1. AllianceChicago Services - Architecture Overview and Q&A
Matt Sterling
Director, Information Technology

2. Agenda IT Team Organization Infrastructure Review Best practices
Uptime Calculations
Security topics (if time or join us tomorrow)
Please ask questions as we go along

3. AllianceChicago Resources
We supply all services through Citrix XenApp or XenDesktop
There is an encrypted connection between the workstation you access from and the Citrix NetScaler in the datacenter. Users have no direct access to servers.
We handle software updates for windows and for Centricity as well as all other supporting applications that HB utilizes.
We do not get involved in user administration, access control and utilization of Centricity Practice Solution. This is the responsibility of the health center

4. IT Team Organization

5. Cyxtera Datacenter
350 E. Cermak

6. Security - Physical
350 E Cermak has at least three layers of physical security
Digital Reality runs the entire building and secures access into the first floor of the building
Once getting off the elevator to the 7th floor, two access doors limit access to the datacenter floor. The first access to the lobby is badge only, the second access door requires fingerprint and badge at the same time.
Once on the datacenter floor, a badge is required to enter our dedicated cage.
Cameras record access to all areas in and outside of the building
Normal tier-3 N+1 datacenter protections for power and cooling exist
Annual SAS70 audit is completed by the datacenter service provider

8. DR and Business Continuity
We have a significant amount of redundancy within our infrastructure
We have N+1 host server blades available
We have N+1 power and network capabilities
We do not contract currently for compute capabilities outside of our secured datacenter

9. DR and Business Continuity
We now have multiple layers of backup within the datacenter and off site
We have snapshots of data on the same storage system available at a regular interval depending on the server
We are implementing snapshots of data from our production storage system to a DR storage system on a regular interval
We have a separate Commvault backup system which captures backups every evening
We use that same Commvault system to capture SQL log information every 15 minutes for CPS databases
We copy backups from the local Commvault system to a Azure data vault off site on a regular basis depending on the type of data

10. DR and Business Continuity
We have tiered all of our servers according to risk to determine expediency of deploying patches and emergency software updates
We have tiered all of our servers according to system restore procedure to determine frequency and mode of backup

11. DR and Business Continuity Future
In the future, we may move our redundant storage off site and consider utilizing older hardware to support a diminished access capacity that could be available at a moment's notice with little downtime. (decisions on cloud strategy with GE will impact this decision)

12. Best Practices with AllianceChicago resources
Moving from computer to computer
If you are not carrying a laptop from room to room, take advantage of “Disconnect” from the Citrix screen
If you do not see “Disconnect” then you likely do not have 3.alliance-ehrs.org included as a “trusted site” in your Internet Explorer settings
When you log back in after using “Disconnect” please be sure to wait up to 10 seconds for your session to reappear the way you left it. That means it will return as minimized if you made it smaller to get to the other screen to disconnect

13. Best Practices – Windows Updates
Take Windows updates on endpoint workstations whenever they are available
Updates typically come out on “Patch Tuesday” from Microsoft which is once a month
Plan to role out to many computers only after testing on a few
Change management is recommended in order to avoid having a bad next day

14. Best Practices – Citrix Receiver
AllianceChicago is currently using Citrix XenApp version 7.6 LTSR
We have immediate future plans to upgrade to Citrix XenApp Version LTSR
Citrix recommends that you install the most current version of their Receiver application to remain within support
However, they are maintaining an LTSR (Long term Service Release) version on which AllianceChicago users should standardize

15. Best Practices – Citrix Receiver (Cont.)
The current version of LTSR receiver is linked to on the AllianceChicago applications icon page

16. Best Practices – Citrix Receiver (Cont.)
All software updates should be tested in your environment before installing to all machines
It is recommended to turn off the ability for the receiver to update itself on supported computers by GPO (or can change manually or during install)

17. Downtime identification and communication
How to classify an issue (user, computer, network, application)
Internal escalation process for IT issues or EMR issues
Communications plan to report from site to site
How to escalate quickly to AllianceChicago with the most info possible

18. Uptime Statistics – User Impact
Downtime event impact is calculated by actual session impact
Director reports on actual user session begin and end times
Omit sessions ended before event and omit sessions that started after the event
Prior two weeks on the same day of the week in the same hours are used as usual baseline activity as an average
The hours of the event – actual session times are calculated
The difference between typical activity and actual activity is defined in work minutes to determine the impact and those minutes are reported

19. Uptime for last 12 months
*September anomaly was caused by three events during business hours. Two events impacted only Erie and was due to a GE update that caused issues which allowed a single user to lock up all other users on the database. The third issue was firewall problem which was caused by a software bug confirmed by Cisco.

21. Security- Network
Encryption is maintained for all access into and out of the AllianceChicago services
With very few exceptions, user and administrative access to AllianceChicago resources is only through Citrix access through a purpose-built Citrix NetScaler appliance.
The few exceptions are limited by IP address for specific encrypted access for administrators
Layered security is in place (and in process of being reconfigured for additional controls)
Biennial penetration testing (next test to be completed before the end of this calendar year)
Internet Access is secured by CenturyLink for major treats before traffic even gets to our own controlled firewall

22. Security- Authentication
Authentication for Health Center users is managed by each Health Center
We use Microsoft Active Directory to manage authentication for both Citrix and Centricity using the same username and password
Groups are created by AllianceChicago for Health Center administrators to categorize staff access
Password renewal policy can be defeated by Health Center administrators by clicking the "do not change password" setting on each user. This is not recommended.
Regularly (at least quarterly) review with HR the access of all users in Active Directory and all assigned security groups to ensure access is limited to only active staff with permissions and rights reflective of their current position.

23. Security - Data is moved through interfaces
Scanned documents enter in through an encrypted transfer of files from a server at each Health Center to a server in our DMZ and then an encrypted transfer of the files from the DMZ to a shared location in the system. The files are then attached to the EMR using a hosted document management application.
All automated processes for data leaving the datacenter (labs, pharmacy) is handled through encrypted connections to partner sites

24. Security - Data moved from the datacenter to the health center
Each Health Center controls the ability of each users' access to downloading files to their local workstation through group settings they control
Some Health Centers have purchased a dedicated report server which administrative users can be granted access to and can pull data to the health center from that server
Reports and other documents can be prepared for printing and then printed to users local devices

25. Future plans for a CSIO office
Build out cyber security office in a joint effort with Health Choice Network
Dedicated staff centralized to focus internally
Dedicated staff to provide as a service
Health centers are the biggest risk

26. Importance of the Health Center's security processes
HIPAA security reviews focus on processes that are controlled by each health center
Policies for the creation and deletion of users
Policies around chart access
Policies around handling printed materials
Computers used to access AllianceChicago are managed by the health center
Security patches to Windows and updates to Citrix Receiver