Introduction to Healthcare Information Technology
Objectives
• List and describe standard networking devices• Explain the function of servers• Explain how to set up basic networking• List the steps for troubleshooting a network• Describe different options for EHR/EMR network
technologies
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Introduction to Healthcare Information Technology
Healthcare IT: Challenges and Opportunities
• Computer network– Foundation of computing technology in an office
• Network IT operations support electronic health records
• Chapter topics– Common network devices– Network servers– Setting up a network– Troubleshooting a network– Technologies used for EMRs and EHRs
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Standard Network Devices
• International Organization for Standardization (ISO) reference model– First released in 1978– Describes how dissimilar computers can connect
together on a network– 1983 version of the model is still used today– Breaks networking steps into seven layers
• Each layer contains different networking tasks
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Table 4-1 OSI reference model
© Cengage Learning 2013
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Standard Network Devices (cont’d.)
• Ethernet– Most common local area network (LAN) technology
today– Divides data into small units called packets
• Standard network devices– Classified by the OSI layer at which they function
Introduction to Healthcare Information Technology
Hubs
• Older devices• Connect multiple Ethernet devices on a network
– Typically use shielded twisted-pair (STP) copper cables
• Work at the Physical Layer (Layer 1) of the OSI model
• Do not read any data passing through them• Ignorant of source and destination
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Figure 4-2 A hub is an older type of network device; today hubs have largely been replaced by switches
© Cengage Learning 2013
Introduction to Healthcare Information Technology
Switches
• Network switch– Device that connects network segments together– Has more intelligence than a hub– Operates at the Data Link Layer (Layer 2)– Identifies specific devices connected to its ports– Can forward frames intended for a specific device
• Or all devices
• MAC address (hardware address)– Used to identify each device connected to the switch
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Introduction to Healthcare Information Technology
Switches (cont’d.)
• Core switches carry traffic between switches• Workgroup switches connect directly to network
devices
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Figure 4-3 Core and workgroup switches
© Cengage Learning 2013
Introduction to Healthcare Information Technology
Routers
• Operate at Network Layer 3• Forward packets across computer networks• Steps
– Read destination address– Send packet to next network toward its destination
• Can filter out specific types of network traffic– Security function
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Introduction to Healthcare Information Technology
Domain Controllers
• Domain– Collection of devices that share a central directory
database• Domain controller
– Server that manages security-related elements on the network for the user
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Introduction to Healthcare Information Technology
Servers
• Several different types of services and servers• Several different protocols• Servers must be properly managed to be effective
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Introduction to Healthcare Information Technology
Services and Servers
• Print services– Allow multiple users to share printers across a
network• File services
– Allow users to share files from a central location• Application services
– Processes that run software for network clients• Communication services
– Manage E-mail, telephony, and instant messaging
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Introduction to Healthcare Information Technology
Server Management
• Common tasks associated with managing servers– Load balancing– Allocating storage space
• Load balancing– Used to evenly distribute work across a network
• Advantages of load-balancing technology– Reduces probability of overloading a single server– Optimizes resources for the benefit of each
networked computer– Reduces network downtime
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Introduction to Healthcare Information Technology
Server Management (cont’d.)
• Hardware load balancer– Also called a Layer 4-7 router
• Managing storage– Important due to the large number of documents that
are retained today– Electronically stored information subject to legal
discovery• Storage virtualization
– Hides the physical resources of storage from the user
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Introduction to Healthcare Information Technology
Protocols
• Rules for communication• Essential for proper communication to take place
between network devices• Three common protocols
– Transmission control protocol / internet protocol (TCP/IP)
– Wireless protocols– Remote desktop protocol (RDP)
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Introduction to Healthcare Information Technology
Protocols (cont’d.)
• TCP/IP protocol– Several protocols that function together
• IP protocol functions at layer 3 to provide addressing and routing
• TCP is the main transport layer protocol that establishes connections between devices
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Figure 4-4 OSI model vs. TCP/IP model© Cengage Learning 2013
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Protocols (cont’d.)
• Domain Name System (DNS)– Maps an IP address to its symbolic name– Database divided and distributed to many different
Internet servers• Dynamic Host Configuration Protocol (DHCP)
– Assigns dynamic IP addresses rather than static– DHCP server leases an IP address to a computer– When computer is off the network, IP address can
be reassigned to another computer
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Protocols (cont’d.)
• File Transfer Protocol (FTP)– Method for transferring files across the Internet– Links servers
• Methods for using FTP on a local host computer– Command prompt– Web browser– FTP client application
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Figure 4-6 FTP client software© Cengage Learning 2013
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Protocols (cont’d.)
• Wireless protocols– Enable mobile communication
• Wireless local area network (WLAN) standards– IEEE 802.11-2007– IEEE 802.11n-2009
• Advantages of 802.11n over previous standards– Higher speed (up to 600 Mbps)– Coverage area– Reduces interference– Improved security
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Protocols (cont’d.)
• Remote desktop protocol (RDP)– Allows user to access another computer remotely
over a network– Provides remote display and input capabilities over
network connections– Designed to support different types of networks and
protocols
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Basic Network Setup
• Setting up a network– Involves understanding connections to the network
devices and configuring network hardware• A variety of possible configurations exist
Introduction to Healthcare Information Technology
Client Connections
• Network interface card (NIC)– Also called client network adapter– Hardware needed to send and receive data on a
wired network
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Figure 4-7 NIC and cable
© ronstik/www.Shutterstock.com
Introduction to Healthcare Information Technology
Client Connections (cont’d.)
• Wireless client network interface card adapter– Performs same functions as a wired NIC– No external RJ-45 cable connection– Uses an antenna (may be embedded)– May plug into the USB port
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Figure 4-8 USB wireless NIC
© Oleksiy Mark/www.Shutterstock.com
Introduction to Healthcare Information Technology
Network Hardware
• Modem– Device that changes analog to signal to digital
• Internet modem– Also called broadband modem– Connects computers and networks to the Internet
• Router– Connects with Ethernet patch cable to the Internet
modem– Generally preconfigured to act as a DHCP server
• Can also be configured to support port forwarding
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Introduction to Healthcare Information Technology
Network Hardware (cont’d.)
• Methods of communication between wireless clients– Ad hoc mode– Infrastructure mode
• Wireless access point– Used in infrastructure mode– Receives all wireless signals– Serves as a bridge between wired and wireless
networks
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Figure 4-12 Infrastructure mode with AP© Cengage Learning 2013
Introduction to Healthcare Information Technology
Network Hardware (cont’d.)
• Access point should be located near the middle of the coverage area
• Security settings for a wireless network– Turn on Wi-Fi Protected Access 2 (WPA2)– Disable Service Set Identifier (SSID)– Center antenna placement– Reduce power levels– Create guest network
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Introduction to Healthcare Information Technology
Network Troubleshooting
• Connectivity problems– Check that network devices are receiving power– Use the command line utility ping to check for
connectivity– If message “100% packet loss”, connectivity problem
may be with ISP– Use tracert to display route (path) a packet travels
• Shows where the transmission was stopped– Make sure cables are not crimped, broken, or torn
loose from connectors
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Introduction to Healthcare Information Technology
Network Troubleshooting (cont’d.)
• Interference– Strong external signal interferes with the signal being
transmitted• Fiber optic cables immune to interference• Radio frequency interference
– Caused by broadcast signals from a radio or TV transmitter
• Electromagnetic interference– May be caused by phones, radios, appliances, lights,
etc.
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Network Troubleshooting (cont’d.)
• Wireless signal issues– Due to multiple paths the signal takes to reach the
receiver• Wave propagation
• Solution to wireless network interference– Move the AP or the source of the interference
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Table 4-2 Wireless signal interference
© Cengage Learning 2013
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Figure 4-17 Incorrect and correct wave propagation and multipath
© Cengage Learning 2013
Introduction to Healthcare Information Technology
Network Troubleshooting (cont’d.)
• IP settings– Network problems can occur if same IP address
assigned to more than one device• Use Windows command-line utility ipconfig/all
– Lists all settings for the device
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Introduction to Healthcare Information Technology
Network Technologies for EHR/EMR
• Two broad categories of decisions– Cloud versus local network– Installed applications versus remote access
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Introduction to Healthcare Information Technology
Cloud Computing vs. Local Network
• Cloud computing advantages– Can reduce hardware, software, and personnel costs– Pay only for computing resources needed at a given
time– Resources can be adjusted as needs change
• Cloud computing disadvantages– Separate entity responsible for managing security
and privacy of the EHR/EMR
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Introduction to Healthcare Information Technology
Installed Applications vs. Remote Access
• Remote access configurations– Can save time and cost
• Not all applications may run efficiently in a remote access setting– Especially specialized healthcare applications
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Introduction to Healthcare Information Technology
Summary
• OSI reference model is a conceptual representation of how data moves through a computer network
• Several different types of servers exist• Network load balancing helps evenly distribute
work across a network• Computer network protocols
– Rules for communication between network devices
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Introduction to Healthcare Information Technology
Summary (cont’d.)
• Wireless local area networks are based on IEEE standards 802.11 and 802.11n
• Different types of network hardware perform different functions– Internet modem, router, wireless access point
• Determining most appropriate network technology for managing EHRs and EMRs not an easy task– Advantages and disadvantages of remote and local
access configurations
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