SYSTEM INFRASTRUCTURE ASSESSMENT

<CENTRAL AZ INTEMED CONSULTING COMPANY>

<NATHANIEL LUEDEKER>

04/14/2016

System Infrastructure Assessment template

A Brief Overview: The prohibitive startup costs of an electronic healthcare record system
can be a substantial barrier for a healthcare facility. In addition, physical space needed for
the equipment that comprises a client-server system is not always available in facilities still
bogged down and occupied by reams of paper files.
Starting with a cloud-based system offers a practical solution to meet the above
challenges. A cloud-based system with its inherently low startup cost minimizes the need for
separate servers and in addition allows a gradual migration to an electronic record. A later
conversion to a server system would be an option as space for equipment is cleared in the
current paper chart storage area upon migration to a predominantly electronic record, as the
amount of storage needed for paper charts decreases. A vendor that offers both the option of
client-server or cloud based systems would be worth considering.

Component

Example:
Database Server

Current System

Two redundant
database servers

Application Server
Billing only.

Planned System

Use current servers

with expanded
memory

Could be upgraded
later as noted
above.
Upgrade would be
to the 4D Web
Application Server.

Rationale/Explanation
Current database
system is capable of
handling the traffic
for the planned
system, but requires
more memory to hold
all the patient
records.
As the conversion to
EHR progresses, and
space in the area
currently occupied by
paper records is freed
up, this can be
addressed if it is
decided to change to a

System Infrastructure Assessment template

client-server system.
4D Web is great for
web/services client.
Accessible on Cloud;
practitioners can get
information off site.
It runs on Windows
and Macs. Size can
be customized to a
facilitys needs.

Web Server

Staff Workstations

None. Currently
with cable Internet
access ((Windows 7
/ server IIS 7.5.)
with WiFi available
to staff and
patients.

Front/back office
desktop
workstations

Start with a
minimal one, for
the purposes stated
in rationale, then
upgrade to
Windows IIS 10.
if converting to
client-server system

Simple desktop in
each exam room.
Front/back office
workstations with
web access

Allow patient access

to create a PHR via a
web portal, cloud
backup for our
facility, and access to
online references to
assist in patient care
and decision making.
Windows IIS 10. we
feel will offer extra
security.
A simple desktop in
each exam room will
allow documentation
of exam, history, and
vital signs, which will
go into application for
EHR. Orders will
also be entered in
exam room terminals.
Front/back office will
have terminals for
scheduling,
generating referrals,
prior auth requests,
generating patient
visit summary and
education handouts,
as well as web access
for reference

System Infrastructure Assessment template

Desktop
workstations.

Desktop
workstations.

Physician
Workstations

Printers, fax,
copier, scanner,
hub, WiFi router

Peripheral Devices

Software
Application(s)

Printers front/back
office. Either
separate fax/copier
or a single device
that serves as both.
Scanners to scan
outside hard copy
records to interface
with patients EHR,
hub, WiFi router

Chart review, review

of results of labs or
images ordered,
nurse/assistant
documentation, intervisit communications,
outside records
received. They will
also have web access
for reference. .

Front and back office

would need printers to
generate needed hard
copies both for office
use as well as to give
to patients. The EHR
system would have
built-in fax
capabilities, but
manual faxing may be
needed in some cases.
A hub and WiFi
router will be needed
as used presently
EHR, billing,
The EHR system
scheduling, access
would serve for
Database for patient to references and
scheduling, order
demographics,
care notes for
entry, referral and
billing
patients, patient
prior auth request
portal for their own generation, as well as
Microsoft Office.
PHR access, EDMS e-prescribing. Charge
software, if not
capture by EHR
included in EHR
would generate CPT
system software, to codes and ICD-10
manage scanning
codes for billing
and other imports.
purposes. Access to
Software would
online references
come as part of a
would assist in patient
package deal with
care and decision
the system chosen. making. The patient
There would also
portal for their PHR
be a web link where access would allow
patients can fill out them to message the

System Infrastructure Assessment template

their demographic
and history
information prior to
their initial
appointment.

LAN

Network

LAN (with cloud

backup upon
conversion to
client-server
system) and a
portal for off-site
access by staff as
well as a patient
portal for PHRs.

clinic, receive
messages from us,
and schedule
appointments. A web
link e-mailed to new
patients would allow
them to fill in
demographic and
history information
prior to their initial
appointment and save
time for them and
staff.
Cloud backup would
allow the clinic to
continue to operate in
the event of a system
crash if converting to
a client-server system.
Off-site access portal
for staff would allow
access to patient
records without
having to come to the
office after hours or
weekends for on-call
person. .