1. Introduction to Healthcare Information Technology
Chapter Four
Network IT Operations

2. 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

3. 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

4. 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

5. Figure 4-1 OSI layers
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6. Table 4-1 OSI reference model
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7. 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

8. 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

9. Figure 4-2 A hub is an older type of network device; today hubs have largely been replaced by switches
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10. Switches Network switch MAC address (hardware address)
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

11. Switches (cont’d.) Core switches carry traffic between switches
Workgroup switches connect directly to network devices

12. Figure 4-3 Core and workgroup switches
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13. 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

14. Domain Controllers Domain Domain controller
Collection of devices that share a central directory database
Domain controller
Server that manages security-related elements on the network for the user

15. Servers Several different types of services and servers
Several different protocols
Servers must be properly managed to be effective

16. Services and Servers Print services File services Application 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 , telephony, and instant messaging

17. Server Management Common tasks associated with managing servers
Load balancing
Allocating storage space
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

18. 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

19. 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)

20. 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

21. Figure 4-4 OSI model vs. TCP/IP model
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22. 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

23. Figure 4-5 DNS lookup
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24. 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

25. Figure 4-6 FTP client software
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26. Protocols (cont’d.) Wireless protocols
Enable mobile communication
Wireless local area network (WLAN) standards
IEEE
IEEE n-2009
Advantages of n over previous standards
Higher speed (up to 600 Mbps)
Coverage area
Reduces interference
Improved security

27. 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

28. Basic Network Setup Setting up a network
Involves understanding connections to the network devices and configuring network hardware
A variety of possible configurations exist

29. Client Connections Network interface card (NIC)
Also called client network adapter
Hardware needed to send and receive data on a wired network
Figure 4-7 NIC and cable
© ronstik/

30. 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
Figure 4-8 USB wireless NIC
© Oleksiy Mark/

31. Network Hardware Modem Internet modem Router
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

32. 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

33. Figure 4-12 Infrastructure mode with AP
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34. 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

35. 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

36. 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.

37. 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

38. Table 4-2 Wireless signal interference
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39. Figure 4-17 Incorrect and correct wave propagation and multipath
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40. 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

41. Network Technologies for EHR/EMR
Two broad categories of decisions
Cloud versus local network
Installed applications versus remote access

42. 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

43. 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

44. 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

45. Summary (cont’d.)
Wireless local area networks are based on IEEE standards and n
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