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Chapter 10

Information Technology and Systems Infrastructure Assessment

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EHR System Architecture

• Computing architecture refers to the technical building blocks that support the operation and use of a computer system

• Fundamental computer system architecture supports– Input/output– Processing– Storage

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Input/Output (I/O) Devices• Also known as human-computer interfaces, because

they are the connection between a human and the computing power of the application in the computer

• Input/output devices:

• Personal computers• Workstations• Desktops• Laptops/Notebooks• Tablets• PDAs• Smart phones

• Keyboards• Display screens• Navigational devices• Optical character recognition

(OCR)• Document scanners• Bar codes• Voice/speech input• Printers

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I/O Considerations• Source of power

– Cabled to electrical outlet or battery

• Network connectivity– Wired vs. wireless connectivity

• Portability– Consider size, weight, heat

• Computers on wheels (COW)*• Wireless on wheels (WOW)• Workstations on wheels (WOW)

• Screen (real estate)– Size and resolution

• Navigational devices– Consider ease of use and loss concerns

* Not considered politically correct!

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Data Storage• “Secondary” storage devices = drives

– Secondary to primary storage in the computer’s processors

• Storage media– Magnetic tape

– Magnetic disks

– Optical disks

– Flash drives/USB drives

• Storage configuration: RAID

• Storage area networks (SAN)

• Storage management

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Computer Categories

• Supercomputer

• Mainframe computer

• Minicomputers

• Microcomputers

• Portable microcomputers

• Handheld computers

• Network computers (thin clients)

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Communications and Network Architecture

• Two or more computers communicate makes a network– Client/server architecture:

– Web services architecture:

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Network Configuration

• LAN

• WAN

• WLAN

• VPN

• Topology– Physical– Logical

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Network Components• Network Operating System

– Windows, Unix, or other• Network Interface

– NIC, LAN Adapters, wireless access card• Transmission Medium

– Hardwire cable, infrared light, radio frequencies• Other devices

– Hub– Bridge– Router switch– Gateway– Multiplexor– Modems

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Network Protocols

• Rules of the road

• OSI– Seven layers

• TCP/IP

• FTP

• HTTP

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Application Software• Operating System (O/S)

– Platform

• Application software (source code)– Makes applications perform their functions

• Application integration– Different applications which have been designed from the same

platform to work together

• Application interface– Hardware, software, data definition, messaging protocols to

exchange data between applications from different systems

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Standards Related Organizations• HL7

• DICOM

• NCPDP

• IEEE

• ANSI-ASC X12N

• ASTM

• HITSP

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Systems Reliability, Privacy & Security

• Reliability– Errors

– Crashes

– Performance problems

• Privacy and Security– HISPC

– HIPAA Privacy Rule

– HIPAA Security Rule

– State data breach notification laws

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Security Risk Analysis• Threats to security

– Agents– Targets– Events

• Unauthorized access• Modification, alteration, and

destruction• Denial of service• Repudiation

• Vulnerabilities– Gaps that occur in

administrative processes, physical facility, and technical infrastructure

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Security Controls

• Management support• Applications and data criticality analysis• Policies and procedures• Information security official• User responsibility• Administrative, physical, and technical controls• Training• Ongoing auditing and monitoring

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Conclusion

• Information technology and systems infrastructure assessment – Describes current environment– Compares to standards/user needs– Evaluates technical requirements for new

applications– Plans for acquisition of technology– Plans for technology obsolescence