Component 8: Installation and Maintenance of




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Unit Objectives

By the end of this unit the student will be able to:




  1. Identify 12 possible steps to choosing an EHR system

  2. Gather functional requirements from institution and users

  3. Document use-cases and relate them to functional requirements



Unit Topics / Lecture Titles

3 System Selection – Functional and Technical Requirements


Unit References

(All links accessible as 1/26/2012)


Lecture 3

  1. Adler, K. G. (2005). How to select an electronic health record system. Fam Pract Manag, 12(2), 55-62. Retrieved from http://www.aafp.org/fpm/2005/0200/p55.html.

  2. HIMSS. (2011). Davies Award past recipients (for achievement in implementation of EHRs). Retrieved from himss.org: http://www.himss.org/davies/pastRecipients_org.asp.

  3. HL7 Electronic Health Record (EHR) Work Group. (2007). HL7 2007 EHR-S Functional Model. Retrieved from http://www.hl7.org/ehr/downloads/index_2007.asp.

  4. Illinois Foundation for Quality Health Care. Guidelines for Evaluating EHRs. (2009). Retrieved from http://www.ifmc-il.org/provider/documents/guidelines_for_evaluating_ehrs.pdf.

  5. Johnson, N. (2011, September 12). HHS launches healthIT.gov, FederalTimes.com. Retrieved from http://blogs.federaltimes.com/federal-times-blog/2011/09/12/hhs-launches-healthit-gov/

  6. Office of the National Coordinator (ONC) for Health Information Technology. How to Implement EHRs, Step 3: Select or Upgrade to a Certified EHR. Retrieved from http://www.healthit.gov/providers-professionals/step-3-select-or-upgrade-certified-ehr.

  7. Quinsey, C. A. (2006). Using HL7 standards to evaluate an EHR. Journal of AHIMA, 77(4), 64A-64C. Retrieved from http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_031102.hcsp?dDocName=bok1_031102.

  8. Stratis Health. (2009). Requirements Analysis. Retrieved from http://www.stratishealth.org/documents/HITToolkitNH/1.Adopt/1.3Select/1.3.5Requirements_Analysis.doc.


Lecture 3 Charts, Tables, Figures

3.1 Table: Quinsey, C. A. (2006). Using HL7 standards to evaluate an EHR. Journal of AHIMA, 77(4), 64A-64C. Retrieved from http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_031102.hcsp?dDocName=bok1_031102.


Lecture 3 Images

None in this lecture.


Unit Required Readings

None in this lecture.


Unit Suggested Readings

  1. Should CCHIT Influence Your EHR Selection? By Don Fornes http://www.softwareadvice.com/articles/medical/should-cchit-influence-your-ehr-selection/ An excellent overview of CCHIT’s role in EHR selection and the criteria certified by the organization.

  2. Healthcare Industry show demonstrates wealth of opportunities, By Steve Hicks http://mindset.mercurypay.com/?p=475 An overview of Interoperability, Meaningful Use, and Revenue Cycle Management


Student Application Activities

comp8_unit3_actvities.doc

comp8_unit3_activity_key.doc

comp8_unit3_self_assess.doc

comp8_unit3_self_assess_key.doc
Component 8/Unit 4
Unit Title

Structured Systems Analysis and Design
Unit Description

This unit will discuss the basics of developing a project plan and the role of a project manager.


Unit Objectives

By the end of this unit the student will be able to:




  1. Identify the 8 basic components to a project plan

  2. Define the role of a project manager

  3. Equate the basic project plan components to a typical EHR implementation plan

  4. Create a project plan for system design and implementation



Unit Topics / Lecture Titles

4 Structured Systems Analysis and Design


Unit References

(All links accessible as of 2/15/2012)


Lecture 4

  • Brown, C (2009, March). “It Used to be the Iron Triangle” [Internet].Available from http://www.betterprojects.net/2009/03/it-used-to-be-iron-triangle.html

  • Columbus, Suzanne. "Small Practice, Big Decision: Selecting an EHR System for Small Physician Practices." Journal of AHIMA 77, no.5 (May 2006): 42-46. Available on the Internet: http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_031357.hcsp?dDocName=bok1_031357

  • DerGurahian, Jean (2010, March). “Slow, steady EHR implementation plan better for doctors’ offices” [Internet]. Available from: http://searchhealthit.techtarget.com/news/2240016960/Slow-steady-EHR-implementation-plan-better-for-doctors-offices

  • Hohly, Marge.  Project Plan Definition[Internet]. 2007. [Cited July 2010]: [about 5 screens]. http://www.cerritos.edu/hohly/WorkExperience/project plan_instructions.htm

  • Launi, Joe. Creating a Project Plan. JNM [serial on the Internet]. 1999 Sept; [cited 2010 August 15] http://www.tdan.com/view-articles/5266

  • Lonergan, Kevin. Project Management. Free Management Library [Internet]; [cited 2010 August 5]; Available from: http://www.managementhelp.org/plan_dec/project/project.htm

  • A Roadmap for an EHR Implementation at a Practice. Binary Spectrum [Internet]. http://www.binaryspectrum.com/HealthcareSolutions/ElectronicMedicalRecords/Roadmap-for implementation-of-EHRsystem-at-a-practice.html

  • Turbit, Neville(2005,June). “Defining the Scope of a Project” [Internet]. PerfectProject.com. Available From: http://www.projectperfect.com.au/info_define_the_scope.php.

  • Wikipedia (2011, December). “Scope (Project Management)” [Internet]. Cited December 2011 from Wikipedia.com: http://en.wikipedia.org/wiki/Scope_(project_management.

  • Wikipedia (2010, December). “Scope (Project Management)” [Internet]. Cited December 2010 from Wikipedia.com: http://en.wikipedia.org/wiki/Scope_(project_management


Lecture 4 Charts, Tables, Figures

None used in this lecture.


Lecture 4 Images

Slide 5 : The Project Diamond. Courtesy Scott Neal. Used with permission.

Slide 7 : The Role of a Project Manager. Courtesy Scott Neal. Used with permission.
Unit Required Readings

None used in this lecture.


Unit Suggested Readings

  1. “How to Successfully Navigate Your EHR Implementation” by Kenneth Adler, February 2007, http://www.aafp.org/fpm/2007/0200/p33.html

  2. “EHR Implementation Roadmap: 2005 Pilot” 2005 http://hosteddocs.ittoolbox.com/AS030504.pdf. This is an EHR Implementation plan template students may use as a guide to developing their own plans for the activities.


Student Application Activities

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comp8_unit4_activity_key.doc

comp8_unit4_self_assess.doc

comp8_unit4_self_assess_key.doc
Component 8/Unit 5
Unit Title

Software Development Life Cycle
Unit Description

This unit introduces the student to the SDLC model and explores its application to well-known software and its utility for healthcare IT systems.


Unit Objectives

By the end of this unit the student will be able to:




  1. Define the steps of the Software Development Life Cycle, or SDLC, and the purpose and importance of each.

  2. Describe different models of the SDLC and their key differences.

  3. Describe how and why an HIT software application would go through the SDLC.


Unit Topics / Lecture Titles

5 Software Development Life Cycle


Unit References

(All links accessible as of 1/26/2012)


Lecture 5

  1. Kay, R. I. (2002, May 14). QuickStudy: System Development Life Cycle. ComputerWorld.com. , Retrieved from http://www.computerworld.com/s/article/71151/System_Development_Life_Cycle?taxonomyId=011

  2. Sofandi, A. (2010, August 31). Introduction to Software Development Life Cycle (SDLC). Retrieved from AlphaSoft Indonesia website: http://agusofyandi.wordpress.com/2010/08/31/introduction-to-software-development-life-cycle-sdlc/


Lecture 1b Charts, Tables, Figures

None in this lecture.


Lecture 1b Images

Slide 6: Waterfall model of SDLC. Image courtesy of Scott Neal.

Slide 7: Iterative model of SDLC. Image courtesy of Scott Neal.

Slide 20: Waterfall model of SDLC. Image courtesy of Scott Neal.

Slide 23: Iterative model of SDLC. Image courtesy of Scott Neal.

Slide 24: Spiral model of SDLC. Image courtesy of Scott Neal.


Unit Required Readings

None in this lecture.


Unit Suggested Readings

  1. “Software development Life Cycle” Volumes I and II by the State of Maryland , Revised August 2008, http://doit.maryland.gov/policies/Documents/sdlc/sdlcvol1.pdf and http://doit.maryland.gov/policies/Documents/sdlc/sdlcvol2.pdf These articles give a great in depth introduction to managing large scale projects using SDLC. These articles serve as the State of Maryland’s guidelines for SDLC with step- by – step breakdowns of each of the accepted SDLC phases.

  2. “Systems development Life Cycle Models.” [Powerpoint via the Internet]. http://www.docstoc.com/docs/7806897/SDLC-Models This is a concise introduction to a wide variety of SDLC models including those discussed in the lecture.

  3. “Introduction to Software development Life Cycle” as found in Agus Soyfandi’s blog http://agusofyandi.wordpress.com/2010/08/31/introduction-to-software-development-life-cycle-sdlc/ This article offers a more abridged perspective to SDLC and SDLC methodologies.

  4. “Quick Study: Systems Development Life Cycle.” By Russel Kay (also available in podcast from the website.) http://www.computerworld.com/s/article/71151/System_Development_Life_Cycle?taxonomyId=011 Another introduction to SDLC, the waterfall model, and the spiral model. The next text, which may be behind a “paywall” or not easily accessible, since it is suggested.


Student Application Activities

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comp8_unit5_activity_key.doc

comp8_unit5_self_assess.doc

comp8_unit5_self_assess_key.doc

Component 8/Unit 6


Unit Title

System Security Procedures and Standards
Unit Description

This unit includes Federal State and local health information regulations for EHRs, computer and network system vulnerabilities and best practices for identification and mitigation of those vulnerabilities, information access and protection measures, and user security training.


Unit Objectives

By the end of this unit the student will be able to:




  1. Identify regulatory requirements for EHRs

  2. Provide training for system users regarding the methods and importance of security compliance

  3. Identify administrative, physical, and technical safeguards for system security and regulatory compliance

  4. Identify best practices for system security

  5. Identify best practices for risk / contingency management


Unit Topics / Lecture Titles

6 System Security Procedures and Standards


Unit References

(All links accessible as of 1/31/2012)


Lecture 6a

  1. Department of Health and Human Services (HHS), Office of Civil Rights (OCR), HIPAA Privacy Rule. 45 CFR Subtitle A (10-1-11 Edition) Part 154.514 Retrieved January 20, 2012 from GPO: http://www.gpo.gov/fdsys/pkg/CFR-2011-title45-vol1/pdf/CFR-2011-title45-vol1-sec164-514.pdf

  2. Enforcement Highlights. (2012, January 12) Retrieved from U.S. Department of Health & Human Services website: http://www.hhs.gov/ocr/privacy/hipaa/enforcement/highlights/index.html

  3. Hamilton, K. (2009, January 15). EHR security and privacy. Retrieved from SC Magazine website: http://www.scmagazine.com/ehr-security-and-privacy/article/125983/

  4. Minnesota Health Information Clearinghouse, Medical Records Information. (n.d.) Retrieved January 12, 2012 from Minnesota Department of Health: http://www.health.state.mn.us/clearinghouse/medrecords.html

  5. Numbers at a Glance. (n.d.) Retrieved January 12, 2012, from U.S. Department of Health & Human Services website: http://www.hhs.gov/ocr/privacy/hipaa/enforcement/highlights/indexnumbers.html

  6. Poremba, S. M. (2008, May 23). Retrieved from SC Magazine website: http://www.scmagazine.com/proliferating-hipaa-complaints-and-medical-record-breaches/article/110555/

  7. Summary of the HIPAA Privacy Rule. (n.d.). Retrieved from U.S. Department of Health & Human Services website: http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html

  8. Summary of the HIPAA Security Rule. (n.d.). Retrieved from U.S. Department of Health & Human Services website: http://www.hhs.gov/ocr/privacy/hipaa/understanding/srsummary.html


Lecture 6a Charts, Tables, Figures

None in this lecture.


Lecture 6a Images

None in this lecture.


Lecture 6b

    1. Common Types of Network Attacks. (n.d.) Microsoft Windows TCP/IP Core Networking Guide. Distributed Systems Guide, Windows 2000 Server . http://technet.microsoft.com/en-us/library/cc959354.aspx

    2. Hartley, Carolyn (2005). A Secure EHR Foundation. [PowerPoint slides]. Retrieved from http://www.mtech.edu/nchci/EHRConference/Attachments/Securing%20the%20EHR%20System.pdf

    3. Health Information Privacy - Summary of the HIPAA Security Rule. (n.d.). Retrieved February 8, 2012, from U.S. Department of Health & Human Services website: http://www.hhs.gov/ocr/privacy/hipaa/understanding/srsummary.html

    4. Password Strength (n.d.). Retrieved January 12, 2012, from Wikipedia: http://en.wikipedia.org/wiki/Password_strength#Guidelines_for_strong_passwords

    5. University of Wisconsin-Madison HIPAA Security Best Practices Guidelines, #3 Audit Controls, 4D. (2004, April 13). Retrieved from University of Wisconsin – Madison: http://hipaa.wisc.edu/docs/auditControls.pdf


Lecture 6b Charts, Tables, Figures

None in this lecture.


Lecture 6b Images

Slide 8: VPN example, 2012. Provided by Scott Neal

Slide 10: Firewall example, 2012. Provided by Scott and Nolan Neal
Unit Required Readings

None in this lecture.


Unit Suggested Readings

  1. “Hardening Servers with Security Templates” by WindowsSecurity.com , 2010, http://www.windowsecurity.com/articles/Hardening-Servers-Security-Templates.html This article outlines the use of security templates and group policy to harden server infrastructure. The article provides a look into the many faucets that must be considered when implementing a secure server strategy.

  2. “Educating your Employees on Basic Security Principles.” By David Kelleher; May 27, 2009 [Podcast via the Internet]. http://www.net-security.org/article.php?id=1241


Student Application Activities

comp8_unit6_activity.doc

comp8_unit6_activity_key.doc

comp8_unit6_self_assess.doc

comp8_unit6_self_assess_key.doc

Component 8/Unit 7


Unit Title

System Interfaces and Integration
Unit Description

This unit explores the issues and challenges involved in interfacing and integrating systems including understanding system requirements and the messaging and other techniques used between various systems.


Unit Objectives

By the end of this unit the student will be able to:




  1. Determine and document system interfaces and integration requirements

  2. Describe the pitfalls associated with installing a new application in an environment of pre-existing applications

  3. Give examples of interfacing modalities


Unit Topics / Lecture Titles

7 System Interfaces and Integration


Unit References

(All links accessible as of 2/15/2012)


Lecture 7

  1. Adler, K. G. (2005). How to select an electronic health record system. Fam Pract Manag, 12(2), 55-62. http://www.aafp.org/fpm/2005/0200/p55.html

  2. Chaffee, B. W., & Bonasso, J. (2004). Strategies for pharmacy integration and pharmacy information: Technical aspects of interfaces. Am J Health Syst Pharm. 61(5). http://www.medscape.com/viewarticle/471252

  3. Corepoint Health. (2010). The role of an interface engine in modern healthcare. http://www.corepointhealth.com/whitepapers/role-of-interface-engine-in-modern-healthcare

  4. DeSonier, N. (2006). What is cardinality in HL7? HL7standards.com. http://www.hl7standards.com/blog/2006/11/02/what-is-hl7-cardinality/

  5. Zywiak, W., & Drazen, E. (2010). Integrating EHRs: Hospital trends and strategies for initiating integrated EHRs within their communities. CSC.com. http://assets1.csc.com/health_services/downloads/CSC_Integrating_EHRs.pdf


Lecture 7 Charts, Tables, Figures

7.1 Table. Neal, S., 2012.


Lecture 7 Images

Slide 6: Illustrations of point-to-point & interface engine. Images courtesy of Scott Neal.

Slide 18: HL7 interface engine. Image courtesy of Scott Neal.

Slide 21: Point-to-point EHR interface. Image courtesy of Scott Neal.

Slide 22: Point-to-point vs. HIE EHR interfaces. Image courtesy of Scott Neal.
Unit Required Readings

None in this lecture.


Unit Suggested Readings

  1. “HL7 Messages” By Gunther Schadow. [Internet], Revised 1996, http://aurora.regenstrief.org/~gunther/oldhtml/messages.html This is a reference guide for deciphering HL7 2X messages

  2. “HL7 International.” [Internet], Revised 2010, http://www.hl7.org/ This is the official HL7 website which highlights HL7, discuses HL7 as a standard and outlines the organization’s goals and achievements.

  3. Interfaceware’s website at: http://www.interfaceware.com/hl-7.html This site provides users with an excellent launching point for understanding the HL7 standard


Student Application Activities

comp8_unit7_activity.doc

comp8_unit7_activity_key.doc

comp8_unit7_self_assess.doc

comp8_unit7_self_assess_key.doc

Component 8/Unit 8


Unit Title

Troubleshooting, Maintenance and Upgrades, and Interaction with Vendors, Developers, and Users
Unit Description

This Unit explores aspects of setting up a robust support structure for troubleshooting and maintaining the system, including developing troubleshooting and escalation procedures, measuring system performance, and communication with vendors (or local developers).


Unit Objectives

By the end of this unit the student will be able to:




  1. Identify and implement an effective troubleshooting procedure for reporting, evaluating, fixing, deploying, and follow-up of errors, problems, or limitations for the system

  2. Integrate downtime schedule for OS, network, database, and client application maintenance and updates



Unit Topics / Lecture Titles

8 Troubleshooting, Maintenance and Upgrades, and Interaction with Vendors, Developers, and Users


Unit References

(All links accessible as of 1/15/2012)


Lecture 8a

  1. Boyer, E. and Soback , M. (2005). Production Support. Implementing an Electronic Health Record System. J. M. Walker, E. J. Bieber and F. Richards, Springer London: 95-100. http://www.springerlink.com/content/n520ghg078416463/

  2. Felt-Lisk, S; Johnson, L; Fleming, C; Shapiro, R; Natzke, B. 2009 September 22 [Internet]. . Toward understanding EHR use in small physician practices. Available from: http://www.thefreelibrary.com/Toward+understanding+EHR+use+in+small+physician+practices.-a0216632134

  3. Heubusch, K. "Physician Practices and Information Management: HIM Professionals Offer Value in Changing Practices." Journal of AHIMA 79, no.8 (August 2008): 18-22.

  4. Lake,T, Collins, T, and Ginsburg, P (2011). “Fostering Health Information Technology in Small Physician Practices: Lessons from Independent Practice Associations”. National Institute for Health Care Reform. [Internet]. http://www.nihcr.org/HIT-and-IPAs.html.

  5. Pereira, P (2010). “After EHR system implementation, maintenance, service questions remain “, SearchHealthIT. [Internet]. http://searchhealthit.techtarget.com/news/2240020962/After-EHR-system-implementation-maintenance-service-questions-remain


Lecture 8a Charts, Tables, Figures

None in this lecture.


Lecture 8a Images

Slide 8: “EHR Troubleshooting Workflow” by Scott Neal. Used with Permission


Lecture 8b

  1. Boyer, E. and M. Soback (2005). Production Support. Implementing an Electronic Health Record System. J. M. Walker, E. J. Bieber and F. Richards, Springer London: 95-100. http://www.springerlink.com/content/n520ghg078416463/

  2. “Event Tracing for Windows” (2011). Microsoft.com. [Internet]]. http://msdn.microsoft.com/en-us/library/ff545699.aspx .

  3. “Guide to Reducing Unintended Consequences of Electronic Health Records” (2011). AHRQ. [Internet]. http://www.ucguide.org/

  4. Halamka, John. “10 tips for troubleshooting complex EHR infrastructure problems”. KevinMD.com. [Internet]. http://www.kevinmd.com/blog/2010/09/10-tips-troubleshooting-complex-ehr-infrastructure-problems.html.

  5. “SQL Server Security, Performance & Tuning.” (2009).SSQA.net. [Internet]. http://sqlserver-qa.net/blogs/perftune/archive/2009/07/26/5820.aspx

  6. “Technical Comparison of Oracle Database 10g and SQL Server 2005: Focus on Manageability, May 2005” (2005, May). Oracle. [Internet]. http://www.oracle.com/technetwork/database/focus-areas/manageability/ss-1.pdf

  7. Wunder, Bill “Benchmarking Techniques Using T-SQL Part 1 - System Statistical Functional”. [Internet]. http://64.29.220.154/articles/viewarticle.aspx?id=17797.


Lecture 8b Charts, Tables, Figures

None in this lecture.


Lecture 8b Images

None in this lecture.


Unit Required Readings

None in this lecture.


Unit Suggested Readings

  1. “Try these Efficiency Strategies When Setting Up a Helpdesk ” by Techrepublic.com , 2004, http://articles.techrepublic.com.com/5100-10878_11-5112468.html This article goes through 5 steps of. Setting up an effective and successful help desk from the ground up.

  2. “Educating your Employees on Basic Security Priciples.” By David Kelleher; May 27, 2009 [Podcast via the Internet]. http://www.net-security.org/article.php?id=124

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