The hospital information system (HIS) located in the IT data center, implemented in the hospital, is very interesting to learn about it, because it is in compliance with the standard norms and allows the company to having a good data flow, however there is some issues to be resolved. The (HIS) system originally made to integrate information system of the whole hospital including medical, administrative, financial and legal aspects, and its service processing. The system in use is an IBM series Z9EC mainframe, with a LINUX OS, a DB2, counting 18 Processors with 32 GB RAM, and AES security system.

In our case (HIS) undergoes to the client/server architecture, with a sub-system defined as Windows Exchange Server, which is an IBM system x3250, XEON Dual core 2. 6 GHZ, and 2GB RAM, RAID 1, and MS windows SERVER 2003 enterprise. The other server, which has the same characteristics with a tiny difference in the OS system, which is LINUX. Among this network structure we can also evaluate the Remote Access Server, an IBM system X3250 type, running under LINUX OS. To access the internet, there are two routers liable for these operation.

The first router is CISCO system 7609 router, and the second one is CISCO system ASA 5510 VPN (Virtual Private Network). CISCO 7609 router, delivers high performance router, deployed at the network edge, where the IP services, redundancy, and fault resiliency are critical. CISCO system ASA 5510, on the other side, is used for remote access to inside the protected area of the hospital network. What we can squeeze out from our analysis to the (HIS) system is that, the system is operating the same way as an ERP system, since all data resources in this department are managed by the cited system.

RIS data center The radiology information system (RIS) data center, is subject to tracking and scheduling radiology patients, and result reporting, and image tracking capabilities. It is a computerized data base, used to store, manipulate, and distribute patient radiological data and imagery. The (RIS) data center in our case study, is a complements (HIS) system, however, it operates independently. The (HIS) machine is an Apple cluster servers running under MAC OS, with a remote desktop and running PACS. Workstations are an Apple IMAC, 2. GHZ, and 2 GB RAM, working with fiber and wireless and relaying on 2 OS systems, virtualization with MAC and windows XP professional. Two printer machines, one HP B&W laser printer HP4350 and 1 koduk 6800 dry laser DICON to film printer. All the workstations are related through an Ethernet network 1000 BASE F, using single mode fiber. We previously put light on PACS system. The PACS system is usually a peace of the (RIS) system and supported by it. It is a medical imaging technology which provides economical storage and convenient access to image from multiple modalities. In our case PACS is of the RIS model.

OR, ICU, and Ward floor systems The support connection is assured by an Ethernet network 1000base F, with single mode fiber. Three entities in this department, first entity described is the OR system, and encircling RIS imaging and the OR workstations. Second entity is concerning Ward rooms, bed locations. Each Ward and each ICU area have wireless access point. Each room has 1 network connection per bed, the connection is carried out by a HUB of 24 port FO per Ward or ICU. Last entity is nurses stations and all the workstations computers are running on Mac leopard and windows XP pro.

Human Resources department The (HR) as part of the structure of the business model of the hospital had highlighted its objectives and strategies in short and long terms basis. One of the liabilities that managers of this department took under their shoulders is to focusing on the workforce, and make sure that the working environment, compensations, leadership development, fair workplace, reducing litigation , are being respected and fully activated since the employees are the main power resources of the hospital. In other strategies, the hospital is committed to Recruit, etain, and retain the very best employees that the organization can afford Grow/enhance a participative employee culture that includes a focus on diversity and sensitivity awareness programs Be an employer of choice Create the environment for our employees success To create and maintain a risk management program to keep in compliance with legally- mandated federal, state, and local laws, regulations, rules, and procedures to reduce litigation exposure to the company in a diligence manner, achieved through policy and procedure development and enforcement.

Facilities In the same business system strategy context the hospital has drawn, some areas are being modeled and restored such as the emergency department, children play areas, hospital’s waiting areas. The projects are under discussion and need approval from the director responsible for these works. Papers plan has been submitted to the director, showing a detailed basic measurements with budget, also bids had been placed seeking best offers from outside stores and seeking the how much is going to be the cost.

Research options for improving the current systems (including ERP, CRM & KM), and recommend additions to the system based on your assigned reading for this week? Throughout our assessment of the HIS system of the hospital, we found out that the major IT departments are working independently from each other. A way to improve the HIS system is to have it integrated with their RIS system and/or PACS system using health level 7 HL7 interface. The DICOM messages from the PACS and the messages from the radiology information system RIS can communicate and make the system seamless by using the HIS.

The process will be that the images are sent in the PACS which with the HL7 integration create an order in the RIS since there is limited patient demographic information on the images themselves, such as only names, MRN, procedure names, and accession number, the other patient information will be received via HIS system with the integration of HL7. The current storage backup is by using RAID 1, which is disk storage RAID 1 is not appropriate, because of so many disks accumulate, therefor going digital is much better with radiology exams instead of using hardcopies, so that radiologists anywhere can read the xams, but also for easy storage and storing in less amount of space. Using RAID is less practical instead of just getting a back-up server. RAID is the cheaper and outdated means of redundancy. It may be cheaper, but it is not the most safe or efficient. Disks can be easily lost or damaged and sorting through them is not efficient. Having multiple servers is not the most cost-effective, but it will pay off in the long run because it will be the most resourceful and proficient. Stricter rules for entry into sections of the hospital are a way to ensure that patient’s information is not unprofessionally eing viewed. Having less unnecessary systems and computers on the network that may be clogging up the system and increasing bandwidth will help to improve network speed. One other solution that could enhance greatly the HIS systems of the company is using a total hospital information system (THIS), which is a union between the HIS and ERP solution. The latest software product for hospital information management, that would streamline the functionality of a modern hospital in a big way. (B. K Kulkoumi, chief HIS, siemens india at meditel 2004). Customer relationship management (CRM) HIPAA) has been incorporated as a major part of the employees handbook. However, there are some improvements to work on regarding how the confidential patient records are to be maintained as well as employees are to conduct business regarding these records. Therefore, telephone conversations regarding patient information, should not be revealed in a public areas such as waiting rooms, elevators, or cafeteria or outside the hospital. An additional precaution to ensure the security of their customers and elevate the service quality, the hospital should install video surveillance systems, however, these system ust be communicated to the patient’s hospital, in order to still in compliance with the (HIPAA) and explain to customers that this act remains security measurement precaution. Describe what improvements might improve relationships with outside organizations and global organizations, including physician practices, insurance companies, and suppliers for the hospital. The improvements that might improve relationships with outside organizations as well as global organizations, including physician practices, insurance companies, and suppliers for the hospital, are first of all, developing a new medical standards that will acilitate the implementation of the ERP system. Considering the fact that all the healthcare organizations strongly relies upon a relationship between physicians, laboratories, hospitals, insurance companies, suppliers , and government agencies, the complexity of these circuit makes implementing the ERP systems that would accumulate and manage all of the resources, a difficult process. Many large health care organizations, have viewed the consolidation of entities the only way to maintain control over the staffing resources. Unfortunately, this technic has led costly investment.

An effective solution is implementing ERP applications that would performs some modalities such as forecasting workloads, managing human resources and identifying specific workflows. forecasting workloads: The challenge of using such forecasts with optimum effectiveness lies in gathering the information at a central location and disseminating it to the appropriate areas of the organization. ERP systems can facilitate information access by collecting and storing historical information in a standard format that is readily accessible to all departments. Managing human resources: Managing human resources.

By linking workload information to the scheduling and staffing systems, an ERP system can facilitate dynamic management of human resources throughout a healthcare system-at least to the extent that the system has flexible staffing. An ERP system would allow department managers to link staffing matrices with time-and- attendance data for each shift, thereby allowing productivity reporting on a shift-by-shift basis. Improved staffing efficiency could result in a significant financial benefit, given that labor costs can represent more than 50 percent of a healthcare provider’s total costs.

Identifying specific workflows: Healthcare workflow depends on many different clinical and business factors. In essence, each patient requires a unique workflow based on the combination of his or her clinical needs, physician’s preference, and the business rules imposed by the applicable insurance company or government funding program. For this reason, a healthcare system must be able to customize the way each patient moves through the healthcare delivery continuum. To the degree that a healthcare system can accomplish this customization, it can educe the cycle time for inpatient care, while efficiently managing outpatient processes Conclusion Patton fuller community hospital has some gaps to fill out regarding its business systems. One of the major concerns is RIS system that is implemented independently from the HIS system, and should be integrated to assure good workflow. Other concern may be resumed in the multiple software in place, thing that would be shorted if we can implement an ERP system or THIS which is a combination between ERP and HIS system, and which would allow the existence of one operating system through all departments.

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