NTC425 Phoenix Yates Community Hospital HIT and HIE Network Upgrade Project Resource: Yates Community Hospital HIT and HIE Network Upgrade Project You ar

NTC425 Phoenix Yates Community Hospital HIT and HIE Network Upgrade Project Resource:

Yates Community Hospital HIT and HIE Network Upgrade Project

You are part of the Yates Community HIT and HIE Network Upgrade Project. You have been tasked with diagraming the current Yates Community HIT network and HIE system so the team has the correct starting point for its work.

Read the Yates Community Hospital HIT and HIE Network Upgrade Project document.

Create a high-level diagram in Microsoft® Visio® of the Yates Community HIT network.

Include the following:

The network components
The basic data communication path between the components
How and where the components interact and exchange information
Annotations of where the network currently complies with ISO OSI, HL7, and TC215 standards, where it does not, and what changes are needed to enable compliance
Annotations of where additional hardware will be needed to support full compliance with information exchange requirements
Annotations denoting where additional standards need to be addressed Yates Community HIT and HIE Network Upgrade Project 1
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Yates Community HIT and HIE Network Upgrade Project
Yates Community Hospital Background
Yates Community Hospital (Yates Community) is a small, rural, independent hospital.
Yates Community’s IT infrastructure is stable, but dated. The IT Director has worked to maintain
compliance with the standards necessary to ensure the hospital maintains its accreditation. Currently,
with limited funding, the network and its components only meet the bare-minimum accreditation
Yates Community recently received a grant to upgrade its health information technology (HIT) network
and health information exchange (HIE) system. Yates Community has been operating as a Private HIE
system for years. However, Yates Community has outgrown this design and must upgrade to meet
modern HIE standards. The primary goal of the transition is to enable the hospital to upgrade to the
National HIE Architecture Model; which will allow it to communicate with the Regional Health Information
Organization (RHIO) and Nationwide Healthcare Information Systems (NHIS). This will involve upgrading
the outdated Electronic Health Records (EHR) system to enable the interface with the RHIO. The
secondary goal is to support Yates Community in providing state-of-the-art care to its community by
maximizing the quality and speed of communication within the Yates Community network components.
Project Description
You are part of the team assigned to use the grant to design and implement the National HIE system and
upgrade the HIT network to support the updated HIE architecture. This project is named the Yates
Community HIT and HIE Network Upgrade Project.
Over the next five weeks, you will complete milestone assignments to meet the final objective of an
implemented, optimized HIE network.
Yates Community Network Overview
Yates Community is currently operating within a private HIE architecture that includes internal databases.
(See Figure 1). The only external interfaces that are rudimentary to the system are between the referring
physicians (primary care doctors), e-prescribing, billing clearance house, and reference labs.
Patient Care Procedure Background
1. A referring physician sends a patient to another doctor for specialty care or services at Yates
2. The specialist completes these services and sends specimens to the reference laboratory.
3. A reference laboratory performs various tests on patient specimens for hospitals. Most hospitals
do not have their own reference laboratories.
HIE Architecture
Since Yates Community is a small and private governing organization, it initially operated with a private
HIE architecture based on the interoperability of its internal HIT systems with very few external interfaces.
Thus far, it has successfully operated as a Private HIE organization operating its own HIT systems. It
also has not relied on external or remote databases. A new architecture is needed to enable the required
Copyright © 2018 by University of Phoenix. All rights reserved.
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Figure 1. Current High-level Private Architecture
Yates Community has not implemented the full suite of Health Level 7 (HL7) protocols. It has met the
Meaningful Use Stage 1 requirements, but has not yet met the Meaningful Use Stage 2 requirements.
The EHR system is not certified to the Office of the National Coordinator (ONC) for Health Information
Technology standards. Therefore, obtaining certification is a critical task of this project.
Hardware Configuration

The Picture Archiving and Communication System (PACS) is operating on a Windows® 2003 Server
and includes Windows® XP clients throughout the facility (unsupported software).
All other HIT system client workstations operate on Windows® 10; these workstations access the HIT
The nurses use iPads for mobility between patient rooms. The iPads access the EHR. The iPads do
not allow for unique password; iPad passwords are 6 digits.
HIPAA Compliance
Yates Community has not met all the Health Insurance Portability and Accountability Act (HIPAA) security
standards, including issues related to the following:
• Yates internal and external e-mail traffic does not have a means to be encrypted. Encryption is
required for exchange of Patient Health Information (PHI).
• Yates Community’s only password requirement is to contain six characters. Password need to be
more complex to add security to information within computers and applications.
• Yates Community allows for shared network accounts. This is in violation of the HIPAA Security Rule
requiring unique accounts.
Copyright © 2018 by University of Phoenix. All rights reserved.
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Yates Community RHIO System Requirements
The primary goal of the project is to migrate the current Yates Community architecture to a National HIE
architecture through the Northeast RHIO. The Northeast RHIO has five hospitals from five different states
with five distinct HIE networks.
Figure 2. National HIE and RHIO Architectures
In addition to enabling communication with the Northeast RHIO, this project must also ensure Yates
Community meets regulatory requirements; such as the HIPAA Security Rule. The system must also
meet HL7 and TC215 interoperability requirements, which are described in detail below.
Interoperability and External Communications
With the upgrade, the location of the Yates Community patient medical records will be hosted at the
National level under purview of the NHIN. The Yates Community network infrastructure upgrade must
enable interoperability with the RHIO and NHIO. The following requirements need to be included in the
upgraded HIE architecture:
• EHR Certification: The Yates Community EHR must be certified to enable a smooth integration to the
Northeast RHIO.
• Secure, Interoperable Data Exchange:
o Transmission Control Protocol/Internet Protocol (TCP/IP) over Virtual Private Network (VPN):
Currently Yates Community uses a business-to-business (B2B) VPN with its current external
interfaces (Billing Clearing House, e-Prescribing, and Reference Lab). This will need to be
extended to the RHIO to protect data while in transit (i.e., between Yates and the RHIO). The
VPN will allow data exchange over a secure private network. Specifically, it provides end-to-end
encrypted connectivity. The B2B VPN capability is an efficient method to ensure interoperability
with the RHIO.
o Secure Web Services: There is a web interface from the hospitals to the RHIO. Accessing the
RHIO website must be a secured transmission via industry standard Secure Socket Layer (SSL).
SSL allows HIE members to send and receive PHI through secure communications over the
Internet. In addition, this data can be updated in real time via this method.
o Secure File Transfer Protocol (SFTP): SFTP will be required to exchange files between Yates
Community and the RHIO. This method is used when data is sent and received; either in batches
or a document at a time. These are usually done based on set schedules. Data backups
typically use SFTP.
o Secure E-Mail: E-mail that contains PHI must be secured via encryption during transmission. E-
Copyright © 2018 by University of Phoenix. All rights reserved.
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mail is allowed for exchanging PHI, but is not a preferred practice. If PHI is exchanged via email,
it must be encrypted.
HL7 Standards: Yates Community must become HL7 compliant to participate in the Northeast RHIO.
o The process of transmitting clinical data between internal HIT applications, the Yates Community
EHR, and the RHIO must be upgraded to comply with HL7 standards .
o Third party vendor HIT systems which operate within the Yates Community network environment
will also be required to adhere to the HL7 standards.
Meaningful Use Stage 2 Compliance: Yates Community must become compliant with Meaningful Use
Stage 2 to be an HIE member of the Northeast RHIO.
Copyright © 2018 by University of Phoenix. All rights reserved.

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