HIM 425 Module 5 Final Project Milestone Two Example

Final Project Milestone Two: Choosing a Foundation, a Potential Solution for Cedar Fork Community Health

[Student Name]

Southern New Hampshire University

HIM 425: Healthcare IT Infrastructure and Network Management

Final Project Milestone Two

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Final Project Milestone Two: Choosing a Foundation, a Potential Solution for Cedar Fork Community Health

Milestone One defined Cedar Fork Community Health's problem as a record that is neither reliably available nor complete, and it set six requirements any solution must meet: no single point of failure for the record, two independent network paths to every clinic, reliable video at every site, clinical phone messages in the record without overwhelming clinicians, tested downtime and recovery procedures, and a fit with the budget and support capacity. This milestone describes three potential solutions, scores them against those requirements and develops the strongest in more detail.

Three Potential Solutions

Option A rebuilds the current design with redundancy: two new servers configured so one takes over if the other fails, replicated storage, a new battery backup and cooling for the closet, and improved network links to the mountain clinics. The record would stay on-premises. Option B moves the record to the vendor's hosted service, retires the local server and gives each clinic two independent internet connections managed by a software-defined network, as designed in Module Four. Option C migrates the current record software to rented cloud infrastructure managed by a contractor, with the same network upgrades as Option B. All three options include retiring the separate messaging tool, since that part of the problem is a workflow and software decision rather than a hosting one.

Scoring Against the Requirements

Table 1 shows how each option meets the six requirements, rated as fully met, partly met or not met. Option B meets five fully and one partly; Option A meets three fully; Option C meets four fully but depends on a contractor Cedar Fork has not yet found.

Table 1. Options Scored Against Milestone One Requirements

Note. Ratings by the author with the IT support provider and practice managers.

Why Vendor Hosting

Option B removes the risk that caused the spring outage by moving the record into the vendor's data centers, which have redundant power, hardware and staff watching them around the clock. Griebel et al. (2015) found in their review of cloud computing in health care that hosted services offer scalability and reduced local maintenance, while raising concerns about security, legal agreements and dependence on connectivity. Option B addresses the connectivity concern through the redundant network design and the legal concern through a business associate agreement with stated recovery time and recovery point objectives, which set how fast service must come back and how many minutes of recent entries could be sacrificed. The security case is also strong. Neprash et al. (2022) counted ransomware attacks on providers each year and saw the annual number roughly double over six years, and a vendor with a dedicated security operation is better placed to detect and contain an attack than a health center relying on eight hours a month of outside support.

Bringing Messages Into the Record

The messaging gap needs a workflow solution as much as a technical one. Under the proposal, the separate messaging tool will be retired and every patient call will be recorded as a telephone encounter in the record, where it becomes part of the chart. Simply sending those encounters to clinicians would create a new problem. Primary care inboxes were already crowded with dozens of daily alerts when Murphy et al. (2016) measured them, and Cedar Fork logs about 2,300 phone messages a month. Encounters will therefore go first to a nurse pool at each clinic, where nurses handle refill requests and routine questions under standing protocols and route only messages needing a clinician's judgment to the clinician's inbox. A monthly audit of 100 encounters will check that clinical advice is documented and that routing works.

Planning for Downtime

Hosting reduces but does not eliminate downtime. Larsen et al. (2018) found that patient safety reports involving downtime frequently described delays with laboratory results and medications, which shows that planning must cover information flow as well as access. The vendor offers a downtime viewer: one workstation per clinic holding view-only schedules, problem lists, medication lists, allergies and recent results refreshed every hour. Each clinic will also keep a downtime kit with paper forms matching the electronic templates, and the health information team will own a reconciliation procedure with a target of entering all downtime documentation within 48 hours. The plan will be tested twice a year with scheduled drills.

Cost and Funding

Option B's costs are spread over time rather than concentrated up front. Setup and data migration fees total about $38,000, network equipment and installation for five clinics about $41,000 and the downtime viewer workstations about $6,000, for a first-year capital cost of about $85,000, within the $120,000 available. Ongoing costs of roughly $6,400 a month for hosting and $1,900 a month for connections replace current server maintenance and part of existing circuit costs. The health center's federal infrastructure grant application will request support for the network upgrade, which would free funds for staff training.

Risks of the Proposed Solution

Three risks remain. Dependence on the vendor means Cedar Fork must negotiate strong contract terms for uptime, recovery, data return at contract end and breach notification. The migration itself could disrupt care if poorly timed, so it should occur over a weekend with a tested rollback plan. And staff may resist retiring the familiar messaging tool, which calls for early involvement of nurses in designing the telephone encounter workflow. The final project will address these risks in its implementation plan.

Conclusion

Of the three potential solutions, the vendor-hosted record with redundant network paths best meets Cedar Fork's requirements. Paired with a redesigned telephone encounter workflow, a local downtime viewer and a funded budget, it addresses availability and completeness together. The final project will turn this potential solution into a technology solution brief with an implementation plan.

References

Griebel, L., Prokosch, H.-U., Köpcke, F., Toddenroth, D., Christoph, J., Leb, I., Engel, I., & Sedlmayr, M. (2015). A scoping review of cloud computing in healthcare. BMC Medical Informatics and Decision Making, 15, Article 17. https://doi.org/10.1186/s12911-015-0145-7

Larsen, E., Fong, A., Wernz, C., & Ratwani, R. M. (2018). Implications of electronic health record downtime: An analysis of patient safety event reports. Journal of the American Medical Informatics Association, 25(2), 187-191. https://doi.org/10.1093/jamia/ocx057

Murphy, D. R., Meyer, A. N. D., Russo, E., Sittig, D. F., Wei, L., & Singh, H. (2016). The burden of inbox notifications in commercial electronic health records. JAMA Internal Medicine, 176(4), 559-560. https://doi.org/10.1001/jamainternmed.2016.0209

Neprash, H. T., McGlave, C. C., Cross, D. A., Virnig, B. A., Puskarich, M. A., Huling, J. D., Rozenshtein, A. Z., & Nikpay, S. S. (2022). Trends in ransomware attacks on US hospitals, clinics, and other health care delivery organizations, 2016-2021. JAMA Health Forum, 3(12), Article e224873. https://doi.org/10.1001/jamahealthforum.2022.4873