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Appendix B - Site Evaluation Reports (Excel)DOC Ahtanum View CC [converted to PDF] DOC Airway Heights CCDOC Cedar Creek CCDOC Clallam Bay CCDOC Coyote Ridge CCDOC Larch CCDOC McNeil Island CCDOC Monroe CCDOC Olympic CCDOC Pine Lodge CC for WomenDOC Rap/LincolnDOC Seattle Community Justice CenterDOC Stafford Creek CCDOC Washington CC for Women Walla WallaDOC WCC SheltonDOC Washington CC for Women PurdyDSHS WCCW Mission CreekDSHS Washington State PenitentiaryDSHS FircrestDSHS Frances Haddon Morgan CenterDSHS Lakeland VillageDSHS Rainier SchoolDSHS Yakima Valley SchoolDSHS Child Study and Treatment CenterDSHS Eastern State HospitalDSHS Western State HospitalDSHS Camp Outlook (Basic Training Camp)DSHS Canyon View Community FacilityDSHS Echo Glen Children's CenterDSHS Green Hill SchoolDSHS Maple Lane SchoolDSHS Naselle Youth CampDSHS Oakridge Community FacilityDSHS Parke Creek Community FacilityDSHS Ridgeview Community FacilityDSHS Twin Rivers Community FacilityDSHS Woodinville Community FacilityDSHS Secure Community Transition Facility - KingDSHS Secure Community Transition Facility - PierceDSHS Special Commitment CenterDVA Spokane Veterans HomeDVA Washington Soldiers Home & ColonyDVA Washington Veterans HomeDVA Central Office - WDVA

Appendix C - Financial Analysis (PDF)DOC - Financial AnalysisDSHS - Financial AnalysisDVA - Financial Analysis

Publications Medical Records Technology Gap (MRTG)October 28, 2008Final Technical Report (Word) [converted to PDF] - Contact: Judy Sweet

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Page 1 Final Technical Report

Medical Records Technology Gap (MRTG) Project Final Technical Report

October 28, 2008

Prepared By:

Washington State Department of Information Services and

Deloitte Consulting


Medical Records Technology Gap (MRTG) Project Final Technical Report

Table of Contents

EXECUTIVE SUMMARY .............................................................................................................................. 3 SECTION I: PROJECT CONCLUSIONS AND RECOMMENDATIONS ................................................... 5

Background ........................................................................................................................................... 5 Objectives ............................................................................................................................................. 5 Approach ............................................................................................................................................... 6 Infrastructure Assessment Results ........................................................................................................ 6 Cost Analysis Results ........................................................................................................................... 9 Conclusions ......................................................................................................................................... 12

Network .................................................................................................................................. 13 Workspace .............................................................................................................................. 13 Desktop infrastructure............................................................................................................. 13 Printers/Scanners .................................................................................................................... 14

Recommendations ............................................................................................................................... 15 Network .................................................................................................................................. 16 Workspace .............................................................................................................................. 16 Desktop and mobile device infrastructure .............................................................................. 16 Printers/Scanners .................................................................................................................... 17

SECTION II: SUPPORTING DETAIL ......................................................................................................... 18

Approach ............................................................................................................................................. 19 Key Conditions and Assumptions....................................................................................................... 20 Infrastructure Requirements ............................................................................................................... 22 Analysis of Site Visits......................................................................................................................... 25 Analysis of Site Visits: Technical Gap Identification ........................................................................ 26

Facility Modifications ............................................................................................................. 26 Disaster Preparedness ............................................................................................................. 26 Cabling/Pathways ................................................................................................................... 27 WAN/LAN.............................................................................................................................. 27 User Devices ........................................................................................................................... 28 Printers/Scanners .................................................................................................................... 28 WAN Bandwidth Requirements ............................................................................................. 29 Wireless Requirements and Recommendations ...................................................................... 33

Cost Analysis ...................................................................................................................................... 36 Cost Analysis Conditions and Assumptions ........................................................................... 36 Cost Estimates to Close Gaps ................................................................................................. 39 One-Time Costs ...................................................................................................................... 40 Ongoing Annual Costs ............................................................................................................ 41

SECTION III: APPENDICES ..................................................................................................................... A-E


EXECUTIVE SUMMARY

The Department of Information Services (DIS) was appropriated funds for the Medical Records Technology Gap (MRTG) Project in the 2007-09 biennium operating budget through the following budget proviso: “Evaluate the information technology infrastructure capacity for institutions operated by the Department of Corrections (DOC), Department of Social and Health Services (DSHS), and Department of Veterans Affairs (DVA). The evaluation will detail the status of the participating institution’s infrastructure and recommend an improvement strategy that includes the use of electronic medical records.” The department will report back the evaluation findings and recommendations to the appropriate committees of the legislature.

This MRTG project report presents the status of technology infrastructure at sites operated by agencies listed in the budget proviso and recommends infrastructure improvements, with associated costs, to support the use of an Electronic Medical Record (EMR) system.

The project was co-managed by DIS and Deloitte Consulting with excellent participation from DOC, DSHS and DVA. These agencies will be among the most likely to pursue an advanced EMR system in the future since they provide a variety of medical and counseling services to their constituents.

The project approach included three major stages:

1. Identify and confirm technology infrastructure requirements for a future EMR system;

2. Conduct onsite reviews of existing technology infrastructure; and

3. Conduct technical and financial analysis for all sites to identify gaps between current and required EMR infrastructure. Recommend improvement actions with cost estimates to close infrastructure gaps.

Major conclusions and recommendations of the project confirm that nearly all sites require additional workstations, data access points, and networked printers for a future EMR system. Many sites require new wireless solutions and mobile devices. Additional infrastructure findings verified the need for upgraded network capabilities, minor facility build-outs to accommodate computer equipment, improved fire suppression, and improved electric power subsystems at multiple sites.

The required levels of investment varied significantly between agencies and from site to site. Some sites required only minor modifications to support their future EMR needs while some required very large investments.

Recommendations and cost estimates are presented at the site level and at the agency level. Costs are grouped according to one-time and ongoing annual costs. Many purchases can be made before acquiring an EMR system because the improvements are independent of the system selected. These should occur as soon as possible. Other purchases should be made after agencies select an EMR system and determine how it will be implemented. At a detailed level, there are over 1,000 recommended actions documented in the site evaluation reports, and included in the MRTG Financial Cost Model Output found in Appendix C.


This report is organized into the following sections:

• Section I: Project Conclusions and Recommendations.

This section presents the project’s conclusions, recommendations and cost estimates to close infrastructure gaps at agency and statewide levels.

• Section II: Supporting Detail

This section provides the supporting detail behind the approach, assumptions, and requirements that support project analysis.

• Section III: Appendices

The Appendices contain supporting project documentation such as EMR infrastructure requirements, the individual site evaluation reports, and cost estimates to close infrastructure gaps.


SECTION I: PROJECT CONCLUSIONS AND RECOMMENDATIONS

Background

The Washington State Department of Information Services (DIS) received authorization in 2007 to conduct a technology gap assessment to evaluate infrastructure readiness to support a future Electronic Medical Records (EMR) system.

The scope of the technology gap assessment included selected sites operated by DOC, DSHS, and DVA. As noted in the Executive Summary, this project was deemed critical for the support of agencies that provide a variety of medical and counseling services to the constituents served by these agencies. These agencies would be among the most likely to pursue an advanced EMR system solution in the future.

DIS engaged Deloitte Consulting to conduct the assessment, report on findings, and develop recommendations for infrastructure improvements. The project was initiated in late March 2008. By late July 2008, all 43 selected sites were visited, the data was analyzed, and gap resolution costs were estimated.

This report contains a review of the assessment, findings, and recommendations developed during the MRTG project.

Objectives

The MRTG project objectives include:

• Identify infrastructure requirements to support a future EMR system;

• Complete site evaluations at 43 identified sites from DSHS, DVA, and DOC;

• Identify infrastructure gaps at each site, in the context of future EMR infrastructure requirements;

• Develop recommendations to close gaps, and develop estimated costs for closing the infrastructure gaps;

• Perform analysis and produce a final report to include:

- Observations, Trends and Recommendations;

- Implementation and sustainability costs;

• Identify policies or practices that could influence infrastructure implementation for a future EMR system; and

• Report results to the Legislature.


Approach

The approach for conducting this assessment project involved three major stages:

1. Identify technology infrastructure requirements for a future EMR system. This process involved collecting inputs from agency medical and IT management representatives and collecting EMR system implementation trends from the health care industry.

2. Conduct onsite reviews of existing technology infrastructure at each of the 43 sites selected for the assessment. These included 17 sites from DOC, 22 sites from DSHS, and 4 sites from DVA. Please see Table 5 on page 25 for a list of sites visited. The onsite reviews included a representative mix of sites from both western and eastern Washington. Within DSHS, there were multiple sites from the following administrations and divisions:

• Division of Developmental Disabilities / Residential Habilitation Centers (DDD/RHC);

• Health and Recovery Services Administration (HRSA);

• Juvenile Rehabilitation Administration (JRA); and

• Special Commitment Center (SCC).

Agency and site representatives participated in the setup and coordination of site visits, as well as the review and signoff of site evaluation report deliverables.

3. Conduct technical and financial analysis for all sites to develop recommended improvement actions and estimate the one-time and ongoing costs to implement those recommendations. Over one thousand recommended improvement actions across the 43 sites have resulted from the site visits. Each of these improvement actions has an estimated cost associated with it.

Throughout the project there was a need to assess technology infrastructure in the context of a future EMR application system. The project approach considered how medical care business drivers affect technology infrastructure requirements.

It is important to note that an EMR application system solution has not yet been defined or selected. As a result, Deloitte Consulting brought its experience and background knowledge on EMR system trends from the health care industry and gathered information on the status, needs, and direction of EMR initiatives within each agency and each site to develop baseline infrastructure requirements. Appendix A contains the EMR infrastructure requirements used in this project.

Infrastructure Assessment Results

The project has identified EMR technology infrastructure gaps between existing and necessary infrastructure in each of the following investment categories:

• Facility Modifications: Identified needs for minor facility build-outs to accommodate additional computer equipment, resolution of cooling issues, upgrades to uninterruptible power supplies (UPS), and additional physical enclosures for network equipment.


• Disaster Preparedness: Identified gaps primarily in the area of proper fire suppression in main computer rooms (MDF’s) and telecommunications closets (IDF’s).

• Cabling/Pathways: Identified needs for installation of new fiber cable between buildings, and new data drops to support new devices and access points.

• Wide Area Network (WAN) / Local Area Network (LAN): Highlighted needs for upgraded switches, upgraded WAN service, and equipment to support wireless solutions.

• User Devices: Identified necessary workstations, laptops, notebooks, etc. to support a future EMR solution, primarily to provide access to electronic information at or near the point of service.

• Printers/Scanners: Identified gaps in the area of networked multifunction devices that would be needed for EMR system printing, scanning, faxing, and copying.

The required levels of investment varied significantly between agencies and from site to site. Some sites required only minor modifications to support their future EMR needs while some required very large investments.

In addition to upgrading and adding to various types of existing infrastructure equipment, the project has identified numerous areas for which wireless solutions can augment existing wired LAN configurations to greatly enhance the productivity of EMR system end users. With the eventual elimination of the paper chart, access to the electronic medical records needs to be at or near the point of care to improve mobility and productivity of the end user. Appropriately placed wireless solutions provide that capability.

Special Notes on workstations and mobile devices: While over 1400 additional standard workstations were recommended across all 43 sites in the study, a significant majority of these (over 1000) were needed at DSHS DDD/RHC sites, which do not have up to date workstation technology to support a future EMR application. Approximately 350 new laptops, notebooks, and/or tablets were also recommended across the 43 sites.

The following chart shows the approximate number of medical/counseling care workstations and mobile devices that need to be replaced or added, relative to current device counts.

Workstations and Mobile Devices across all 43 sites

Existing Satisfactory Devices

Recommended # of Replacements

Recommended New Devices for EMR

Deployment

Standard Workstations 4740 1060 385

Mobile Devices (laptops,notebooks, tablets, etc.)

320 n/a 350

Cross-agency observations:

• Nearly all sites require additional workstations, data drops, and networked printers.

• Many sites require access points for wireless solutions and mobile devices.


• DOC is in better condition with respect to the local network at their sites, as much of the network infrastructure and switching equipment has been recently upgraded. At the same time, several older DOC sites had some of the most constrained work areas observed for medical workers.

• Several of the DSHS sites (most notably, Western State Hospital and Lakeland Village) have the greatest needs for fiber cable upgrades to their local networks.

• While there were few major differences between sites as a function of geography, any site which was extremely remote from a city typically had very limited options for WAN service. An example is DOC’s Clallam Bay Corrections Center (CC).

• There are several large “big ticket” capital projects that are necessary to meet some of the EMR system requirements such as:

1. Network re-designs and/or network fiber implementation at Western State Hospital, Lakeland Village, McNeil Island CC, and SCC.

2. Electric power system upgrades at McNeil Island CC, Special Commitment Center (SCC), Rainier School, Fircrest, Lakeland Village, Eastern State Hospital, Naselle Youth Camp, and Washington Corrections Center.

3. Wireless solution implementation for new and existing buildings at multiple sites within ten sites at DOC, eighteen sites at DSHS and two sites at DVA.

The details of the recommended improvements for each site are contained in the 43 site evaluation reports that were completed during the site evaluation stage of the project. These reports have been posted to the project SharePoint site http://sharepoint.dis.wa.gov/mrtg/, delivered to DIS, and are included in this report as Appendix B.

The estimated costs for implementing improvements are contained in Appendix C – MRTG Financial Cost Model Output. These cost estimates are presented at the site level and at the agency level and are grouped according to one-time and ongoing annual costs. As noted earlier, there are over one thousand recommended actions for which pricing estimates have been developed.

The detailed analysis supporting these cost estimates are included in the Excel-based MRTG Cost Model that is maintained by DIS. At this most detailed level, the MRTG Excel-based Cost Model specifies the costs for recommendations by site, building, and where appropriate, the room where the items are to be implemented. The data in the financial cost model corresponds directly to the actions to close infrastructure gaps recommended in the site evaluation reports.

http://sharepoint.dis.wa.gov/mrtg/�


Cost Analysis Results

The estimated costs to resolve identified infrastructure gaps by Agency in 2008 dollars

Table 1. Estimated One-Time Infrastructure Costs (2008 dollars)

are presented in the two tables that follow. Table 1 shows one-time infrastructure costs, and Table 2 shows ongoing annual costs and additional FTEs. As described in detail below, there are investments that can be made before an EMR system is selected and those that should be made after an EMR system is selected.

| ---------- Breakdown of Best Estimate ----------------|

Best Estimate Description:

The column titled “Best Estimate” depicts the summary of the best approximation of costs (in 2008 dollars) for all recommended items with an uncertainty factor applied. Since all participants on the project agree that there are uncertainties associated with most recommended items and actions, the project has applied an uncertainty factor for all items. This uncertainty factor is only 5-10% higher than the initial base for well-understood commodity items such as workstation personal computers (PCs) and can be up to 35-45% higher for actions that are difficult to quantify such as the installation of additional fiber cable or the major upgrading of an electrical subsystem for an entire facility. Breakdown of Best Estimate for One-Time Costs: The two columns on the right of Table 1 show a breakdown of the best estimate column for one-time costs. Before System Selection (One-Time): This column contains costs for investments that can be made before an EMR system is selected. These include electrical subsystems, fire protection, cooling, and selected LAN and WAN upgrades. After System Selection (One-Time): This column contains costs for investments that should be made after an EMR system is selected. These include wireless solutions, data drops, build outs, and remaining LAN and WAN upgrades.

One - Time Costs By Agency

Best Estimate Before System Selection

After System Selection

DOC $ 7.452 million $ 2.501 million $ 4.951 million

DSHS $20.352 million $ 7.311 million $13.041 million

DVA $ 0.922 million $ 0.305 million $ 0.616 million

Total $28.726 million $10.117 million $18.609 million


Table 2. Estimated Annual Ongoing Infrastructure Costs (2008 dollars) | ------ Breakdown of Best Estimate ---------|

Best Estimate Description: This column has the same definition as for Table 1, but for ongoing costs.

Breakdown of Best Estimate for Ongoing Costs: The third and fourth columns of Table 2 show a breakdown of the best estimate column for ongoing costs. Before System Selection (Ongoing): This column contains ongoing costs for investments that can be made before an EMR system is selected. These include new workstations for sites needing refresh programs, the ongoing maintenance for purchased items, and FTE costs to support this first set of infrastructure investments. After System Selection (Ongoing): This column contains ongoing costs for investments that should be made after an EMR system is selected. These include costs for additional leased equipment (workstations, printers, and mobile devices), the ongoing maintenance for purchased items, and costs for the full complement of additional FTEs to support EMR-specific infrastructure.

Additional FTEs: This column indicates the estimated number of additional infrastructure support staff needed solely for the support of a new EMR system, due to new technology requiring new skills, and higher EMR system availability and responsiveness requirements. The indicated number of additional FTEs represents the full complement of additional FTEs needed by the time of system implementation. The need for additional FTEs is affected by the changes to the overall infrastructure landscape that come with a new EMR system, as well by increased security and legal requirements for EMR. These FTEs can be phased in on an as needed basis, based on when new EMR infrastructure is introduced.

Ongoing Costs (Annual) By Agency

Best Estimate

Before System Selection

After System Selection

Additional FTEs

DOC $ 0.966 million $ 0.104 million $ 0.966 million 2

DSHS $ 4.300 million $ 1.500 million $ 4.300 million 13

DVA $ 0.364 million $ 0.104 million $ 0.364 million 2

Total $ 5.630 million $ 1.708 million $ 5.630 million 17


Example of Annual Costs with Inflation Adjustment included

An illustration of how these costs could occur by year is presented in Table 3 and Table 4.

The tables assume that funding for the project becomes available in FY10, a system is selected by the end of FY10, and appropriate one-time costs would be invested in FY10 and FY11. The one-time investments could be estimated as follows for FY10 – FY12.

Table 3. Estimated One-Time Infrastructure Costs by Year (escalated for inflation from 2008 base)

|-------- Before System Selection ------ | --------- After System Selection --------------------------------|

Notes: These estimates represent the net additional expense (in addition to the current IT infrastructure budgets) to support necessary EMR infrastructure and correspond to the Best Estimates in the project cost analysis. These estimates include a 5% annual inflation factor and are a function of base 2008 Best Estimates. The financial estimates in this example assume that the necessary infrastructure investments that are independent of which EMR solution is selected can proceed as soon as funding is available (in FY10) and that after an EMR system solution is selected, the remaining one-time investments can proceed (in FY11).

Table 4. Estimated Annual Ongoing Infrastructure Costs by Year (2008 dollars adjusted for inflation)

|---- Before System Selection ---- | --------- After System Selection -------------------------------|

Table 4 presents the estimated annual ongoing costs by fiscal year. To reiterate, the financial estimates in the example above assume that certain specific ongoing costs not dependent on which EMR solution is selected can proceed as soon as funding is available in FY10. After an EMR system solution is selected the remaining ongoing costs can ramp up to a full level in FY11.

Additional notes and assumptions for Table 3 and Table 4:

• Ongoing costs include the cost for additional FTEs.

$ 6.517 $ 6.207 $ 1.793 Total

$ 0.421 $ 0.401 $ 0.109 DVA

$ 4.978 $ 4.741 $ 1.575 DSHS

$ 1.118 $ 1.065 $ 0.109 DOC

FY12 FY11 FY10 Annual Ongoing Costs (millions)

One - Time Costs (millions) FY10 FY11 FY12

DOC $ 2.626 $ 5.459 n/a

DSHS $ 7.676 $ 14.378 n/a

DVA $ 0.320 $ 0.680 n/a

Total $10.622 $ 20.517 n/a


• These estimates include sales tax.

• System selection would need to be complete by the end of FY10 with initial operational implementations beginning in FY12.

• Investments in one-time costs would be complete by the end of FY11.

• Inflation costs would increase with budgeting delays.

Conclusions

In summary, nearly all sites require additional workstations, data drops, and networked printers. Many sites require access points for wireless solutions and mobile devices. It should be noted that there are some infrastructural characteristics that are in fairly decent shape, and require little or no change. For example, at most DOC sites, DOC’s local network infrastructure and switching equipment have recently been upgraded.

There is one agency administration that appears to be severely lacking proper IT funding. DSHS’s DDD/RHCs have had little formal IT budget at all, and often work with surplus IT inventory that is 5-8 years old. As well as introducing new equipment, our recommendations stress that the replacement equipment needs to be placed into a formal refresh plan.

Within many sites, the placement and use of workstations, laptops, and other mobile devices is restricted by the types of patients, inmates, residents and clients who may be near the workstations and devices. Additional security, or removal of mobile devices from open areas, is often required. For example, for DSHS mental health facilities, based on “close observation” policies requiring eye-to eye contact, use of mobile devices may be restricted.

As noted earlier, there are several large “big-ticket” capital projects that are necessary to meet some of the EMR system requirements. These include:

• McNeil Island CC and SCC: electric power remediation and network fiber implementation.

• Wireless solution implementation for new and existing buildings (multiple sites).

• Rainier School electric power distribution upgrade.

• Western State Hospital network re-design and implementation.

• Fircrest electric power distribution and backup generation upgrade.

• Lakeland Village south campus electric distribution upgrade.

• Lakeland Village fiber network upgrade.

• Eastern State Hospital power system upgrades.

• Naselle Youth Camp electric system upgrades.

• Washington CC (Shelton) electric system upgrades.


Network

Most sites have moderate to high standards for fiber and UTP cabling, but some exceptional challenges exist at Western State Hospital and Lakeland Village. These sites either don’t have sufficient fiber cabling between their MDF and IDFs or have inappropriate fiber cabling such as one single connection to stacked workgroup switches. Nearly all sites require expansion of existing cabling to support a future EMR system, in terms of additional data drops in certain areas and/or power lines to support wireless networks. Recommended data drops will support additional multifunction devices and workstations.

The general network architecture of the agencies evaluated does not provide the highest availability levels, due to lack of redundancy in the LAN and WAN. Some of the sites need upgrades on network hardware and WAN bandwidth because their existing network hardware is too outdated to support a future EMR system.

Wireless networks have generally not been allowed thus far in any sites due to security concerns. New security standards that address wireless networks are in development by staff to the Information Services Board. These updated standards will apply when infrastructure purchases begin.

Less tangible gaps related to network management and operational processes exist:

• Knowledge Sharing: Improved knowledge sharing of current network status between agencies’ headquarters and sites would improve the management and availability of the future EMR system.

• Documentation: Some of the sites have insufficient documentation standards for cabling and network architecture.

• Network architecture: Each agency can improve its network architecture to achieve a more stable, robust and secure network. For example, current network security depends on firewalls and user level security features such as anti-virus software. Through advances in network level security design, network security could be stronger for a future EMR system by implementing features such as virtual separation of EMR users.

• Network Management System: Although each agency has a certain degree of Network Management capability (such as DOC’s SolarWinds and DSHS’s Orion), and each agency supports its sites with WAN monitoring, most larger sites will need more effective LAN and system level monitoring services for EMR.

• Quality of Service (QoS): DIS has a plan for QoS implementation. The importance of QoS comes from providing adequate controls that support multiple traffic types (voice, video and data) across the shared State Enterprise Network.

Workspace

Limitations in physical space are a big concern for many facilities. Some facilities have converted a storage room to an office, utilized an office divider to create a work space, or used a closet as a medication station.

Space limitations for some DOC and some DSHS facilities are more serious because those facilities do not have flexibility to place those devices in an open area, due to security reasons.

Desktop infrastructure

In general, there are not enough user devices in locations where the future EMR system will be utilized, such as exam rooms, patient rooms, and nurse stations.


Particularly for DDD/RHC facilities, most currently deployed desktop PCs are not capable of supporting a modern EMR system.

Printers/Scanners

The current number of networked printers would not likely support the future workflow with a modern clinical system. Printing devices are an essential part of an EMR system as there is a transitional period where both paper and electronic medical records exist. Not having enough networked printers could lead to an ineffective workflow.

Most facilities have very limited or no scanning capability, which will become important once computerized charting is implemented. They will be used to scan items such as insurance cards and external documentation into the EMR system.

Additional Notes on Current Systems

It should be noted that several sites have implemented some automated tools and mechanisms for tracking medical record information. For example, the following software and tools are used in multiple locations:

• VistA/Cache

• Worx (Mediware)

• Medimar

• Therap

• Customized access databases

Some sites or agencies will be ready to embrace an EMR solution as soon as possible (such as many DOC sites and Eastern State Hospital). Other sites/agencies need to be brought up to a basic level of infrastructure readiness over the next 2-3 years, and need to improve the technology process, management, training, and comfort level of their end user staff. The apparent imbalance of IT funding across different agencies may need to be addressed when funding EMR infrastructure technology.


Recommendations

It is logical to proceed as soon as possible with those investments that are required and independent of the EMR system solution that is selected. These investments are absolutely necessary for a reliable and available EMR system, but are also necessary for the existing technology environments at the sites. These include:

• Existing workstations needing refresh programs: These are required primarily at the DDD/RHC sites Lakeland Village, Fircrest, Rainier School, Yakima Valley, and Frances Haddon Morgan Center.

• Electrical subsystems: Improvements in this area are required at Eastern State Hospital, Fircrest, Lakeland Village, McNeil Island CC, Naselle Youth Camp, Rainier School, Special Commitment Center, Washington Corrections Center – Shelton, and Yakima Valley.

• Fire protection: Fire protection improvements are needed at nearly all sites.

• Cooling: Air conditioning or ventilation improvements are needed at nearly half (17 of 43) of the sites evaluated.

• Selected LAN upgrades (such as new fiber cable installation): The most significant LAN upgrades involve new fiber cable installation necessary at Western State Hospital, Lakeland Village, and the Child Study Treatment Center.

• Selected WAN service upgrades (if current service is already saturated): Upgrades to WAN service are recommended at nearly half (16 of 43) of the sites evaluated, but only those sites that currently – or soon expect to – experience saturated WAN bandwidth should upgrade in the near term. The remainder of the recommended WAN service upgrades are needed to support a future EMR system.

• Initial FTEs to support the EMR infrastructure at selected locations.

It is also logical to defer investments that depend on the chosen EMR system solution until the system is selected. It would be premature to fully define all devices needed for the future EMR system and it would represent an expense that is “too early” if such equipment and devices were installed more than a year before they are needed for a production implementation. Such investments to defer include:

• Additional workstations needed for EMR;

• Networked printers;

• Mobile devices;

• Data drops;

• Wireless solutions;

• Facility modifications;

• Remaining LAN upgrades (such as upgraded backbone and workgroup switches);


• Remaining WAN service upgrades (not needed now, but necessary prior to EMR implementation); and

• Remaining complement of technical staff needed specifically to support infrastructure an EMR system requires.

An important reason for deferring acquisition/implementation of many items such as mobile devices, wireless solutions, and many new workstations is that requirements cannot be clearly defined until EMR workflow studies based on the selected EMR solution are conducted.

For those investments that are independent of the selected EMR system solution a plan for purchasing and implementation should begin as soon as possible.

Network

The specific network recommendations made for the sites evaluated in this study are summarized as follows:

• Additional fiber cabling, data drops and/or power cabling are recommended at most sites to support future EMR system requirements.

• Through the addition of redundant backbone switches, LAN redundancy is recommended for Western State Hospital and Eastern State Hospital, due to their higher volume and more intense medical and counseling services.

• Network hardware upgrades (Backbone/Workgroup Switches) are recommended for some DSHS and DVA sites because their network hardware may be incapable of supporting an advanced EMR system.

• WAN upgrades and redundant WAN connections are recommended for numerous sites, based on expected bandwidth requirements for an EMR system.

• Wireless network solutions (along with wireless network security measures) are recommended to improve medical staff’s efficiency with an EMR system, and to overcome physical workspace constraints.

Specific Workspace, Desktop, and Print Recommendations

The workspace, desktop, and print recommendations made for the sites evaluated in this study are summarized as follows.

Workspace

For all facilities, a follow-up study needs to be conducted to promote effective access to electronic records on patient condition, completed diagnostic test results, and other information from the patient care teams, due to the unique nature of patient demographics and the workspace environment. It is important to keep in mind that with EMR dependency on paper forms will gradually decline.

Desktop and mobile device infrastructure

The recommendations of this report provide for the following changes:


• Increase the number of workstations/mobile user devices to support computerized clinical documentation, especially in areas where care is provided and in locations where charts are currently being documented.

• Plan to have all clinical workstations put on lease programs to support future clinical systems.

• Standardize and involve clinicians to select end-user device types and access locations.

• Develop policies and procedures to specify locations of mobile devices when not in use.

Printers/Scanners

Multi-function devices, which combine the capabilities of a laser printer, fax machine, copy machine, and scanner into a single device, are recommended to nearly all facilities. Based on Deloitte’s experience, the ratio of workstations to networked printing devices should be in the 6:1 to 9:1 range to support optimal operations.

The details of the specific recommendations made for each site can be found in the MRTG Site Evaluation Reports. Estimated costs for implementing these recommendations can be found in Appendix C - MRTG Financial Cost Model Output.


SECTION II: SUPPORTING DETAIL

This section of the report provides additional details on the approach, assumptions, requirements, and analysis that form the basis for this report.

The materials contained in this section focus on the details behind the approach, infrastructure assessment results, and cost analysis results highlighted in Section I - Project Conclusions and Recommendations.

In this section the project approach is further described with added details on the conditions and assumptions underlying the analysis, as well as documentation on the identification of infrastructure requirements.

Infrastructure assessment topics are addressed in the same sequence as in Section I. After a general discussion of facilities needs such as build-outs, electrical, and fire suppression changes, there are specific discussions on network topics including cabling, pathways, and WAN/LAN, user devices such as desktop and mobile devices, and printing/scanning devices.

Section II is completed with a more in-depth discussion and presentation of the cost analysis results.

The relationship between the detailed material in this section and the summary material in Section I is summarized in the following chart:

Section I – Project Summary

Section II – Supporting Details

Approach • Approach • Key Conditions and Assumptions • Infrastructure Requirements

Infrastructure Assessment Results • Analysis of Site Visits

- Facilities Modifications - Disaster Preparedness - Cabling/Pathways - WAN/LAN - User Devices - Printing/Scanning

Cost Analysis Results • Cost Analysis Conditions and Assumptions

• Cost Estimates to Close Gaps • One-Time Costs • Ongoing Annual Costs • Site Level Costs


Approach

The approach to determining the infrastructural requirements for a future EMR system (which has not been selected) was based on:

• Inputs from agency medical and business representatives;

• Information on EMR system implementation trends and typical EMR system vendor requirements, from Deloitte industry sources and other industry sources; and

• A compilation of technical infrastructure requirements representing known needs of the agencies and sites, and EMR system and industry trends for advanced EMR systems.

The following chart presents the approach and flow of activities that guided the execution of this project:

MRTG Approach Summary

Inf rastructuralFunctional:Electronic Medical

Record for:-- Charting-- Counseling

Appts / SchedulingTicklersAncillary IntegrationDigitized ImagingAccess

Mobile Functionality

Non-Functional:Physical FacilityAvailabilitySecurityPerformanceInteroperability/

IntegrationSupportabilityAccessPortability/Mobility

Physical Site Physical Site No UPS Add UPS $ 40k

Network Network Wired, but need more access points

Add more data drops and access points

$ 75k

Servers Servers No server management sof tware

Install server management sof tware

$ 15k

Workstations Workstations Workstations are outdated

Lease 30 new Lease: $ 600/yr * 30 = $18k/yr

Business/Medical Printers Printers Lack of TCP/IP networking capability

Replace 5 printers with advanced multifunction ptrs

$ 4k/yr * 5 = $ 20k/yr

Scanners Scanners Not TWAIN compliant

Replace 5 scanners

$ 2k*5 = $10 k

Security Security Meets Req N/A N/A

Other:IT StandardsSupportPersonnel

Assumptions

Disaster Recovery Disaster Recovery Fire suppression inadequate

Install f ire suppression system

$ 35k

Storage Storage Meets Req N/A N/A

Questions GeneralRequirements

InfrastructureRequirements

ObservationsIn Field

Gap (site evalreport)

Required Action(site eval report)

Cost by site(final cost model)

As indicated in this approach summary chart, the identified technical infrastructure requirements served as the basis upon which the site evaluations were conducted. If there were no gaps in certain areas, this was so noted in the site evaluation report, and no recommendations were made. When gaps were identified, they were documented along with a proposed recommendation to resolve the gap. In the final stage of the project, costs associated with the recommendations were developed, and overall investment requirements were tallied up.


Key Conditions and Assumptions

Any planning project of this size and complexity will naturally need to have a collection of conditions and assumptions upon which the analysis is based. This section presents the key conditions and assumptions that underlie the analysis contained in this report. Conditions and assumptions include the following:

• The EMR system will be remotely hosted (from the site’s perspective). The project team was asked to assess if any of the reviewed sites’ facilities were potential hosting sites. In general, there were no viable hosting sites among the sites reviewed, so it is very likely that the EMR solution will be remotely hosted (either by a state data center or by a vendor data center).

• For the gap analysis, higher-end advanced capabilities are being pursued for all sites, and then will be selectively pared back on an exception basis. This was done so as to not undercut or underestimate the needs at any site.

• New medical clinics planned for construction or remodel (such as at WCCW Purdy, Monroe CC, WCC Shelton, Maple Lane JRA, and Green Hill School JRA) will have standard data wiring but do not have wireless solutions included in their designs and budgets, except for the Washington State Penitentiary.

• Wherever possible state contract pricing on listed items, and price estimates that were provided by the agencies, have been used for financial estimates. Otherwise, industry standard pricing has been used.

• Software directly related to the management of infrastructure has been addressed in this project.

• WAN bandwidth requirements, analysis, and upgrade recommendations assume typical EMR system bandwidth requirements observed in industry.

• Minor facilities changes to accommodate additional EMR infrastructure equipment (such as the expansion of a room and the building of secure cabinets or enclosures for switches) were in scope for this project.

• The analysis is based on observations of current conditions and known planned changes at facilities.

• Some gaps identified in this report are already being addressed by the agencies (such as DOC’s multifunction printer replacement project).

• Recommended wireless solutions will meet DIS, ISB, and agency standards for wireless security.

• Recommended wireless solutions will, in general, not require Power over Ethernet (PoE) equipment (there are a limited number of exceptions where PoE is proposed because running additional power cabling was cost prohibitive).

• Additional workflow analysis will need to be conducted at the EMR system implementation sites.

• System availability requirements take into consideration the necessary medical service levels of each site. In general, large medical sites with 7x24 clinical and counseling care will


require higher levels of availability than a small community facility with no direct medical care.

• Infrastructural Requirements have been established before the functionality of the EMR system has been defined, and before the EMR system has been selected.

• The types of mobile devices selected for a specific EMR system implementation will be refined more precisely after the EMR system selection and workflow research is underway.

Other Factors Affecting Infrastructure Estimates

This is a pre-design exercise that has been done prior to the EMR system selection. As such, it would be premature to acquire many of the recommended items one or two years before system selection (and three years before system implementation).

This analysis represents a “point in time” study involving individual site visits that spanned a 1-2 day time period at most sites. At numerous facilities, it was noted that the purpose and usage of a particular building, floor, or room was potentially changing in the future. The project team made every attempt to evaluate needs for the future. However, not all anticipated changes may occur.

There are additional activities to complete or fine tune before some recommendations are pursued and before certain equipment is acquired such as:

• Electrical upgrades before significant network upgrades (at certain sites);

• EMR system selection before finalizing wireless solution and mobile device selection; and

• Standard workstation upgrades and refresh programs before EMR testing (at certain sites).

A phased-in implementation should be considered, given the lack of readiness at some sites. Sites with a technically savvy user population that already embraces EMR concepts would be the logical candidates for early EMR adoption and implementation. It would be risky to first attempt an early, full implementation of an EMR solution at a site which has relatively unsophisticated technology users.


Infrastructure Requirements

Definition of Infrastructure Requirements

Infrastructure Requirements identified during this project fall into the following “investment” categories:

• Facility Modifications;

• Disaster Preparedness;

• Servers (for potential hosting sites);

• Cabling/Pathways;

• WAN/LAN;

• User Devices; and

• Printers/Scanners.

Wherever possible, the resolution of a need (or gap) is associated with a specific quantifiable upgrade, acquisition, and/or installation of items, assigned to one of the categories above.

The following templates illustrate the way in which the project documented infrastructure requirements by investment category, and how the observations and gaps were documented during the site visits.


Template 1, titled “INFRASTRUCTURE REQUIREMENTS TEMPLATE”, shows an extract of infrastructure requirements in the network cabling, pathways, and WAN/LAN investment categories.

Template 1. Infrastructure Requirements Template (extract)

Investment Category Requirements

Cabling / Pathways

H. The telecommunications network pathways between the Server Room and the medical service buildings should be able to accommodate updated cabling

1 Conduits should be accessible, serviceable, and able to accommodate updated cabling; Otherwise, alternate conduit paths may be necessary

Cabling / Pathways

I. The LAN (Local Area Network) and WAN (Wide Area Network) equipment at the site should be serviceable and maintainable

1 There should be straightforward access to network drops (such as via rack-mounted patch panels)

2 Telecommunications vaults should be accessible, and their contents should be well-documented

WAN / LAN J. The LAN (Local Area Network) and WAN (Wide Area Network) supporting each site should ensure the appropriate performance and availability level of the EMR system

1 There are sufficient data drops in appropriate locations

2 LAN architecture and cable infrastructure should be scalable

3 LAN utilization level should not exceed vendors recommendation

4 LAN infrastructure should have fault tolerance and redundancy

5 LAN devices should be sufficiently sized such that they can support increase of Workstation and other EMR devices

6 WAN utilization level should not exceed 60% (Average) which is industry standard

7 WAN infrastructure should have redundancy and carrier diversity

8 QoS should be implemented to ensure EMR application performance

9 Network monitoring system should be utilized to track availability and performance of network

10 LAN should be minimum CAT5 cabling, and 100mb capability.

The entire infrastructure requirements template is presented in Appendix A.


Template 2, titled “SITE EVALUATION REPORT TEMPLATE”, shows a representative extract of observations, gap identifications, and potential recommendations that resulted from a site visit. Template 2. Site Evaluation Report Template (Representative Extract)

Investment Category Requirements Observations Gap Score

(0 - 4) Recommendation

Cabling / Pathways


3

1

Conduits should be accessible, serviceable, and able to accommodate updated cabling; Otherwise, alternate conduit paths may be necessary

Conduits in good shape and have room to add more cabling in MDF The electrical room in Building 10 has limited space for an additional cabling

The electrical room in Building 10 cannot accommodate more cabling

3 The electrical room in Building 10 needs to be redesigned to accommodate more cablings for future expansion (also refer to section A above)

Cabling / Pathways


1

There should be straightforward access to network drops (such as via rack-mounted patch panels)

New building is all equipped with patch panels The electrical room in Building 10 does not have patch panels and cables are directory connected to a switch

No straightforward access to network drops for the electrical room in Building 10

3 Recommend to install a rack-mounted patch panel (also refer to Section A)

2

Telecommunications vaults should be accessible, and their contents should be well-documented

Primary man-hole --- near the main road; repairs done in 2005, somewhat messy, but serviceable

None 4 None

WAN / LAN

J. The LAN (Local Area Network) and WAN (Wide Area Network) supporting each site should ensure the appropriate performance and availability level of the EMR system

No function based VLAN nor Network Access Control are implemented at this site

Recommend to implement function based VLAN and Network Access Control to reduce IS Services staff involvement and maintain or enhance Network Security.


No issues are found in new building Nursing station in Building 10 has only 2 data ports with substandard wiring (network drop is on a pole next to desk being exposed)

Network wiring needs to be redone at Nursing station in Building 10 There are only 2 data ports. Usage level of workstation is expected to increase with the future EMR 3 or more data ports will be necessary to support 2 workstations and 1 network printer or multi-function device

3 Make appropriate IDF room for building 10 and implement rack mounted patch panels Improve data drops in Bldg 10 to support workstation and printer Add at least 3 or more data drop in the nursing station on the first floor. Consider making similar modifications to the nursing station on the second floor if it will be utilized in the future.


Backbone switch is small size site grade, low end model

Need more robust, function rich medium size site grade Backbone switch

2 Upgrade Backbone switch

Completed site evaluation reports are provided on the CD included in Appendix B.


Analysis of Site Visits

This table lists all sites for which onsite evaluations were conducted during the project. Table 5. Sites Analyzed in the MRTG project

AGENCY ADMINISTRATION/ DIVISION SITE NAME

DOC Ahtanum View CC Airway Heights CC Cedar Creek CC Clallam Bay CC Coyote Ridge CC Larch CC McNeil Island CC Monroe CC Olympic CC Pine Lodge CC for Women Rap/Lincoln Seattle Community Justice Center Stafford Creek CC Washington CC for Women WCC Shelton WCCW Mission Creek Washington State Penitentiary DSHS DDD/RHC Fircrest DDD/RHC Frances Haddon Morgan Center DDD/RHC Lakeland Village DDD/RHC Rainier School DDD/RHC Yakima Valley School HRSA Child Study and Treatment Center HRSA Eastern State Hospital HRSA Western State Hospital JRA Camp Outlook (Basic Training Camp) JRA Canyon View Community Facility JRA Echo Glen Children's Center JRA Green Hill School JRA Maple Lane School JRA Naselle Youth Camp JRA Oakridge Community Facility JRA Parke Creek Community Facility JRA Ridgeview Community Facility JRA Twin Rivers Community Facility JRA Woodinville Community Facility SCC Secure Community Transition Facility - King SCC Secure Community Transition Facility - Pierce SCC Special Commitment Center DVA Spokane Veterans Home Washington Soldiers Home & Colony Washington Veterans Home Central Office – WDVA


Analysis of Site Visits: Technical Gap Identification

Technical gaps have been identified in all investment categories evaluated during the assessment project. Over 1,000 recommended activities are noted in the site reports and are included in the cost estimates for gap resolution and these cost estimates have been incorporated into the MRTG Financial Cost Model. An overview of the gaps identified will now be provided. Investment categories used in this assessment are facility modifications, disaster preparedness, cabling/pathways, WAN/LAN, user devices, and printers/scanners.

Analysis of Site Visits: Technical Gap Identification – Key Observations & Recommendations

Facility Modifications

Numerous sites have medical workspace area or IT facility gaps. Examples of these types of gaps are: limited medical workspace areas, inappropriate IDF locations and space, insufficient HVAC systems in MDF’s or IDF’s, UPS weaknesses, and a few minor gaps related to physical security.

Facility modifications recommended to support a future EMR system typically have been made to provide more reasonable workspace into which EMR-related devices and workers can be located. (Note: When workspace and facility constraints existed, the project team also considered smaller mobile devices such as notebooks or PDAs when such an option was more economically viable than build-out construction.)

Types of facility modifications recommended include the following:

• Build-outs were recommended when additional end user devices were needed in specific areas, and there were no reasonable areas in which the devices could be placed, stored, and/or protected. While most build-outs are relatively small (<200 square feet), a small number are larger, with the largest being a build-out needed at the Monroe CC Minimum Security Unit (MSU), and several moderate sized build-outs at WCC-Shelton.

• Some of the build-outs are for IDF construction, such as at the Green Hill School (Z building IDF), or for MDF modifications such as the Canyon View Network Closet Relocation.

• Some of the sites have inappropriate locations or limited space for IDF’s. (Such as Canyon View Community Facility and the Green Hill School).

• For MDF’s and IDF’s that had cooling issues, improved air conditioning or venting was recommended.

• Numerous IDF’s (most frequently within DSHS and DVA) require modest sized UPS devices to ensure continuous electric power to switches.

• A wide variety of minor modifications, such as small cabinets to enclose equipment, and strengthening of doors and windows for MDF’s and IDF’s were noted in the recommendations.

Disaster Preparedness

Disaster Preparedness relates to the mechanisms in place to control the effects of disruptions due to man-made or natural disasters. The most common gap in this category was the lack of proper fire suppression devices in MDF’s and IDF’s. These rooms often had only fire sprinkler systems, which would be damaging to computing equipment if they were activated.


In general, most MDF’s were in need of a robust gas-based fire suppression system. For those MDF’s, an FM200 system was recommended. Note: several DOC sites already have an FM200 system or plan to implement the system soon (such as Monroe CC, Stafford Creek CC, and Clallam Bay CC). FM200 system installation requires MDF room modification in most cases, because gases should be sealed and kept inside of the MDF room to effectively suppress fire.

Most IDF’s had either water fire suppression or no fire suppression at all. For these, the general recommendation was to add fire extinguishers.

The project team did request documentation on formal disaster recovery plans from the sites. However, fewer than five sites actually provided documentation on, or references to, a formal disaster recovery plan for their site. (The most comprehensive local disaster recovery plan was provided by the Fircrest RHC).

Cabling/Pathways

Cabling/Pathways refer to the physical connections between network devices at a site, and include fiber cabling between buildings, CAT5/CAT6 data cabling to user devices, and power cabling that may be needed to support wireless access points. Also included in this investment category are any necessary new pathways to house the cabling, such as new conduits and/or trenching.

The types of cabling/pathway gaps that were identified include the need for installation of new data cabling to support existing and new devices, power and data cabling to support wireless solutions, patch panels in MDF rooms, and miscellaneous small additions of electrical outlets. The most significant improvements to make in this area are:

• The installation of new fiber cable to better support the availability and reliability of network connections to multiple buildings (major investments required at Lakeland Village, Western State Hospital, and the Child Study Treatment Center (CSTC)). Some of these new fiber cable installations require new trenching/pathways, but wherever the existing trench/pathways are available for new fiber cable, utilization of the existing pathway has been recommended.

• Power cabling to support wireless solutions – recommended wherever Power over Ethernet (PoE) is not recommended.

• Additional data drops to provide access to new devices and to wireless access points.

It was clearly noted during site evaluations that the degree of difficulty (and cost) of installing new fiber cable, power cabling, and data drops varies widely from site to site. Installations in wooden buildings in low security facilities are significantly easier than those cabling installations in hardened buildings in high security settings. The levels of difficulty and cost differences have been incorporated into the MRTG Financial Cost Model Output.

WAN/LAN

A wide variety of WAN/LAN gaps have been identified and improvements have been recommended during this study. The purpose of identifying gaps and making recommendations to close the gaps is to ensure an appropriate level of performance and availability for the EMR system. At the same time, new technology such as wireless networking has been recommended to help medical staff provide services more efficiently. Types of WAN/LAN improvements actions include:

• Add new or upgraded backbone or workgroup switches for sites with insufficient network hardware capabilities and power.


• Upgrade WAN service by:

1. Installing 10 MB service for large and very large sites;

2. Adding additional T-1 service to provide 2 X T1 for large sites; or

3. Upgrading to T1 service for small and medium sized sites. More details of this WAN upgrade are explained in the next section “Additional Analysis – WAN”, page 29.

• Introduce 10MB service if T1 or 2 X T1 service cost was similar to 10MB service. In situations where the cost for a specific WAN service is unreasonably high due to geographic location (such as 10 MB service for Clallam Bay CC), the next most reasonable level of service has been selected.

• Add wireless access points for wireless solutions. Wireless solutions will provide the network connectivity either where the wired network is not available such as high security level areas of DOC’s SEG units, or where medical staff needs mobility to keep medical record charts updated.

• Introduce wireless controllers, firewalls, and intrusion detection devices to support wireless solutions to conform to DIS ISB and agency specific security standards, as wireless technologies continue to evolve.

User Devices

Gaps in the area of necessary EMR user devices (workstations, laptops, notebooks, tablets, PDA’s) were identified in situations where access to electronic medical record information will be necessary, but an adequate user device is not available in a particular location or setting. Put simply, the user device needs to be where the EMR user will be recording or viewing medical information.

Standard workstations were recommended in a variety of locations where charting is typically done, such as in nursing stations, exam rooms, med rooms, and pill dispensing rooms.

Mobile devices were recommended in areas where EMR users require mobility and portability for their electronic access. Most recommendations for mobile devices were accompanied by proposed wireless solutions for appropriate locations within the particular site.

The number of additional user devices required varied significantly from site to site:

• While over 1400 additional workstations were recommended across all 43 sites in the study, a significant majority of these (approximately 1000) were needed at DDD/RHC sites, which do not have sufficiently up to date workstation technology to support a future EMR application.

• Additionally, over 350 new laptops, notebooks, and/or tablets were recommended, for future EMR use at over half of the sites evaluated, and a relatively small number of PDA’s were recommended at selected sites.

Printers/Scanners

Nearly all sites had EMR-related gaps in the areas of needed networked printers and scanners. Additional networked multifunction devices have been identified in the recommendations, to support a variety of typical


EMR needs in the future such as networked printing, copying, scanning, and faxing. As a general rule, there should be one shared printer for every 6-9 workstations. This can be dependent on usage and workflow.

The current DOC project of updating printers to multifunction devices was taken into consideration, to avoid duplication. If it was fairly certain that upgraded multifunction devices were about to be implemented at a site, these acquisitions were not recommended in the MRTG site evaluation reports.

Another general recommendation was to minimize or progressively eliminate many desktop printers where appropriate, and replace them with networked multifunction devices. An example of where an overuse of standalone desktop printers was prevalent was at Eastern State Hospital, in the Medical Records Department.

Analysis of Site Visits: Additional Analysis - WAN

WAN Bandwidth Requirements

The project team has developed rough approximations of WAN requirements of a future EMR system. WAN bandwidth affects application performance and the effectiveness of EMR user operations.

EMR systems typically require relatively moderate to high levels of network bandwidth in comparison to other applications, because of large amounts of historical medical record data and current trends of merging multimedia data such as X-Ray images into the application. Clearly, these requirements can vary depending on the EMR solution selected and the features chosen for use. A simple model, similar to those used by EMR system vendors for preliminary WAN bandwidth estimation, assumes that major predictors of bandwidth usage are:

• Number of users;

• Types of users;

- Clinical User Type A: Doctors, psychologists, psychiatrists, counselors

- Clinical User Type B: Nurses, medical assistants

- Back Office User: Administrative assistants, billing, medical records staff

• Number of concurrent users during busy hours;

• Number of printers and the amount of printing; and

• Degree of image processing.

WAN Bandwidth Estimation by Site Category

Initial required bandwidth estimations can be drawn from Table 6 on Bandwidth Requirements, based on user types, printer counts, and size category of site.

The estimated bandwidth requirement is only for EMR application usage. The bandwidth for other applications such as Email and agency specific business applications has to be taken into consideration to select appropriate total WAN service.

The recommended average WAN bandwidth utilization rate by industry standards is no more than 60% of total bandwidth. Therefore, the desired WAN service for a 6,000 Kbits/sec (6Mbits/sec) total bandwidth requirement would be 10MB Ethernet service.


Table 6. Bandwidth requirement estimates by site category

Categorization of Sites

Based on the approximate number of users in user type groups, number of printers, frequency of potential digital image usage, and the characteristics of patient and site specific medical services provided, the following chart categorizes the sites analyzed during this MRTG project.

Table 7. Categorization of sites (as mapped to Table 6)

Category Site

Small(less than ½ T1)

DOC: Cedar Creek CC, Larch CC, Olympic CC, Rap/Lincoln, Seattle CJC, WCCW Mission Creek; DSHS: Child Study Treatment Center, Camp Outlook, Oakridge Community Facility, Parke Creek Community Facility, Ridge View Community Facility, Twin Rivers Community Facility, Woodinville Community Facility, SCTF - King County, SCTF - Pierce County; DVA: Headquarters, Spokane Veterans Home

Medium(less than 1 T1)

DOC: Airway Heights CC, Ahtanum View CC, Clallam Bay CC, Pine Lodge CC, Stafford Creek CC; DSHS: Frances Haddon Morgan Center, Green Hill School, Canyon View Community Facility, Echo Glen Children's Center, Maple Lane School, Naselle Youth Camp, Yakima School; DVA: Washington Soldiers Home - Orting, Washington Veterans Home -Retsil

Large(up to 2 T1’s)

DOC: Coyote Ridge CC, Monroe CC, McNeil Island CC, Washington State Penitentiary, WCC Shelton, WCCW Purdy; DSHS: Eastern State Hospital, Fircrest, Lakeland Village, Rainier School, Special Commitment Center

Very Large(up to 10 mb/s)

DSHS: Western State Hospital

* Total Bandwidth Requirement without Digital Image Number of Clinical User A X 8Kbits/sec + Number of Clinical User B X 0.5 X 8Kbits/sec + Number of Back office User X 8Kbits/sec + Number of printers X 30Kbits/sec* Total Bandwidth Requirement (including Digital Image)

Total Bandwidth Requirement X 1.2

10MB Ethernet2 X T1T1T1WAN Service for EMR System

6,000 ~ 9,2641,584485149Total Bandwidth

Requirement (Kbits/sec)

1,000 ~ 1,5442648125Digital Image

1,800 ~ 3,00060 ~ 100360121806602Printer

200 ~ 40025 ~ 50648324162Back Office User

2,800 ~ 4,000700 ~ 100080020016040328Clinical User B

200 ~ 32025 ~ 409612324162Clinical User A

Average Bandwidth

requirement(Kbits/sec)

Count

Average Bandwidth


Count

Average Bandwidth


Count

Average Bandwidth


Count

Very LargeLargeMediumSmall

10MB Ethernet2 X T1T1T1WAN Service for EMR System

6,000 ~ 9,2641,584485149Total Bandwidth

Requirement (Kbits/sec)

1,000 ~ 1,5442648125Digital Image

1,800 ~ 3,00060 ~ 100360121806602Printer

200 ~ 40025 ~ 50648324162Back Office User

2,800 ~ 4,000700 ~ 100080020016040328Clinical User B

200 ~ 32025 ~ 409612324162Clinical User A

Average Bandwidth


Count

Average Bandwidth


Count

Average Bandwidth


Count

Average Bandwidth


Count

Very LargeLargeMediumSmall

Based on the assumptions and inputs of this preliminary model, initial estimates would indicate that:• Small Sites require part of a T1 for EMR• Medium Sites require nearly half of a T1 for EMR• Large Sites require between one T1 and two T1s for EMR• Very Large Sites can require most or all of a 10 MB service for EMR


Assumptions for Bandwidth Estimates

The assumptions used in these WAN bandwidth requirement estimations are as follows:

• Multiple Types of User Groups:

- Clinical User Type A: Doctors, psychologists, psychiatrists, counselors;

- Clinical User Type B: Nurses, medical assistants; and

- Back Office User: Administrative assistants, billing, & medical records department personnel.

• Clinical User A Group : 100% of the total user count is reasonable to use for “Number of Concurrent Users during peak hour” (If there are 12 doctors, then assume 12 concurrent doctor users during peak hour).

• Clinical User B Group: 50% of total user count is reasonable to use for “Number of Concurrent Users during peak hour” since not all Nurse FTEs will be online during the peak hour (If there are 200 Nurse FTEs, then assume 100 concurrent nurse users during peak hour).

• Back Office User : 100% of total user count is reasonable to use for “Number of Concurrent Users during peak hour”.

• Printers: Number of multifunction printing devices is another factor to be integrated into the bandwidth requirement. Estimated as a function of the number of devices. The frequency of printing depends on business operations of the specific functions of a department.

• Image Processing: Estimated as 20% of combined total bandwidth requirement of Clinical User, Back Office User, and Printer network load.

• Average bandwidth requirements in Table 8 are derived from estimation techniques used by major EMR system vendors. Actual bandwidth requirements of a future EMR system could be higher or lower than these estimates.


Table 8. WAN bandwidth requirement based on user type/device count

Type DescriptionNumber of

Concurrent Users during peak hour

Average Bandwidth

RequirementSource Note

Clinical User A

Doctors, psychologists, psychiatrists, counselors

100% of total user count 8Kbits / sec / user

Multiple EMR system vendors

Traffic simulation process will define more precise bandwidth requirement after EMR system is selected

Clinical User B

Nurses, medical assistants

50% of total user count 8Kbits/ sec / user Multiple EMR system vendors

Back Office User

Admins, billing & medical records department personnel

100% of total user count 8Kbits / sec / user


PrinterMultifunction print/scan/fax devices

100% of total device count 8Kbits / sec / device


ImageAssumption : 20% of total combined bandwidth requirement of Clinical User A&B, Back Office User and Printer


Analysis of Site Visits: Additional Analysis - Wireless

Wireless Requirements and Recommendations

The MRTG project team has carefully considered the value and viability of potential wireless network solutions for the sites that were evaluated. Some healthcare industry observations shed some important perspectives:

• According to the report, "Telecommunications, IT, and Healthcare: Wireless Networks, Digital Healthcare and the Transformation of US Healthcare 2006-2011," much of the high costs inherent in the current healthcare system are related to the proximity of the patient and provider as well as to the archaic administrative systems used to manage records and exchange information.

• Until recently, cost, hardware configuration compatibility, and service issues have slowed acceptance and adoption of wireless technology in healthcare by hospitals and practitioners. Improved reliability, higher data rates, and the evolution of robust endpoint devices with longer battery life are now enabling healthcare providers to justify the investment in wireless technology. As reliability, price points, and healthcare application availability continue to improve, the proliferation of wireless technology in healthcare and in particular wireless-enabled devices will leave no area of clinical care untouched. The result will be increasing penetration for wireless technology in a broad spectrum of healthcare applications.

• In addition to upgrading and adding to various types of existing infrastructure equipment, the project has identified numerous areas for which wireless solutions can augment existing wired LAN configurations, to greatly enhance the productivity of EMR system end users. With the eventual elimination of the paper chart, access to the electronic medical records needs to be at or near the point of care. By improving mobility and productivity of the end user wireless solutions provide that capability.


Wireless Solution Recommendations by Site: Wireless solutions have been recommended to varying degrees at each of the following sites:

Table 9. Wireless Solution Recommendations by Site

AGENCY ADMINISTRATION/ DIVISION SITE NAME

DOC Ahtanum View CC Airway Heights CC Clallam Bay CC McNeil Island CC

Monroe CC Pine Lodge CC for Women Stafford Creek CC Washington CC for Women WCC Shelton Washington State Penitentiary

DSHS DDD/RHC Fircrest DDD/RHC Frances Haddon Morgan Center DDD/RHC Lakeland Village DDD/RHC Rainier School DDD/RHC Yakima Valley School HRSA Child Study and Treatment Center HRSA Eastern State Hospital HRSA Western State Hospital JRA Canyon View Community Facility JRA Echo Glen Children's Center JRA Green Hill School JRA Naselle Youth Camp JRA Oakridge Community Facility JRA Parke Creek Community Facility JRA Ridgeview Community Facility JRA Twin Rivers Community Facility JRA Woodinville Community Facility SCC Special Commitment Center

DVA Spokane Veterans Home Washington Soldiers Home & Colony

Summary

Wireless implementations have been recommended for at 30 of the 43 sites visited, sometimes in limited areas where charting and/or pharmaceuticals are administered at the point of care. Costs associated with implementing a wireless solution include access points, cabling and pathways for both data and power, controllers, firewalls, intrusion detection, and maintenance costs associated with the wireless equipment, as well as design costs. In addition, a number of portable devices, ranging from rolling carts to PDA’s, are recommended to further mobilize the physicians, counselors, and nursing staff.

Summary by Agency

• DOC – Wireless is recommended at 10 of the sites visited. It is recommended in almost all Segregation/IMU and Close Observation units, as well as in the medical facilities where


inpatient services are rendered. In these settings – particularly where cell-side or bed-side charting is required – as the physical chart is phased out, the most effective way to enter electronic medical information into a future EMR system is at the point of care, often with a wireless connected device. Where new medical buildings are anticipated, regardless of the planned scope of service, it is recommended that wireless be implemented during construction.

• DSHS – Wireless solutions are recommended for DDD/RHC and HRSA sites where intensive patient management occurs in the residential units. For JRA, wireless is recommended for most sites, as behavior tracking occurs in the residential units. The SCC on McNeil Island has 4 buildings where wireless is being recommended, including the medical facilities (Cedar) and the intensive management units.

• DVA – Wireless is recommended in the medical buildings at the facilities in Spokane and Orting, where extensive rewiring would need to occur regardless of the data mode selected.


Cost Analysis

Cost Analysis Conditions and Assumptions

Cost estimates for necessary equipment acquisitions and supporting actions have been estimated in 2008 dollars in the financial cost model. Sales tax has been included in the estimates.

Cost estimates presented in this section and in Appendix C were developed as follows:

• Initial Base: Represents the initial approximation of cost for an item or action, given all available input information and an assumption of complete control over unknowns.

• Best Estimate: Includes an additional cost (on top of the initial base) for uncertainty factors, such as changes in scope or pricing between now and time of implementation. The degree to which the best estimate is above the initial base depends on the type of investment item: Standard commodity items such as workstations have a smaller percentage (5-10%) added for uncertainty, while large capital projects such as an electrical redistribution system have a larger percentage (35-45%) added for uncertainty.

Due to a variety of uncertainties surrounding the implementation of the EMR initiative, it is prudent to include the uncertainty factor in the Best Estimate for planning purposes.

Once site evaluation reports were completed and recommended activities and acquisitions were confirmed, the project team estimated costs of implementing the recommendations. The sources of information for conducting the cost analysis are described below:

• For recommended actions, and for quantity of items to acquire:

- Site Evaluation Reports were the primary source of information for gathering the counts and quantities of infrastructure items needed.

• For pricing and cost estimates:

- State/Agency standard published pricing: The most preferred source of pricing information for any investment was to use actual published prices for goods and services offered by state or DIS master contracts.

- Agency/site historical pricing and observations: The next most preferable source of pricing information was to use observed and reported prices and costs obtained from site representatives during the site visits. This also helped to demonstrate that for some items, there was a range of prices that could be viewed as realistic. The project team also contacted existing state contractors to obtain normal ranges of costs for non-commodity items such as small build-out construction costs and for fiber cable installation.

- Industry observed pricing: Another source of price and cost information was from known industry pricing, available from recent Deloitte project work and infrastructure/equipment acquisitions.


- Additional research of vendors and products (vendor websites, published papers): If none of the above sources yielded useful information, the project team researched vendor websites and published papers. These sources were usually used to corroborate a second source of pricing information for a particular item.

Capital/One-time costs vs. ongoing costs

As costs were researched, tracked, and input into the MRTG Financial Cost Model, they were designated as either one-time (typically capital) or ongoing costs. Any upfront one-time costs to support EMR system infrastructure were classified as one-time costs.

The most typical ongoing costs were those which continue indefinitely, and were generally the same as time progressed (except for inflation adjustments). Examples of ongoing costs are:

• Leases for workstations and laptops

• Leases for multifunction printers

• Maintenance on various networking devices and services

• Service fees for Wide Area Networks

• Additional FTEs required solely to support new EMR technology


Price Lists: Indication of sources used

The information sources used for each price or cost estimate developed are indicated in the unit price list tab of the Excel version of the MRTG Financial Cost Model. An excerpt of this price list is shown below:

Price - Initial Base

TAX TOTAL -Initial Base

TOTAL - Best Estimate

Source

NetworkBackbone Switch with Modules $74,000.00 $4,810.00 $78,810.00 $102,453.00 DOC InvoiceBackbone Switch yearly maintenance cost $5,000.00 $325.00 $5,325.00 $6,922.50 DOC InvoiceWorkgroup Switch - 24 ports non POE $1,500.00 $97.50 $1,597.50 $2,076.75Workgroup Switch - 24 ports non POE yearly maintenance cost

$205.00 $13.33 $218.33 $283.82

Workgroup Switch - 48 ports non POE $2,700.00 $175.50 $2,875.50 $3,738.15Workgroup Switch - 48 ports non POE yearly maintenance cost

$330.00 $21.45 $351.45 $456.89

Workgroup Switch - 24 ports POE $2,700.00 $175.50 $2,875.50 $3,738.15

Workgroup Switch - 24 ports POE yearly maintenance cost $330.00 $21.45 $351.45 $456.89Wireless controller (less than 12 APs) $5,500.00 $357.50 $5,857.50 $7,614.75Wireless controller (13 - 24 APs) $7,900.00 $513.50 $8,413.50 $10,937.55Wireless controller (24 - 50 APs) $11,000.00 $715.00 $11,715.00 $15,229.50Wireless Controller Maintenance Cost (less than 12 APs) $860.00 $55.90 $915.90 $1,190.67Wireless Controller Maintenance Cost (13 - 24 APs) $1,240.00 $80.60 $1,320.60 $1,716.78Wireless Controller Maintenance Cost (24 - 50 APs) $1,720.00 $111.80 $1,831.80 $2,381.34Wireless AP Maintenance Cost $120.00 $7.80 $127.80 $166.14Wireless Access Points $1,050.00 $68.25 $1,118.25 $1,453.73WAN Initiation (10 mb) $30,000.00 $1,950.00 $31,950.00 $41,535.00

WAN Yearly Charge (10 mb) $18,000.00 $1,170.00 $19,170.00 $24,921.00

WAN Initiation (T-1) $15,000.00 $975.00 $15,975.00 $20,767.50WAN Yearly Charge (T-1) $9,600.00 $624.00 $10,224.00 $13,291.20WAN Initiation (Fractional T-1) $12,000.00 $780.00 $12,780.00 $16,614.00WAN Yearly Charge (Fractional T-1) $6,000.00 $390.00 $6,390.00 $8,307.00

Fiber Optic Patch Cord $100.00 $6.50 $106.50 $138.45 DIS Master ContractsFirewall + IDPS for Wireless $7,200.00 $468.00 $7,668.00 $9,968.40 DIS Master Contracts, DOC past invoices & Cisco website

Firewall + IDPS Maintenance $1,450.00 $94.25 $1,544.25 $2,007.53 DIS Master Contracts, DOC past invoices & Cisco website

DIS Master Contracts, DOC past invoices & Cisco website

Analysis based on Lakeland Village and Rainier School's research of WAN upgrade to 10 mb

Examples provided by agency administration leads and site technical managers;


Cost Estimates to Close Gaps

Introduction

As noted earlier, after all site visits were completed, the recommended actions from the Site Evaluation Reports were entered into an MRTG Financial Cost Model. Cost estimates were developed for recommended infrastructure acquisitions, upgrades, leases, and special projects. The one-time and ongoing annual costs for these recommended items and activities were tabulated by site, by administration, and by agency.

This section presents the results of this cost estimation at the following levels:

• Summary: Summarized at the agency level, with grand totals for the entire project

• By Agency: Summarized at the site level, with subtotals for agency and administration

Full details at the site level are contained in the MRTG Financial Cost Model Output in Appendix C.

At a summary level, the estimated costs to resolve identified infrastructure gaps by Agency in 2008 dollars are as follows:

• One-time costs:

One-Time Costs By Agency

Best Estimate

DOC $ 7.452 million DSHS $20.352 million DVA $ 0.922 million Total $28.726 million

• Annual ongoing costs:

Ongoing Costs (Annual) By Agency

Best Estimate

DOC $ 0.966 million DSHS $ 4.300 million DVA $ 0.364 million Total $ 5.630 million


One-Time Costs

A site-level view of the estimated one-timeTable 10. One-time costs

costs organized by agency and administration is shown in Table 10:

Investment Type One-Time

Agency Administration Site Best EstimateDOC (blank) Ahtanum View CC $131,019

Airway Heights CC $343,285Cedar Creek CC $60,614Clallam Bay CC $177,011Coyote Ridge CC $9,086Larch CC $66,440McNeil Island CC $1,356,338Monroe CC $1,161,819Olympic CC $17,201Pine Lodge CC for Women $208,705Rap/Lincoln $14,027Seattle Community Justice Center $0Stafford Creek CC $410,578Washington CC for Women $366,453Washington State Penitentiary $483,223WCC Shelton $2,473,977WCCW Mission Creek $172,528

(blank) Total $7,452,304DOC Total $7,452,304DSHS DDD/RHC Fircrest $2,931,144

Frances Haddon Morgan Center $261,078Lakeland Village $2,119,867Rainier School $1,513,851Yakima Valley School $590,767

DDD/RHC Total $7,416,706HRSA Child Study and Treatment Center $1,142,537

Eastern State Hospital $1,263,760Western State Hospital $6,896,266

HRSA Total $9,302,563JRA Camp Outlook (Basic Training Camp) $2,077

Canyon View Community Facility $96,779Echo Glen Children's Center $117,198Green Hill School $142,402Maple Lane School $237,686Naselle Youth Camp $455,545Oakridge Community Facility $33,988Parke Creek Community Facility $107,771Ridgeview Community Facility $67,154Twin Rivers Community Facility $39,129Woodinville Community Facility $46,316

JRA Total $1,346,045SCC Secure Community Transition Facility - King Co $5,435

Secure Community Transition Facility - Pierce Co $5,435Special Commitment Center $2,275,712

SCC Total $2,286,582DSHS Total $20,351,896DVA (blank) Central Office - WDVA $52,185

Spokane Veterans Home $285,312Washington Soldiers Home & Colony $395,210Washington Veterans Home $189,385

(blank) Total $922,092DVA Total $922,092Grand Total $28,726,292


Ongoing Annual Costs

A site-level view of estimated ongoing annual costs organized by agency and administration is shown below. Table 11. Ongoing annual costs

Investment Type On-Going

Agency Administration Site Best Estimate DOC (blank) Ahtanum View CC $10,324

Airway Heights CC $101,950 Cedar Creek CC $18,050 Clallam Bay CC $35,032 Coyote Ridge CC $7,509 Larch CC $9,430 McNeil Island CC $84,706 Monroe CC $202,184 Olympic CC $22,500 Pine Lodge CC for Women $25,120 Rap/Lincoln $3,239 Stafford Creek CC $65,897 Washington CC for Women $96,154 Washington State Penitentiary $197,054 WCC Shelton $75,291 WCCW Mission Creek $11,988

(blank) Total $966,428 DOC Total $966,428 DSHS DDD/RHC Fircrest $400,269

Frances Haddon Morgan Center $99,841 Lakeland Village $482,014 Rainier School $814,684 Yakima Valley School $88,434

DDD/RHC Total $1,885,241 HRSA Child Study and Treatment Center $50,723

Eastern State Hospital $334,930 Western State Hospital $1,144,219

HRSA Total $1,529,872 JRA Camp Outlook (Basic Training Camp) $284

Canyon View Community Facility $19,219 Echo Glen Children's Center $40,175 Green Hill School $141,686 Maple Lane School $219,751 Naselle Youth Camp $39,439 Oakridge Community Facility $13,687 Parke Creek Community Facility $31,092 Ridgeview Community Facility $32,440 Twin Rivers Community Facility $3,530 Woodinville Community Facility $29,996

JRA Total $571,300 SCC Special Commitment Center $313,451 SCC Total $313,451

DSHS Total $4,299,864 DVA (blank) Central Office - WDVA $208,000

Spokane Veterans Home $38,446 Washington Soldiers Home & Colony $59,810 Washington Veterans Home $57,381

(blank) Total $363,637 DVA Total $363,637 Grand Total $5,629,930

Page i Final Technical Report

SECTION III: APPENDICES

Page ii Final Technical Report

APPENDICES

Table of Contents

A. Infrastructure Requirements Template: Complete Listing ......................................................... 1

B. Site Evaluation Reports .......................................................................................................... B-1

C. MRTG Financial Cost Model Output ..................................................................................... C-1

D. Other Observations ................................................................................................................. D-1

Policy Changes ....................................................................................................................... D-1 People/Process Changes ......................................................................................................... D-1 QoS for Network Resource Management ............................................................................... D-2 Network Management Systems .............................................................................................. D-2 Additional Network Security .................................................................................................. D-2 Site-wide improvements that are not just for EMR ................................................................ D-2 E. Implementation Considerations for Future EMR Systems ..................................................... E-1

Dependence on Technology Infrastructure Processes and People.......................................... E-1 The types of service being rendered ....................................................................................... E-1 The readiness for an EMR implementation ............................................................................ E-1 Costs unique to the particular EMR solution chosen .............................................................. E-1

Costs related to necessary changes to workflow, staff training, and enforcement of new operations policies and standards ........................................................................................... E-1

Page A-1 Final Technical Report

A. Infrastructure Requirements Template: Complete Listing The following template contains all infrastructure requirements identified for this project.

Investment Category


1 Back up & redundancy should be in place

2 Power usage requirement should not exceed power capacity

3 Evident UPS power outlet to standalone UPS; Sufficient UPS for MDF, IDF

4 Dual power feed from different parts of the grid for critical sites and devices

1 Cooling should have dedicated controls

2 Cooling should have redundancy for critical sites hosting site

1 Conduits should be accessible, serviceable, and able to accommodate additional cable and/or updated cabling; Otherwise, alternate conduit paths may be necessary

Preventative Measures


Requirements

A, The physical location(s) should have enough floor space capacity to house all the site's required infrastructure equipment.Additional equipment can vary depending on selected solution and needs of the site: Typically, this can potentially include: - small rack-mounted servers and storage to support local processing - necessary file and print servers (if not already in place) - workstations placed in locations of medical service personnel - Mobile carts, Tablet PC's, PDA's used by medical service personnel - printers, scanners- upgraded network devices (routers/switches) in network room - upgraded fiber, cable, or wiring in conduits between buildings

B. The electrical infrastructure of the Data Center or Server Room should support maximum uptime and availability

D. The telecommunications network pathways between the Server Room and the medical service buildings should be able to accommodate updated cabling


Cabling / Pathways

C. The Data Center or Server Room should have appropriate HVAC capacity

E. The Data Center or Server Room should have measures to protect from natural disasters and fire



Servers

1 The EMR system servers should have redundant power supply, and should be included in assessment of new power requirements

2 The EMR system servers should not exceed industry standard utilization level (e.g. CPU, Memory usage)

3 The EMR system servers should have redundant network connection function such as channel or stand-by network connection

4 Server monitoring software should be implemented to track performance and availability

Servers

1 Conduits should be accessible, serviceable, and able to accommodate updated cabling; Otherwise, alternate conduit paths may be necessary

Cabling / Pathways

1 There should be straightforward access to network drops (such as via rack-mounted patch panels)

2 Telecommunications vaults should be accessible, and their contents should be well-documented

WAN / LAN





5 LAN devices should be sufficiently sized such that they can support increase of Workstation and other EMR devices




Cabling / Pathways

F. The EMR system servers should have appropriate capacity and function to ensure required performance and availability; Note: In this context: the EMR system includes the future EMR system and the existing medical records system that will integrate to or interface with the future EMR system

G. EMR system server should meet appropriate security levels to comply with HIPAA standards






9 Network monitoring system should be utilized to track availability and performance of network


WAN / LAN

1 There should be technology in place to support agency network security standards

2 There should be measures to prevent attacks from viruses and hackers

3 Network should provide secure remote access

Cabling / Pathways

1 Wireless network should support security method which includes strong encryption

2 Sufficient Wireless access points (with associated pathways, power cabling, and data cabling) should be available for uninterrupted access for mobile devices

User Devices

1 Sufficient number of workstations should be in place

2 Workstations should have Intel Pentium D or faster CPU

3 Workstations should have 1 GB or more memory

4 Workstations should have 6 GB or more hard disk space

5 Workstations should have DirectX 9.0 Capable, 256MB of RAM, Support for Pixel Shader 2.0 as a Video card capability

6 Workstations should have native 1024X768 or greater display

7 Workstations should have 100Mpbs or faster network connection

M. User workstations and workstations on mobile carts should be able to run the EMR application with appropriate performance and security levels

K. Network architecture and design should ensure appropriate level of security

L. New technologies such as wireless networks and convergence networks, which can increase productivity of clinicians and reduce the cost, should be considered with these requirements



8 Workstations should have optical mouse with scroll wheel

9 Workstations should have Windows XP SP2 or Windows Vista with the latest patch

10 Workstations should have Internet Explorer 6 or higher

11 Workstations should have Adobe Acrobat reader for printing report

12 Internet Explorer should have 128-bit encryption enabled

13 Internet Explorer should be configured to accept and use ActiveX controls

14 Internet Explorer should have plug-ins available as required for thin client emulation software

15 Internet Explorer should have Java Virtual Machine function enabled

User Devices

Printers

1 Appropriate printing capacity should be available to EMR system users dependent on work function.

2 Windows compatible print server should exist to support network printers

3 Shared printers should have TCP/IP networking capability

4 Printers should be compatible with the OS's which run remote thin emulation software for back office printing

5 Printers should have Windows compatibility to support front office printing needs

6 Printer should have static IP Address to allow access with remote thin client emulation software

7 Print server should have redundancy such as clustering


N. Mobile devices such as laptop, tablet PC and PDA should comply with EMR system vendor's recommended specification at the time of implementation

O. The site's printing system should support business and EMR system requirements

P. Appropriate security methods should be mandated to prevent unauthorized personnel from accessing sensitive medical record information on printers



Scanners

1 Scanners should have Intel StrongARM or Xscale processors

2 Scanners should have full sheet scanning capability and be TWAIN compliant

WAN Network Bandwidth

1 Lab system

2 Pharmacy system

3 Radiology system


1 The EMR system should have a viable interface and connection to appropriate Federal Programs

2 The EMR system should have a viable interface and connection to Medicare

3 The EMR system should have a viable interface and connection Medicaid

4 The EMR system should have viable interfaces and connections to County jail systems

S. There should be viable interface methods and connections between the existing external systems and the future EMR system

Q. Scanning system should support business and EMR system requirements

R. There should be viable interface methods and connections between the existing ancillary systems and the future EMR system

Page B-1 Final Technical Report

B. Site Evaluation Reports The CD in this appendix contains an electronic copy of each site evaluation report completed during the MRTG project. The site evaluation report excel file names are listed below.

AGENCY SITE SITE EVALUATION REPORT FILE NAME

DOC Ahtanum View CC MRTG Final Site Evaluation Report_DOC_Ahtanum View Corrections

Center_0701_lk_F.xls DOC Airway Heights CC

MRTG Final Site Evaluation Report_DOC_AHCC_Spokane_0701_vcs_F.xls

DOC Cedar Creek CC MRTG Final Site Evaluation

Report_DOC_CEDAR_CREEK_0525_vcs_F.xls DOC Clallam Bay CC MRTG Final Site Evaluation Report_DOC_Clallam Bay Corrections

Center_0702_vcs_F.xls DOC Coyote Ridge CC MRTG Final Site Evaluation Report_DOC_Coyote Ridge Corrections

Center_0711_vcs_F.xls DOC Larch CC MRTG Final Site Evaluation Report_DOC_LARCH_0525_vcs_F.xls

DOC McNeil Island CC MRTG Final Site Evaluation Report_DOC_MICC_0520_vcs_F.xls

DOC Monroe CC MRTG Final Site Evaluation Report_DOC_MCC_0523_vcs_F.xls

DOC Olympic CC MRTG Final Site Evaluation Report_DOC_Olympic Corrections

Center_0620_lk_F.xls DOC

Pine Lodge CC for Women

MRTG Final Site Evaluation Report_DOC_PLCCW_Medical Lake_0701_vcs_F.xls

DOC Rap/Lincoln MRTG Final Site Evaluation

Report_DOC_RapLincoln_Tacoma_0625_LK_F.xls DOC

Seattle Community Justice Center

MRTG Final Site Evaluation Report_DOC_Seattle Community Justice Center_0620_lk_F.xls

DOC Stafford Creek CC MRTG Final Site Evaluation Report_DOC_SCCC_0528_vcs_F.xls

DOC

Washington CC for Women

MRTG Final Site Evaluation Report_DOC_WCCW Purdy_515_vcs_F.xls

DOC WCC Shelton MRTG Final Site Evaluation Report_DOC_WCCS_0611_vcs_F.xls

DSHS

WCCW Mission Creek

MRTG Final Site Evaluation Report_DOC_WCCW Mission Creek _515_vcs_F.xls

DSHS

Washington State Penitentiary

MRTG Final Site Evaluation Report_DOC_Washington State_Penitentiary_0701_vcs_F.xls

DSHS Fircrest MRTG Final Site Evaluation Report_DSHS_Fircrest_0625_lk_F.xls

DSHS

Frances Haddon Morgan Center

MRTG Final Site Evaluation Report_DSHS_FHMC_Bremerton_528_vcs_F.xls

DSHS Lakeland Village MRTG Final Site Evaluation

Report_DSHS_Lakeland_Village_0610_vcs_F.xls DSHS

Rainier School MRTG Final Site Evaluation Report_DSHS_Rainier School_0611_vcs_F.xls

Page B-2 Final Technical Report

DSHS

Yakima Valley School

MRTG Final Site Evaluation Report_DSHS_Yakima Valley School_0701_lk_F.xls

DSHS

Child Study and Treatment Center MRTG Final Site Evaluation Report_DSHS_CSTC_0606_vcs_F.xls

DSHS

Eastern State Hospital MRTG Final Site Evaluation Report_DSHS_ESH_0702_vcs_F.xls

DSHS Western State

Hospital MRTG Final Site Evaluation Report_DSHS_Western State Hospital_0721_vcs_F.xls

DSHS

Camp Outlook (Basic Training Camp)

MRTG Final Site Evaluation Report_DSHS_JRA_Camp Outlook_0703_vcs_F.xls

DSHS Canyon View

Community Facility

MRTG Final Site Evaluation Report_DSHS_JRA_Canyon View_0620_mh_F.xls

DSHS

Echo Glen Children's Center

MRTG Final Site Evaluation Report_DSHS_JRA_Echo Glen_0625_mh_F.xls

DSHS Green Hill School MRTG Final Site Evaluation Report_DSHS_Green Hill

School_0531_vcs_F.xls

DSHS Maple Lane School MRTG Final Site Evaluation

Report_DSHS_JRA_MAPLE_LN_0520_vcs_F.xls DSHS

Naselle Youth Camp

MRTG Final Site Evaluation Report_DSHS_Naselle Youth Camp_0531_vcs_F.xls

DSHS

Oakridge Community Facility

MRTG Final Site Evaluation Report_DSHS_JRA_Oakridge_0515_mh_F.xls

DSHS Parke Creek

Community Facility MRTG Final Site Evaluation Report_DSHS_JRA_Parke Creek_0620_mh_F.xls

DSHS

Ridgeview Community Facility

MRTG Final Site Evaluation Report_DSHS_JRA_Ridgeview_0620_mh_F.xls

DSHS

Twin Rivers Community Facility

MRTG Final Site Evaluation Report_DSHS_JRA_Twin Rivers Community Facility_0613_vcs_F.xls

DSHS

Woodinville Community Facility

MRTG Final Site Evaluation Report_DSHS_JRA_Woodinville_0626_mh_F.xls

DSHS

Secure Community Transition Facility - King

MRTG Final Site Evaluation Report_DSHS_SCTF KC_0701_lk_FF.xls

DSHS

Secure Community Transition Facility - Pierce

MRTG Final Site Evaluation Report_DSHS_SCTF PC_0526_vcs_FF.xls

DSHS

Special Commitment Center MRTG Final Site Evaluation Report_DSHS_SCC MI_0601_vcs_FF.xls

DVA

Spokane Veterans Home MRTG Final Site Evaluation Report_DVA_SVH_0610_mh_F.xls

DVA

Washington Soldiers Home & Colony

MRTG Final Site Evaluation Report_DVA_WS_Orting_0602_vcs_F.xls

DVA

Washington Veterans Home MRTG Final Site Evaluation Report_DVA_WVH_0507_mh_F.xls

DVA

Central Office – WDVA MRTG Final Site Evaluation Report_DVA_HQ_0531_vcs_F.xls

Page C-1 Final Technical Report

C. MRTG Financial Cost Model Output The CD in this appendix contains a PDF copy of the MRTG Cost Model’s financial analysis output for all sites. There is one PDF file for each agency (DOC, DSHS, and DVA) evaluated in the project. The PDF files included on the CD are: MRTG Financial Analysis – DOC_v17.pdf (pdf output for all DOC sites) MRTG Financial Analysis – DSHS_v17.pdf (pdf output for all DSHS sites) MRTG Financial Analysis – DVA_v17.pdf (pdf output for all DVA sites) For each site the financial analysis output presents the one time and ongoing costs for each recommended EMR infrastructure investment. To find, by site, the itemized costs for the recommendations to close infrastructure gaps, open the file “MRTG Financial Analysis – agency_v17.pdf”, where agency is the agency of the desired site. The cost information in the file is presented in alphabetical order by site, with one-time costs followed by ongoing costs. All financial analysis conducted for this project was based on data in the MRTG Cost Model. Specifically, the financial analysis output in the three pdf files listed above was generated directly from the Site Cost Summary Tab of the MRTG Cost Model (Excel version) by respectively selecting each of the agency identifiers (DOC, DSHS, DVA) in cell B1 of the Site Cost Summary Tab.

Page D-1 Final Technical Report

D. Other Observations

While outside of the scope of the MRTG project, additional gap areas were observed during the project. There may be additional costs required to close some of these gaps. These gaps are more difficult to quantify (in terms of cost) at this time, and are less directly related to the acquisition of additional technology infrastructure. These include costs for the following:

Policy Changes

Policy topics were addressed in several areas during this project. The most notable topics were an assessment of information security policies in general, and a review of specific security policies for wireless networks.

General Information Security Policies: An important set of policies that need to be adhered to are Health Insurance Portability and Accountability Act (HIPAA) policies. HIPAA’s security standards are fairly general: Compliance with HIPAA policies can generally be met if 1) agencies have documented policies and procedures regarding information security, 2) those policies are followed and enforced, and 3) mitigating measures are taken to resolve weaknesses. In fact, several DSHS and DVA sites indicated that they had regularly passed HIPAA compliance reviews. One important observation was made for DOC sites: Technology infrastructure support staff did not believe that DOC necessarily needed to be HIPAA compliant, yet medical care staff at DOC sites believed that their sites needed to be HIPAA compliant.

Specific policies for wireless networks: New policies for wireless networks are currently under development by the ISB. The project team’s primary discussion on wireless network security was with representatives from DIS Enterprise Services. That discussion confirmed that the current ISB standards require a minimum of a firewall device to protect the wireless segment of the network, and that an IDPS (Intrusion Detection/Prevention System) is desirable. In this project’s estimate of wireless implementation costs, the costs of firewalls and IDPS devices have been included in the cost estimates.

People/Process Changes

The eventual success of an EMR system initiative will heavily depend on the agencies’ people (both technical and medical) and the processes that support them. Many health care organizations are challenged with acquiring and maintaining the right skill sets for advanced systems implementations.

A national report on health IT (HIT) staffing in April, 2008 estimated that hospitals will be understaffed by more than 40,000 positions once the U.S. HIT agenda is fulfilled and hospitals move to higher levels of IT adoption. The report, “Characterizing the Health Information Technology Workforce: Analysis from the HIMSS (Healthcare Information and Management Systems Society) Analytics™ Database”, was released by Dr. William Hersh, a professor at the Oregon Health & Science University. Dr. Hersh’s report was included in a Capitol Hill Steering Committee on Telehealth and Healthcare Informatics briefing, “Training an HIT-Enabled Healthcare Workforce: Addressing Shortages”.

Several of the following initiatives may be required:

• Retraining of current staff - Improve the existing skill base through tailored training programs that deliver the specific skills required. This is dependent on available training, relevant staff availability and the ability of the staff to ‘take on the required skill’.


• Importing skills from the private industry - There are a number of key areas where the skills the state agencies require are available in private industry. However, these resources need to be available (and seeking employment) to be moved.

• Recruitment of staff with relevant skills - One way to close the ‘skill gap’ is to recruit staff with the required experience. There are two main areas of concern that would need to be addressed: First, ensuring that the skills gap fits a precise role/ job description. Second, many IT skills have a market premium that can create discrepancies in the salary structure.

QoS for Network Resource Management

It has been noted that Quality of Service (QoS) for managing network resources is currently in the planning stages at DIS. DOC, DSHS, and DVA will continue to be involved in QoS’s implementation.

The primary goal of QoS is to provide priorities including dedicated bandwidth, controlled latency (required by some real-time and interactive traffic), and improved loss characteristics. Also important is making sure that providing priority for one or more network traffic flows does not make other flows fail. QoS technologies provide the elemental building blocks that will be used for future applications in campus, WAN, and service provider networks. There are various ways of implementing QoS and the implementation will depend on the types of network switches chosen and the software installed on those switches.

For example, the Cisco 2960 series and Cisco 4500 series switches recommended in several MRTG site evaluation reports offer software image versions that provide advanced QoS class and policy maps, as well as QoS traffic policing capabilities. Many non-Cisco hubs and switches currently installed at MRTG sites do not offer such software. Implementation of QoS capabilities without the software features available in newer Cisco switches can be cumbersome and costly.

When the agencies upgrade network switches in a manner consistent with recommendations in the MRTG site reports, QoS can be implemented cost-effectively. QoS setup will implement the appropriate software configuration changes in the network switch and router equipment.

Deloitte recommends that DIS and the agencies continue with their pursuit of QoS network management features.

Network Management Systems

As noted earlier, agency level network management systems capabilities vary from agency to agency. Although each agency has a certain degree of Network Management capability (such as DOC’s SolarWinds and DSHS’s Orion), and each agency supports its sites with WAN monitoring, larger sites will continue to evaluate LAN and system level monitoring services for EMR.

Additional Network Security

Network level security features could be improved for a future EMR system, beyond what is currently implemented. Current network security depends on firewalls and user level security features such as anti-virus software. Through advances in network level security design, network security could be stronger for an EMR system by implementing features such as virtual separation of EMR users.

Site-wide improvements that are not just for EMR

It has been observed during this project that numerous infrastructural investments benefit not only a future EMR system, but they benefit many of the overall operations of the entire site. Electrical system upgrades, facility build-


outs, upgraded network switching equipment, and additional user devices will benefit other applications and services besides a new EMR system. Since these costs are not all fully attributable to EMR infrastructure and support, and generally can benefit all technology and operations at a site or agency, their costs may also be difficult to allocate to appropriate entities.

Page E-1 Final Technical Report

E. Implementation Considerations for Future EMR Systems

The following topics are typically considered during preparations for a future EMR system. While not directly within the scope of the MRTG project, these topics are normally addressed during the implementation of an EMR system.

Dependence on Technology Infrastructure Processes and People

Deloitte’s past project experience clearly indicates that appropriate technical work process redefinition, technical support processes, technical training, change management, and end user training are all necessary for a successful system implementation.

The types of service being rendered

Each agency and administration has a unique set of clients accessing health care. The most common type of service rendered at most DOC sites is primary care, with limited inpatient care and behavioral health. The DVA homes operate much more like a hospital, so are in need of a strong inpatient module. For DSHS, some of the administrations require a model that has an excellent behavioral health module, such as the DDD/RHC’s, while others need both behavioral health and a robust inpatient module, like Eastern and Western State Hospitals.

The readiness for an EMR implementation

The acceptance and readiness for EMR system implementation varies greatly within and across the agencies. DOC, for example, has strong advocacy for EMR at the medical leadership level, and many of the staff have worked in other medical settings where EMR systems have been implemented, so are knowledgeable and accepting of the concept. There are also strong proponents of an advanced EMR system within DSHS executive management, and this is exemplified by several significant implementations of the VistA product at several sites. Other agencies/administrations have been working with a bare minimum of technology for so long (such as DDD/RHC) that the idea of an EMR system is barely conceivable in the near term. So, not only would the implementation of an EMR system need to be phased in over time, a simpler solution may be necessary at some of these sites in order to maximize acceptance and usage of the implemented system.

Costs unique to the particular EMR solution chosen

Implementation of an EMR solution is a major multi-year undertaking with significant risks and challenges, and it will be vitally important to set clear expectations of the work and changes ahead, as well as to establish adequate staffing, management and budgetary resources for the effort. While the largest costs of an EMR solution will be associated with the software selection, implementation, and training, there may be additional infrastructure costs which cannot be foreseen now, due to changes in available technology and changes in EMR system requirements for a particular vendor.

Costs related to necessary changes to workflow, staff training, and enforcement of new operations policies and standards

As noted previously, EMR system implementation costs include much more than just software licensing costs and technical infrastructure improvement costs. Workflow studies (which are typically conducted once a solution is selected, staff training (both for EMR technical support and EMR functionality and operations training), and new process and policy development also require budgeting in the overall EMR initiative.

Copy of doc_Ahtanum.xls Page 1 of 1

State of WashingtonMRTG ProjectSite Visit Summary

Site Name Ahtanum View Corrections Center

Site Location & Date of Site Visit 2209 S 64th Ave, Yakima WA 98903 -- 6/19/2008

Primary Site Contacts (Technical and Medical) Technical : Linda Davis, Medical : Schana Wright

Other Site Representatives contacted during the site visit

Steve Hansson (Plant Manager)

# Category Details

1

Site Buildings deemed to be in scope (containing EMR system equipment or sites of medical / counseling care) and those deemed out of scope

In Scope:Medical unit building (E), Living unit (A, B, C, D), Office building (Lab & dental), Multipurpose building

Out of Scope:Admin building, maintenance building

2

Specific acronyms used at the site and in the site evaluation report

3

Additional Introductory Information Minimum security level for offendersMost of the offenders are old or sick125 offenders (Maximum capacity) and 20 medical staffs (2 doctors and 1 Physician assistant)

4

Final Revisions Made (July, 2008) Redundant backbone switches are being recommended only in the largest, most critical locations where it is necessary to support planned changes.Redundant print servers are not being recommended.FM200 gas-based fire suppression systems are being recommended only in MDF's or highly critical IDF's where physically viable; Otherwise, fire extinguishers are being recommended.For IDF's where A/C installation is not practical, venting (for air circulation with building air) is being recommended.

This summary provides overview information on the logistics of the site visit summary for a specific site, and is intended to serve as an introduction to the site evaluation report that has been written for the site.

In addition to site name and location data, specific information contained in this summary includes:

- Site Contacts- Site Buildings deemed to be in scope and out of scope for the study- Specific acronyms used at the site and in the site evaluation report- Additional introductory information that may be helpful in understanding the context of the site visit

Deloitte Consulting Confidential

Copy of doc_Ahtanum.xls Page 1

Site visit date: 6/19/2008

[0 - Not Met,

4 - No Gap]

Category Investment Category

MDF, Power and Living units (A, B, C, D)

Medical unit (E), Office building (Lab, dental & physical therapy) and

Multipurpose buildingGaps Score

(0 - 4) Potential Recommendation

Physical Space


Living units have no nurses station. Doctors and nurses come to the living units to provide medical service because most of offenders are too old or sick to move : Wireless requirement

MDF room is in living unit building

There is one SEG area which has two rooms inside.

MDF room is small and hot. MDF rack is full. Current backbone switch (Cisco Catalyst 5500) will be upgraded to a bigger switch.

Doctors and nurses provide medical service in the patient room : Wireless requirement

Lab and dental room (office building) : hiring a dentist.

Multipurpose building : physical activity space, doctors come to this building : Wireless requirement

Multipurpose building IDF : 2nd floor, secure cage, no issue

MDF rack is full 3 MDF room is small but cannot move to other location because of existing cables

Recommend an additional rack for expansion and upgrade in MDF room

Th i t l h lth it i D it


Power company : Pacific Power

Power outage is not very common

One generator (400KW) which is sufficient to covers entire campus

4 None


No issue No issue None 4 None


UPS at MDF Medical unit IDF : No UPS No power backup from UPS 2 Recommend a UPS in medical unit IDF


N/A (non-hosting site) N/A N/A N/A N/A

Site: Ahtanum View Corrections Center (2009 S 64th Ave, Yakima WA 98903)


State of WashingtonMRTG ProjectSite Evaluation Report

Agency/Administration: DOC

Data Center / Server Room


Requirements









(0 - 4) Potential RecommendationRequirements


MDF : Hot, need an air-conditioner IDFs : No air-conditioner but room temperature

None 2 Recommend a dedicated air-conditioner in MDF room

2 Cooling should have redundancy for critical hosting sites


1

Conduits should be accessible, serviceable, and able to accommodate additional cable and/or updated cabling; Otherwise, alternate conduit paths may be necessary

All of conduits are in decent shape All of conduits are in decent shape None 4 None


MDF : Sprinkler Medical unit IDF : Sprinkler

Multipurpose building IDF : No fire suppression

Sprinkler in MDF room is not appropriate

2 Recommend FM200 gas based fire suppression in MDF room

Recommend fire-extinguisher in IDF rooms

Servers

N/A - no servers (other than file/print servers) will be used for EMR solution

1

The EMR system servers should have redundant power supply, and should be included in assessment of new power requirements

N/A N/A N/A N/A N/A

2The EMR system servers should not exceed industry standard utilization level (e.g. CPU, Memory usage)

N/A N/A N/A N/A N/A

3

The EMR system servers should have redundant network connection function such as channel or stand-by network connection

N/A N/A N/A N/A N/A

4Server monitoring software should be implemented to track performance and availability

N/A N/A N/A N/A N/A

ServersCurrently meet DOC security standards

Currently meet DOC security standards

None 4 None




Cabling / Pathways

Cabling /




Servers(if applicable)








1


Conduits are in decent shape Conduits are in decent shape None 4 None

Cabling / Pathways

1There should be straightforward access to network drops (such as via rack-mounted patch panels)

MDF : Rack mounted patch panel, cabling is in decent shape

IDFs : Rack mounted patch panel None 4 None

2Telecommunications vaults should be accessible, and their contents should be well-documented

Accessible

Documentations exist

None 4 None

WAN / LAN


Living unit has no data port but Wireless network will provide network connection

Sufficient data drops in every office room

For patient area in medical unit, wireless network will provide network connection

None 4 None


Backbone switch : Cisco Catalyst 5505 X 1, will be upgrade to Cisco Catalyst 6509 soon

Medical building IDF : Cisco Catalyst 2950 X 1

Multipurpose building IDF : Cisco Catalyst 2900 X 1

None 4 None


No statistics but can assume very low utilization- Backbone switch has not been fully utilized

No issue None 4 None

Cabling / Pathways











No redundant Backbone switch

No redundant connection from Backbone switch to IDFs' Workgroup switch

Single fiber connection from Backbone switch to workgroup switches

No redundant Connection from building Backbone switch to a Workgroup switch but fiber cables are available

No redundancy 2 Although redundancy is recommended by implementing a duplicate Backbone switch, determination by DOC is that redundancy will not considered.

5LAN devices should be sufficiently sized such that they can support increase of Workstation and other EMR devices

Data ports are sufficient and wireless network will support additional data port requirement

Data ports are sufficient and wireless network will support additional data port requirement

None 4 None


WAN is 2 X T1 from Qwest

Need to contact DOC HQ for utilization rate

None (Currently) 4 None


Redundancy None 4 None


Pending DIS implementation None N/A None

9Network monitoring system should be utilized to track availability and performance of network

DOC HQ provide NMS function None N/A None


CAT5 or higher CAT5 or higher None N/A None

WAN / LAN

1There should be technology in place to support agency network security standards

Per DOC standards; None 4 None




DIS VPN None 4 None

Cabling / Pathways



Network









2

Sufficient Wireless access points (with associated pathways, power cabling, and data cabling) should be available for uninterrupted access for mobile devices

User Devices


No requirement because mobile devices will replace workstation requirement

Therapy room (Office building) : No workstation, needs one workstation

Pharmacy : Two small workstations or notebooks are required

Additional workstation requirement

2 Acquire 3 more workstations


None 4 None


None 4 None


None 4 None

5Workstations should have DirectX 9.0 Capable, 256MB of RAM, Support for Pixel Shadier 2.0 as a Video card

None 4 None


None 4 None


None 4 None


None 4 None

9Workstations should have Windows XP SP2 or Windows Vista with the latest patch

None 4 None


None 4 None


None 4 None


None 4 None


None 4 None

Living unit requires wireless network :1st floor : 1 AP inside of SEG unit2nd floor : 3 APs for patient living unit

User devices


Recommend wireless network implementation in living unit, medical unit and multipurpose building

Wireless network is required for living unit, medical unit and multipurpose building

0

DOC standard

Medical unit requires wireless network :2 APs for patient room area

Multipurpose building requires wireless network :1 AP for entire building (Open space)








14Internet Explorer should have plug-ins available as required for thin client emulation software

None 4 None


None 4 None

User Devices

Mobile device requirement 0 Acquire 3 tablet PCs (2 for doctors and 1 for nurses)

Printers

1Appropriate printing capacity should be available to EMR system users dependent on work function.

No requirement One multifunction device will be implemented by DOC program

None 4 None


None 4 None


None 4 None

4Printers should be compatible with the OS's which run remote thin emulation software for back office printing

None 4 None

5Printers should have Windows compatibility to support front office printing needs

None 4 None

6Printer should have static IP Address to allow access with remote thin client emulation software

None 4 None


1 print server but OK because site is not hosting candidate

None 4 None


Place all printers in a secure location and implement controls for secure printing. Also, it is recommended to PIN number on printer configuration to increase security.

Scanners


No real scanning capabilities now No real scanning capabilities now Need scanning capability 0 Will be supplied by multifunction devices recommended



Scanner

Printers





Networked and static IP assigned

The doctor and nurses need tablet PCs









1 Lab system Utilize outside Lab test provider N/A N/A N/A

2 Pharmacy system Pharmacy of Washington State Prison Shelton provide pharmacy service

None None None

3 Radiology system Utilize outside provider N/A N/A N/A


1The EMR system should have a viable interface and connection to appropriate Federal Programs

N/A N/A N/A N/A


N/A N/A N/A N/A


N/A N/A N/A N/A

4The EMR system should have viable interfaces and connections to County jail systems

N/A N/A N/A N/A

External Systems



Ancillary Systems

Copy of doc_Airway_Heights.xls Page 1 of 1


Site Name Airway Heights CC

Site Location & Date of Site Visit Spokane, WA 5/27 - 5/28/08

Primary Site Contacts (Technical and Medical) Dave DeJardine - IT, Rusty Smith, Health Care Manager


Vicky Hall - Medical Secretary, Sandy Sabantino - IT,

# Category Details

1


In-Scope: Medical Center, including PT, Dental, Primary Care, Optical, Mental Health, Medical Records, Pharmacy, and Pill Lines. Ancillary clinic at MSU, Pill line outside of main clinic, SPU, Intake

2Specific acronyms used at the site and in the site evaluation report

m/f - Multifunction Devices; dp - data port, w/s - workstation; MDF - Main Distribution Facility; IDF - Intermediate Distribution Facility; COU - Close Observation Unit; SMU - Special Management Unit, PA - Physician's Assistant; PT - Physical Therapy/Therapist; RN - Registered Nurse; MA - Medical Assistant.,

3

Additional Introductory Information All Sick Call is done at the infirmary - 2 people per unit are seen daily. Sign up is on unit at officer's desk, which is brought over dailyThere is a small outpatient clinic at the minimum security prison. Medical records also accessed at pill lines, SMU, Intake

4 10mb circuit added recently, as well as a compression device to assist with bandwidth issues.

5






Copy of doc_Airway_Heights.xls Page 1

Date of Visit: 5/27-28/2008

[0 - Not Met,

4 - No Gap]

Category Investment Category Observations Gap Score


Physical Space


Medical staff members are experiencing space limitations and patient care is often provided in hallways. There is no nursing station for outpatient clinic (currently using a counter as a workarea) and there is no space to place additional workstations and multi-function device needed for the future EMR system. Space for nursing station for Inpatient (Bldg D5-167) is also limited.

Also, we observed that there is a limited space in MSU Medical area. There is an initiative to expand this area, but it is in very early stage.

Server Room, MDF and IDFs are sufficiently sized. The future EMR system is not likely to be hosted at this location and the number of servers and network devices are not expected to increase unless staff level is expected to increase dramatically in the future.

New building is planned to be constructed between K and H buildings; however, medical records will not be accessed in the new building.

Not enough space for Medical staff members to work effectively

3 It is recommended to implement wireless for D5 and utilize laptops and rolling carts to increase flexibility. Outpatient nurses need additional workspace (C-128)(See Section L for more detailed recommendation for wireless) New medical expansion will also help with space constraints.


There are 4 generators located in Bldg A2 Central Power Plant that can produce total of 4000 KW. They are well maintained and tested monthly.The generators are feeding power to Server Room, MDF, IDFs and all areas where medical care is provided. One of the generators is dedicated to the medical building.

However, an interface to operate the generator is custom developed and it requires a professional from Bothell to fly in and reprogram them when the load needs to be rebalanced. A request has been made several times to upgrade the interface, but it has never yet received funding.

There is a risk of not being able to operate the generators when they are needed.

3 Recommend that funding get approved for the required upgrade to the generator operator interface


Current power capacity is sufficient to support additional hardware required for the future EMR system

None 4 None


Server Room, MDF and most IDFs are equipped with APC UPSs

no UPS for Bldg D5 IDF (Room # 153)no UPS for Bldg D2 IDF (Room # 124)

no UPS for Bldg D5 IDF (Room # 153)

no UPS for Bldg D2 IDF (Room # 124)

3 Since Bldg D5 IDF provides connections to the main clinical area for the facility, it is recommended to support the switch with a UPS

Since Bldg D2 IDF provides connection to both Bldg D2 and Bldg D4 area, it is recommended to support the switch with a UPS


Only one power feed from outside

Dual power feed to all switches

No dual power feed coming into the facility

3 No Recommendation - It is typically not required to have dual power feed from different parts of the grid for non-hosting sites.

Site: Airway Heights Corrections Center




Agency/Administration: Department of Corrections

Requirements








Dedicated air conditioner is found in Server Room, MDF and most IDFs

no dedicated cooling for D5 IDF (Room # 153)no dedicated cooling for D2 IDF (Room # 124)

no dedicated cooling for D5 IDF (Room # 153)

no dedicated cooling for D2 IDF (Room # 124)

2 Recommended to install an air conditioning system to D5 IDF, since the IDF provides connections to the main clinical area for the facility.

Recommended to install an air conditioning system to D2 IDF, since the IDF provides connections to both D2 and D4 area.


MDF (C1-109) and PBX/Demark (C1-110) can be covered by the shared HVAC system for the C1 building

None 4 No Recommendation - It is typically not required to have redundant HVAC for non-hosting sites.

1


Conduits are getting full and new conduits are in the process of being added to accommodate the new treatment facility for MH/CD. This may not address the need for conduit space for additional cabling in the existing building.

May need additional conduit to accommodate additional cabling requirements.

3 May need to add additional conduit to existing medical building - It depends on new building design, and cannot be quantified at this time.


There is fire detection, but no fire suppression in MDF. There is a fire extinguisher in a hallway.Server Room had a fire extinguisher, but it was located across the room from the door, and access would be blocked if a fire ensued.

Insufficient fire suppression in place

0 Acquire a gas fire suppression (FM200) for MDF. Relocated fire extinguisher in Server Room.




Cabling / Pathways






Servers

1


Not Applicable N/A No Recommendation - No current servers will be used in future EMR



3


Not Applicable N/A No Recommendation - Redundant network connection is not necessary as EMR servers will not be hosted at this site


Not Applicable N/A No Recommendation - Only file and print servers are on site and advanced monitoring capability should only be applicable at hosting site

ServersNot Applicable N/A No Recommendation - All DOC sites are exempted from

HIPAA compliance

1


4" conduit between the MDF (C building) and the medical building (D building) are accessible and serviceable. The conduit is close to full, but multiple strands of fiber (6 pairs) exist between the buildings and there is no need to run additional fibers

None 4 None

Cabling / Pathways


Rack mounted patch panels are observed in MDF and IDFs. However, MDF still utilizes punchdowns for data.

MDF still utilizes punchdowns for data

2 Recommended to access all network drops via patch panels


Telecommunications vaults are accessible through manholes (MH00, MH01, MH23, MH22). Contents are well documented with pictures of manholes.

None 4 None

WAN / LAN






Cabling / Pathways







Most of the data drops in the area where medical records are accessed are already utilized, and there will be more needed once an EMR is in place.

Additional data drops required 3 Recommended to add 14 more data drops in total:Add 2 more data drops in A wing Inpatient Nurses StationAdd 2 data drops at Old Security Desk outside of COUAdd 1 data in Med Room (144)Add 1 data in Blood Draw roomAdd 1 data in Outpatient Nurses StationAdd 1 data in Dietary (129) - this room is in a difficult place to bring in data.Add 1 more data drop in P-8T pill lineAdd 1 data drop in Exam Room (D3-155)Add 1 more data drop in C3-124AAdd 1 more data drop in C3-125AAdd 1 data drop in Interview Room in Staging (D4-113)No Recommendation to add additional data drops for building D5; however, we recommend to implement wireless for clinical area of D5 (See L section of this report)SMU - Medical Room has conduit, but no wire so needs data line pulled.


LAN architecture is scalable and no issues are found.Switches were just upgraded in December 2007. - Cisco Catalyst 6509 for MDF, C0 IDF and C3 IDF - Cisco Catalyst 2960 for all other IDFsCAT5 or CAT6 throughout the site with Fiber backbone (6 pairs of Multi-Mode Fiber cable between buildings)

None 4 None


No issues are reported None 4 None


No redundant core switch No redundant core switch 2 Install an additional switch in MDF with dedicated fiber for added redundancy

Regarding redundant core switch: DOC does not intend on having redundant core switches at institutions unless it is deemed a critical location

Install an additional switch in C0/D1 IDF with dedicated fiber for added redundancy

Also, it was brought to our attention that neither MDF nor C0/D1 IDF has enough power to accommodate the redundant core switch. We recommend to upgrade the power supply as needed, if redundant core switch is introduced.


The switch in D2 IDF (D2-124) has only three more ports available

The current switch in D2 IDF cannot accommodate additional devices required for the future EMR system

1 Upgrade to a 48-port switch


It is expected to have around 40 concurrent EMR users and 10 Mbps WAN is expected to be sufficient.

Also, this site utilizes Cisco WAE (Wide Area Application Engine) 600 series to optimize WAN performance.

None 4 None


No redundant WAN backup circuits due to budget constraints.

No redundancy and carrier diversity with WAN

0 Ideally, it would be recommended to have an additional T1 for redundancy;

However: DOC connects to the DIS MPLS network within a controlled network. Having a redundant ISP connection is not feasible.


QoS is currently not Implemented at DOC No QoS implemented at DOC 0 Recommend to implement a bandwidth management strategy including Quality of Service (QOS)

Network






Network is not monitored at local site, but DOC can monitor WAN and LAN on an ad hoc basis utilizing the following technologies:

SolarWins : device and bandwidth utilization monitoringNetQoS suite : Protocol and application level utilization monitoringCirrus : Configuration Management

None 4 None


CAT5 or CAT6 throughout the site None 4 None





WAN / LAN


as per DOC HQ standards None 4 None




VPN access is not currently provided to care staff, but Secure VPN service can be received from DIS

None 4 None

Cabling / Pathways


No Security standard is set for wireless since no wireless solution hasn't been implemented at DOC

No Security standard is set for wireless

N/A Recommend to set a standard for a wireless solution (New DOC HQ standards will provide wireless security standard)

2


None in place No wireless solution is implemented or planned

0 Recommended to implement wireless solution for the clinical area of D5. Since AHCC is experiencing space limitations, implementation of wireless solution provides more flexibility and can alleviate the space issue.

Total of 8 wireless access points are recommended to cover the area.

User Devices

All workstations are on 3 year-lease cycle and most of the current workstations are upgraded by 2012.

MacAfee's ePO product for virus protection and Microsoft's WSUS product to push out Microsoft security patches and fixes to all workstations.

None 4 None


There are workstations in all offices, but Heath Care staff will require to have more access to computers and the number of required workstations is expected to increase to support the workflow with the future EMR system.

Short of workstations in exam rooms and some offices

2 It is recommended to add 15-20 more workstations, especially if wireless is not implemented:

Add 4 workstations in Dental area (1 workstation per Dental chair)Pharmacy needs 1 more workstationInpatient Nurses Station needs 2 more workstationsAdd 1 workstation in Blood Draw area and 1 in Optometry, and 1 in DietaryAdd 1 workstation in D5-141AAdd 1 workstation in D5-138Add 1 workstation in D5-155Add 1 workstation in D5-127Add 1 workstation in D5-132Add 1 workstation in D3-155 (wall mounted to save the space)Add 3 workstation in C3-124Add 1 workstation in D4-113


None 4


None 4


None 4

5

Workstations should have DirectX 9.0 Capable, 256MB of RAM, Support for Pixel Shader 2.0 as a Video card capability

None 4




Current standard DOC workstation specs will be sufficient for EMR system use (given ongoing 3 year replacement cycle)

The latest leased PC Spec is Intel Core Duo CPU, 2 GB RAM, 80 GB Hard disk, ATI Radeon X2300 HD 256 MB PCI Express graphic card, 1280X800 display, wireless & Gigabit Ethernet connection and Optical wheel mouse

Confirm that, when ordered, all new workstations meet this specification.

User devices






None 4


None 4


None 4


None 4


None 4


None 4


None 4


None 4


None 4


None 4

User devices





User Devices

Mobile devices are currently not formally utilized by care staff members since most mobile devices are against policy to be inside the perimeter of a Prison Facility

Needs for portable devices with the future EMR system are identified in D5 and more laptops, tablet PCs and/or rolling carts are required

3 Formalize the process to provide an additional laptops or tablet PCs for medical professionals who could provide care/group sessions in new wireless areas.

Acquire 5 rolling carts with laptopsAcquire 10 - 15 laptops, some which may replace some of the workstations recommended in M1.

Printers


DOC is in process of evaluating/replacing existing printers with multi-function devices

Volume of printing/scanning is expected to increase with the future EMR system and the current number of printers are inadequate to support the future workflow

2 Recommend to have at least 10 multi-function devices spread over campus

Acquire 7 multi-function devices for D5Acquire 1 multi-function device for D4Acquire 1 multi-function device for D3Acquire 1 multi-function device for C3-125A

Recommended to procure multi-function devices which have a high processing speed, has full sheet scanning capability and be TWAIN compliant

Note: DOC is currently reviewing multi-function devices within the DOC


Windows compatible print server is hosted on site to provide network printing capability.

None 4 None


All printers have TCP/IP networking capability None 4 None


Reflections 3270 emulation software is utilized None 4 None


Printers are windows compatible None 4 None


Printers have static IP address None 4 None


Utilizes a Printer backup software that backup the printer server's configurations. If the printer server goes down, the configurations are loaded to another server to function as new Print server.

None 4 None


Printers are in secured areas. In addition, it is planned to configure password protected printing once the existing printers are replaced with multi-function devices..

None 4 None

Scanners


0


0


Uses OBTS and Liberty to track some medical information, so would need interfaces for those systems if continued. A number of home-grown databases have been developed for lack of an EMR system. In addition, there is a need to interact with regional health providers.

None 4 No infrastructural recommendations at this time; Information exchanges among existing systems and regional healthcare providers need to be further studied once the future EMR solution is determined. Data conversion for those databases that are being replaced would also be necessary.

1 Lab system Laboratory tests and services are mostly done through Quest Diagnostics and users can log into Quest's website to see lab results

None 4 None


Printers





Ancillary Systems

Recommendation to add more multi-function devices (see Section O-1)

No enough scannersOnly a few scanners are utilized in the area where medical records are accessedScanner





2 Pharmacy system DOC has a centralized pharmacy solution from Correctional Pharmacy Software (CIPS)

Not using a automated pill distribution system.

4 Recommend adding Pyxis machines in order to reduce the number of errors that can occur in pill distribution. One at each pill line.

3 Radiology system Film based X-ray is done on site None 4 No infrastructural recommendations at this time; Radiology's

XRAY equipment would need to be upgraded to accommodate digitized x-rays



Information can be exchanged via State's network None 4 None


Billing for the Services provided on site is handled internally; otherwise, billing information is sent to the central billing office in Olympia

None 4 None


Billing for the Services provided on site is handled internally; otherwise, billing information is sent to the central billing office in Olympia

None 4 None


None demonstrated, but if traffic can get to state network, it is feasible

None 4 None

External Systems


Copy of doc_Cedar_Creek.xls Page 1 of 2


Site Name Cedar Creek CC

Site Location & Date of Site Visit Littlerock, WA --- May 22, 2008

Primary Site Contacts (Technical and Medical) Technical: Shelly Maestas; Medical: Lynn Larsen-LeVier


Plant / Electrical: Ron Cannon

# Category Details

1


In scope: Administration building (houses the Main Equipment Room (EMR))Medical Clinic (site of nearly all medical care)CD Wing (extension of Medical Clinic)Cascade Residence building (site of inmate intake and initial medical screening)Timberline building (technical support)

Out of Scope (no medical or counseling care; no future EMR system equipment)Olympic Residence BldgAlpine SchoolDining Hall (no dietician)WarehouseRecreation BldgAll DNR bldgsAll maintenance and storage building on the lower campus near Timberline

2


DNR: Dept of Natural ResourcesCD: Chemical DependencyBLDG: BuildingMER: Main Equipment Room, comparable to MDFIDF: Intermediate Distribution Facility (single building telco room)




Copy of doc_Cedar_Creek.xls Page 2 of 2

# Category Details

3

Additional Introductory Information Cedar Creek is a minimum security work camp;Fewer than 10 medical / counseling professionals for 400 inmates;Construction underway to house an additional 100 inmates;Other than initial intake, no medical care is provided in the residences

4


5

Site Evaluation Report Deloitte Consulting Confidential

Copy of doc_Cedar_Creek.xls Page 1

Date of Site Visit: 5/22/2008

[0 - Not Met,

4 - No Gap]


Administration Bldg, Cascade Intake / Residence Bldg, Timberline Building, All Other Buildings

Medical Clinic and CD (Chem Dep) Area Gaps Score


Physical Space


For all buildings reviewed:Acceptable work space for current staff

MER (Main Equipment Room): Plenty of physical space (35' X 15')

Cascade IDF: Space adequate

Timberline IDF: Space adequate

General work space acceptable

Med Clinic IDF: Door to Clinic IDF is a thin, accordion style door -- It can be locked, but it is weak and can be knocked in very easily (and inmates are sometimes near the area of the door)

Door to Clinic IDF room needs to be strengthened

3 Installed a strengthened, lockable door to the Clinic IDF room


Five generators in place for entire complex; Largest is a 400KW Pow'rGard generator (manufactured by T&J) with Cutler transfer switch;

Also: Near Timberline: 155 KW Caterpillar 3306 diesel generator

None 4 None


Main electric feed from PSE; Overhead power lines coming in, up to entry point on road near Timberline;

No issues with power capacity, except for CD wing of Clinic -- see note at right

Power usage in Chemical Dependency (CD) Wing of Clinic is fairly near its maximum, but any new EMR system devices would not add any significant load in this wing

None 4 None


Large APC UPS in place in Main Equipment Room (MER), and smaller UPS devices in place in all IDF rooms

Small UPS in IDF None 4 None


Site: Cedar Creek CC


Requirements











None n/a n/a Not practical / economically viable in this remote location


Separate air conditioning in MER: Compu-Aire MTA-112; Excellent cooling

None 4 None


None needed None 4 None

1


All conduits in good shape; accessible ; cables well-mounted, near ceiling

None 4 None


No effective fire suppression;

DR Plan: Quick hardware replacement

No effective fire suppression No effective fire suppression in MER or IDF rooms serving future EMR system users

0 Acquire FM200 gas fire suppression for the following room:MER: FM200 to cover large 35' X 15' areaFor IDF's for Med Clinic, Cascade, and Timberline bldgs: fire extinguishers for IDF closets

Servers

1


APC UPS in place in MER None 4 None


No current servers would be used for hosting EMR system (except for file/print servers)

None 4 None

3



None 4 None



None 4 None

ServersSecurity levels in place, per DOC standards





Cabling / Pathways











1


Conduits accessible & serviceable; adequate capacity for additional cabling needed

None 4 None

Cabling / Pathways


MER: standard patch panelsCascade IDF: standard patch panelsTimberline IDF: standard patch panels

Med Clinic IDF: standard patch panels None 4 None


All vaults documented at DOC HQ (contact point = Charlie Ryman)

None 4 None

WAN / LAN


Admin building: no EMR system workers would work in Admin bldgCascade Intake Area: Needs one additional data drop (for laptop use);Cascade Holding Room: Plenty of data drops in office outside office (for laptop use);Timberline: No additional needs for EMR system

Medical Clinic generally very well wired with data drops for future EMR system use, with the following exception:

Need one additional data pull in nurse office room;Need one additional data drop in CD group counseling room

Need one data drop in Cascade, one data pull in Clinic (nurse office room), and one data drop in CD counseling

3 Install data drops and data pulls as indicated at left, under Gaps




Cabling / Pathways








MER: Main backbone switch is a 48-port CISCO Catalyst 6500E, with ample free ports;Dedicated fiber to each building;Large APC UPS;(An additional new patch panel is on order)

Cascade IDF: Cisco 2960, mounted on wall, in secure area;4 Free ports on Cisco 2960, 3 available ports on patch panelSmall APC UPS

Timberline IDF (supporting tech support only -- no EMR system users):Cisco 2960;Located in Secure, cool basement)

100 mb fiber throughout

Med Clinic IDF: CISCO Catalyst 2960 (24 ports), with over 12 ports free (enough for future EMR system usage)Small APC UPS;Fire detection, but no fire suppression;

Some minor stabilization of loose data cables and wires needed

None

(Fire suppression gaps noted above)

4 None, except for some minor stabilization of loose data cables and wires needed in the Med Clinic IDF room

Also recommend that no UPS devices be removed from MER and IDF rooms (replace with comparable models when necessary)


No issues: 10/100 mb LAN speed; low utilization

None 4 None


No redundancy n/a - LAN redundancy not cost-justified

n/a None


LAN switches and routers all appropriately sized for future EMR system use -- see LAN device descriptions above, on item J.2


None 4 None


Currently lightly used;WAN bandwidth is currently T-1(being confirmed by Shelly)

None - based on expected low user load (and little, if any, digitized imaging review), T-1 should be sufficient

4 None


No carrier diversity -- only one choice (Qwest)

n/a - redundancy and carrier diversity not practical in this remote location

n/a None

Network








Pending implementation of QOS by DOC

n/a- pending implementation by DOC

n/a None


Can be monitored by DOC on an ad hoc basis

None 4 None


Entire complex is CAT5 minimum, with 100 mb capability

None 4 None

WAN / LAN


In place, as per DOC standards None 4 None




In place, as per DOC standards (VPN access possible)

None 4 None

Cabling / Pathways


No wireless in place; none needed No wireless in place; none needed None 4 None

2



User Devices











Cascade - Intake Area: No stationary workstations needed (can be satisfied with laptop from med clinic)

Cascade - Holding Room Area: No stationary workstations needed (can be satisfied with laptop from med clinic)

Admin and all other buildings: No EMR system access required

There are several rooms in the Medical Clinic that need an additional workstation (each room has sufficient data drop in place, with the exception of the nurse office room:Entry desk: needs 1 workstationNurses room: needs 1 workstationExam room (which will become dental): needs 1 workstationEnclave/lab room: needs 1 workstationExam Room #2: needs 1 workstationMed Room: needs 1 workstationNurse Office Room: needs 1 workstationProcedure Room: needs 1 workstation

Several rooms (as noted at left) in the medical clinic need new workstation

2 Acquire additional workstations (8) and install in Med Clinic, as indicated in observations at left


None 4 None


None 4 None


None 4 None

5Workstations should have DirectX 9.0 Capable, 256MB of RAM, Support for Pixel Shader 2.0 as a Video card

None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


User devices








None 4 None

User Devices

No mobile devices for medical services and counseling used or needed, except for medical visits to the Cascade intake and holding areas

Small number of additional laptops would be required for medical, dental, and CD counseling staff when away from the immediate clinic office area:

To facilitate productivity in areas outside the immediate medical clinic area, approximately 3 laptops would be needed (for 6-8 medical / dental / counseling staff)

0 Acquire additional laptops (3) -- two for medical, one for counseling, for future EMR system use, to support EMR data access and charting outside the medical clinic

Printers


No printers needed for EMR system in Administration, Cascade, or Timberline

Need one networked multifunction printer in the medical entry office

Need one networked multifunction printer in the front room of the CD area

Need one networked multifunction printer in the medical entry office

Need one networked multifunction printer in the front room of the CD area

2 Acquire 2 mid-sized multifunction printers for use in the medical clinic and in the CD area, to support networked print, scan, copy, fax functions


as noted above as noted above








Static IP Addresses used as noted above as noted above


No redundancy needed as noted above as noted above



t d b t d b

Scanners

Very light scanning requirements at this time

Future scanning needs can be met with the additional of multifunction print/scan/fax devices, as noted above

Same as above: Acquire 2 mid-sized multifunction printers for use in the medical clinic and in the CD area, to support networked print, scan, copy, fax functions



1 Same as above: Acquire 2 mid-sized multifunction printers for use in the medical clinic and in the CD area, to support networked print, scan, copy, fax functions



1 Same as above: Acquire 2 mid-sized multifunction printers for use in the medical clinic and in the CD area, to support networked print, scan, copy, fax functions



Scanner

Printers










1 Lab system

Lab System and services provided by Qwest

None - due to light user load (less than 4 at any time), current WAN bandwidth is sufficient to support necessary interface access to these systems supporting EMR

4 None

2 Pharmacy system

CIPS - Pharmacy system None - due to light user load (less than 4 at any time), current WAN bandwidth is sufficient to support necessary interface access to these systems supporting EMR

4 None

3 Radiology system No xray services provided --- provided either through WCC Shelton or Olympia hospitals

None 4 None



None required from this site (necessary access would be done from DOC HQ)

None 4 None



None 4 None



None 4 None



None 4 None

External Systems



Ancillary Systems

Copy of doc_Clallam_Bay.xls Page 1 of 1


Site Name Clallam Bay Corrections Center

Site Location & Date of Site Visit 1830 Eagle Crest Way Clallam Bay, Washington 98326. 6/10/2008

Primary Site Contacts (Technical and Medical) Technical : James Johnson, Medical : Sharon Morgan


# Category Details

1


In Scope:Support building, D unit building, IMU building

Out of Scope:A, B, C unit building, MSC (Medium/Minimum Security Complex) building

2


IMU : Intensive Management Unit

3

Additional Introductory Information Maximum to minimum security levelThere are 900 offenders and 450 staff35 Medical staff provide medical serviceNew telecommunication cabling project will start soon which includes a new IT building outside of walls

4






Copy of doc_Clallam_Bay.xls Page 1


Site: Clallam Bay Corrections Center

[0 - Not Met,

4 - No Gap]


Medical Unit & MDF (Support building) D Unit building and IMU building Gaps Score


Physical Space


New IT building will be constructed outside of correction center perimeter soon and the current MDF will be moved to the new building.

New data / voice cabling project will start soon with new IT building and this project includes at least 2 data ports in every room and office of every building except for inmate living units.

New IDF rooms will replace the current one as a part of the new cabling projectMedical unit is inside of the Support building, 2nd floor.There is no in-patient unit, only out-patient service is provided.Medical unit : No issue with physical space for medical staffMDF : Roomy, no issue (will move to new location soon - new cabling project)IDF : Roomy, no issue (will move to new location soon - new cabling project)

Nurses go to D unit (one of the living unit similar to IMU) and IMU to provide cell-side care

There is one mental health office room in D unit

There is one multi-use room in D unit for medical staff

There is one medicine room in IMU

No issue of physical space of medical staff

IDFs : Roomy, no issues (move to new location soon - new cabling project )

None 4 None



Power : Clallam County PUD.1 line from two source.Power outage is very common.4 generators support the whole campus and 2 X 1000KW out of 4 generators support medical unit, D unit and IMU, of which one is primary and the other one is backup.Capacity of the generator which supports medical unit is enough but it's capacity is not fully utilized due to limited distribution system capability.New IT building will have a new, dedicated generator.

None 4 None


Current power distribution system has limitation on supporting huge additional power requirement, but a few more workstations, printers and wireless APs won't be a problem

None 4 None




Requirements









UPS at MDF and IDF UPS at all IDFs None 4 None




MDF : Air-conditionerIDF : No air-conditioner but room temperature

IDFs : No air-conditioner but room temperature OK

None 4 None



1


All conduits are in decent shape All conduits are in decent shape None 4 None


MDF : No fire-suppression but will have once moved to new locationIDF : Sprinkler

IDFs : Sprinkler Lack of fire suppression in MDF 3 Recommend gas based fire suppression (FM200) for new MDF room IDF rooms house only 1 switch. Recommend adding a fire extinguisher.

Note: DOC does not intend to install FM200’s in IDFs; For MDF’s: Yes, if the physical infrastructure supports it.

Servers


1


N/A N/A N/A N/A N/A


N/A N/A N/A N/A N/A

Cabling / Pathways













3


N/A N/A N/A N/A N/A


N/A N/A N/A N/A N/A



None 4 None

1



Cabling / Pathways


MDF : Rack mounted patch panel, cabling is in decent shapeIDFs : Rack mounted patch panel



AccessibleNew cabling project documentation will replace current documentation

None 4 None

WAN / LAN


New medical building : At least 2 data drops in every room of the new building

New IMU building : Pods area are wireless candidate but no data cable was included in construction plan

Living units : No medical room, current medical process doesn't require network access. No more data drops will be required because living units are wireless candidate

No UTP data cabling for wireless network AP in IMU building pods area

2 See recommendation for wireless in Section L

Cabling / Pathways











Cabling : New cabling project will accommodate the future requirement

Backbone switch : Cisco Catalyst 6509 X 1

Workgroup switch : Cisco Catalyst 2960 X 1

Workgroup switch : Cisco Catalyst 2960

None 4 None, assuming new cabling project proceeds


No statistics but can assume very low - Backbone switch has not been fully utilized




No redundant Connection to Workgroup switch but fiber cables between MDF to IDF are available


No redundancy n/aNote: Regarding the Redundant core switch: DOC does not intend on having redundant core switches at institutions unless it is deemed a critical location


Sufficient available ports Sufficient available ports None 4 None


WAN is 2 X T1 from CenturyTelVery difficult to upgrade WAN connection due to limited Telecom infrastructure in Clallam BayDOC HQ has WAN utilization but current WAN may not support future EMR requirement

WAN utilization rate is too high 2


Redundancy None 4






CAT6 in new cabling project None N/A None

WAN / LAN






Network

Need to discuss WAN upgrade with DOC HQ

Note: DOC / Clallam Bay has no control over Wide Area Network speed at this location. Fiber only goes out as far as Forks at this time.

Additional Note (related to J-7): DOC connects to the DIS MPLS network within a controlled network. Having a redundant ISP connection is not feasible.







DIS VPN None 4 None

Cabling / Pathways


2


User Devices


Pill line : No workstation, need 2 workstationsTelemedicine room : No workstation, need 1 workstationLab room : No workstation, need 1 workstation

D unit multiuse room : No workstation, need 1 workstationIMU medicine room : No workstation, need 1 workstation




None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None

User devices



Medical Unit : 2 APs for each corridor (X 2), total 4 APs with power line

D unit : 1 AP for each pod (X 3), total 3 APs with power line

IMU : 1 AP for each pod (X 6) and 1 AP for hall way, total 7 APs with power line

Wireless network is required 0Medical Unit, D unit and IMU need wireless network

DOC standard







None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None

User Devices

Mobile device requirement 0 Acquire 6 mobile cart with Notebook and 7 PDAs

Printers


Each side of medical unit needs 1 multifunction device but there is no multifunction device on doctor's office side

Multifunction device requirement

2 Acquire 1 more multifunction device


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


1 print server No redundancy 0 Backup print server: desirable, but not being recommended at this time

Printers




Nurses need 6 mobile cart to provide medical service in treatment rooms and bedside of sick roomsNurses need 3 shared PDA to distribute medication at D unit and IMU Doctors need 4 PDAs to access medical record at D unit and IMU







Place all printers in a secure location and implement controls for secure printing. Also, it is recommended to modify print server configuration to increase security.

Scanners


No real scanning capabilities now No real scanning capabilities now Need scanning capability 0 Will be supplied with multifunction devices recommended in current project plan


No real scanning capabilities now No real scanning capabilities now Need scanning capability 0 Will be supplied with multifunction devices recommended in current project plan


1 Lab system Utilize outside Lab test provider : Quest DiagnosticsResult by dedicated printer

N/A N/A N/A

2 Pharmacy system Pharmacy of Washington State Prison Shelton provide pharmacy service

None None None

3 Radiology system Old radiology machine - no digital capability

N/A N/A N/A



N/A N/A N/A N/A


N/A N/A N/A N/A


N/A N/A N/A N/A


N/A N/A N/A N/A

Scanner


External Systems




Ancillary Systems

Copy of doc_Coyote_Ridge.xls Page 1 of 1


Site Name Coyote Ridge Correction Center

Site Location & Date of Site Visit Post Office Box 769 Connell, WA 99326-0769 -- 6/17/2008

Primary Site Contacts (Technical and Medical) Technical : Steve Curtis Bressler, Medical : Amy Sawyer


Mark Noyes (Facility Manager)

# Category Details

1


In Scope:Old medical unit - Building 7, South campus IDF - Building 19, New medical unit - Building L, New SEG - Building M and IT building

Out of Scope:Living Units on new north campus and all other buildings in south campus except for building 7 and 19


SEG : Segregation unit

3

Additional Introductory Information Minimum to maximum security level for offenders who are not sick nor weakThe new north campus can house 2048 inmates 16 Medical staff provide medical service.currently, and operate on 10 hour shifts during the week, 4 hour shift on the weekends. However, they will be operating 24/7 when the new facility is up and running.There is no pharmacy currently. Meds are delivered from WCC. However, there will be a phamacy on the new campus.

4






Copy of doc_Coyote_Ridge.xls Page 1


Site: Coyote Ridge Corrections Center

[0 - Not Met,

4 - No Gap]


North campus (New medical unit - L, SEG - M & MDF)

South campus (Old medical unit - 7, IDFs (building 7 & 19) & power) Gaps Score


Physical Space


North campus is under construction

There will be a new medical building, SEG unit, living units and IT building by end of this year based on plan

New IT building is already utilized

No wireless network has been considered for the new SEG building (M) or medical bldg.

MDF : Very spacious and good security level

Old medical unit will stay to provide medical service to minimum security inmates

Building 19 IDF : Main hub for south campus, direct connection from MDF of north campus, spacious

Building 17 IDF : Spacious, no issue

None 4 None



Franklin county PUD

Power capacity is sufficient for additional power requirement

2 generators (2500 KW X 2) support entire campus (Primary and backup structure)

1 generator (750KW) supports medical unit - building 7 and other buildings on south campus

Building 7 & 19 IDFs don't have generator backup due to the lack of generator power capacity. New generator would cost $10K

A few of the functions currently housed on the south campus are slated to move to new north campus. If so, this generator could support building 7 &19 IDFs

None 4 None




UPS at MDF UPS at all IDFs None 4 None







Requirements










MDF : Air-conditionerIDF : No air-conditioner but room temperature OK

IDFs : No air-conditioner but room temperature OK

None 4 None



1




MDF : Gas-based FM200 Building 19 IDF : Fire alarm

Building 7 IDF : No fire suppression

None 4 None

Servers


1


N/A N/A N/A N/A N/A


N/A N/A N/A N/A N/A

3


N/A N/A N/A N/A N/A


N/A N/A N/A N/A N/A



None 4 None

Cabling / Pathways


Cabling /














1



Cabling / Pathways


MDF : Rack mounted patch panel, cabling is in decent shape



Accessible

North campus construction drawings have network cables and data drops

None 4 None

WAN / LAN


Optometry room of the new medical unit doesn't have data drops - requires 4 data ports

Rest of the rooms of the new medical unit have sufficient data ports in each room

Nurses Station - needs external conduit to cover wire that is out in the open and runs across the room to a workstation on the far side of the room from the data port.Pharmacy - needs external conduit to cover wire that is out in the open and runs across the room to a workstation on the far side of the room from the data port.

Lack of data ports in the Optometry room of the new medical unit

2 Recommend 4 data ports in the Optometry room of new medical unit on the North Campus.

Recommend 8 - 10 feet of external conduit each in the Pharmacy and Nurses Station on the South Campus.


Cabling : Assume the plan is appropriate for EMR standardBackbone switch : Cisco Catalyst 6509 X 1

Building 19 IDF : Cisco Catalyst 6509 X 1, no issues

Building 7 IDF : Cisco Catalyst 2950 X 1, no issues

None 4 None




Cabling / Pathways











No redundant connection from Backbone switch to Building 19 IDF switch but fiber cables between MDF to IDF are available

No redundant Connection from building 19 IDF switch to a Workgroup switch but fiber cables are available

No redundancy 0Note: Regarding the redundant core switch: DOC does not intend on having redundant core switches at institutions unless it is deemed a critical location. Therefore, no recommended action


Data ports are being considered in 99% of the medical facility (we noted one room designated for optometry that does not have any data ports planned).

Building 7 IDF : Ports are almost full but this won't be an issue because many of the existing workstations will move to the new north campus buildings

None 4 None


WAN is 2 X T1 from CenturyTel Current WAN bandwidth will not be sufficient for slated growth

1


Redundancy None 4






CAT6 CAT5 or higher None N/A None

WAN / LAN






DIS VPN None 4 None

Cabling / Pathways

Network

Need to contact DOC HQ for utilization and WAN upgrade because this campus will be the biggest correction center in the state










2


User Devices


Assume sufficient workstations in new buildings

Nurse station : 1 more workstation with conduits from data port

Exam room 1 : 1 more workstation




None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None

10 Wireless Access Points for SEG building (M) with power line to each Access Point

Wireless network is required inside of SEG building - M

0

DOC standard


New SEG unit building(M) needs wireless for cell-side care1 Access Point for each corridor (10 corridors)

No compelling reason for wireless network

User devices








None 4 None


None 4 None

User Devices

Mobile device requirement 0 Acquire 6 tablet PCs (2 for doctors and 4 for nurses)

Printers


Assume sufficient printing power will be implemented in new buildings

A new multifunction device will be implemented based on the recent DOC-wide printer study.

None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


1 print server but OK because site is not hosting candidate

None 4 None


Place all printers in a secure location and implement controls for secure printing. Also, it is recommended to add PIN numbers on printer configuration to increase security.

Scanners


No real scanning capabilities now No real scanning capabilities now Need scanning capability 0 Will be supplied with multifunction devices based on DOC-wide study underway.


No real scanning capabilities now No real scanning capabilities now Need scanning capability 0 Will be supplied with multifunction devices based on DOC-wide study underway.

Doctors and nurses need tablet PCs




Scanner

Printers











2 Pharmacy system Pharmacy of Washington CC Shelton provide pharmacy service

None None None

3 Radiology system Utilize outside provider N/A N/A N/A



N/A N/A N/A N/A


N/A N/A N/A N/A


N/A N/A N/A N/A


N/A N/A N/A N/A


Ancillary Systems

External Systems


Copy of doc_Larch.xls Page 1 of 2


Site Name Larch CC

Site Location & Date of Site Visit Yacolt, WA -- May 23, 2008

Primary Site Contacts (Technical and Medical) Technical: Joe Watson, Rory Grant; Medical: Rich Enders


Plant: Jim; Electrical: Terry

# Category Details

1


In ScopeProgram Building (houses all medical care personnel)New Warehouse (houses MDF)Secured Holding (houses secure cells for inmates in holding - 72 hour max)Gym (potential disaster recovery location)

Out of Scope:Housing Units A and B and Existing Barracks (no medical care delivered)Administration Building (no medical workers or medical / counseling care)Kitchen / Dining (no dietary staff)ShopDNR bldgs

2


CD: Chemical Dependency

3

Additional Introductory Information Larch is a minimum security work camp;Fewer than 10 medical / counseling professionals for approximately 400-450 inmates;No medical care is provided in the residences




Copy of doc_Larch.xls Page 2 of 2

# Category Details

4



Copy of doc_Larch.xls Page 1


[0 - Not Met,

4 - No Gap]


Maintenance Bldg, Secured Holding Bldg, Gym PROGRAM BLDG and CD Area Gaps Score


Physical Space


For "in scope" structures, Generally ample space throughout buildings and rooms;

For one IDF (in the Secured Holding building), the IDF is in an open boiler room / janitor closet, with inmate access to laundry

No physical space issues For Secured Holding IDF: unsecure location for IDF equipment

3 Recommend, for Secure Holding IDF: Move switch slightly to allow physical enclosure, for protection (minor carpentry task)


Generator: 1450 KW Caterpillar 3516; tested twice per month

None 4 None


Main power feed from Clark Co. PUD; plenty of capacity

None 4 None


Small, older UPS in MDF (Matrix 3000) No UPS in Program Bldg IDF Need larger, new UPS for MDF; Need small UPS for Program Building IDF

3 Acquire larger, new UPS device for MDF room;

Acquire UPS for Program Bldg IDF



Site: Larch CC


Requirements









None n/a n/a Not practical / economically viable in this remote location


Separate air conditioning in MDF: AirFlow Brand ; Excellent cooling

None 4 None


None needed (not an EMR system hosting site)

None 4 None

1


All conduits in good shape; accessible ; standard 4" conduits installed throughout complex in 1996; cables well-mounted, near ceiling

None 4 None


No effective fire suppression (water or none);

No effective fire suppression (water); No effective fire suppression in MDF or IDF rooms serving future EMR system users

0 Acquire FM200 gas fire suppression for the following room:MDF: FM200 to cover large 20' X 12' areaFor IDF's for Secure Holding, Warehouse/IT, and Program bldgs: fire extinguishers

Servers

1



None 4 None



None 4 None

3



None 4 None



None 4 None

ServersSecurity levels in place, per DOC standards

None 4 None


Cabling / Pathways













1


Conduits accessible & serviceable; Standardized 4" conduits installed in 1996; adequate capacity for additional cabling needed

None 4 None

Cabling / Pathways


MDF: standard patch panels

Warehouse / IT IDF: standard patch panelsSecure Holding IDF: standard patch panels

Program Building IDF: standard patch panels

None 4 None


Documentation provided for all telco system vaults.Total of 9 telco vaults for the complex: For future EMR system, the most critical vaults are in manholes #1,2,5,6, which serve the path to the Program BldgAll vaults also documented at DOC HQ (contact point = Charlie Ryman)

None 4 None

WAN / LAN


Admin building: no EMR system workers would work in Admin bldg

Maint / IT bldg: no additional needs

Secure Holding bldg: Needs one more data drop in the Control Office (hardened building) -- to be used by future laptop user

Gym: No Additional needs

Admitting Office supporting the waiting Area for med treatment:Four (4) data drops all full -- would need one more data drop for additional multifunction printer

Exam Room: no data drop

Dental Office (new): needs one data pull;

CD: need to activate one data port in each of 3 counseling rooms

Per observations at left:Need one data drop in Secure Holding bldg, one data drop in admitting office, one data drop in Exam room, one data pull in Dental office, and 3 data ports activated in the CD counseling area

3 Recommend additional data drops as follows:Need one data drop in Secure Holding bldg, one data drop in admitting office, one data drop in Exam room, one data pull in Dental office, and 3 data ports activated in the CD counseling area

Cabling / Pathways










MDF: Main backbone switch is a 48-port CISCO Catalyst 6506, with ample free ports;Dedicated fiber to each building; Per telco documentation, no single fiber traversing over 260 feetSmall, old UPS for MDF;

Warehouse/IT IDF: Cisco 2960, 4 Free ports on Cisco 2960,

Secure Holding IDF Cisco 2960;

Gym IDF (potential DR site):(upstairs in attic) - no special air:Cisco 2960 with 24 ports, with 21 ports free

100 mb fiber throughout

Program Bldg IDF: CISCO Catalyst 2960 (48 ports), with over 11 ports free (enough for future EMR system usage)No UPS;Fire detection, but water fire suppression;

Plenty of Space; Clean and dry

None 4 None


No issues: 10/100 mb LAN speed; low utilization

None 4 None


No redundancy n/a - LAN redundancy not cost-justified

n/a None




None 4 None


Currently lightly used;WAN bandwidth is currently T-1

None - based on expected low user load (and little, if any, digitized imaging review), T-1 should be sufficient

4 None

Network







No carrier diversity -- only one option (Qwest/Century Tel)

n/a - redundancy and carrier diversity not practical in this remote location

n/a None


Pending implementation of QOS by DOC

n/a- pending implementation by DOC

n/a None


Can be monitored by DOC on an ad hoc basis

None 4 None


Entire complex is CAT5 minimum, with 100 mb capability

None 4 None

WAN / LAN






In place, as per DOC standards (VPN access possible)

None 4 None

Cabling / Pathways



2



User Devices










Sufficient number of stationary workstations in Maint/IT, Secured Holding, Gym (Secured Holding access would be via laptop)

No workstation in exam room

No workstation in new dental office

Need two additional workstations, for placement in Program Bldg exam room and dental office

3 Acquire two additional workstations mounted on swivel arms (for more secure viewing of screen), for use in Program building exam room and dental office


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None

User devices








None 4 None

User Devices

With the exception of medical visits to the Secure Holding area, no mobile devices for medical services and counseling needed in these areas

Small number of additional laptops would be required for medical, dental, and CD counseling staff when away from the immediate clinic office area:

To facilitate productivity in areas outside the immediate Program Bldg medical clinic area, approximately 3 laptops would be needed (for 6-8 medical / dental / counseling staff)

0 Acquire additional laptops (3) -- 2 for medical staff's future EMR system use, to support EMR data access and charting outside the Program building medical clinic, and 1 shareable laptop for use amongst CD counselors

Printers


No additional printers needed for EMR system in Administration, Warehouse, Secure Holding, or Gym

Need one multifunction printer in Program Building medical area

Need one multifunction printer in Program Building medical area

3 Acquire 1 mid-sized multifunction printer for use in the Program Bldg medical clinic , to support networked print, scan, copy, fax functions










Static IP Addresses used as noted above as noted above


No redundancy needed as noted above as noted above



t d b t d b

Scanners

Very light scanning requirements at this time


Same as above: Acquire 1 mid-sized multifunction printer for use in the Program Bldg medical clinic , to support networked print, scan, copy, fax functions



1 Same as above: Acquire 1 mid-sized multifunction printer for use in the Program Bldg medical clinic , to support networked print, scan, copy, fax functions



1 Same as above: Acquire 1 mid-sized multifunction printer for use in the Program Bldg medical clinic , to support networked print, scan, copy, fax functions

Scanner

Printers











1 Lab system

Lab System and services provided by Qwest

None - due to light user load (less than 4 at any time), current WAN bandwidth is sufficient to support necessary interface access to these systems supporting EMR

4 None

2 Pharmacy system

CIPS - Pharmacy system None - due to light user load (less than 4 at any time), current WAN bandwidth is sufficient to support necessary interface access to these systems supporting EMR

4 None

3 Radiology system Access to web-based xray system on an as-needed basis

None 4 None




None 4 None



None 4 None



None 4 None



None 4 None

External Systems



Ancillary Systems

Copy of doc_McNeil_Island.xls Page 1 of 1


Site Name McNeil Island Corrections Center

Site Location & Date of Site Visit McNeil Island, WA -- 5/13/2008

Primary Site Contacts (Technical and Medical) Technical : Ted Aubry, Medical : Brenda Montgomery


Plant / Facilities: John Kessler

# Category Details

1


In Scope:Corridor building (containing: IMSVCS1, IMSVCS3, MDF, and core medical units), Buildings A, B, C, D, E, and the F building (Living Unit and IMU), B block building (Demarcation point)

Out of Scope:Admin building, Steam plant building, Maintenance building, G unit building



3

Additional Introductory Information McNeil Island CC was formerly a Federal Prison, and has been part of the State prison system since the 1980's.WAN service is 10 mb, provided via microwave, from QwestMICC faces many of the electrical and undersea cabling challenges that the DSHS SCC facility does.

4






Copy of doc_McNeil_Island.xls Page 1

Date: 5/13/2008

[0 - Not Met,

4 - No Gap]


Corridor building : IMS 1 & 3, Pharmacy, Mental health Care Unit,

MDF & IDF roomLiving Unit : A, B, C, D, E IMU : F Gaps Score


Physical Space


Pharmacy: Sufficient space for current needs, but looking to manage meds for SCC as well. Different formulary would require additional space.MDF & IDF : enough space for additional network and other IT equipments

MDF : MDF is part of storage space. General environment is in very poor shape

Units A-E: Very similar layouts physically

Assuming inmate kiosks are out of scope (there are 10 of them on A-E)

Nurse and counselor room inside of F Unit are small. No space for an additional workstation. Notebook or tablet PC type mobile devices are adequate solution for additional computing power requirement

Pharmacy: If pharmacy is not centralized, this pharmacy would need to expand when it takes on the SCC pharmacy relationship.MDF : MDF is part of storage space. General environment is in very poor shape

2 Pharmacy: Store room adjacent to the pharmacy could be utilized for additional space requirements. Would require renovation, including access through a solid brick and probable rebar.MDF : Build adequate protective barriers and environmental controls to safely and securely house the MDF.

Main power : Tacoma PowerPower outage : 3 or 4 time a year (Average)Storm is the biggest reason for long-term power outage (e.g. 5 days power outage last year)


MDF and IDF : UPS existsGenerator : test once a month

Current MDF UPS is too small to support both existing network devices and future redundant Backbone switch

A unit IDF : UPS exists Potential capacity problem of MDF UPS

2 Bigger capacity UPS for Network devices in MDF room


Electric power capacitor and distribution issues affect the island - Power feed from Tacoma Power is not always clean and stable

Power feed from Tacoma Power is not always clean and stable

2 Pursue electric power distribution / capacitor improvements


Yes None 4 None


No dual power source No dual power source 0 Dual power feed is not required


MDF : 2 small-room-grade air conditionersIDF : No air conditioning

IDF : No air conditioning MDF : weak air-conditioningIDF : no air-conditioning

2


Not a critical hosting site N/A




MDF : Air-conditioning needs to be upgradedIDF : Air-conditioning is not critical problem because most IDFs have one workgroup switch


Site: McNeil Island Correction Center



Requirements









1


MDF - IDF : Conduits are not full IDF : Conduits are not full Catalyst 2950 None 4 None


Sprinkler Sprinkler Water fire suppression not ideal 3 Gas base fire suppression (FM200) is recommended in MDF, and fire extinguishers for the 7 IDFs

Servers

Only applies to hosting sites; MICC is not a candidate given the variable power supply.




N/A N/A

1


N/A


N/A

3


N/A


N/A

ServersOnly applies to hosting sites; MICC is not a candidate given the variable power supply.




N/A None

1


Conduits are able to accommodate additional cabling throughout entire campus

None 4 None

Cabling / Pathways


MDF : no patch panelIDF : patch panel

Patch panel in MDF 2 MDF patch panel is recommended


No proper documentation of current cabling

Cabling / Pathways

Cabling / Pathways














WAN / LAN

DOC is upgrading Network devices (Cisco 1900 & 2950 switch -> Cisco 2960 switch)

A-Unit: Provide full services (short of surgery and infirmary), including mental health

B-Unit thru E-Unit have identical future needs and gaps:These are 4 units of 2 floors each, so single floor reqs have been multiplied X 8:


Mental Health Care Unit : Every room needs at least 1 data drop (4 rooms)Pill Room: There are 3 data drops, 1 workstation, 1 HP LaserJet 1022n networked printer. 2 pill windows. Currently enter data 3x. No Pixis machine in room.Inpatient Mental Health, Offices have data, but cells, exam room and pill room does not.

Unit A : Treatment Room - 3 dp; Chart Room - 1 data, 1 workstation present, but not enough for number of staff accessing area. A & B Pills and Treatment are administered at the cell doors. Units B - E: all exam rooms have 1 data port.

3 data drops for nurse and counselor office inside of pods. Exam room does not have data.

Additional data drops needed at Corridor Line Windows, up on the Medical Unit at the officers desk, lab, triage room, Injection Station, Xray room, Storage room next to pharmacy, dental area, Close Observation Unit, Unit A Chart Room and Pill Room; F Unit exam room; and in all 4 rooms on the Mental Health Unit.

1 Add data drops where needed -- as indicated at left, or wireless access points where justified (Medical Unit, Inpatient Mental Health Unit, COU). Dockable tablets on rolling carts (see section M) may also be an option where immediate access to online data is not necessary.Summary of data drops needed for standard (non-wireless) data connections:Pill Line Windows: 2, Medical Unit -- Officers Desk: 1, Lab: 1, Triage: 1, Injection Stn: 1, xray: 1, Pharm storage: 1, dental: 1, COU: 1, Unit A (Chart & Pill): 2, F exam room: 1, mental health: 4


From MDF to IDF of each unit : 6 pairs of fiber cable. 1 for Gigabit Ethernet connection between the Backbone switch and Workgroup switches. 4 fiber cables are available.

None 4 None


No issue. Backbone switch is Cisco 6509

None 4 None


No redundant Backbone switch No redundant Backbone switch n/a Per latest discussion, additional redundant backbone switch will not be implemented -- No recommendation


Enough capacity None 4 None


WAN is 10M Ethernet Microwave connection from Qwest. Sufficient bandwidth for EMR system

None 4 None


No redundant WAN connection.There is marine fiber cable which is not currently used. This available

No WAN backup n/a A Redundant WAN connection is desirable (but may not be viable) -- No recommendation


No QoS is implemented No Qos is implemented n/a DIS will implement state wide QoS on WAN


DOC is managing Network Monitoring SystemDIS and Qwest monitor the microwave connection

None 4 None


CAT5 cabling at medical service is provided

None 4 None

WAN / LANDOC security standard None 4 None

Network










4


4


DIS VPN None 4 None

Cabling / Pathways

IMSVCS3 Check in area is also a candidate for wireless access: Small 20' X 30' area: 2 Access Points

Mental Health area is also a candidate for wireless access: Small 20' X 30' area: 2 Access Points

No compelling justification in these living units

F unit is candidate location for wireless. Doctors and nurses provide cell side care.There are 3 pods which would require 2 APs respectively and 1 additional central location with 1 AP

Summary of requirements at left:IMSVCS3 check-in: 2 APIMU (F-Unit): 7 APInpatient Mental Health: 2 AP

0 Add wireless access points and associated cabling where justified at left (IMSVCS3 Medical Unit, Inpatient Mental Health Unit, IMU/COU in F-Unit). Dockable tablets on rolling carts may also be an option where immediate access to online data is not necessary.


No wireless No wireless No wireless N/A 0 N/A

2


IMSVCS3 Check in area is also a candidate for wireless access: Small 20' X 30' area: 2 Access Points

Mental Health area is also a candidate for wireless access: Small 20' X 30' area: 2 Access Points

No compelling justification in these living units

F unit is candidate location for wireless. Doctors and nurses provide cell side care.There are 3 pods which would require 2 APs respectively and 1 additional central location with 1 AP

Summary of requirements at left:IMSVCS3 check-in: 2 APIMU (F-Unit): 7 APInpatient Mental Health: 2 AP

0 Add wireless access points and associated cabling where justified at left (IMSVCS3 Medical Unit, Inpatient Mental Health Unit, IMU/COU in F-Unit). Dockable tablets on rolling carts may also be an option where immediate access to online data is not necessary.

User Devices


Corridor Med Room, 1st Floor: long narrow room with 2 pill lines, 1 workstation, not near the lines. 3rd Floor Medical: workstations locations: Nurses station (1) Exam Room, Triage room, Injection station, Trauma Room, Pharmacy, Radiology, Dental, Medical Records, Pill Room--some workstations, but not enough. COU: plan is to convert COU to Hospice unit so 8 beds would be utilized 24/7. Isolation rooms would stay. Officers station has 2 w/s for tracking inmate movement.

Unit A Chart Room: 1 workstation, need 1 more. Only unit to have a chart room. Pill Rooms A - E: No data, so no workstations. Units B - E: No workstations in any of the 8 exam rooms.

1 workstation for nurse and counselor respectively

Corridor Med Room, 1st Floor: 2 additional workstations needed, 1 at each pill line. 3rd Floor Medical: Additional workstations needed: 1 at Officer's Desk for registration / check-in, 1 in Lab, 1 in Triage, 1 at Injection Station, 1 in Trauma Room, 1 in Pill Room. COU: Officers Station- 1 for entering medical info. Unit A: 1 in Chart Room, 1 in Pill Room laptop due to space restrictions. B-E Units: 1 workstation in each exam room (2 exam rooms per unit). F Unit: 1 in Exam Room. Mental Health: Rooms need workstations, or Psychiatrists and Psychologists need laptops or tablets to take notes during Group Therapy. Dental would need 2 workstations.

1 See Gaps. Also potential for rolling carts with dockable laptops or handheld devices 1 per nurse per shift in Medical, COU, Mental Health.


None (DOC standard) 4








User devices


DOC standard



























User Devices

6 doctors, 6 counselors, and 6 support staffs would need mobile devices

A-Lower: Pill Room: Needs a laptop No mobile devices for doctors 0 Provide 12 - 15 mobile devices to doctors, counselors and support staff.

Printers

DOC is implementing the multi-function devices

A-E buildings are in need of one medium sized networked multifunction printer per bldg


Corridor Med Room (1st Floor) has one small HP laserjet, could use a multifunction printer. Medical Services (3rd Floor) Medical Records : 1 M/F device inside of room which is shared by many users on same floor. For those on the main hall, need to pass through 2 locked doors to get to unit. Lab also has a M/F printer. Dental does not have a printer

Unit A: M/F machine in 1 office. A-E buildings are in need of one medium sized networked multifunction printer per bldg

1 printer A - F unit needs Multi Function device Additional machines needed in Medical Services in Dental, and one to serve those on working on the main hall.

2 Recommend at least 8 multi function devices spread over campus.


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


No redundant Print Server No redundant print server n/a Redundant print server implementation desirable, but no formal recommendation (per final review)

Printers



No issues








Security an issue because nurse office is open to inside of pod

Some places have security issues, due to printers being in open areas with foot traffic

2 Recommend limiting access to printers and/or initiating coded retrieval available through configurations.

Scanners0 See Printer Recommendations


4


4


Mental Health Unit could make use of telemedicine connections, and if implemented, would certainly justify additional WAN fiber bandwidth. Would also require additional phone lines (3 closely situated in room)

A-Unit could make use of telemedicine connections, and if implemented, would certainly justify additional WAN fiber bandwidth. Would also require additional phone lines (3 closely situated in room)

F-Unit could make use of telemedicine connections, and if implemented, would certainly justify additional WAN fiber bandwidth. Would also require additional phone lines (3 closely situated in room)

10 mb OK for limited telemedicine

2 Add additional phone lines to 3 rooms to support telemedicine.

1 Lab system

Quest Diagnostics Will need ability to upload information from Quest Diagnostics to EMR system.

0 See Gaps

2 Pharmacy system

Use CIPS, scan barcodes from blister packs. Room is long and narrow, with 2 pill lines. 3 data drops, 1 w/s 1 small printer. Don't use Pixis.

Interface will be required between existing Pharmacy system and new EMR system if CIPS is still in use.

0 See Gaps. Install Pixis machines

3 Radiology system

Xray machines are not digitized, but may have the capability to be upgraded. Dental xrays also require ability to be digitized.

Equipment will require upgrades to interface with EMR system

0 See Gaps



Information can be exchanged via State's network



none 4 none


Billing information is sent to the central billing office in Olympia



none 4 none





none 4 none





none 4 none

Scanner


External Systems




Ancillary Systems

Copy of doc_Monroe.xls Page 1 of 2


Site Name Monroe Correctional Complex

Site Location & Date of Site Visit Monroe, WA -- May 1-2, 2008

Primary Site Contacts (Technical and Medical) Technical: Cheryl Bancroft, Charlie Rutan, Bruce Ensign; Medical: Dave Kenney


Plant / Electrical: Mike Ferrucci, Paddy Hescock

# Category Details

1


In Scope:WSRU: Medical Clinic, medical service area, and Inmate CellsMSU: Inmate Services / intake TRU: All medical and counseling areasIMU, SEG, and core medical areasSOU Core, SOU Expansion, including Inmate Services (Bldg G)IT / Communications Bldg

Out of Scope:MSU Residence Units (Bldgs A-D)Commissary, Vehicle Storage, Motor PoolWarehouses and ShopsCommand Plant Office

2


MSU: Minimum SecurityWSRU: Washington State Reformatory Unit: Original prison coreTRU: Twin Rivers Unit - Sex Offender Treatment ProgramIMU: Intensive Management, SEG: Segregation UnitSOU: Special Offender Unit




Copy of doc_Monroe.xls Page 2 of 2

# Category Details

3

Additional Introductory Information Monroe CC is the largest prison in the systemApprox 2600-2700 offenders25-30 nurses per shift, 8 nurse practitioners, 2 physiciansLarge number of inmates (1/3 to 1/2) are on meds

Largest, most significant upcoming project: New medical clinic to be built:Number of infirmary beds will increase from 30 to 180.Not feasible to do complete wireless, but there are strong candidate areas where cell side care is necessary, and open pod structures are conducive to wireless solution (For instance, every pill needs to be taken to the inmate in IMU, SEG

4

Final Revisions Made (July, 2008) Redundant backbone switches are being recommended only in the largest, most critical locations where it is necessary to support planned changes.Redundant print servers are not being recommended.FM200 gas-based fire suppression systems are being recommended only in MDF's or highly critical IDF's where physically viable; Otherwise, fire extinguishers are being recommended.For IDF's where A/C installation is not practical, venting (for air circulation with building air) is being recommended.Several scores re-set after overall review and comparison to other sites


Copy of doc_Monroe.xls Page 1

Site visit date: May 1-2, 2008

[0 - Not Met,4 - No Gap]


(0 - 4)Potential Recommendation

Physical Space


MSU: Small, cramped quarters; lack of workstations in key patient care areas; lack of workstation on pill line, over-usage/incompatible use of rooms; education room is used for waiting area; nurses station is also used for patient care; broken fax in Medical RecordsWSR: MDF was dirty and walls were in disrepair. Rumored that a dead rat was recently found in the room.SOU: C & D Units - no nurses stations, share counselor's office. Pill room is located in old janitor closet.IMU: Trauma Room also serves as exam room and office space for midlevels. Very messy. Nurses station is also med room.

See Observations.

2

MSU: Need additional medical office space in order to house the PC's and Printers/Scanners/Fax necessary to implement an EMR system - appr. 1000 sq ft.WSR: clean MDF and fix walls to prevent further rat activity.SOU: acquire more space in order to be able to house nursing staff and EMR equipment, minimum of 2 10 X 10 or larger workspaces. Existing med rooms would need to be expanded in order to house the Pixis machines.IMU: acquire one more room to be used as shared office for mid-levels and/or specialists.

1 Back up & redundancy should be in placeMain MDF: Generator, UPS and battery power in placeMSU: 2 UPS in placeSOU: UPS in IDF, but it is supposed to be removed

None3

Recommend keeping existing UPS in IDFs.


Main MDF: Power usage well under max: 18 amp usage by "black boxed" equipment in MDF; DC power supplyWSR- Pharmacy: all power to pharmacy is on one circuit, except for the island. This includes the perimeter of the large work area, and all offices. Frequent power outages. Both printers can't be run at once.

Main Pharmacy needs more power supply

3

Add another power circuit to the Pharmacy


Core MDF for SOU: One UPSE-Unit sub-IDF: UPS - OK 4

4 Dual power feed from different parts of the grid for critical sites and devices Campus: single power feeds to all MDFs and IDF's n/a Dual power feed from different parts of the grid for

critical sites and devices


MSU: Adequate AC.SOU: Marginally OK in Core MDF. Significant cooling problem in C,D IDF room -- over 80 degrees: No A/C, and heavy heat coming from transformers; Assume same issue in AB wing; Adding cooling is possible, but difficult and expensive. E-unit IDF - central AC only.TRU: AC unit was not operating - room at 78 degrees;WSR: AC unit was not on, but since in the basement, temp was ok; Main MDF: 2 AC units, 1 in need of replacement.

1

Add or replace stand alone HVAC units in all MDFs and IDFs

2 Cooling should have redundancy for critical sites Main MDF: 2 AC units, 1 in need of replacement. 1

Replace older AC unit in Main MDF




State of WashingtonMRTG ProjectSite Evaluation ReportAgency/Administration: DOC

Site: Monroe Correctional Complex, Monroe, WA

Requirements







(0 - 4)Potential RecommendationRequirements

1


Conduits accessible; enough space to accommodate additional data cable ; man-holes accessible at points between buildings; well documented 4


Main MDF: Excellent. Kedde FM200 gas suppression.MSU: MDF has a wet pipe fire suppression system;WSR: 2 fire extinguishersTRU: wet pipeSOU: No fire suppression

Fire suppression system was sub-standard in all areas except the Main MDF.

3

Fire suppression system should be updated to a minimum of dry pipe in the main MDF and the sub-MDF's

Servers

1


Main MDF: Generator and battery power in place

None

4

None


n/a: new system servers would be added with future solutionN/A No Recommendation - No current servers will be used

in future EMR

3The EMR system servers should have redundant network connection function such as channel or stand-by network connection

No redundancy

If selected as a hosting site, a redundant network connection would be required. n/a

Add redundant network connection to support future EMR system if selected as a hosting site.


Well-monitored4

Serversn/a: new system servers would be added with future solution; Exempt from HIPAA compliance standards

1


Conduits accessible, serviceable, and generally good room for additional fiber

None

4

None

Cabling / Pathways


All modern patch panel equipment (updated in the last year)4

None



Cabling / Pathways






Cabling / Pathways






All vaults well documented with CAD drawings and color photos; accessibleAll manholes are numbered; most are standard telephone manholes;Some manhole conduits look full, but in these cases there is plenty of unused cable that could be removed; Many conduits filled with removable icky-pick

None

4

None

WAN / LAN

1 There are sufficient data drops in appropriate locations to support the EMR system.

MSU: Data drops exist in all rooms except where the pill line is; however, there is no room for the equipment given the current overload on the space available.WSR: No data drops in Pill Room or LockdownTRU: No data drop in Treatment Room.SOU: Nurses Station requires additional data drops Medical Records needs additional wire pulled to existing data port. A and B Unit Med Rooms, Data port just outside door; need to pull wire through conduit to available ports. A Unit Exam Room could pull up to 2 wire to existing data ports.C & D Units: No nurses station or med rooms. Pill room is in a closet off the counselor's office. No data ports, but has conduit for wire to be pulled.E & F Units: Med room have data dropsG Unit: New infirmary. All rooms have data.IMU: Medical Records has one visible data port, another believed to be behind the actual records, so inaccessible. Exam Room has data. Nurses station has 6 data ports.SEG: Conduits in ceiling ready for wireless.

Additional data drops needed throughout the campus in order to support an EMR system and peripheral devices.

2

MSU: Data drops exist in all rooms except where the pill line is; however, there is no room for the equipment given the current overload on the space available.WSR: Add data drops in Pill Room and LockdownTRU: Add data drop in Treatment Room.SOU: Pull wire for two additional data drops Pull additional wire to existing data port in Medical Records. A and B Unit Med Rooms, pull wire through existing conduit to available ports. A Unit Exam Room pull 2 wires to existing data ports.C & D Units: Pull wire to Med Rooms.IMU: Expose hidden data port, or pull additional wire to Medical RecordsSEG: Run wire for Access Points for wireless connectivity.


High end CISCO 6509 equipment in MSU MDF and Catalyst 2960 in IDF's- very scalable; additional ports available

4

3 LAN utilization level should not exceed 60% on average (min).

OK - 100 mb, 1 gb multi-mode cable 4


No LAN redundancy n/a

5LAN devices should be sufficiently sized such that they can support an increase in workstations and other EMR devices

OK - 100 mb, 1 gb multi-mode; all modern, recently updated, well-sized Cisco , Catalyst switches

4

6 WAN utilization level should not exceed selected vendor's recommendation 2 T1 lines to site

Any EMR solution selected would require additional bandwidth to fully support all applications and interfaces.

0 Recommend upgrading WAN connection to 10 mbps.


No WAN redundancy n/a

8 QoS should be implemented to ensure EMR application performance None - pending DIS or DOC initiatives

n/a


SolarWinds : device and bandwidth utilization monitoringNetQoS suite : Protocol and application level utilization monitoringCirrus : Configuration Management

None 4 None


CAT5 throughout the site None 4 None

WAN / LAN

1 There should be technology in place to support agency network security standards


Network










Secure VPN available to DIS concentrator None 4 None

Cabling / Pathways

No wireless is currently being planned for the new building. No wireless on rest of the campus, with the exception of the wireless access points have pathways installed at the IMU.


A security standard for wireless has not been set since a wireless solution has yet to be implemented within DOC

No Security standard is set for wireless n/a Recommend a standard for wireless solution (New DOC HQ standards will provide wireless security standard)

2


No wireless is currently being planned for the new bldg. No wireless on the rest of the campus with the exception of the wireless access points have pathways installed at the IMU.

No wireless is currently being planned for new bldg. Also needs to be considered for other critical areas where mobility of the inmates is restricted.

n/a New Bldg: Wireless Access Points should be included in the design.to reduce the cost of implementation.Wireless Access Points should be considered for Seclusion wards

User Devices


MacAfee's ePO product is utilized for virus protection and Microsoft's WSUS product to push out Microsoft security patches and fixes to all workstations.

1 Sufficient number of workstations must be in place to support appropriate performance of the EMR application.

MSU: Only two workstations are available for use by the nursing staff, no workstation at the pill line; Med Records had sufficient number of work stations; patient care is not delivered to living quarters except in the case of emergency or lockdowns which are rare.WSR: Pharmacy - expectation that workload will increase once new medical facility is online; patient care is not delivered to living quarters except in the case of emergency or lockdowns which are rare. Pill line room has no workstation or data drop.TRU:Nurses station has appropriate number of workstations, as do offices and dental; trauma room and treatment room do not.SOU: Core Nurses Station has 1 workstation and 1 network printer and limited space. Core Exam Room has data, no workstation. Medical Records has 1 workstation, as does lunchroom. A & B Unit Med Rooms don't have workstations or wiring, Drugs are delivered door to door in the Close Observation Unit and in A & B units. C & D units Med Rooms have space limitations. A Unit exam room has 1 workstation.

Not enough workstations in place to support appropriate performance of the EMR application

2 MSU: Add 2 workstations for the nursing staff, add 1 workstation in the room for the pill line.WRS: Pharmacy - add 2 workstations for anticipated increased staffing. Pill line room needs 1 workstation; 2 tablets with or without wireless to be used in seclusion and living quarters.TRU: Add 1 workstation in trauma room and 1 workstation in treatment room. May need to be laptops in order to lock up for security reasons.SOU: Core Nurses Station 2 additional workstations for 4 hour overlap of nurse shifts and provider usage. Exam room 1 workstation needed. Meds are hand delivered to the Close Observation Unit cells CB1-26 thru CB 1-29 so 1 or 2 tablets are justified that can be synched back to EMR system. Medical Records needs additional workstation. A and B Unit Med Rooms each need 1 workstation. Meds are deliverd door to door on A & B units, so 1 or 2 tablets are justified that can be synched back to EMR system (may be shared with COU). C & D units: 1 workstation or laptop given space constraint in each med room. 1 or 2 workstations for nurses assuming space is

B Unit does not have an exam room, inmates are brought to the A unit. C & D units don't have Nurse Stations. Expansion E & F units: Med room has data but noworkstation. G unit has new infirmary, but not enough workstations.IMU: Medical records has 1 data port visible, may be another behind the bookcases storing the medical records. Only 1 workstation for 2 people who need constant access. Nurses Station had adequate number of data ports, but space was limited so not enough workstations.

Expansion E & F units: 2 laptops, one for each med room. G Unit Infirmary: 1 workstation for Lab, one laptop for Med Room, 2 workstations in dental assistants office; workstation needed in both exam rooms and Psych consult. Laptops may be justified for security purposes. Nurses station needs 1 or 2 more workstations, and the lunch room may need another workstation. The Treatment room needs 1 workstation. Need laptop or tablet that can be synched to EMR system for med delivery to Close Observation Units.IMU: Medical Records - 1 additional workstation; Trauma/Exam Room needs laptop. Need workstation for mid-level office, assuming space is available. Two additional workstations in Nurses station, plus one for the pill line.SEG: 1-4 laptops with wireless capabilities


User devices









5Workstations should have DirectX 9.0 Capable, 256MB of RAM, Support for Pixel Shader 2.0 as a Video card capability




9 Workstations should have Windows XP SP2 or Windows Vista with the latest patch

Windows XP SP2 None 4 None

10 Workstations should have Internet Explorer 6.1 or higher

Internet Explorer 6 None 4 None


Acrobat is standard S/W None 4 None


This feature is not turned on but could be activated on EMR requirements

No encryption 2 Turn on the function when EMR system is implemented



No ActiveX controls 2 Turn on the function when EMR system is implemented



No thin client emulation 2 Turn on the function when EMR system is implemented


JVM exists None 4 None

User Devices

Several additional mobile laptops or tablets justified Needs for portable devices with the future EMR system are identified and more laptops or tablet PCs are required (approx. 15-20)

3 Formalize the process to provide an additional laptops or tablet PCs for medical professionals who could provide care in new wireless areas.Purchase approximately 15-20 laptops or tablet PCs

Printers

1 Appropriate printing capacity should be available to EMR system users dependent on work function.

MSU: Multifunction machine in the Med Records area is not configured for anything but printing; 2nd printer is being utilized, but it is temporary; no printer in nurses station.WSR: expectation that workload will increase once new medical facility is online; SOU: Pharmacy has 4 small laser printers and 1 refill printer. Medical Records large printer is out of service, has one small laserjet printer. Nurses Station has one small laser jet printer.IMU: Medical Records does not have a printer

Not enough printers to support EMR system 1 Recommend 1 printer for every 5 workstations in new facility placed in central and secure location. In existing locations, a number of multifunction machines are justified (10-15), based on workflow.



None 4 None


TCP/IP networked printer None 4 None


No emulation software is utilized at DOC Emulation software is necessary for back office printing

0 Emulation software is strongly recommended for client-server based EMR application and to support back office printing

5 Printers should have Windows compatibility to support front office printing needs





None, but confirm that new workstations meet this planned specification.None 4


Printers







No redundancy in print server Lack of redundancy with print server 0 Redundant print server would be required only if Monroe is selected as a hosting site;No recommendation at this time


Printers are not in completely secure area Potential unintended access to printed material by unauthorized personnel

3 Implement secured printing option (process configuration on print server) -- No additional cost

Scanners

Some Sharp MX550's, but only used for faxingMSU: Medical Records can only receive faxes, they go over to the medical area to send faxes.SOU: Central Pharmacy has no scanner.

Scanners are currently inadequate to support the current business as well as any future EMR system requirements

2 Refer to O1.


Will be addressed through purchase or lease of new multi-function devices

4 Refer to O1.


Will be addressed through purchase or lease of new multi-function devices

4 Refer to O1.

WAN/LANExisting T1 lines (2) would be insufficient bandwidth to support an EMR systems need to interface with ancillary systems.


1 Lab system Drawn inhouse, analysis contracted out to Quest Diagnostics; no bandwidth issues

None 4

2 Pharmacy system

CIPS is in use, but not meeting the needs of the Pharmacy Staff (no inventory tracking, incorrect pricing, no barcode reading);Pills are hand-counted, creating large source of drug errors.Ordering done online using Cardinal.com

Interface needed between CIPS and new EMR assuming that CIPS is not replaced with a compatible Pharmacy application; also need interface between SIPS and Cardinal.Pill Lines need to be automated.

2 Upgrade the pharmacy system; Install Pixis machines at each pill line station (7 across campus)

3 Radiology system

TRU: DR unit installed, but not hooked to network although fiber is there.SOU: upgrading to CR system;

X-Ray machines need to be digitized and connected to network so that images can be uploaded directly to EMR

3 Already in the process of upgrading equipment over next few months to accommodate digitization. Expand bandwidth to 10 mbps to accommodate image size and clarity.

WAN/LAN


Information can be exchanged via State's network Existing T1 lines (2) would be insufficient bandwidth to support an EMR systems need to interface with external sources.




Existing T1 lines (2) would be insufficient bandwidth to support an EMR systems need to interface with external sources.










Scanner

External Systems

Ancillary Systems





Copy of doc_Olympic.xls Page 1 of 1


Site Name Olympic Corrections Center

Site Location & Date of Site Visit 11235 Hoh Mainline Forks, Washington 98331-9492

Primary Site Contacts (Technical and Medical) Technical : Steve Dunker, Medical : Miranda Puksta


Greg Banner (Facility Manager)

# Category Details

1


In Scope:Medical building, Hoh building and Admin building (MDF)

Out of Scope:Admin building, Clearwater building, Ozette building



3

Additional Introductory Information Minimum security level for offenders who are not sick nor weakThere are 37 offenders5 Medical staffs provide medical service

4






Copy of doc_Olympic.xls Page 1


[0 - Not Met,

4 - No Gap]

Category Investment Category Medical and Hoh building MDF Gaps Score


Physical Space


Patients come to medical building except for emergencyHoh building multipurpose office is used as medical interview room when offenders are transferred to this facilityPatients don't stay in SEG (segregation) unit more than 72 hours, which means no cell-side care is provided

Medical room spaces are sufficient to provide serviceHoh building interview room is not appropriate to put fixed workstation, A notebook could be utilized

Medical building IDF : No issueHoh building IDF : Attic space but secure




Power : Clallam County PUD.Power fluctuation is common because facility is close to main power distribution point of Power provider4 generators support the whole campus and power capacity is sufficient to cover entire campus

None 4 None




UPS in IDFs UPS in MDF None 4 None

Site: Olympic Corrections Center (11235 Hoh Mainline Forks, WA 98331-9492)




Requirements











IDFs : No air-conditioner but temperature was OK.Hoh building IDF could be hot in summer because it is in attic space. No system down time has happened

Air-conditioner None 4 Recommend tracking temperature of Hoh building IDF



1




IDFs : No fire suppression. MDF : Gas based fire suppression No fire suppression in IDF's 4 Recommend adding fire extinguisher in each IDF..

Servers


N/A N/A N/A N/A

1


N/A N/A N/A N/A N/A


N/A N/A N/A N/A N/A

3


N/A N/A N/A N/A N/A


N/A N/A N/A N/A N/A



None 4 None




Server Room


Cabling / Pathways








1



Cabling / Pathways


IDFs : Rack and wall mount patch panel. Decent shape

Good rack system None 4 None



WAN / LAN


Medical building has sufficient data drops inside of rooms

N/A None 4 None


Workgroup switch : Cisco Catalyst 2950 X 1 at each IDF

Backbone switch : Cisco Catalyst 6509 X 1

None 4 None







Cabling / Pathways









No redundancy n/a Per DOC design standards, redundant backbone switch is not being recommended




WAN is 1 X T1 from CenturyTelUtilization rate must be very low

None 4 None


No redundancy No redundancy 0 Recommend fractional T1 (512K) for redundant WAN connection






CAT5 or higher None N/A None

WAN / LAN






DIS VPN None 4 None

Cabling / Pathways

Network









None N/A None

2



None N/A None

User Devices


Exam room : No workstation but a notebook is appropriate due to space and security issueLab room : No workstation, need 1 workstationHoh building multipurpose room : No workstation but a notebook is appropriate due to security issue


2 Acquire 1 more workstation. See Section M for laptop recommendations.


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None

DOC standard


User devices






None 4 None


None 4 None


None 4 None

User Devices

Mobile device requirement 0 Acquire2 Notebooks for doctors and nurses. (Shared)2 PDAs for doctors and nurses (Shared)

Printers


Small networked printer in main medical office, need 1 multifunction device

Multifunction device requirement

2 Acquire 1 multifunction device


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


1 print server No redundancy n/a Redundant print servers are not being recommended


Place all printers in a secure location and implement controls for secure printing. Also, it is recommended to modify printer configuration for high security level

Scanners



Doctors and nurses need PDA and notebook to go to IMU and living unit even though wireless network is not available.Mobile devices could be sync up when they are online




Scanner

Printers










1 Lab system Utilize outside Lab test provider : Quest DiagnosticsResult by dedicated printer

N/A N/A N/A

2 Pharmacy system Washington State Shelton Corrections Center provides pharmacy service

None None None

3 Radiology system Washington State Clallam bay Corrections Center provides X-Ray service

N/A N/A N/A



N/A N/A N/A N/A


N/A N/A N/A N/A


N/A N/A N/A N/A


N/A N/A N/A N/A

External Systems



Ancillary Systems

Copy of doc_Pine_Lodge.xls Page 1 of 1


Site Name Pine Lodge CC for Women

Site Location & Date of Site Visit Spokane, WA 5/27 - 5/28/08

Primary Site Contacts (Technical and Medical) Kim Tuckford - IT, Mary Gonos - Health Care Manager


Gary Thurow - Plant Manager

# Category Details

1


In-Scope: Medical Center Only, including PT, Dental, Primary Care, Optical, Mental Health, Medical Records, and Pill Lines. Pharmaceuticals are supplied by Airway Heights.

2


m/f - Multifunction Devices; dp - data port, w/s - workstation; MDF - Main Distribution Facility; IDF - Intermediate Distribution Facility; COU - Close Observation Unit; PA - Physician's Assistant; PT - Physical Therapy/Therapist; RN - Registered Nurse; MA - Medical Assistant.

3

Additional Introductory Information Care is provided 16/7, not 24 hours. At peak times there are 2 doctors, 1 dentist, 1 hygenist, 2 psychologists, 2 psychiatrists, a social worker, PA, PT, RN, 2 MA's and a Nurse Supervisor, plus 4 more staff.A new medical building is being proposed. The concept paper and cost factors have been developed. It would add an additional 3,200 sq. ft. to the existing building, with 8 infirmary beds, 2 negative pressure rooms, and 2 COU. A Lab would also be housed there as well as additional offices.Minimum Security Prison for women, with an average of 350 - 360 inmates, but can be upwards of 400 at times.All cabling was upgraded 5 years ago to CAT5.

4






Copy of doc_Pine_Lodge.xls Page 1


[0 - Not Met,

4 - No Gap]



Physical Space


The medical building was built in 2002, but people are experiencing space limitations and no sprinklers are found in the building. Planning to expand the medical building by 3200 square feet within the next 5 years. (A capital project concept paper and project proposal has been submitted)

Sufficient space in MDF and IDF for any conceivable addition of EMR-related equipments

No sprinklers in the medical building

3 Although it is not directly related to EMR, it is recommended to equip sprinklers to all rooms of the medical building, especially since these rooms are used for medical purposes.


One generator exists, but the generator is not feeding power to the medical building. Constantly having power outages, especially in winter.

Emergency generation capabilities for the administrative building (MDF resides in the administrative building) is requested through a Capital project

No generator for the medical building

0 Significant recommendation to provide generator for the medical building

Medical Record Tech's office needs additional power outlets.



None 4 None


MDF and IDF are equipped with APC UPS 1400 for switches

APC UPS 1400 is old and already discontinued by APC

1 Replace 2 UPSs in MDFReplace 1 UPS in IDF


Not present No dual power feed 0 No Recommendation - It is typically not required to have dual power feed from different parts of the grid for non-hosting sites.


Dedicated air conditioner is found in MDF and IDF None 4 None


Not present None 0 No Recommendation - It is typically not required to have redundant HVAC for non-hosting sites.





Requirements


Site: Pine Lodge Corrections Center for Women








1


Enough capacity to accommodate additional cables None 4 None


No fire suppression in either MDF or IDF None in place 0 Acquire gas fire suppression (FM200) for MDF and IDF

Note: DOC does not intend to install FM200’s in IDFs; For MDF’s: yes if the physical infrastructure allows it.


Cabling / Pathways






Servers

1





3





ServersNot Applicable N/A No Recommendation - All DOC sites are exempted from

HIPAA compliance

1


Conduits between the admin building and the medical building are accessible and serviceable. There is enough room in conduits to accommodate additional cables.

None 4 None

Cabling / Pathways


Rack mounted patch panels are observed in MDF and IDF

None 4 None


Telecommunications vaults are accessible through manholes; Documentation available through DOC HQ

None 4 None

WAN / LAN


In general, there is a sufficient number of data drops in the medical building; however, storage/utility rooms without any data drops may be converted to office or exam room due to space limitations.

Lack of data drops in potential offices/exam rooms

3 Add 1 data drop in Med Utility Room (it is recommended to place a networked multi-function device in here. See Section O-1)Add 1 data drop in Dental Utility RoomAdd 1 data drop in Chart RoomAdd 1 data drop in Med RoomAdd 1 data drop in Med Storage RoomAdd 1 data drop in Exam Room 4 (only for ISDN line ports for Telemedicine exist)




H. The telecommunications network pathways between the Server Room and the medical service buildings should be able to accommodate updated cablingCabling /

Pathways








LAN architecture is scalable and no issues are found.Cisco Catalyst 2950 switch is out of data ports in the IDF. Catalyst 6500 in MDF with plenty of open ports.100Mb Ethernet throughout the site with Fiber backbone

None 4 Upgrade to a 48-port switch


No issues are reported. Compression technology is in place.

None 4 None


No redundant core switch No redundant core switch 2 Ideally, PLCCW could install an additional switch in MDF with dedicated fiber for added redundancy;



The switch in IDF has only one more port available The current switch in IDF cannot accommodate additional workstations required for the future EMR system

1 Upgrade to a 48-port switch


2xT1 WAN is expected to be sufficient, based on current staff count and inmate count.

Currently, there are around 20 to 25 concurrent users. The staffing level could increase with the expansion of the medical building, but it is not expected to significantly affect WAN utilization.

Also, this site utilizes Cisco WAE (Wide Area Application Engine) 600 series to optimize WAN

None 4 None


No redundant WAN backup circuits due to budget constraints.


0 No Recommendation - redundancy and carrier diversity not practical in this location

Note: DOC connects to the DIS MPLS network within a controlled network. Having a redundant ISP connection is not feasible.




Network is not monitored at local site, but DOC can monitor on an ad hoc basis utilizing the following technologies:


None 4 None



Network





WAN / LAN







None 4 None

Cabling / Pathways


New DOC HQ standards will provide wireless security standard

None 4 None

2


None in place No wireless solution is implemented or currently planned

0 Recommend implementing a wireless solution for the existing medical building and the future expansion area. Since PLCCW is experiencing space limitations, implementation of wireless solution provides more flexibility and can assist in alleviating the space issue.

The medical building will have around 9000 sqft after the expansion and walls are not hardened. Total of 4 wireless access points are recommended. Also, upgrade cables from CAT5 to CAT5e.

User Devices



None 4 None


There are workstations in all offices, but exam rooms do not have workstations in general. Care staff will need to have more access to computers and the number of required workstations is expected to increase to support the workflow with the future EMR system.

Short of workstations in exam rooms and some offices

2 11 or more workstations needed in the following places:

Add 1 more workstation in Dental OfficeAdd 2 workstations in Dental Suites (one on each side)Add 1 more workstation in Nurse's OfficeAdd 1 workstation in Exam Room 2Add 1 workstation in Exam Room 3Add 1 workstation in Exam Room 4Add 1 workstation in Chart Room (planning to be used as Exam Room)Add 1 more workstation in Med RoomAdd 1 workstation in Med Storage RoomAdd 1 more workstation in Provider's Office


None 4


None 4


None 4

5


None 4


None 4




User devices









None 4


None 4


None 4


None 4


None 4


None 4


None 4


None 4


None 4





User Devices

A few laptops are currently utilized by select staff members since most mobile devices are against policy to be inside the perimeter of a Prison Facility

Needs for portable devices with the future EMR system are identified and more laptops or tablet PCs are required

3 Formalize the process to provide an additional laptops or tablet PCs for medical professionals who could provide care/group sessions in new wireless areas.

Purchase 5 more laptops

Printers


Only two networked printers are utilized in the medical building. One in Mary's office and another in Medical Record Room.

DOC is in process of evaluating/replacing existing printers with multi-function devices

Volume of printing/scanning is expected to increase with the future EMR system and the current number of printers are inadequate to support the future workflow

2 Add 1 small multi-function device in Med RoomAdd 1 multi-function device in Med Utility RoomReplace the printer in Mary's office with a multi-function deviceReplace the printer in Medical Record Room with a small multi-function device

Recommend procuring a multi-function device which has a high processing speed, has full sheet scanning capability and be TWAIN compliant

Number of Direct In Dial (DID) lines would need to be increased in order to support additional fax functionality of multi-function printers.

Note: DOC is currently reviewing multi-function devices within the DOC



None 4 None




No emulation software is utilized for printing Emulation software is necessary for back office printing







No redundancy in print server Lack of redundancy with print server

n/a No Recommendation - Redundant print server is not required for non-hosting site


Printers are in secured office areas None 4 None

Scanners


0


0


1 Lab system Laboratory tests and services are mostly done through Quest Diagnostics and users can log into Quest's website to see lab results

None 4 None

Recommendation to add more multi-function device is included in Section O-1

No scannersScanners are not utilized in the medical buildingScanner

Printers





P. Appropriate security methods should be mandated to prevent unauthorized personnel





2 Pharmacy system

DOC has a centralized pharmacy solution from Correctional Pharmacy Software (CIPS)

CPOE (Computerized Physician Order Entry) system for the pharmacy system is being piloted and necessary equipment is being brought into this site.

Pharmacy service is provided by Airway Heights CC

None 4 None

3 Radiology system

Northwest Mobile Imaging visits to this site with a mobile radiology device. Users are able to check results via website and are not currently experiencing any performance issues.

None 4 None






None 4 None



None 4 None



None 4 None

External Systems


Ancillary Systems

Copy of doc_Rap_Lincoln.xls Page 1 of 1


Site Name Rap/Lincoln Park Work Release

Site Location & Date of Site Visit Tacoma, WA -- 6/16/2008

Primary Site Contacts (Technical and Medical) Bill Johnson - IT, Penny Boyce - Nurse Manager


Tammy Williams - Nurse

# Category Details

1


In-Scope: Admin Building, Rap House, Lincoln Park

2


m/f - Multifunction Devices; dp - data port, w/s - workstation; MDF - Main Distribution Facility; IDF - Intermediate Distribution Facility; NP - Nurse Practitioner, CCO - Community Corrections Officer; CD - Chemical Dependencies

3

Additional Introductory Information Rap/Lincoln Park Work Release conducts rehabilitative programs for 50 developmentally disabled or mentally ill adult offenders.

There are 1 full-time nurse and a few part time nurses. It is planned to have 2 full-time nurses in the future. The clinic is open Monday through Friday 8 AM to 5 PM. Nurses are the primary users of the future EMR system. In addition, there are counselors, a visiting nurse practitioner, a visiting psychologist, case manager, supervisor, secretary and community corrections officers who will need to access medical information in various degrees.

4






Copy of doc_Rap_Lincoln.xls Page 1


[0 - Not Met,

4 - No Gap]



There is no network closet for the facility. Network equipment is placed in a small lockable wall mounted cabinet. A server, a monitor and an UPS are placed on a desk right below the cabinet in a corner of Admin Building. The cabinet used to be locked all the time; however, the cabinet's door is currently kept open since the network equipment started to overheat after a new router was installed.

Server/monitor/UPS are not secured and it could lead to security risks, equipment vandalism and/or accidental damage of the equipment.

Purchase a larger cabinet with proper ventilation/cooling to house the network equipment and the server/UPS/monitor.

Physical Space


Medical care is provided in Admin Building where the Exam Room (also used as Nurses Office) is located, and Chemical Dependency counseling is conducted in a private office. There are sufficient work spaces in the facility for workers to access medical records without disturbing their workflows. However, 2 nurse practitioners and 1 psychologist come to this facility from the other DOC facilities like McNeil Island CC. Since there are no offices for them, they utilize a conference room and/or Community Corrections Officer's office.

There is a plan to have a minor remodel (add a sink and move and rearrange the room) for nurses room/exam room. Med station/pill line in Rap House is very small and there is no space to place a workstation.

The med station/pill line in Rap House is too small to have a workstation

Recommend expanding or relocating the med room/pill line, so a workstation (and possibly a med dispensing machine like Pyxis) can be placed within the room. This would require an additional 10 - 12 sq. ft.

1 Back up & redundancy should be in placeThere is no generator, but this facility hasn't experienced many power outages in the past. Also, considering the types of care being provided on site, having a generator is not absolutely critical.

No generator 3 No Recommendation - it is not absolutely critical to have emergency power generation capability.



None 4 None


1 UPS (Smart APC-UPS SC 1500) is sufficient to cover the network equipment.

None 4 None




There is no dedicated air-conditioner for the network cabinet. However, there is an air-conditioner in a hallway of Admin building.

No dedicated cooling 2 No Recommendation - See recommendation in Section A about purchasing a larger cabinet with a good ventilation/cooling



1







A, The physical location(s) should have enough floor space capacity to house all the site's

required infrastructure equipment.Additional equipment can vary depending on

selected solution and needs of the site: Typically, this can potentially include:

- small rack-mounted servers and storage to support local processing

- necessary file and print servers (if not already in place)

- workstations placed in locations of medical service personnel

- Mobile carts, Tablet PC's, PDA's used by medical service personnel

- printers, scanners- upgraded network devices (routers/switches)

in network room - upgraded fiber, cable, or wiring in conduits

between buildings



Cabling /

Requirements

Site: Rap/Lincoln Park Work Release





Requirements

1




There is a small fire extinguisher on a wall right by the network cabinet None 4 No Recommendation - a fire extinguisher is appropriate for the network cabinet


Cabling / Pathways





Requirements

Servers

1





3





ServersThe system server will be housed remotely - N/A Assume new server will be compliant N/A None.

1


No known issue. Since medical care is provided in Admin building where the network equipment is, cable upgrade is not necessary for the future EMR system.

None 4 None

Cabling / Pathways


Rack mounted patch panel observed in the network cabinet. None 4 None


Telecommunications vaults are accessible through manholes None 4 None

WAN / LAN


In general, there are a sufficient number of data drops in the facility; however, there is no data drop in the med room.

No data drop in the med room 3 Add 2 data drops in Med Room to accommodate a workstation and possibly a med dispensing machine. Also, electrical outlets need to be added to the room.


LAN architecture is scalable and no issues are found. Cisco Catalyst 2950 switch is sufficient considering the size of this facility.

None 4 None





Pathways







Requirements


No issues are reported. None 4 None


No redundant core switch No redundant core switch 2 No Recommendation - Since medical care can be provided by community health providers, high redundancy is not absolutely critical.


The switch has 48 ports and about half of them are currently used. None 4 None


Full T-1. Also, this site utilizes Cisco 3845 to optimize WAN performance. The number of users accessing medical record is small (less than 10 concurrent users) and more bandwidth wouldn't be necessary for the future EMR system.

None 4 None


No redundant WAN backup circuits due to budget constraints. No redundancy and carrier diversity with WAN

0 No Recommendation - redundancy and carrier diversity not practical in this location


QoS is currently not Implemented at DOC No QoS implemented at DOC 0 Recommend implementing a bandwidth management strategy including Quality of Service (QOS)


Network is not monitored at local site, but DOC can monitor on an ad hoc basis utilizing the following technologies:


None 4 None



Network





Requirements

WAN / LAN







None 4 None

Cabling / Pathways


N/A - No Wireless None N/A N/A - No compelling reasons to implement wireless

2


N/A - No Wireless None N/A N/A - No compelling reasons to implement wireless

User Devices

All DOC workstations are on 3 year-lease cycle and most of the current workstations are upgraded by 2012.


None 4 None


There are sufficient number of workstations in general as there are workstations in all offices including a conference room. However, there is no workstation in the med room.

Needs a workstation in the med room 3 Add 1 workstation in the med room in Rap House.


None 4


None 4


None 4

5


None 4


None 4


None 4




User devices








Requirements


None 4


None 4


None 4


None 4


None 4


None 4


None 4


None 4





Requirements

User Devices

A laptop is currently utilized by Supervisor, but non of the staff members have a laptop.


3 Add 2 laptops to be shared among nurses and visiting medical providers to provide more flexibility.

Standardize and formalize a process to provide laptops or tablet PCs for staff members who require more mobility, as necessary.

Printers


Only 1 networked printer (Sharp MX-5500N multi-function device) is utilized in this facility. The device is located in a hallway of Admin building (a few doors away from the Exam Room/Nurses Office)

There is local printer in each office.

Printing capacity is not exceeded and current number of printers is adequate.

4 None


Since there is only one network printer/multi-function device, a dedicated print server is not utilized in this facility. Windows compatible network printing utility to provide network printing capability.

None 4 None


The printer/multi-function device has TCP/IP networking capability None 4 None


The printer/multi-function device is compatible with thin emulation software for back office printing

Emulation software is necessary for back office printing



The printer/multi-function device is windows compatible None 4 None


The printer/multi-function device has static IP address None 4 None


No redundancy in print server Lack of redundancy with print server 0 No Recommendation - Redundant print server is not required for non-hosting site


The printer/multi-function device is located in a hallway of Admin building, but it is properly segregated by divider panels. Also, patients cannot come into Admin building without being escorted.

None 4 Recommend to configure secure print functionality of the multi-function device to prevent unauthorized personnel from accessing sensitive medical record information.

Scanners


There is 1 multi-function device with scanning capability. None 4 None


Sharp MX-5500N is TWAIN compliant and has full sheet scanning capability.

None 4 None


1 Lab system

Laboratory tests and services are mostly done through Quest Diagnostics and users can log into Quest's website to see lab results

None 4 None

2 Pharmacy system

DOC has a centralized pharmacy solution from Correctional Pharmacy Software (CIPS)

Pharmacy service is mostly provided by Shelton Pharmacy and Lincoln Pharmacy for emergency

None 4 None

3 Radiology system

There are not many needs for radiology service; however, it is typically contracted out to Tacoma Radiology or send patients to ER if there is a need

None 4 None

Scanner

Printers




Ancillary Systems







Requirements





Billing information is sent to the central billing office in Olympia None 4 None


Billing information is sent to the central billing office in Olympia None 4 None


None demonstrated, but if traffic can get to state network, it is feasible None 4 None

External Systems


Copy of doc_Seattle_Community_Justice_Center.xls Page 1 of 1


Site Name Washington State DOC Seattle Community Justice Center

Site Location & Date of Site Visit 1550 4th Avenue South Seattle, Wa 98134. 06/12/2008

Primary Site Contacts (Technical and Medical) Technical : Jesse Nelson


# Category Details

1


In Scope:Main building


3

Additional Introductory Information DOC office to help offenders reenter societyNo medical staff nor medical roomPlan to add medical room exists

4






Copy of doc_Seattle_Community_Justice_Center.xls Page 1


[0 - Not Met,

4 - No Gap]

Category Investment Category Main building and MDF Gaps Score


Physical Space


Seattle CJC (Community Justice Center) helps offenders reenter society with education, training and job

There is no medical unit or room but the plans for one medical room exists.Potential medical room is the IT storage room which has sufficient space to provide basic medical service

MDF : no space issue

None 4 None

Site: Washington State Seattle Community Justice Center (1550 4th Avenue South Seattle, WA 98134)



Requirements








Power : City of Seattle LightA generator covers only emergency lightsThis site doesn't need high availability because there are no long term residents

None 4 None




UPS in MDF None 4 None


N/A (non-hosting site) N/A N/A N/A


MDF : Air-conditioner None 4 None



1


All of conduits are in decent shape None 4 NoneCabling / Pathways











MDF : Sprinkler (which is OK due to low availability target)

None 4 None

Servers


1


N/A N/A N/A N/A


N/A N/A N/A N/A

3


N/A N/A N/A N/A


N/A N/A N/A N/A

ServersCurrently meets DOC security standard

None 4 None

1


Conduits are in decent shape None 4 None

Cabling / Pathways


MDF : Rack mount patch panel None 4 None

Cabling / Pathways













WAN / LAN


Potential medical room has 12 data ports

None 4 None


5 stacked Cisco Catalyst 2960 switches which is sub-standard but don't recommend network switch upgrade due to low availability targetMDF serves the potential medical roomCables inside of MDF are messy but will be organized soon

None 4 None


No statistics but can assume very low None 4 None


Network






N/A due to low availability target N/A N/A N/A




WAN is 1 X T1 from QwestNeed to check the utilization rate with DOC Headquarter

None 4 Need to check utilization rate with DOC HQ


No redundancy No redundancy 4 None






CAT5 or higher None N/A None

WAN / LAN






DIS VPN None 4 None






Cabling / Pathways



None N/A None

2



None N/A None

User Devices


N/A N/A N/A N/A


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None



DOC standard






None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None

User Devices

N/A N/A N/A N/A

Printers


N/A N/A N/A N/A


None 4 None


None 4 None


None 4 None

User devices

Printers









None 4 None


None 4 None


1 print server None due to low availability target

4 None


Scanners


No real scanning capabilities now Need scanning capability 0 Will be supplied by multifunction devices recommended in m/f assessment in progress.


No real scanning capabilities now Need scanning capability 0 Will be supplied by multifunction devices recommended in m/f assessment in progress.


1 Lab system N/A N/A N/A N/A2 Pharmacy system N/A N/A N/A N/A3 Radiology system N/A N/A N/A N/A



N/A N/A N/A N/A


N/A N/A N/A N/A


N/A N/A N/A N/A


N/A N/A N/A N/A

Scanner


External Systems



R. There should be viable interface methods and connections between the existing ancillary systems and the future EMR systemAncillary

Systems

Copy of doc_Stafford_Creek.xls Page 1 of 1


Site Name DOC Stafford Creek Corrections Center

Site Location & Date of Site Visit 191 Constantine Way, Aberdeen, WA 98520. 5/15/2008

Primary Site Contacts (Technical and Medical) Technical : Jacob Sainsbury, Medical : Kathy Reninger


# Category Details

1


In Scope:D building (IT Department & MDF room), F building (IMU & SEG), G1, H1, H2, H3, H4, H5 & H6 building (Living Unit), R building (Medical Unit)

Out of Scope:A, B, C, E, U & V building

2


IMU : Intensive Management UnitSEG : Segregation Unit

3

Additional Introductory Information Buildings were built in 2000Total 70 medical staffsIn-patient and out patient service

4






Copy of doc_Stafford_Creek.xls Page 1


[0 - Not Met,

4 - No Gap]

Investment Category R building (Medical Unit) F building (IMU & SEG Unit) D Building (MDF room), G & H1 ~

H6, G Building (Living Unit) Gaps Score(0 - 4) Potential Recommendation


IDF room is spacious Medical room is very small. No space to locate workstation due to safety reason. Need bigger medical room with separate secure space where nurses can access medical record

Dental room is spacious

IDF room is spacious and rack has empty slots

MDF room is very spacious and has lots of empty rack space for additional IT equipment.IDF room of each building is spacious and IDF racks have ample empty slots

IMU and SEG unit medical room is too small

2 Recommend bigger medical room for IMU/SEG - approximately 300 sq ft - with separate secure space where nurses can access future EMR system.

Main power : 2 loops. One is from Raymond and the other one is from AberdeenPower capacity has lots of rooms for additional IT and EMR requirement


MDF and IDF : UPS existsGenerator : test once a month

IDF : UPS exists IDF : UPS exists None 4 None


No issues No issues No issues None 4 None


Yes Yes Yes None 4 None


Dual power source Dual power source Dual power source None 4 None


R building IDF : too hot and no air conditioning

Recommend air-conditioner or venting in R building IDF2MDF : good HVAC systemIDFs : central air conditioning

IDF : very hot, no air conditioning IDF : air-conditioning


Requirements







Site: Stafford Creek Correction Center




H6, G Building (Living Unit) Gaps Score(0 - 4) Potential RecommendationRequirements


1


IDF : Conduits have room for additional cabling

IDF : Conduits have room for additional cabling

MDF : Conduits have room for additional cablingIDF : Conduits have room for additional cabling

None 4 None


Sprinkler fire suppression Sprinkler fire suppression Sprinkler fire suppression;

It has been reported that the MDF room is below the water table; The MDF/server room has received water damage in the past.

Water fire suppression in MDF;

MDF susceptible to water damage

2 Recommend a gas base fire suppression (FM200) in MDF;

No straightforward resolution of MDF / ground water issue; Recommend that further study be conducted for options to divert ground water from this area of the building

Servers

N/A N/A N/A N/A N/A N/A

1


N/A N/A N/A


N/A N/A N/A

3


N/A N/A N/A


N/A N/A N/A

ServersNew servers would be added at host site that would be HIPAA compliant.

N/A N/A N/A

1


Conduits have room for additional cabling



None 4 None

Cabling / Pathways


Patch panels exist Patch panels exist Patch panels exist None 4 None




Cabling / Pathways


Cabling / Pathways








Good documentation Good documentation Good documentation None 4 None

WAN / LAN

DOC will upgrade workgroup switches (Cisco 3500 -> ?)


Main Medical Offices: All offices have 1 or 2 data ports. All medical personnel in central part of main office building are connected to their workstations through an 8 port patch on a central pillar. The conference room has 4 open data ports. Needs 3 additional voice to support telemedicine/teleconferences with outside professionals. Medical Records has sufficient workstations, but not located near the data port, so 1 CAT5 cable runs loose down the floor - tripping hazard..Outpatient Clinic: Exam Room - has 6 unused data ports. Most are covered in black tape. Would need 3 voice connections near television screen for telemedicine;Nurses Station - 6 open data ports, most covered in black tape;Provider's office/Exam Room: data port located on opposite wall from workstation. Tripping hazard. Optometry - needs data and w/s;

1 data port in medical room and dental room

Sick call room (where the patients come to ask for medical service) has enough data drops (At least 3)

Cat5 Cable in medical records needs new conduit and placement

Cat5 Cable in provider office / exam room needs new conduit and placement

R Bldg Med Room near pill line needs a data drop

Optometry needs a data drop

R Bldg medical offices need 3 additional voice lines for telemedicine

3 Run conduit down wall in Medical Records to contain CAT 5 cable (approx 15'-20'); Run conduit under cabinet in Providers Office/Exam Room to contain CAT 5 cable (approx 8'-10'); add data port in Med Room near pill line in R bldg,

Add data drop for Optometry

Add 3 voice lines in R Bldg main medical offices for telemedicine

R Bldg Observations Continued:Nurse Supervisor - has w/s and plenty of data ports, ok;Offices 1313 - 1316 all have data;Radiology needs data for x-ray machine. New x-ray machine will be justified since this one has been in existence since the CC opened in 2001. Data port and w/s are in file room;Pill Lines: 5 pill lines per day through 2 windows. Needs 1 data port on west wall near pill line window;Pharmacy: Has adequate number of data portsDental: Has adequate number of data ports.







LAN and cables to user locations are scalable


From MDF to IDF of each unit : 6 pairs of Multi-Mode Fiber cables and 6 pairs of Single-Mode Fiber cables for Gigabit Ethernet connection. Current network use 1 pair of fiber cable

None 4 None


No issue. Backbone switch is Cisco 6509

None 4 None


No redundant Backbone switchNo redundant connection between Backbone switch and workgroup switches

No redundant Backbone switch n/a A redundant Backbone switch could be considered, but is counter to current DOC network design.No Recommendation


Enough empty ports on workgroup switch

Enough empty ports on workgroup switch

Backbone Switch : enough empty slots for additional workgroup switchesEnough empty ports on workgroup switch

None 4 None


WAN is T1 X 2 (US West Communication). Low utilization

None 4 May need to upgrade bandwidth (beyond 2 X T-1) in future. It depends on EMR system requirements and utilization rate when the EMR system is implemented.


2 T1 provide redundancyNo carrier diversity

No carrier diversity 2 Carrier diversity is cost prohibitive, due to location


No Qos is implemented No Qos is implemented 0 DIS will implement state wide QoS on WAN


DOC Headquarter manages WAN and LANDOC standard monitoring system

None 4 None


CAT 5 or higher None 4 None

WAN / LANDOC security standard None 4 None




DIS VPN can be used DIS VPN can be used DIS VPN can be used None 4 None

Cabling / Pathways

F building : 6 PODS : 1 AP for each PODS


No wireless No wireless No wireless N/A 0 N/A







2


Inpatient Unit is good candidate for wireless. 21 beds housing inmates for surgery prep, post surgical, infirmed, COU and Negative Pressure Room.

F building IMU and SEG units are the candidate location. Doctors and nurses provide cell side care.There are 3 pods which would require 2 APs respectively, and 1 additional location with 1 AP

No wireless and not required. No wireless access points currently.

0 F building : Recommend 6 APs for PODS + 1 AP for medical roomR Building: Need wireless access points in upper level of R building. Estimate up to 4 access points needed.

User Devices

Main Medical Offices: All medical personnel in main office building have a workstation. The two Health Managers and the Medical Doctor have dockable laptops. The conference room, used for medical meetings needs a workstation, or laptops may be brought in, as there are data ports. Also needs television for telemedicine/teleconferences with outside professionals. Medical Records has sufficient workstations.Outpatient Clinic: Exam Room - has 1 workstation and Pixis machine for medical supplies. Needs television screen for telemedicine;Nurses Station - Only 2 workstations. Needs 1 - 2 more to handle traffic flow. At least 1 desktop, and if more of the professional staff have laptops then they can plug in as there are 6 open data ports;Provider's office/Exam Room : 1 workstation located on opposite wall from data port:Optometry - needs data and w/s;

No workstation in medical room and dental room

See observations. 3 F building : Add 1 workstation for a nurse in medical room

R Building: Add 4 desktop workstations, and 2 -3 rolling carts with laptops for inpatient unit.

Nurse Supervisor - has w/s and plenty of data ports, ok;Offices 1313 - 1316 all have data and 1 w/s, except for 1314 (transportation) need 1 w/s;Radiology - Data port and w/s are in file room;Pill Lines: 5 pill lines per day through 2 windows. Needs 2 laptops (to accommodate space limitation), one near each window;Pharmacy: Has adequate number of workstationsDental: No data or workstations in the main dental clinic, only in the dental office. Space is tight, but could use 1 more workstation, either in the existing office, or one at other end.




DOC standard



DOC standard None 4

None
















User Devices

6 doctors, 6 counselors, and 6 support staff would need mobile devices

No mobile devices for doctors 0 Acquire 1 PDA for F building (IMU & SEG) medical room

Provide mobile devices to doctors, counselors and support staff (approximately 18-22 total: 8-10 notebooks, and 10-12 tablets ). Also need 2 laptops for pill line.

Acquire 2-3 laptops for rolling carts

Printers

DOC is implementing the multi-function devices


Medical Office: Canon Image Runner 5570 is not set up to fax or scan. Supposed to be replaced in the near term with a multifunction device. Medical Clinic: Dental office needs own multifunction device. Medical Records also needs own device, as does Pharmacy and Nurses Station

IMU & SEG unit don't need a printer because of security issue

See observations at left 2 Upgrade existing printers to multifunction printers in the following 4 key locations:

Medical Office, Medical Records, Pharmacy, and Nurses Station

Also add multifunction printer in Dental

==>> For a total of 5 multifunction printers




None

Print serverStatic IP on printersNo issue

None



4








No redundant Print Server No redundant print server n/a No recommendation - redundant print servers only for hosting site


Printer in Medical Office is not secure. Printer in Medical Office is not secure.

0 Recommend enabling security features on printers in open areas (Medical Office, Nurses Station)

Scanners

Medical Office: Canon Image Runner 5570 is not set up to fax or scan. Supposed to be replaced in the near term with a multifunction device. Medical Clinic: Dental office needs own multifunction device. Medical Records also needs own device, as does Pharmacy and Nurses Station

IMU & SEG unit don't need a printer because of security issue

See observations at left 1 Add multifunction devices (as indicated above under printer recommendations). Remove existing fax machines.


New multifunction devices are compliant

N/A


New multifunction devices are compliant

N/A


1 Lab system

Labs are sent offsite, and would continue to do so. Has web-interface with lab provider.

No infrastructure gaps 4 No infrastructural recommendations at this time; Regarding adequacy of WAN bandwidth, May need to upgrade 2 X T1 bandwidth in future. It depends on EMR system requirements and utilization rate when the EMR system is implemented

2 Pharmacy system

Uses CIPS which would need to be interfaced or replaced. Also uses pixis for meds and supplies.

No infrastructure gaps 4 No infrastructural recommendations at this time; Regarding adequacy of WAN bandwidth, May need to upgrade 2 X T1 bandwidth in future. It depends on EMR system requirements and utilization rate when the EMR system is implemented. Uses CIPS which would need to be interfaced or replaced. Also uses pixis for meds and supplies.

3 Radiology system

Equipment would need to be upgraded to accommodate digitized x-rays

No infrastructure gaps 4 No infrastructural recommendations at this time; Regarding adequacy of WAN bandwidth, May need to upgrade 2 X T1 bandwidth in future. It depends on EMR system requirements and utilization rate when the EMR system is implemented.

Radiology's XRAY equipment would need to be upgraded to accommodate digitized x-rays

4 Other

Uses OBITS and Liberty to track some medical information, so would need interfaces for those systems if continued. A number of home-grown databases have been developed for lack of an EMR system.

No infrastructure gaps, but final solution would need interfaces to EMR for all ancillary systems and/or databases that are intended to be retained. Data conversion for those databases that are being replaced would also be necessary.

4 No infrastructural recommendations at this time; Regarding adequacy of WAN bandwidth, May need to upgrade 2 X T1 bandwidth in future. It depends on EMR system requirements and utilization rate when the EMR system is implemented. Would need interfaces to EMR for all ancillary systems and/or databases that are intended to be retained. Data conversion for those databases that are being replaced would also be necessary.






none 4 none













none 4 none





none 4 none





none 4 none

Copy of doc_WA_CC_Women_Purdy.xls Page 1 of 2


Site Name Washington Corrections Center - Women (WCCW)

Site Location & Date of Site Visit Purdy, WA -- 4/28/2008

Primary Site Contacts (Technical and Medical) Technical: Jack Michel, Bruce Ensign; Medical: Eric Hernandez


Christina Abby (HCM2)

# Category Details

1


In Scope: Current Medical Clinic Building, New Medical Clinic Building;Building M (location of pill dispensing)Z BuildingMain Server room / MDF (Outside fence)Special Needs Building;Residence Bldgs (inspected, but no need for EMR system access; emergency care only - counselors have normal desktop access to network)

Out of Scope: Maintenance shops and out-buildings needing no access to future EMR system


MDF: Main Distribution FacilityIDF: Intermediate Distribution Facility

3

Additional Introductory Information New medical building already in budget: will be at least 2.5 X size of current medical building;New building plans already include data cable wiring, with at least 2-4 data ports per room;However, no wireless is planned for the new building;Z building and special needs building are security hardened w/ concrete -- Special Needs building is approx 1/2 size of Z buildingStaff currently uses OBTS system;Medical Staff: 8 nurses, 3 doctors




Copy of doc_WA_CC_Women_Purdy.xls Page 2 of 2

# Category Details

4



Copy of doc_WA_CC_Women_Purdy.xls Page 1


[0 - Not Met,

4 - No Gap]



Physical Space


Sufficient space in MDF and IDFs for any conceivable addition of EMR-related to equipmentMDF Room is at least 20' X 20', not even half full; APC UPS systemCISCO 2821 router taking inbound fibre from State Ring

This report assumes that construction of new medical clinic proceeds as planned and will have sufficient space for workstations and printers/scanners in nurse stations, exam rooms, ICUs and other clinical area.

None 4 No action required, but over the long term DIS and DOC need to confirm full support of medical clinic construction and completion


Electrical power: Single primary feed (single core switch); Backup and redundancy via UPS and generator. The generator is tested every month to make sure it functions when needed.

None, other than no dual power feed

4 No Recommendation - Dual power feed is not necessary as it is cost prohibitive and is not consistent with agency's practice


No issues None 4 None


Every IDF has a small UPS for a workgroup switch and a large UPS in MDF for servers and network devices.Observed that UPS is working properly (actually being used on 4/28)

Per DOC, there is a UPS in every closet. -- (As the UPS's fail, DOC is replacing them with surge protectors.)

None 4 None




HVAC is present and sufficiently sized None 4 None







Requirements


Site: Washington Correction Center for Women (Purdy)








1


Most conduits are accessible and serviceable; single-mode and multi-mode fibres are running between buildings;No cabling for wireless currently planned for new medical clinic

Some IDFs are difficult to access because of physical security

Additional cabling will be necessary to support wireless in new medical clinic

2 Add appropriate cabling (ceiling) to support wireless in new medical clinic and in Z Building (4 + 4 access points) and in Special Needs Bldg (2 + 2 access points)


No measures are in place to protect from natural disasters and fire

None in place 0 Install fire suppression system in MDF


Cabling / Pathways






Servers

1





3




Basic sever monitoring software exists and it should be acceptable for non-hosting location

None 4 No Recommendation - Only file and print servers are on site and advanced monitoring capability should only be applicable at hosting site

ServersNot Applicable - All DOC sites are exempted from HIPAA compliance

N/A

1



Cabling / Pathways


Rack mounted patch panels are observed in every IDF room.

None 4 None


No issues or problems None 4 None

WAN / LAN

This site has and uses VLAN's based on function, e.g., servers and printers, users, etc.


In general, there are sufficient number of data drops at locations where Medical Record is accessed; however, there is a need to have a data drop at pill dispensing location in Building M

Need new data drop at pill dispensing location in Building M

3 Recommend to have a data drop within the pill dispensing room (bldg M)





Pathways








LAN architecture is scalable and no issues are found.100Mb Ethernet throughout the site and an additional equipment upgrade is pending. Also, it is planned to provide 10GE (Gigabit Ethernet) between buildings.

None 4 None


No known issues None 4 None


No redundant core switchMulti-mode and single-mode fibres are utilized to provide redundant connection between buildings

No redundant core switch n/a While it was initially recommended to install an additional switch in MDF for added redundancy, this is counter to DOC design standards;No Recommendation


LAN devices will be upgraded and the upgraded LAN devices can support expected increase of workstations and other EMR devices

None 4 None


10 mb connection between site and State WAN None 4 None


DOC does not have redundant WAN backup circuits due to budget constraints.


n/a Recommend to have multiple WAN carriers and separate physical connections for higher availability


QoS is currently not Implemented at DOC No QoS implemented at DOC n/a Recommend to implement a bandwidth management strategy including Quality of Service (QOS)



None 4 None



Network





WAN / LAN






Secure VPN service is provided by DIS None 4 None

Cabling / Pathways




n/a Recommend to set a standard for a wireless solution (New DOC HQ standards will provide wireless security standard)

2



n/a Significant recommendation to implement a wireless solution for new medical clinic, Z building, and Special Needs Building

User Devices



None 4 None


In general, there are enough workstations to support the workflow with the future EMR system; however, we observed lack of workstations in Z building receiving and accepting area.

Gap in number of workstations in building Z- receiving/accepting area.Additional med workers will need workstation.

3 Recommend to add 3 more workstations in Z building receiving and accepting area. Wiring is already in place; adding wireless is not necessary.

For new building: If a 1:1 workstation to med worker ratio is maintained, and if the new building results in approx 30 additional med workers, approx 30 additional workstations will be required


None 4


None 4


None 4

5


None 4


None 4


None 4


None 4




User devices




























User Devices

About 20 laptops currently in use

A handful of personal PDA's used to hold drug reference and diagnostic info

Needs for portable devices with the future EMR system are identified and more laptops or tablet PCs are required (5 ~ 10)

3 Formalize the process to provide an additional laptops or tablet PCs for medical professionals who could provide care in new wireless areas.Purchase 5 ~ 10 laptop or tablet PC

Printers


Heavy usage of printers and faxes is observed and printing/faxing capacity is currently exceeded

Even if printing demand goes down with future EMR system, current printers may not be enough

2 Consider adding a multi-function device at each nurse station and general clinical area to support the future workflow with EMR

Two to four additional multi-function devices are recommended in the new building



None 4 None












0 No Recommendation - Redundant print server is not required for non-hosting site


Generally printers are in secured office areas, but there are some printers which could potentially be accessed patients

Printers are not in secured area 3 Make sure to place a printer in a secure location, so that unauthorized personnel can't easily access the printer. Also, it is recommended to modify print server configuration to increase security.

Scanners


Only one scanner (Sharp MX550) is found.MX550 is a modern multi-function device which has high processing speed

None 2 Recommendation to add more multi-function devices is included in Section O-1


Sharp MX550's Scanning functionality is TWAIN complaint

None 4 None


A lot of interactions with St. Joseph Medical CenterSt. Joseph Medical Center utilizes Elysium EMR and an ability to exchange medical record with the system is necessary

No WAN Bandwidth Gap expected

4 No Recommendation - 10 mbps WAN is sufficient

1 Lab system

Laboratory tests and services are mostly done through Quest Diagnostics. However, some basic lab tests such as urine dip are done within the facility. Users can log into Quest's website to see lab results





Scanner

Printers








2 Pharmacy system

DOC has a centralized pharmacy solution from Correctional Pharmacy Software (CIPS) - It is a pharmacy software system specifically for prison or jail pharmacy. DOC wants to be able to see patients' basic medical information (lab results, progress notes, diagnosis, formularies and clinical outcome) to be accessible through CIPS once a new EMR system is implemented. DOC is also planning to have a central pharmacy which can serve all DOC sites. Pharmacy located in WCCW is also expected to be much smaller once the central pharmacy is created. Users are currently not experiencing performance issues.



3 Radiology system


Once new building is completed, radiology service will be provided within the facility and will have own digital imaging system.





Information can be exchanged via State's network No WAN Bandwidth Gap expected














External Systems


Ancillary Systems

Copy of doc_WA_CC_Women_Walla_Walla.xls Page 1 of 1


Site Name Washington State Penitentiary

Site Location & Date of Site Visit Walla Walla - 6/3/08

Primary Site Contacts (Technical and Medical) Cynthia Hoffman - IT Supervisor; Richard Cross- Nurse Manager


Carl Ungerecht - Plant Supervisor; Kimberly Kiesz - Medical Records staff; Brian Hatley - IT; Dale Christiansen - IT; Manuel - IT; Kyle - Nurse Supervisor

# Category Details

1


In Scope:East Complex - Units 1, 4, 5, 6, 7, 8, MSU, Old Admin Bldg (Medical Records), Medical Bldg (assumed that building will still be used for some type of medical care even after the new hospital is built).West Complex - BAR units, D,E,F,G, IMU North and SouthOut of Scope: Satellite Clinic on West Campus, Intake area (this may move to one of the new housing units (D - G on West Complex).


BAR Units- Adams, Bachelor, Rainier; MSU - Minimum Security Unit; m/f - Multifunction Devices; dp - data port, w/s - workstation

3

Additional Introductory Information New Hospital Buidling broke ground on 6/2/08. Approximately 55,000 sq. ft., 65 beds. Will take the place of the existing facility on 2nd and 3rd floor and the small satelite clinic. The outpatient clinic will stay. Not sure what will happen with 2nd (currently inpatient) and 3rd (currently MH) floors of old hospital building. Could be used for a Geriatrics/long-term nursing facility.All new buildings have cable and power in ceilings for wireless access points. New buildings include IMU South, Units D,E,F,G, and new hospital.Central Pill line serves all of general population. Sick call stations are being put back on all the units, may be shared with Property in some cases.

5






Copy of doc_WA_CC_Women_Walla_Walla.xls Page 1


[0 - Not Met,

4 - No Gap]


East Campus (A80, C10, D50, D51, D52, D60, D70, D80, D90, E 50), MDF

and Power

West Campus (B40, E10, E20, E30, E60, K30, K40, K50, K60, K70, K80

and K10)Gaps Score


Physical Space


East campus buildings are old;C10 is a medical building but new medical building construction will start soon

MDF : IT building (J40), very spacious and well managed

IDFs : All of the IDFs are the standardized secured cabinet with ventilation and rack inside and current rack has empty units for additional network devices

West campus buildings are new or refurbished, some of them are still empty

K10 building IDF is a fiber distribution point to the west building IDF

All of the IDFs are inside of very spacious, standardized IT room or electrical room, except for E60 IDF which is a cabinet inside of storage room which still has enough space

None 4 None


4 Generators : 1 for IT building and 3 identical generators for entire campus, each of the campus generators can provide 2 Mw

None 4 None


Power company : Pacific Power and LightPower capacity from power company is sufficientCampus power system was upgraded 6 years ago and all of the buildings have ample power capacity

None 4 None


MDF : Each power supply of one server or network device has different UPS power source

IDF : All of the IDFs have UPS

IDF : All of the IDFs have UPS None 4 None


N/A (Non hosting site) N/A N/A N/A N/A




Site: Washington State Penitentiary

Data Center /


Requirements







and Power


and K10)Gaps Score



MDF : Good HVAC system

IDFs : All of the IDFs have good ventilation systems; cool or moderate temperature even without air-conditioner

IDF : All of the IDFs have air-conditioning

None 4 None


N/A N/A N/A N/A N/A

1


Very good cabling status

All of the UTP cable conduits have enough available space for cabling expansion

Fiber cable conduits (ducts between buildings) are fairly full, but there are already enough existing available fiber cablesException : A80 and C10, but still 2 pairs and 3 pairs are available



Fiber cable conduits (ducts between buildings) are full but there are already enough existing available fiber cablesException : A80 and C10, but still 2 pairs and 3 pairs are available

None 4 None


MDF : Sprinkler

IDFs : No fire suppression, except for C10 which has sprinklers

B40 and E30 IDFs : Fire detectorAll other IDFs : Sprinkler

Sprinkler in MDF roomNo adequate fire suppression in IDF rooms

2 Recommend gas based fire suppression (FM200) for MDFRecommend at least fire detector in IDFs which don't have fire suppression (A80,D50, D51, D52, D60, D70, D80, D90, E 50)

Note: DOC does not intend to install FM200’s in IDFs; For MDF’s: Yes, if the physical infrastructure allows it.

Servers

N/A (Non hosting site) N/A N/A N/A N/A

1


N/A N/A N/A N/A N/A


N/A N/A N/A N/A N/A

3


N/A N/A N/A N/A N/A


N/A N/A N/A N/A N/A

ServersCurrently meet DOC security standards Currently meet DOC security standards None 4 None







Server Room


Cabling / Pathways





and Power


and K10)Gaps Score


1








None 4 None

Cabling / Pathways


D70 & D80 IDFs : Rack mount patch panel

MDF and all other IDFs : Rack mount patch panel



Accessible

Documentation is partial and incomplete but waiting for more information from Mike Garretson

None 4 None

WAN / LAN


Old Admin Bldg: Photo ID room (utilized by Med. Records for copying) - needs data to convert copier to a printer/copier/fax. Medical Records is already slated to have more data and 3 more workstations.Medical Bldg: Data port needed for copier - Canon Image Runner in Nurses Supervisors office. 1 more data port needed in Nurses Station. Lab needs data port for network m/f device (currently has stand-alone HP P1505N). Dental - cable to 2nd workstation is snaked across the counter top from 1 side to the other. Needs to be contained in conduit for safety. Procedure Room needs additional dataport for when scope is digital. X-ray needs a dataport for a printer. The DryView 8100 is networked, but may need upgrade to digital. Mental Health (3rd Floor) needs 1 more data port. Nurses Room also needs 1 more data port. Conference room needs 2 more data pulls to existing ports, and additional phone lines added if used for telemedicine.

IMU North - Dental has an open port where data can be pulled if x-ray is digitized.IMU South - needs additional cable pulled to open port in Nurses station.D,E,F,G: needs phone line for each central area in order to hook up fax capability on multifunction machines.B,A,R: Pill lines need data

See observations at left 3 Recommend approximately 15 additional data ports or pulls in the East Complex, as outlined in the observations. West complex has conduit with face plates that can accommodate additional data pulls. The BAR unit pill lines require new data ports. MSU needs new data port in break room, and additional pull to data port in the 2nd floor supply room.


Cabling / Pathways






and Power


and K10)Gaps Score


Open area at back of Mental Health Unit and one large office are being converted into cubicles. Assuming that data is in the works for these areas.Pill lines for general population is done out of the Control Room. The data lines were difficult to follow, but looks like a couple of lines would need to be added, which may be difficult. Unit 5 (Special Housing Unit): Pill line room will be taken off line when population changes to general. Sick call room needs data and locking port, as patients access this area when not in use for sick call. Larger counselors office has an extra data cable, that needs a port. Top floor needs 2 data cables and a lockable port.Unit 6, 7 and 8: Sick call rooms need data port for m/f ptr.Unit 1 & 4: no needsUnit 8: needs data port for multifunction machine.MSU: Sick call is done in break room currently, which has no data and no voice, needs both. Pill line needs additional data for printer.


None 4 None


N/A N/A N/A


Single Point of Failure n/a Ideally, Recommend redundant Backbone switches and backup connection to Workgroup switches (Utilize available fiber cables)


Recommend dedicated fiber connection to stacked workgroup switches; -- then this additional connection will provide redundancy


Backbone and workgroup switches : enough empty ports

Workgroup switches : Enough empty ports

None 4 None


WAN is 10Mbps Ethernet from Charter BusinessEnough bandwidth to support future EMR system

None 4 None

Network

Fiber cables between MDF and IDFs : all of the IDFs will have at least 6 pairs of Multimode or Single mode fiber cables, more than 3 pairs are available for additional connection except for A80 IDF

Backbone switch is Cisco Catalyst 6513 X 1

Workgroup switches are Cisco Catalyst 2960 or 2950 24 or 48 ports model

No redundant Backbone switchNo redundant fiber connection to Workgroup switchesSome of the IDFs have stacked 2 Workgroup switches (A80, C10, D52 & K80)

No statistics is existing but Catalyst 6513 is the highest level of Cisco switch product line





and Power


and K10)Gaps Score



No redundancy No carrier diversity 2 Recommend 1 T1 backup connectionCarrier diversity is not economically viable option

Note: DOC connects to the DIS MPLS network within a controlled network. Having a redundant ISP connection is not feasible.




DOC IT team manages WANNo local management system

None 4 None


CAT5 or higher None 4 None

WAN / LAN




DIS VPN None 4 None

Cabling / Pathways


Assume that new wireless network would be compliant.

Assume that new wireless network would be compliant.

N/A n/a N/A

2


D51 and D 52 (Units 1 and 4) are candidates for wireless, especially Unit 4 as it is expected to stay as a segregation unit. 4 halls each 225' long. The 2nd and 3rd floors of the old hospital building (C10) are also candidates, assuming that they will still be utilized for patient care which requires cell to cell care. 5 - 6 AP's on each floor. Hallways are approximately 75 feet long

All newer buildings have been designed with cabling and power for wireless, so anywhere wireless may be needed, the cabling exists, but access points would need to be purchased. IMU South would need 6 AP. IMU North has 4 pods on each end, 1 AP needed per pod. D51, D52 building need wireless : 2 AP per each corridor, 2 corridors per each building. E10, E20, E30 buildings need wireless : 1 AP per each pod, 3 pods per each building

Wireless network needs access points

n/a D51 : 4 APs with power lineD52 : 4 APs with power lineC10 : 12 APs with power lineE10 : 3 APs with E20 : 3 APs withE30 : 3 APs with

User Devices



4 None


NonePer DOC standards





and Power


and K10)Gaps Score



Additional workstations needed at the following locations: Medical Records - 3, but already slated to receive; Outpatient Clinic - 1 in Nurses Station, 1 in PT, 1 in Trauma Room; 2 in Pharmacy; Inpatient - 1 in Nurses Station, 1 in Nurses Room; 1 for the General Pop. Pill Line; Mental Health - 2 in Nurses Station, and 1 in Nurses Room; Unit 5 - 1 in Sick call, 1 in lg. Counselors office, 2 in Top floor office; Unit 1 & 4; 1 w/s at Officers Desk; Unit 7 - 1 ws in Property Room.MSU - needs workstation in break room where sick call is done. 2nd Floor supply room where pill line is also needs workstation.

IMU Exam Room needs workstation. IMU South has a rolling cart, but needs laptop attached. Needs 1 desktop or laptop in Med Room. Needs laptop for rolling cart in IMU North.B,A,R Units: Rainier will have a nurse 16 hours a day for Mental Health and Protective Custody. Pill line needs workstation

See observations at left. 2 Approximately 20 workstations needed in East Complex; West complex needs 1 or 2 workstations and a few laptops for wireless areas (see Section N).















User Devices

IMU South has a rolling cart, but needs laptop attached. Needs 1 desktop or laptop in Med Room. Needs laptop for rolling cart in IMU North.

IMU South has a rolling cart, but needs laptop attached. Needs 1 desktop or laptop in Med Room. Needs laptop for rolling cart in IMU North.

2 IMU South needs laptop attached to rolling cart. Need 1 desktop or laptop in Med Room. Need laptop for rolling cart in IMU North.

None4

User devices


Lease program, DOC standard PC spec with standard S/W image None





and Power


and K10)Gaps Score


Printers


Any printer with a blue dot is slated to be upgraded to a networked multifunction (m/f) machine, so only looked at areas where there was not already a printer or a blue dot did not exist. Nurses supervisor in Medical Building needs an m/f, as does the Provider's Office. Lab needs a m/f. Dryview printer in Xray needs to be upgraded to digital. Pharmacy needs a mf device. Needs mf device to replace HP8000N in the open area at the back of Mental Health where cubes are being installed. Unit 6, 7 and 8 each need a m/f, as does the sick call room for units 1 & 4 (shared), MSU needs m/f in break room (sick call) and 2nd floor supply room (pill line).

Rainier needs m/f device at pill line. See observations at left. 2 Recommend 10-12 additional m/f devices. Need to get copy of printer survey in order to compare to see if any of these are already being anticipated.









ScannersSee O1. See O1. See O1. See O1. See O1.


Assume new m/f devices will be compliant.



n/a None





n/a None

Scanner

Printers




None2 print servers (Primary and backup)Static IP assigned on printers

4 None





and Power


and K10)Gaps Score



1 Lab system

No infrastructure gaps: Functional interface needs: Will need ability to upload information from Quest Diagnostics and Walla Walla to EMR system.

4 None: WAN bandwidth will support interfaces

2 Pharmacy system

Pixis units are not installed. Would require 4-6 units on East Complex

Pixis units are not installed. Would require 9 units on West Complex

No infrastructure gaps: Functional interface needs: Interface will be required between existing Pharmacy system and new EMR system if CIPS is still in use.

2 Recommend installation of Pixis machines

3 Radiology system

No infrastructure gaps: Functional interface needs: Equipment will require upgrades to interface with EMR system

4 None: WAN bandwidth will support interfaces




none 4 none



none 4 none



none 4 none



none 4 none


Ancillary Systems

External Systems


Copy of doc_WCC_Shelton.xls Page 1 of 2


Site Name Washington Corrections Center

Site Location & Date of Site Visit Shelton, WA -- 5/16/2008

Primary Site Contacts (Technical and Medical) Technical: Norma Fitzgerald; Medical: Bob Baker


Kevin Grover (DOC), Fiber / Cable Management: JD

# Category Details

1


In Scope: IMU, Receiving, Infirmary (to be replaced by 2011), Residence Units R1-R3, Residence Units R4-R7, Cedar, Technical Support Building (includes server room), Generators

Out of Scope: Building G (no medical-related activities), External Maintenance Buildings

2


R1-R7: Residence BuildingsIMU: Intensive Management UnitBldg C: ReceivingBldg D: Infirmary

3

Additional Introductory Information The WCC in Shelton is the primary intake center for male inmates entering the State prison system. Approximate inmate count is 1700.Total medical-related FTE is approx. 86 (including contractors)Total number of workstations on the WCC campus is approx. 390, and the ratio of medical workers to workstations (on a peak shift) is approx.1:1

A new medical infirmary project is already in pre-design, with a July, 2009 construction start, and completion by 2011.

Additional plans (beyond 2011) call for an additional 198-bed unit, and another receiving unit)

The current facility is beyond its planned inmate capacity: For example, the R-4 residence unit is doubled up with 240 inmates in 120 cells (originally design for 1 inmate per cell)




Copy of doc_WCC_Shelton.xls Page 2 of 2

# Category Details

4


Note: a final change was made to the wireless recommendation to remove the wireless AP coverage in the R1-R3, which was primarily intended to support 2 rolling pill carts (Not cost-effective, and the pill carts can hold dockable laptops). In addition, an early suggestion to move current IDF rooms to new locations was deemed impractical.


Copy of doc_WCC_Shelton.xls Page 1

Date of Visit: 5/16/2008

[0 - Not Met,

4 - No Gap]


D Unit (Medical Bldg)., C Unit (Receiving), MDF, associated IDF's

Residential Units (R1 - R7 & Cedar), associated IDFs IMU, associated IDF Gaps Score


Physical Space


Plans for New infirmary building are in the works - predesign is already done. 2011 is the target date for new building. A 198 bed living unit is slated for 2013, along with a new receiving unit. Another new 198 bed living unit is slated for 2015.

MDF & Server room : spacious

C, D building (Medical building) IDF : Spacious

Note: Pharmacy operations in Infirmary (D bldg), which serves at least 9 other DOC sites, may move to another offsite location in future

R1 - R3: Receiving. Cell side care for wellness checks and pill delivery. R4, R5, R7, R8: Residential Units were not built with medical in mind. These units each have an exam room, but they are currently used for office space for custody. Has a pill line for A & B . No room for sick call, so it is all done at the Infirmary. 25% no shows.

R5, R7, and Cedar (similar sized living units to R4) do not have comparable central station and office area that R4 has ---

R6: Pill line is from a Counselor's office. No place for sick call, so it is all done at the Infirmary.

All of IDFs are not a separate room. It i ll bi t All f th i

Built in 1984IMU building -- houses approx. 120 inmates: 3 PODS at each side of building, 2 medical areas at each sideIMU building IDF : IDF is in hot water pipe room, not appropriate location

Insufficient space in R-4 - R7 and Cedar to provide for care and house equipment to support future EMR.

IMU, R1 ~ R7 & Cedar building IDF are not appropriate

Facility Note for R4-R6 and Cedar, not directly related to EMR: Each building needs a room with a sink to facilitate basic medical care.

1 Recommend including wireless access points in design of new Infirmary building.

Additional space needed to provide for sick call and pill lines at R4-R7 and Cedar. 5'x10' minimum allotment in each unit. No ability to add on to existing structures, so would need to renegotiate existing space; or if that is not feasible, add a small building in close proximity that would accommodate all units.

R5, R7, R6, and Cedar each need a central station / office area comparable to R4. (400 sq ft minimum). This additional space could include the space for sick call, pill noted above.

Recommend new, separate and secure IDF room with air-conditioner and fire suppression for IMU, R1 ~ R7, Cedar building.

Main power : Puget Sound EnergyPower outage : 3 or 4 time a year (Average)Storms are the biggest reason for long-term power outage, but also had lines torn up by back hoe.Power is close to max.Research was done to study additional power capacity requirement


2 substations feed the campus, providing alternate source of power. However, 1 does not immediately kick in if the other fails. It requires a call to the service provider to make the switch.Generators exist but are in poor shape - original equipment from 1964. Staff hope they will be upgraded when the new buildings are built.UPS: in MDF

UPS doesn't exist in some IDF due to space issues but IT department will install it soon

Newer generator installed in 1984 when IMU was built.

Generators are outdated and in need of replacement.

2 Recommend upgrade to generator for main campus (if not part of plan for new medical facility).Generator upgrade needs to be to at least 1500 KW


Power usage is close to max.Research was done to study additional power capacity requirement

Electric power capacity will certainly be exceeded with the addition to the new buildings (earliest being the new Infirmary and new 198-bed unit being built between 2011 and 2013.)

1 Recommend that appropriate upgrade to electric power capacity be included in new building plans, and brought online prior to 2011 (Capital Project)

3 Evident UPS power outlet to standalone UPS

UPS in MDF;UPS doesn't exist in some IDFs due to space issues but IT department will install it soon

Currently no UPS in some IDFs (but planned for immediate future)

2 Confirm that UPSs needed for IDF's are being acquired in near future, as planned(No additional cost for EMR infrastructure if acquisition occurs this year)


Site: Washington Corrections Center - Shelton



Requirements











2 substations feed the campus, providing alternate source of power. However, 1 does not immediately kick in if the other fails. It requires a call to the service provider to make the switch.

Generators need to be upgraded to more adequately fill the gap between switching from one substation to another.

3 Upgrade generators, as indicated above


C, D building IDF : No air-conditioning but not hot because IDF rooms are inside of building and there are only 1 or 2 switches

All IDFs : No air-conditioning. Very hot or inappropriate location

IMU building IDF : IDF in hot water room, very hot, no air-conditioning

IDF's: No air-conditioning at IMU, R1 ~ R7, Cedar building

1 Recommend air conditioners in the two most problematic IDFs (w/r to cooling): These are the R2 IDF and IMU IDF


N/A N/A N/A N/A N/A

1


MDF conduits for fiber cables : room for additional cablingConduits from IDFs to workstation : room for additional cabling

Conduits from IDFs to workstation : room for additional cabling

Conduits from IDFs to workstation : room for additional cabling

None 4 None


MDF : FM 200 gas base fire suppressionServer room : no fire suppressionC&D unit IDFs : no fire suppression

IDFs : no fire suppression IDFs : no fire suppression Server room and IDF's : no fire suppression

1 Ideally, recommendation would be to have new, separate and secure IDF room with air-conditioner and fire suppression for IMU, R1 ~ R7, Cedar building; but it is deemed too difficult to re-locate all of the cabling and wiring. Recommendation is to provide fire extinguishers for all 9 IDFs

Servers

Only applies to hosting sites; WCCS is not a candidate.




N/A N/A

1


N/A


N/A

3


N/A


N/A

ServersOnly applies to hosting sites; WCCS is not a candidate.




N/A None

Server Room





Cabling / Pathways

Cabling /











1


No issues No issues No issues None 4 None

Cabling / Pathways


Patch panels exist Patch panels exist Patch panels exist None 4 None


Vaults are accessible but no documentation:

We normally expect formal and detailed documentation of current fiber and UTP cabling which also reflects recent changes and modifications. We couldn’t find that type of documentation at Shelton, but we do believe the documentation is on file at DOC HQ in Tumwater. We did get network configuration document of Shelton from DOC HQ earlier.

No vault documentation available onsite:

Detailed documentation of current fiber and UTP cabling which also reflects recent changes and modifications

1 Recommend detailed documentation for current cabling (unless on file in Olympia DOC HQ)

(Looked for detailed documentation of current fiber and UTP cabling which also reflects recent changes and modifications. (We couldn’t find that type of documentation at Shelton, but we do believe the documentation is on file at DOC HQ in Tumwater))

WAN / LAN

Backbone switch : Cisco Catalyst 6509 X 1Backbone router : Cisco 2800 X 1WAN compression : Cisco WAE 7800Location base VLANs : Managed by DOC headquarterNo NAC (Network Access Control)


Mental Health Screening area needs 2 data ports; Dental suite needs data;

Otherwise, assume that appropriate data ports will be included in the New Infirmary building design

Additional R1-R3 data access will be provided primarily by wireless

R1-R3: Needs one additional data drop per central station on each of two floors: 6 drops total

R4 central station and office area: has sufficient data dropsHowever, R5, R7, and Cedar (similar sized living units) do not have comparable central station and office area ---

North end: Group Therapy room has coaxial cable, but no data drops. Consultation room has no data. Exam room has a data drop, as does the Psychologist's office.South end: Group Therapy is done in consultation room, no data. Exam room has been converted to office, so exams are done at the North end. Both exam room and Psychologists office have data. 3 visitor booths have data, as they are also used by psychiatrists.

See Observations at left 2 Recommend adding data drops in living units where noted:

R1-R3: 6 data drops totalR5, R7, R6, Cedar: 3 data drops each, in remodeled (additional) central station and office areasIMU: North end: Group Therapy room needs 1 data drop. Consultation room needs one data drop.

. In new Infirmary building, if wireless is not selected, put drops in every room, including multiple drops in places such as dental and pharmacy. Assume medical equipment will also be networked (e.g. x-ray). Take into consideration growth and multi-use of rooms.

IMU:North end: Group Therapy room needs 1 data drop. Consultation room needs 1 data drop. South end: Group Therapy / consultation room needs 1 data drop.

Data drops will also need to be installed for recommended wireless APs (12-14) in the IMU pods



Cabling / Pathways








From MDF to IDF of each building : 6 pairs of Multi-Mode Fiber cable. Cables were installed almost 20 years ago. Can't support Gigabit Ethernet due to splicing issue:

We did not conduct specific testing during the site visit, but during the past, Norma said it had been determined that current fiber cables are very old and not capable of supporting Gigabit Ethernet due to bad splicing. (Inappropriate splicing can decrease the speed of network).




Low quality fiber cables between MDF and IDFs

2 After discussion with DOC HQ network representatives, it is decided that the connections and speed of the cables between the MDF and IDFs are adequate


No issue. Backbone switch is Cisco 6509 and ports are available for network expansion

None 4 None


No redundant Backbone switchNo redundant connection between Backbone switch and workgroup switches:

Having one backbone switch represents a “Single Point Of Failure”, which means when this Backbone switch fails, the entire network is not working. EMR system requires very high availability level, particularly for larger sites such as for WCC-Shelton.With a redundant Backbone switch, there should be redundant connection from two backbone switches to workgroup switches in an IDF because this redundant path will ensure a fail-over path. So it will be triangle structure – two backbones and one workgroup switch.

No redundancy n/a Per DOC design standards, it is not consistent with DOC design standards to introduced redundant backbone switches;No recommendation


Backbone Switch : enough empty slots for additional workgroup switchesEnough empty ports on workgroup switch

None 4 None


WAN is T1 X 2 (Qwest). Low utilization None 4 10Mbps WAN may be needed in future. It depends on EMR system requirements and utilization rate when the EMR system is implemented.


2 T1 provide redundancyNo carrier diversity

No carrier diversity 2 Carrier diversity may be cost prohibitive and is not viable for this location.Carrier diversity will be a requirement only for hosting sites


No QoS is implemented No Qos is implemented 0 DIS will implement state wide QoS on WAN:When we discussed the QoS with DIS, the first phase will be the MPLS backbone, but eventually it will be expanded to entire state network in future.


DOC Headquarters manages WAN and LANDOC standard monitoring system

None 4 None

Network









WAN / LANDOC security standards in place None 4 None


DOC security standards in place None 4 None


DOC security standards in place None 4 None


DIS VPN None 4 None

Cabling / Pathways


No wireless currently No wireless currently No wireless currently N/A N/A Assume that new network would comply

2


New infirmary should have wireless access points installed during construction

R1 - R3: needs to consider wireless, and provide for rolling carts with laptops for delivery of cell side wellness checks and meds.

R4-R6, Cedar: Large day use areas and open concrete areas are not good areas for wireless mobile device access (too busy with inmate movement)

Wireless access points appropriate for all 6 pods. 2 per pod, so 12 total. A - C has enclosed glass middle court, which may interfere with signal, so may require up to 2 additional access points.

No wireless in areas where cell side care is delivered.

0 R-1 thru R-3 (455 inmates): Ideally, Add wireless capability for rolling cartsEach unit (R-1, R-2, R-3) has four wings, 120' long each.Estimate 3 AP per wing, plus 1 AP for central area of each unit: 13 AP per unit

This is deemed to be cost prohibitive for rolling carts for R-1 thru R-3, Dockable tablets on rolling carts are the next alternative where immediate access to online data is not necessary (see M1).

Recommend wireless AP installation for IMU: 12-14 total APs for IMU

User Devices











Medical Bldg (Infirmary): Pretty close to a 1-to-1 ratio on workstations. Since new building should be online approximately the same time as this project, took a brief look at the existing area - will need 2-3 additional desktop workstations for Receiving Nurse Station and mental health screening.Dockable laptops or tablets could be used in place of desktop workstations for doctors (Med and Psych.)C Unit Receiving/Screening: Nursing station needs 1 workstation, Mental Health screening needs 2

Infirmary Treatment room: needs one more workstationInfirmary Lab: Needs one more workstationInfirmary Isolation Area: Will need 1 more workstationCOU Suicide Watch: Needs 1 more w/s

R1 - R3: Nurses provide wellness checks and meds cell to cell. Would need a rolling cart with laptop for each staff member who is simultaneously delivering care (approximately 3-4 rolling carts with laptops).R5, R7, Cedar: Will each need 3 new w/s each when additional space is implemented (Total of 9)

Need 2 laptops for rolling carts in IMU.

Need laptop or tablet for inner exam room

C Unit Receiving/Screening: Nursing station needs 1 workstation, Mental Health screening needs 2

Lack of portable devices - only 1 laptop in IMU. Need 2 more laptops for rolling carts

Infirmary Treatment room: needs one more workstationInfirmary Lab: Needs one more workstationInfirmary Isolation Area: Will need 1 more workstationCOU Suicide Watch: Needs 1 more w/s

R5, R7, Cedar: Will each need 3 new w/s each when additional space is implemented (Total of 9)

3 Per observations at left:.

Recommend acquisition of additional workstations, as indicated in observations:

C Unit Receiving/Screening: Nursing station needs 1 workstation, Mental Health screening needs 2

Acquire the following, per gaps listed:Infirmary Treatment room: needs one more workstationInfirmary Lab: Needs one more workstationInfirmary Isolation Area: Will need 1 more workstationCOU Suicide Watch: Needs 1 more w/s

R5, R7, R6, Cedar: Will each need 3 new w/s each when additional space is implemented (Total of 12)

Additional laptop needs are listed below under N


None: DOC standard 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None

DOC standard

User devices







User Devices

Infirmary Mental Health and COU need 3 laptops to support mobile EMR system users

R1 - R3: Nurses provide wellness checks and meds cell to cell. Would need a rolling cart with laptop for each staff member who is simultaneously delivering care (approximately 3-4 rolling carts with laptops).

Need 2 laptops for rolling carts in IMU.

Need laptop or tablet for inner exam room

Insufficient number of laptops for rolling carts and for Mental Health COU, and for IMU

0 Acquire 3-4 rolling carts with laptops for R1-R3;Acquire 2 additional rolling carts with laptops for IMUAcquire 3 laptops for Mental Health / COU;For IMU:Need laptop or tablet for inner exam room

Assuming wireless in new Infirmary, plan to acquire 12-15 laptops for optional wireless access by mobile health care professionals

Printers

DOC is implementing multi-function devices:DOC is currently involved in evaluating statewide implementation of multi-function devices

Pending DOC's evaluation of statewide implementation of multi-function devices:


Medical records has large Sharp MX-M550N networked printer. Needs to be configured for multifunction usage, as does the Panasonic Works 6010 in the main hall. Pharmacy needs a multifunction device.

R1 - R6, and Cedar buildings are in need of one medium sized networked multifunction printer per bldg

Need one medium sized multifunction printer

As indicated in observations at left

1 Recommend at least 9 multi function devices spread over campus, one per building, as indicated in observations


4 None


4 None


4 None


4 None


4 None


No redundant Print Server No redundant print server n/a Redundant print servers are not being recommended


Security an issue because nurse office is open to inside of pod

Some places have security issues


Scanners

Multi-function device is set up to print and scan, but needs a number assigned to voice port in order to be able to fax.

Lacking multi-function devices in most buildings

0 See multifunction Printer Recommendations above


n/a


n/a

1 Print serverStatic IP address on printersNo issue to support front & back end printing



Scanner

Printers










Mental Health Unit could make use of telemedicine connections, and if implemented, would certainly justify additional WAN fiber bandwidth. Would also require additional phone lines (3 closely situated in room)

A-Unit could make use of telemedicine connections, and if implemented, would certainly justify additional WAN fiber bandwidth. Would also require additional phone lines (3 closely situated in room)

F-Unit could make use of telemedicine connections, and if implemented, would certainly justify additional WAN fiber bandwidth. Would also require additional phone lines (3 closely situated in room)

2 X T-1 OK for limited telemedicine

2 Add additional phone lines to 3 rooms to support telemedicine.

1 Lab system

Quest Diagnostics: Will need ability to upload information from Quest Diagnostics to EMR system

Gaps limited to functional interface requirements

2 10Mbps WAN may be needed in future. It depends on EMR system requirements and utilization rate when the EMR system is implemented.

2 Pharmacy system

Use CIPS, scan barcodes from blister paks. Room is long and narrow, with 2 pill lines. 3 data drops, 1 w/s 1 small printer. Don't use Pixis.Interface will be required between existing Pharmacy system and new EMR system if CIPS is still in use.

Gaps limited to functional interface requirements, except Pixis requirement

2 Install Pixis machines. 10Mbps WAN may be needed in future. It depends on EMR system requirements and utilization rate when the EMR system is implemented.

3 Radiology system

Xray machines are not digitized, but may have the capability to be upgraded. Dental xrays also require ability to be digitized.Equipment will require upgrades to interface with EMR system

Gaps limited to functional interface requirements

2 10Mbps WAN may be needed in future. It depends on EMR system requirements and utilization rate when the EMR system is implemented.






none 4 none





none 4 none





none 4 none





none 4 none

External Systems



Ancillary Systems

Copy of doc_WCCW_Mission_Creek.xls Page 1 of 1


Site Name Mission Creek (WCCW)

Site Location & Date of Site Visit Belfair, WA -- 4/30/2008

Primary Site Contacts (Technical and Medical) Technical: Jack Michel; Medical: Bev B.


Plant: Tom Dill

# Category Details

1


In scope: One primary building housing all medical services and some current inmates;Future expansion residence unit will not require onsite medical services (all inmates come to main building)

Out of scope: Residence structures and all separate maintenance buildings


MDF: Main Distribution FacilityUPS: Uninterruptible Power Supply

3

Additional Introductory Information Minimum security women's prison; Approx 110 current InmatesSite expecting significant expansion, with another 115 inmates later this year, and another 100 inmates in another 2 years;Nursing staff to increase to 4; One nurse practitioner 4 days/week, and 1 psychologist;Serious medical cases sent to WCCW-PurdyTheir pharmacy needs are met by the men's WCC prison in Shelton

4






Copy of doc_WCCW_Mission_Creek.xls Page 1 Site Evaluation Report


[0 - Not Met,

4 - No Gap]



Physical Space


The physical space of the main computer room (MDF) is sufficiently sized to house future equipment. Note: The MDF room may not be optimally shaped for ease of service -- it is long and narrow

Redundant backbone switch could require an additional rack, depending on size of the switch. The medical clinic area is fairly tight on space -- this could affect the ability to add more workstations & printer and printed material security level

No major gap 4 None (note: a potential build-out or remodel of the clinic area driven by higher inmate population would likely result in adequate additional space for additional workstations and printers)


Adequate generator onsite (250 KW), but no robust UPS for the Backbone switch

More robust UPS needed for MDF room

2 Acquire and install UPS to support Backbone switch power capacity


Adequate capacity / not exceeded(500 amp)

none 4 None


None More robust UPS needed for MDF room

0 Same as B.1 Recommendation: Acquire and install UPS to support Backbone switch power capacity


None None n/a No action recommended (not economically viable, inconsistent with DOC policy)







Site: Washington Correction Center for Women (Mission Creek)

Requirements







Dedicated cooling in MDF room(mitsubishi mr slim)

none 4 None

2 Cooling should have redundancy for critical sites

No redundancy N/A N/A None - not a critical site hosting EMR system

1


Conduits accessible; enough space to accommodate additional data cable ; man-holes accessible at points between buildings; However, the actual telecommunications cable from the outside to the building is currently above ground -- it needs to be located, trenched, and re-buried

Unstable telecom cable outside of campus

3 Cabling to outside the campus needs to be located, trenched, and re-buried


Sprinklers in place Water base sprinkers 3 Gas based fire suppression is recommended (FM200) for MDF

Servers

1


Not Applicable: Local File and Print only N/A No Recommendation - No current servers will be used in future EMR



3


Not Applicable: Local File and Print only N/A No Recommendation - Redundant network connection is not necessary as EMR servers will not be hosted at this site




N/A






H. The telecommunications network pathways between the Server Room and the medical service buildings should be able to


Cabling / Pathways





1


Conduits accessible; enough space to accommodate additional data cable

None 4 None

Cabling / Pathways


Rack mounted patch panels exist None 4 None


Accessible and documented None 4 None

WAN / LAN

This site does have and use VLAN's based on function, e.g., servers and printers, users, etc.

1There are sufficient data drops in appropriate locations to support the EMR system.

There are no data drops in Lab or in the 2 exam rooms; planned inmate population growth will like necessitate 1-2 additional exam rooms; also there is no data drop at the new med room (pill dispensing location)

Need additional data drops for these additional locations

2 Recommend addition of data drops in the following: Current and existing exam rooms (3-4 drops), Lab (1 drop), and New Med Room (1 drop to pill dispensing location) - which needs a separate new solid run


Current LAN cabling from MDF room to medical clinic has issue with exceeding 295 foot distance limitation (UTP Cable)ALSO: A data re-wiring project is expected (and needed) -- there is substandard data wiring currently in place, particularly in the clinic (exposed wire)

No fiber cables, no Workgroup switch

2 Install 4 or more new fiber cables from MDF room to medical clinic through existing conduit.

Implement additional workgroup switch new secure closet. This new switch will provide addtional UTP data drops to medical clinic which were recommended in J1.

If data re-wiring project does not occur; some rewiring in the clinic is needed (to eliminate exposed data cables)


Estimated to be well under limits; no performance issues reported

None 4 None


No redundancy No redundant Backbone switch, no redundant connection between Backbone switch and Workgroup switch

n/a Redundant Backbone switch not consistent with DOC network design;No recommendation

5LAN devices should be sufficiently sized such that they can support an increase in workstations and other EMR devices

Empty ports are sufficient on the Backbone switch and Workgroup switches

None 4 None


T-1 X 1 in place; sufficient for relatively low volume; Utilization estimated to be well under limits; no performance issues reported

None 4 Note : New Web based main application (OMNI) which could consume significant WAN bandwidth will be deployed on July 1. Need to watch for impact on WAN utilization.


No redundant WAN connection Redundant WAN Connection 0 None - economically unfeasible to bring in redundant carrier.Fractional T1 could be considered as a backup WAN connection


Network

Cabling / Pathways










None 4 None


All cat 5 installed, 100 MB Ethernet is standard None 4 None

WAN / LAN







Cabling / Pathways


none in place None: see below

2


none in place None: No compelling need for wireless: All medical services delivered in contained area: wired workstations in medical area provide sufficient access

User Devices



1Sufficient number of workstations must be in place to support appropriate performance of the EMR application.

Will need approximately 5 more workstations for additional exam rooms, lab and pill dispense room

Not sufficient PCs for Nurse station

2 Acquire 5 additional workstations for medical services


None 4


None 4


None 4





None, but confirm that new workstations meet this planned specification.





5


None 4


None 4


None 4


None 4


















User Devices

Medical has 2 laptops that can be used onsite None n/a None; mobile, PDA, tablets appear not to be necessary here, since all non-emergency treatment occurs in one concentrated area

Printers


New printer for medical area is on order; should provide sufficient print capability

None 4 None



None 4 None


TCP/IP networked printer None 4 None







User devices

Printers










n/a No Recommendation - Redundant print server is not required for non-hosting site


Printer is not in completely secure area Potential unintended access to print by unauthorized personnel

3 Implement secured printing option (process configuration on print server) -- No additional cost

ScannersNew multi-function print/scan/copy will be MX 550 or MX 450 series

None beyond current equipment on order


MX550 is a modern multi-function device which has high processing speed

None 4 None beyond current equipment on order



None 4 None

WAN/LAN

1 Lab system Draw inhouse, contract out to Qwest None - low data volume could

be handled with T-14 No additional WAN infrastructure recommendations

2 Pharmacy system They use WCC-Shelton's Pharmacy operations, which uses CIPS system based in Olympia

None - low data volume could be handled with T-1

4 No additional WAN infrastructure recommendations

3 Radiology system very limited volume - a few xrays read per week; more intense care is sent to WCCW



N l d t l ld N dditi l WAN i f t t d ti

WAN/LANno significant requirements; all could be handled with T-1















External Systems




Ancillary Systems

Scanner


Copy of dshs_Camp_Outlook.xls Page 1 of 2


Site Name Camp Outlook

Site Location & Date of Site Visit Connell, WA -- 6/17/08

Primary Site Contacts (Technical and Medical) Technical : John Verburg, Medical : Pam Welsh-Moon


George Bolduc (Commander/Program Director)

# Category Details

1


In Scope:Medical Room, Office where network equipment existsOut of Scope:Remainder of campus

2


The status of IT infrastructure for Camp Outlook is unusual in that investment into IT is appropriate only when new buildings are constructed. Funding for the new buildings has not yet been confirmed, but Camp Outlook has rough plans for new buildings, and the JRA IT coordinator (John Verburg) has already input his IT requirements into the plans. An important next step is to ensure that there are recommendations which will help Camp Outlook follow IT standards.

Camp is run like a Boot Camp. Strict requirements for entry. They can get their sentences reduced if they go through this program.

No medical records are kept here. Meds are tracked and monitored. The Medical Officer and the Mental Health professional are contract employees, and their firms maintain the medical records of the patients.




3

Additional Introductory Information

Copy of dshs_Camp_Outlook.xls Page 2 of 2

# Category Details

Currently, a med kite is filled out by the kid when they need a refilled prescription or need to be seen by the PA. The Medical Coordinator reviews the kites and determines whether or not the kid needs to be seen by the PA who comes on site 3 days/week. The PA writes directives directly on the kite, and then the Medical Coordinator completes a med memo on a daily basis that summarizes the activity of the day for all kids that had filled out med kites, whether they were seen by the PA or not. If it is determined that additional medical care is warranted, the kid is responsible for scheduling a visit to an outside provider, usually at Lourdes. Prescriptions are faxed to the local Pharmacy, and the night security staff is responsible for preparing the meds for each kid for the following day.

4



Copy of dshs_Camp_Outlook.xls Page 1


Site: Camp Outlook

[0 - Not Met,

4 - No Gap]

Category Investment Category Observations Gaps Score


Physical Space


The camp consists of two large temporary structures. These have been in existence for quite some time, but it is expected that they will be replaced with permanent structures prior to the implementation of an EMR system. There are no designs as yet.

Currently, there is 1 small room used for medical exams and pill distribution.

Current MDF is not in dedicated room. It is small space in corner of office.

Unable to assess gaps since new facility is not in existence or far enough along in the planning stage.

4 None at this time:

The status of IT infrastructure for Camp Outlook is unusual in that investment into IT is appropriate only when new buildings are constructed. Funding for the new buildings has not yet been confirmed, but Camp Outlook has rough plans for new buildings, and the JRA IT coordinator (John Verburg) has already input his IT requirements into the plans. An important next step is to ensure that there are recommendations which will help Camp Outlook follow IT standards.

Recommend new buildings and IT environment meet the standards documented below in this Recommendations column. (Also: Other JRA sites' IT standards could be applied for this site)


No generator exist but it won't be required because this site doesn't require high EMR system availability

None 4 None




Agency/Administration: DSHS/JRA


Requirements








No UPS None 4 Recommend UPS in MDF room when new buildings are constructed




No HVAC but no issue None 4 None



1


Assume new buildings will have decent cabling standard

None N/A Recommend that appropriate cabling standard be applied in the new medical service-related locations when a new facility is built. This would be part of the building plan, not part of the MRTG project.


Servers

1


N/A (None hosting site candidate) N/A N/A N/A


N/A N/A N/A N/A



Cabling / Pathways










3


N/A N/A N/A N/A


N/A N/A N/A N/A

Servers

1



None N/A Recommend that appropriate cabling standards be applied in the new medical service-related locations when a new facility is built. This would be part of the building plan, not part of the MRTG project.

Cabling / Pathways







WAN / LAN

Cabling / Pathways










There is no data drop in the current med room.

None, as current space will no longer be utilized.

0 Recommend that a data drop be placed in the new med room when a new facility is built. This would be part of the building plan, not part of the MRTG project.


Assume new buildings will have decent network standard

None 4 Make sure that new network devices have sufficient ports and performance / capacity characteristics

Cisco Catalyst 2960 - 48 ports grade switch will be sufficient



None 4 See J2 recommendation


N/A (Non-critical site) N/A N/A N/A



None 4 See J2 recommendation


Fractional T1 (768K), no issue because of low EMR system requirement

None 4 None


N/A (Non-critical site) N/A N/A N/A


DIS QoS implementation None 4 None


DSHS ISSD monitors network None 4 None




Network





WAN / LAN


Per DSHS / ISSD standards;Active Directory security

None 4 None


MacAfee None 4 None


VPN access possible None 4 None

Cabling / Pathways


2


User Devices


Assume sufficient workstations in new building

None 4 None; (Assuming that JRA standards are followed when IT infrastructure is implemented in new buildings)


None 4 None


3 years of purchase cycle, up-to-date spec

NoneNone 4



No justification for wireless






None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None

User Devices

Not required. None 4 None

Printers


User devices







Assume sufficient printing power will be implemented in new buildings

None 4 None






7


Place all printers in a secure location and implement controls for secure printing. Also, it is recommended to implement PIN numbers on printer configuration to increase security.

ScannersAssume sufficient scanning capability will be implemented in new buildings





Ancillary Systems

Printers


Scanner







2 Pharmacy system

Local Pharmacy provides drugs - these are currently faxed. Need to be able to interface or utilize med tracking information.

None None None

3 Radiology system Utilize outside providers N/A N/A N/A



N/A N/A N/A N/A


N/A N/A N/A N/A


N/A N/A N/A N/A


N/A N/A N/A N/A

External Systems


Copy of dshs_Canyon_View.xls Page 1 of 2


Site Name Canyon View Community Facility

Site Location & Date of Site Visit East Wenatchee, WA -- 6/10/08

Primary Site Contacts (Technical and Medical) Technical: Dan Kelly - IT, John Verburg


Tom - Supervisor; Pam Arena - Administrator

# Category Details

1


In-Scope: Offices, Living Room area, Kitchen

Out of Scope: Classroom, Maintenance, Resident Rooms

2


m/f - Multifunction Devices, dp - data port, w/s - workstation

3

Additional Introductory Information Canyon View Community Facility conducts rehabilitative and transition programs for juvenile offenders in a home like environment. Primary users of the future EMR system would be counselors, case managers and secretaries. There are no on-site medical staff like nurses or doctors since medical care is provided by regional health providers like Wenatchee Valley Medical Center.

Staff members will soon be using Automated Client Tracking (ACT) for Case Notes, Treatment Report/Target Behavior, Behavioral Assessment and Incident report.

Currently, there is a plan to renovate the facility and add a new recreation building.




Copy of dshs_Canyon_View.xls Page 2 of 2

# Category Details

4



Copy of dshs_Canyon_View.xls Page 1


[0 - Not Met,

4 - No Gap]



Physical Space


There is a plan to update plumbing and remodel dining room / observation booth (duty room), laundry room and restroom. Also, activity room for clients to perform basic exercise and weight lifting is planned to be added. However, data wiring or power capacity upgrades are not included with the remodeling.

A mechanical room with electrical panels and boilers is used as Network closet. The mechanical room is dusty and networking equipments (1 router, 1 switch, and 1 UPS) are exposed without any protection. Also, the mechanical room is not locked during the daytime since janitors also use this room. There is no dedicated cooling and the room is not well ventilated.

Server and demarcation point are located on a bookshelf in a shared office which is used for one-on-one assessment.

There are sufficient work spaces in the building for workers to access medical records without disturbing their workflows.

Current locations for server, demark point and network equipment are not secured and it could lead to security risks, equipment vandalism and/or accidental damage of the equipment. Also, there is no space to place a rack, a patch panel and an air-conditioner that are recommended.

1 Recommend relocation of the network closet to provide to a larger area with a lockable door. Having a well maintained server room/network closet can reduce the chance of having IT related issues. Only one IT personnel supports JRA community homes in Eastern Washington and it could take some time to fix a problem if there are IT related issues.

Note: Recommend adding fire suppression, air-conditioning, a rack, and a patch panel assuming that a more spacious and secure location will be selected for servers and network equipments as the current locations do not have enough space. Also, recommendation adding a workstation and a desktop multi-function device in Duty office assuming that the duty office will be expanded as a part of the planned remodeling.


Electrical power is supplied by Douglas County PUD

There is no generator, but this facility hasn't experienced many power outages in the past.

No generator 3 No Recommendation - Since no medical care is provided on site, it is not absolutely critical to have emergency power generation capability.


Power upgrade was done in 2002 by adding more electrical panels, but current power usage often exceeds power capacity. Power usage level is expected to go up with the addition of new Recreation Building, and additional devices for wireless network and scanning/printing.

Power usage level exceeds power capacity

1 Work with maintenance personnel to upgrade power capacity.


Multiple UPSs for Router, Switch and Server None 4 None


N/A None N/A No Recommendation - It is typically not required to have dual power feed from different parts of the grid for non-hosting sites.


There is no dedicated air-conditioner or ventilation. No separate cooling in Network closet 0 Install a small air-conditioner to maintain appropriate temperature/humidity level.

Also, see recommendation in Section A.


N/A None N/A No Recommendation: Redundant cooling system is not required for a non-hosting site for the future EMR system

1


Cables are wired through ceiling. The cables then go to each room via a small hole and run along the walls without conduits. Also, data jacks are not utilized and cables are directly connected to the switch from the network closet except for the conference room (grouping room).

Cables are exposed 1 Recommend rewiring and adding data jacks by a certified licensed technician to minimize risk of fire hazards or injury.


No sufficient fire suppression in the network closet No sufficient fire suppression in the network closet

2 Add fire extinguisher for Network ClosetAlso, see recommendation in Section A.

Agency/Administration: Department of Social & Health Services/JRA

Site: Canyon View Community Facility






Requirements





Cabling / Pathways





Servers

1


N/A - Local File and Print Server only None N/A No Recommendation - No current servers will be used in future EMR



3





ServersN/A - Local File and Print Server only None N/A No Recommendation - No current servers will be used in future EMR

1


N/A - There is only one building None N/A None

Cabling / Pathways


Cables are directly connected to devices (workstations, printers) from the switch.

No straightforward access to network drops

2 Install a rack-mounted patch panel to increase maintainability of the network. The rack can also be used to organize wires and network equipments.




WAN / LAN




Cabling / Pathways









There are data drops in all rooms which support the current workflow; however, there are a few areas where additional data drops are recommended to accommodate future needs.

Data wiring is not planned for the new recreation building.

Additional data drops are needed

No wall-mounted data jacks

3 Main Building:Add 2 data drops for wireless access pointsAdd 6 data drops to the Duty OfficeAdd 6 data drops to the Conference Room (data jacks and conduits are already there)Add 6 data drops to the Main Admin OfficeAdd 2 data drops to Office 1Add 2 data drops to Office 2Add 2 data drops to Office 3 (Shared Office)Add 2 data drops to Kitchen

Since the future use of the recreation building could change or network access could be required, it is recommended to include data wiring for both wall mounted data jacks and wireless access points, especially, since it is a lot easier to wire during the construction.

New Recreation Building:Add 1 data drop for wireless access pointAdd 6 data drops

Note: There are already a few data drops in each room; however, the numbers shown here are total number of data drops recommended (instead of the additional data drops recommended) since rewiring by a licensed technician is recommended (See recommendation on D1)


It is appropriate for the site (Dell 2724 switch utilized)

See recommendations in Section I-1 and D-1

None 4 None


No network performance issues None 4 None


No LAN redundancy (Non redundant switch) No redundant switch N /A No Recommendation - Since medical care is provided by community health providers and most or all medical records are kept by the community providers, high redundancy is not absolutely critical.


The switch has ports available for additional workstations and/or other EMR devices.

None 4 None


10 Mbps Ethernet, No performance issues reported. Since the number of users accessing medical record is small (10 non bandwidth heavy users at peak time), utilization level is estimated to be well below the limit.

None 4 None


No redundancy with WAN No redundancy with WAN 1 No Recommendation - Since medical care is provided by community health providers and most or all medical records are kept by the community providers, high redundancy is not absolutely critical.


QoS is currently not Implemented at DSHS No QoS implemented at DSHS 0 DIS will implement QoS on SGN


Can be provided on ad hoc basis by DSHS/ISSD None 0 None


At least CAT 5 None 4 None

WAN / LAN


DSHS security standards in place None 4 None




Secure VPN service is available through DIS None 4 None

Cabling / Pathways


N/A - No wireless now None N/A



Network





2


No wireless now No wireless now 0 Recommend implementing wireless for this facility. Having wireless will help the staff members by providing flexibility to document while being with or keeping distance from the clients.

Recommend 2 wireless access points to provide coverage in office area, living room area, grouping area and yard.

Recommend 1 wireless access point for Recreation Building which is planned to be constructed.

User Devices

All workstations are on 3 year-lease cycle, and most or all of the current workstations will be upgraded by 2011. Workstations are currently being updated to Dell 755.

None 4 None


In general, there are a sufficient number of workstations, but staff members are expected to require more access to workstations once they start using an EMR system.

Needs an additional workstation in Duty Room

3 Add 1 workstation in Duty Room


Specs for leased equipment are expected to be sufficient None expected 4 Recommend confirming that new workstations meet this specification.














DSHS standard None expected 4 Recommend confirming that new workstations meet this specification.







To verify, Internet Explorer lists the security in its Help menu, under "About Internet Explorer". Next to the section marked "Cipher Strength" it will say 128-bit if you have the 128-bit secure browser.







User Devices

Currently, 1 laptop is utilized at this facility. Counselors are benefited by having a laptop.

A few laptops are needed 4 Add 3 more laptops

Standardize and formalize a process to provide laptops or tablet PCs for staff members who requires to have more mobility, as necessary

Printers


There are sufficient number of printers to support workflow with the future EMR system. There are 3 networked printers and 1 local printer.

None 4 None



None 4 None

User devices









Printers have TCP/IP networking capability None 4 None


Networked printers are compatible with thin emulation software for back office printing

None 4 None






No redundancy in print server Lack of redundancy with print server 4 No Recommendation: Redundant print server is typically not required for non-hosting site.


All printers are located in secure locations None 4 None

Scanners

There is no Scanner at this site. No Scanner 0 Replace copier in the main Admin Office with a Multi-function device.

Add a desk-top multi-function device for the Duty office.

Recommended procuring devices which have a high processing speed, full sheet scanning capability and is TWAIN compliant


N/A None N/A None


N/A None N/A None


1 Lab system N/A - No Lab system is utilized None N/A None2 Pharmacy system N/A - No Pharmacy system is utilized None N/A None3 Radiology system N/A - No Radiology system is utilized None N/A None



N/A


N/A


N/A


N/A

Printers

External Systems


Ancillary Systems

Scanner

N/A - All medical information is kept on paper. However, this site will also utilizes Automated Client Tracking (ACT) system for Case Notes, Treatment Report/Target Behavior, Behavioral Assessment and Incident report by the end of this year. This information needs to be interfaced or migrated to the future EMR system.

For the future EMR system, information can be exchanged via DSHS's network with an appropriate interface and doesn't expect to see issues with network bandwidth if staff or patient volume does not increase dramatically.



NoneNone


Copy of dshs_Child_Study_Treatment_Center.xls Page 1 of 1


Site Name Child Study Treatment Center (CSTC)

Site Location & Date of Site Visit Lakewood, WA -- 5/8/2008

Primary Site Contacts (Technical and Medical) Technical: Tom Wanless; Medical: Karen Perales (Nurse Manager)


Medical Records: April Rose; DSHS: Stewart Wood

# Category Details

1


In Scope: CSTC Admin Building, Oak Grove Elementary, Firwood High School;Residence Buildings: Camano, Ketron, Orcas

Out of Scope: Waring Building,

2


COU: Close Observation Unit;RSN: Regional Service Network;OFR: Office of Financial RecoveryCAP: Close Attention ProgramWSH: Western State HospitalSMC: network switch manufacturer

3

Additional Introductory Information CSTC houses approx 47 kids, ages 6-18;Oldest kids are in Orcas, 12-15 yrs are in Ketron, 6-12 yrs are in Camano;Approx. 150 employees -- with peak EMR system users around 60, at max; Approx. 50 total PC's, and just 4-5 laptops;No formal medical treatment in elementary school or high school;CSTC uses Cache (like WSH)Network and print services come from WSH

4

Final Revisions Made (July, 2008) Redundant backbone switches are being recommended only in the largest, most critical locations where it is necessary to support planned changes.Redundant print servers are not being recommended.FM200 gas-based fire suppression systems are being recomme





Copy of dshs_Child_Study_Treatment_Center.xls Page 1

Date of Site Visit : 5/8/08

Agency/Administration:DSHS/HRSA

Site:Child Study and Treatment Center[0 - Not Met,4 - No Gap]



Physical Space


Nurses stations in all 3 residence buildings (Camano, Ketron, Orcas) have tight quarters with little room for additional desktop equipment. Direct care staff sit in exposed areas, which are not conducive for desktop workstations as they would be subject to damage. No doctors offices in cottages, only in admin bldg. Due to limited space for desktops and due to security concerns for equipment, the cottages are more conducive to securable small electronic notebook devices.

Approx maximum number of medical care / psych workers on campus at one time: estimated at 60.

IDF Switches are located in the basements of each residence, and in the attic at the administration building, and in the attic of the High School. Equipment is attached to walls, and are not enclosed, exposing them to the elements present, as well as risk of being bumped or tampered with.

Space limitations and concern for physical device security for a need for small electronic notebook devices that can be secured in lockable, protective enclosures.

Switches in cottages are exposed to elements of basement (including boiler) and to potential tampering, bumping; Protective enclosures are needed in the cottages

2 Recommend addition of protective, lockable enclosures for small electronic notebooks. (2 per cottage, near central, open area -- 6 total)

Recommend addition of protective enclosures (such as an iron cabinet) for switches in basements (1 per cottage - 3 total)

All cottages remodeled in the last 10 years -- no electrical issues in cottages

1 Back up & redundancy should be in placeCampus runs off of power from WSH which has UPS and generator backup power

None 4 None


Power usage does note exceed power capacity.

None 4 None


UPS in place None 4 None


None N/A None: Cost Prohibitive


Basements and Attic where switches are located do not have HVAC - central air or local air only. Basement rooms were cool during site visit, but Boilers are in basements, so protection and/or temperature of switching equipment may be an issue

Protective measure 2 Pursue secure cabinet with ventilation for IDFs


None None N/A N/A - need to address basic cooling capabilities first

State of WashingtonMRTG ProjectSite Evaluation Report Template




Requirements








The highest level MDF serving CSTC is located in the WSH administration building. The highest level IDF for CSTC is upstairs in the CSTC administration bldg, and contains switching equipment for distribution to CSTC buildings

1


Network pathway between WSH and CSTC: The CSTC Network is an extension of the WSH network, and is fed from the WSH East Campus. The WSH to CSTC connection is adequate currently, but no redundancy or scalability in place for futureWith the exception to conduits inside the Orcas cottage, conduits for fiber cable (from the Admin bldg to residence IDFs) are not full

Single connection from WSH East Campus represents a potential single point of failure; (lack of redundancy)

2 Recommend one additional fiber cable from WSH East Campus to CSTC, for redundancy


No fire suppression equipment noted in the basements of the cottages; No gas fire suppression in CSTC admin bldg IDF

No adequate fire suppression in cottage basements or in Admin building IDF

0 Recommend fire extinguisher in IDFs



Cabling / Pathways





Servers

1


No redundancy, but not required for non-hosting sites.

N/A


N/A: new system servers would be added with future solution and would not be hosted on site

N/A

3


No redundancy, but not required for non-hosting sites.

N/A


N/A N/A

ServersFuture solution would be HIPAA compliant, as per DSHS requirements

N/A

1


Conduits accessible, serviceable, and generally good room for additional cabling. Noted plenty of open conduit pipes, but site needs diagram of where they lead. Conduits are in the administration bldg and all cottages are in decent shape -- Except for Orcas, the conduits in the cottages are fairly full, but they have sufficient capacity to accommodate the additional cabling recommended in each building (max of 8-10 additional cables per bldg). The one exception is the conduit utilized for CAT5 wiring in Orcas (from the Orcas IDF to workstations -- this conduit is located across the room from the switch) -- this conduit in Orcas appeared to be over 95% full.

Switches are located in the basements of each residence, and in the attic at the administration building. Equipment is attached to walls, and is not enclosed, exposing them to the elements present, as well as risk of being bumped or tampered with.

Switches are unsecured (once in basement of cottages -- they are general storage room and boiler room)

Conduits in Orcas have insufficient capacity to accommodate additional cables

2 Build cabinets around existing switches, or purchase a locking cabinet with adequate ventilation and fire protection. (same as below)

Install an additional 4" conduit pipe to accommodate additional recommended cabling in Orcas.

NOTE: The recommended wireless solution in cottages will minimize the need for additional cabling to support standard workstations

Cabling / Pathways



F. The EMR system servers should have appropriate capacity and function to ensure required performance and availability;


Cabling / Pathways







LAN/WAN is hosted by WSH. Switches are located in the basements of each residence, and in the attic at the administration building. Equipment is attached to walls, and are not enclosed, exposing them to the elements present, as well as risk of being bumped or tampered with.

Additional details on switches:

Hub for Ketron is in CamanoCamano switch is a 24-port SMC (only 4 free ports)Orcas switch is an HP 2524 procurve;No switch in Ketron (UTP copper to Camano)

Switches are unsecured (once in basement of cottages -- they are general storage room and boiler room)

2 Build cabinets around existing switches, or purchase a locking cabinet with adequate ventilation and fire protection.


Critical telco vaults and manhole contents are managed by WSH; No known issues or problems; no documentation on vault contents available (vaults were not physically inspected)

Limited or no documentation on contents of vaults serving CSTC

2 Improved documentation is suggested (and should be included with improvements to the WSH network vault documentation)

WAN / LAN


Residences (Camano, Orcas, Ketron): In each cottage, the common area is where observation takes place, including charting. Dietary Manager has a PC. At Nurses Stations (one in each of the three cottages), up to 7 staff plus visiting professionals all access the space. 2 data ports in each used by 1 PC and 1 printer. Multifunction printer, not networked so only used for copying. There is a staff lounge directly behind the nurses station. Med Room has workstation & Pixis machine running from 1 data port with 4 port Hub.Orcas: Observation booth has 2 unused data points. Charting is done in open area just outside of Close Observation Units instead of inside booth.

No data drops in common areas; no data drops in staff lounges; additional data drops needed in Nurses station; multi-function machines are not networked. Hub in Med Room. For Orcas: there is a need for an additional data drop outside the COU

0 Need data pulled to desks in each common area and a secure place provided to store a laptop. Dockable PDA's may also be an option.

Additional Data Drops needed:Need 1 additional data port in each Nurses Station (in each of the three cottages) for workstations, and one more data port per cottage for the multifunction print/fax/scan machine. Need 1 data port in each Staff Lounge for overflow staff to work on laptops. 1 data port needed in open area outside of COU's in Orcas. For each cottage: 1 additional data port needed in each Med Room (to minimized use hubs). Recommend wireless solution in place of adding any additional cable. (see wireless recommendations below in Section L)


Switches are older model 24 port SMC switches, with very few free ports

Assuming new EMR system and wireless additions in future, current SMC switches will not be sufficient

1 Upgrade all switches to newer switch technology (such as to Cisco Catalyst series). Specifically:

Administration IDF: Upgrade to CISCO 35xx series 48-port switch;Camano IDF: Upgrade to CISCO 35xx series 48-port switch;Ketron IDF: Add a CISCO 2900 series 24-port switch (there is no switch currently);Orcas IDF: Upgrade to CISCO 2900 series 24-port switch


no statistics available (monitoring on request , on ad hoc basis, from DSHS)

None 4 None


No redundancy:Switches in Admin building are stacked;Switches in Camano, Ketron and Orcas are logically stacked on each other

Logically stacked switches implies points of failure;Single fiber connection from WSH also represents a potential single point of failure

0 As noted above, recommend an additional fiber cable from WSHAlso recommend changing the logical architecture of LAN network to eliminate stacked designNeed one additional main switch in Admin building IDF for the redundant connection from WSH (Cisco Catalyst 29xx or 35xx grade)


Network






Switches are older model 24 port SMC switches, with very few free ports

Assuming new EMR system and wireless additions in future, current SMC switches will not be sufficient

1 Upgrade all switches to newer switch technology (such as to Cisco Catalyst series). Specifically:

Administration IDF: Upgrade to CISCO 35xx series 48-port switch;Camano IDF: Upgrade to CISCO 35xx series 48-port switch;Ketron IDF: Add a CISCO 2900 series 24-port switch (there is no switch currently);Orcas IDF: Upgrade to CISCO 2900 series 24-port switch


WAN bandwidth is provided from WSH, with a 10 mb fiber link; Current utilization estimated at under 30% (per WSH); EMR system load from CSTC expected to be very small with respect to 10 mb bandwidth

None - 10 mb WAN bandwidth is expected to be sufficient even for largest sites in this study, including the combined load from WSH + CSTC

4 none


No redundant carrier N/A not economically viable


No QoS is implemented N/A Plans for QoS at DSHS level will be pursued


Can be provided at DSHS network monitoring level

N/A Can be provided at DSHS network monitoring level; A recommended level of network monitoring will be provided for DSHS sites in the final report, after all sites have been visited.


CAT5 throughout campus None 4 none





WAN / LAN


as per HSCS\ISSD HQ standards None 4 None


as per HSCS\ISSD HQ standards None 4 None



Cabling / Pathways


No Security standard is set for wireless since a wireless solution hasn't been implemented at DSHS or at CSTC

No Security standard is set for wireless 0 Recommend a standard for wireless solution (New ISSD standards will provide wireless security standard)

2


Wireless has not been implemented Wireless has not been implemented 0 Recommend implementing a wireless solution for much of the campus. The mobility of the staff is critical, and space is limited for hard-wired equipment. Primary wireless candidate areas are:Central areas of each cottage (Orcas, Camano, Ketron): 3-4 access points per cottage -- access points down full length of hall not needed;Selected areas of admin building: 2 access points serving observation area between elementary school and admin area;Also recommend appropriate Cat 5e cabling to cottages to support wireless solution: The appropriate 5e cabling will include one cable per access point. (i.e., 3-4 cables per cottage) The access points need electrical power via data cabling, which will be satisfied using the suggested upgraded CISCO Catalyst switches for each cottage. Upgrades previously listed for switches and conduits will provide sufficient ports and conduit space for extra cabling needed to support wireless.Note: An alternative for the electric power needed for wireless is to install an electrical power line for each wireless AP instead of upgrading cable

User Devices









Staffing consists of 7 direct care staff per shift at each residence + 4 ancillary staff on the day shift and an additional 30 people in admin. Also have 3 FT psychologists and 4 psychiatrists. The doctors don't have offices in the residences. HCSC staff oversee kids at school while in seclusion, and are charting while observing. There are currently 50 PC's and 4-5 laptops.

NOTE: In resident cottages, CSTC CANNOT have any workstation or device in an open, unsecured area, due to theft, damage, security issues. (for example, one-half of the Orcas cottage (oldest residents) are under close observation and high security)

No workstation in the elementary school

Additional laptops or tablets are justified for mobile staff, as they spend time charting at the residences as well as at the schools. Additional desktop workstations needed in nurses stations and med room in Orcas.

2 See also the recommendations for additional laptops, tablets under Section N (Row 66); In summary the primary means for increasing the number of "workstations" will to provide approximately 5 additional laptops or notebooks per cottage, for use by medical staff. These devices will need to be securable in offices or enclosed, lockable kiosks. We also recommend 5 additional laptops to be allocated to staff working in the administration building.

To reiterate, traditional stationary workstations have limited use in the cottages, as they are difficult to use in open areas, and more difficult to secure than laptops or notebooks.

The additional stationary PC's needed, assuming a new wireless, mobile device solution, are:One desktop workstation for Orcas nurses station, and one desktop workstation for Orcas med room

Additionally: Recommend an additional standard, wired workstation for the Elementary school. The recommended stationary workstation would be placed in the office of the Elementary School.










None 4


None 4








none 4 none

User devices

· Dell Latitude D820 (4)

o T7400, 2.16 GHzo 512 MB RAMo 60 G Hard Driveo Windows XP Professional – Service Pack 3

· Dell OptiPlex 745 (55) - 6 with Dual Monitors

o Intel Corel 2 CPU, 2.13 MHzo 1.00 GB RAMo 80 G Hard Driveo Windows XP Professional – Service Pack 3

· Dell Precision PWS390 (2) with Dual Monitors

o Intel Corel 2 CPU 6700, 2.66 GHzo 1.00 GB RAMo 160 G Hard Driveo Windows XP Professional – Service Pack 3

Dell Latitude D820 workstations have insufficient RAM (512 MB vs. 1 GB)

A small number (5) of Dell workstations need to have Pixel Shader 2.0 as a Video card capability - primarily for medical professionals who would need to read high resolution digital images

3 Ensure that the next cycle of workstations that replace the Dell Latitude D820 workstations have 1 GB RAM;

Acquire 5 video cards (such as NVIDIA geForce 8400 cards) for DirectX 9.0 and Pixel Shader Video support, for selected users -- (unit price $200-$300 each)





User Devices

At least several additional mobile laptops, notebooks, or tablets justified for each cottage

Needs for portable devices with the future EMR system have been identified and more laptops or notebooks are required (estimated need for approximately 20 mobile devices)

1 Formalize the process to provide for additional laptops, notebooks, PDAs or tablet PCs for medical professionals and staff who provide care in new wireless areas.Purchase approximately 20 additional wireless-enabled laptops or notebooks, PDAs, or tablet PC, depending on the solution -- all devices need to be securable:

To be deployed as follows:

5 Laptops or notebooks to nurses/counselors serving Camano5 Laptops or notebooks to nurses/counselors serving Ketron5 Laptops or notebooks to nurses/counselors serving Orcas5 Laptops or notebooks to professionals who are based in the Administration building but have a regular need to be charting notes or progress in cottages or other observation areas such as the "holding rooms" near the elementary school

Note: Must include cost estimate for construction of secure cabinets or "rabbit hutches" for these laptops or notebooks

Printers


Networked printers are limited in the residences - 1 per residence at Nurses Station. Also, copier and fax are separate. There are many stand-alone printers, especially in the offices.

At least 1 additional multifunction printer is needed in each cottage, and in the administration bldg

1 Recommend acquisition and installation of 4 additional networked, multifunction printers (one for each cottage, one for admin building). Mid-sized multifunction devices for copy/print/scan/fax (such as a XEROX phaser 6180mfp) are recommended for each location


Windows compatible none 4 none


TCP/IP network (Common) none 4 none


Yes (Common) none 4 none


Yes (Common) none 4 none


No static IP (Common)Use hostname and DHCP instead of static IP

Prefer use of static IP 0 Prefer use of static IP


N/A, not hosting site N/A N/A N/A


Networked printers are located in the nurses station and stand alone printers are in the offices.

Printed documents are secure because printers are inside of nurses office

4 Could add additional security printing features inherent in the printer configuration to further ensure compliance with HIPAA. (no additional cost)

Scanners

No scanners, only fax machines. Scanners are an important component of EMR systems.

As noted above under printers, Recommend networking multifunction printers at each nurses station and in medical records to enable scanning capabilities.


New multifunction machines would have this functionality

4


New multifunction machines would have this functionality

4



Scanner

Printers







WAN/LAN

CSTC currently uses Cache in a similar manner as WSH

None, with respect to WAN/LAN bandwidth needed to support the Interface

None - current WAN bandwidth (10 mb) and LAN bandwidth (generally 100 mb) is sufficient to support CSTC's relatively low volume activity on these systems. As noted earlier, an additional fiber cable connecting the WSH East Campus and CSTC will provide redundancy and improve reliability

Lab system Utilizes lab services at WSH None, with respect to WAN/LAN bandwidth

needed to support the Interface4 None - as noted above

Pharmacy system Utilizes pharmacy services at WSH and the pharmacy system in Olympia


4 None - as noted above

Radiology system Utilizes radiology services at WSH None, with respect to WAN/LAN bandwidth

needed to support the Interface4 None - as noted above

WAN/LAN

Only need is to communicate with the RSN's and OFR


None - Current WAN bandwidth is sufficient to support low-volume network traffic that would occur between CSTC and these entities

The EMR system should have a viable interface and connection to appropriate Federal Programs

N/A N/A

The EMR system should have a viable interface and connection to Medicare

N/A N/A

The EMR system should have a viable interface and connection Medicaid

N/A N/A

The EMR system should have viable interfaces and connections to County jail systems

N/A N/A

External Systems



Ancillary Systems

Copy of dshs_Eastern_State_Hosp.xls Page 1 of 2


Site Name Eastern State Hospital

Site Location & Date of Site Visit Medical Lake, WA -- May 29-30, 2008

Primary Site Contacts (Technical and Medical) Technical: Dan Rockstrom, Medical: Ronda Kenney, Craig Christiansen


Director of Compliance: Shirley Maike

# Category Details

1


In Scope:All of Eastlake Building: Adult Psychiatric Unit (APU), Forensic Services Unit (FSU), PharmacyAdministration: Contains MDFActivity Therapy (AT) BuildingTherapy PoolWestlake: Focus on Wards B, D, E, and HMH, WorkCenter, Dental, LabSupt's Housing, Linden (currently closed)

Out of Scope:Interlake School, Auditorium, Plant & Maintenance ShopsMartin HallPrimate Center

2


APU: Adult Program Unit; FSU: Forensic Unit; AT: Activity Therapy; GPU: Geropsychiactric Unit;DHCP: Decentralized Hospital Computer Program (VA system); ESH: Eastern State HospitalHMH: Habilitative Mental Health




Copy of dshs_Eastern_State_Hosp.xls Page 2 of 2

# Category Details

3

Additional Introductory Information Current infrastructure project: A large telecommunications and phone system upgrade project is currently in progress -- as a result, many of the infrastructural assessments, in terms of data cabling and MDF,IDF characteristics are based on current plans in the upgrade project.

Total patient count (Eastlake + Westlake): Approximately 317;

Physical location of future EMR system access: Eastlake and Westlake wards. Ward nurses stations, various throughout ward locations. Medical support staff offices Eastlake and Westlake. Westlake laboratory.;

ESH has conducted several prior evaluations on the needs for an EMR system.

Most or all patients in the Eastlake APU and FSU are ambulatory and go to medical staff for treatment, counseling (services not in patient rooms);Some of the patients in Westlake GPU are treated in their rooms

Approximate user device inventory (not on standard 3 year replacement cycle): 320 PC's; 25 laptops

Current Pharmacy System: Medisys WORx pharmacy software system implemented in pharmacy with Pyxis medstation dispensing devices at ward locations. Medisys Medimar software system for med record keeping implemented on all wards. Laboratory; self contained analysis/tech systems.

ESH also uses the VA's Decentralized Hospital Computer Program (DHCP) Version 22.0 with VA Fileman running on InterSystems version Caché 5.015. Our Caché license is for 50 concurrent users. There is no limit on the DHCP or Fileman.

4



Copy of dshs_Eastern_State_Hosp.xls Page 1

Date of Site Visit: 5/29-30/2008

[0 - Not Met,

4 - No Gap]


Eastlake building, Superintendent houses, MDF

Westlake building, AT building, Linden Hall, Therapy pool Gaps Score


Current infrastructure project: A large telecommunications and phone system upgrade project is currently in progress -- as a result, many of the infrastructural assessments, in terms of data cabling and MDF,IDF characteristics are based on current plans in the upgrade project.MDF : Admin building, under construction - part of network upgrade project, will be spacious and secure when project is done;Server room is IT room, need to move servers to MDF room in future

Eastlake bldg IDFs : 0N1 IDF covers 0N1 and 0N2 area, 0N3 IDF covers 0N3, identical structure on 1st and 2nd floor0S1 IDF covers 0S1 and 0S2 area, 0S3 IDF covers 0S3 area1S1 IDF covers 1S1 area and 1 S2 covers 1S2 and 1S3 area, identical structure on 2nd floorFood service IDF covers food service areaAll of the IDFs share space with electrical room, spacious and secure except for 0N3 IDF which is in storage room and exposed without secure protection

Westlake bldg IDFs : Main IDF receives fiber cables from MDF and redistributes cables to individual IDFs, spacious and secureHMH, B, D, E & F IDFs are a small space inside of electrical room but have enough space for network devices and patch panel, secureC, J & G IDFs are shallow closets on the wall but have enough space for network devices and patch panel, secure

AT building IDFs :Main IDF receives fiber cables from MDF and redistribute cables to individual IDF on 1st and 2nd floor, basement janitor room, secure cabinet1st floor IDF will be a secure cabinet on corridor2nd floor IDF will be a secure cabinet on corridor

Linden Hall IDF : Basement, no detail plan

Therapy pool IDF : Location is not decided

Eastlake Building's 0N3 IDF is also used as a storage space. Not completely controlled access to network equipment, which could present a security risk and harm to networking devices.

Details for Linden Hall IDF have not yet been finalized

Details for the location of the Therapy Pool IDF have not been finalized

It is recommended to place a cage around the 0N3 network equipment, so only authorized personnel can access them

It is recommended that the plans for the specs and specific location of the Linden Hall IDF be finalized, as part of the current network upgrade project.

It is recommended that the plans for the specific location of the Therapy Pool IDF be finalized, as part of the current network upgrade project.

Therapy Pool office and class room are very warm --Office is in need of more effective cooling

Need improved cooling for Therapy Pool office Recommend cooling improvement for Therapy Pool office


Individual generator at each building2 generators (500KW & 350KW) for Eastlake bldg

UPS at MDF

1 generator (350KW) for Westlake bldg 1 generator (100KW) for AT bldg : Just for emergency light. Not enough capacity to support workstation and wireless requirement

AT bldg generator is not sufficient 2 Recommend a new, bigger generator for AT bldg (at least 200 KW) that can support IT infrastructure equipment

2Power usage requirement should not exceed power capacity (including power outside the data center)

Power company : Avista CorporationPower capacity from power company is sufficientPower capacity of Admin bldg and AT bldg stretched to limitThere have been multiple requests to increase power capacity for Admin Building, but the facility has not received a budget to proceed with the request.

Back conference rooms behind nurse stations in FSU (1S, 2S, 3S) are short on electric power plugs for future workstations or laptops

Regarding the current network upgrade project: There does not appear to be an associated plan for power upgrade, even though upgraded servers are being installed

AT bldg - Conference Room C: Would need additional power outlets for workstations or laptops

Current power capacity for Admin bldg and AT bldg is likely not sufficient for future EMR system: - MDF is located in Admin Building and it is expected to require more energy to support servers and network equipment. Servers and core switches tend to consume a lot of energy and it is crucial to provide plenty of power to ensure high availability of the future EMR system. - AT Building is also expected to require more energy since additional workstations, network equipment and wireless devices are planned to be added to the building.

Insufficient number of power outlets for conference rooms in AT bldg.

2 Recommend to work with the plant manager to upgrade power system of Admin bldg and AT bldg

Recommend additional power plugs / strips in back conference rooms of 1S, 2S, 3S, and for AT conference room C

3


Agency/Administration: DSHS/HRSA

Site: Eastern State Hospital



Requirements


Physical Space


A. The physical location(s) should have enough floor space capacity to house all the site's







- printers, scanners- upgraded network devices (routers/switches)

in network room - upgraded fiber, cable, or wiring in conduits

between buildings








UPS at MDF None 4 None


N/A (None hosting site) N/A N/A N/A N/A - It is typically not required to have dual power feed from different parts of the grid for non-hosting sites.

1 Cooling should have dedicated controlsMDF : New air-conditioner will be installed None 4 None


N/A N/A N/A N/A N/A

1


MDF: Conduits are in decent shape due to network upgrade project

None 4 None


MDF : Sprinkler No fire suppression in MDF 2 Recommend gas based fire suppression (FM200) for MDF because this is a distribution point for entire campus

Servers

N/A (Non-hosting site) N/A N/A N/A N/A - No current servers are specifically planned to be used in the future EMR system (to be hosted remotely)

If the chosen solution does involve use of any current servers, the physical configuration and racking of servers will be determined after the solution is selected.

1


N/A N/A N/A N/A N/A


N/A N/A N/A N/A N/A

3


N/A N/A N/A N/A N/A


N/A N/A N/A N/A N/A

ServersCurrently meet DSHS/ISSD security standards (audited periodically)

Currently meet DSHS/ISSD security standards (audited periodically)

None 4 None

1


Conduits will be in decent shape due to network upgrade project

Conduits will be in decent shape due to network upgrade project

None 4 None

Cabling / Pathways


Cabling / Pathways

Cabling / Pathways















1

There should be straightforward access to network drops (such as via rack-mounted patch panels)

IDFs should have appropriate environmental controls

IDFs : Straightforward access to network drops via rack-mounted patch panels.

Eastlake IDFs : 0S1, 1S1 & 2S1 are hot, ventilation or air-conditioning don't work properly.Rest of other IDFs don't have dedicated air-conditioner (Central air-conditioning or ventilation) but temperature remains within an acceptable range.

UPS in all IDFs

IDFs : N1 IDFs don't have fire suppression.

IDFs : Straightforward access to network drops via rack-mounted patch panels;

Westlake bldg IDFs: No dedicated cooling system for any of the IDFs; however, shallow network closets can maintain fairly close to the room temperature and another type of IDFs have ventilation. Current condition of IDFs is acceptable since all of the IDFs will have only a few switches.Westlake main IDF: No fire suppression;AT bldg IDFs: No dedicated cooling system for any of the IDFs. Dedicated cooling will not be necessary for the 1st and 2nd floor IDFs as cabinets for network equipment will be placed in hallways. IDF in the basement could get hot as it doesn't have air-conditioner or ventilation.

Linden hall IDF: IDF will be located in basement. Air-conditioning is typically not required for IDFs located in basement as temperature/humidity in basement is stable. Therapy pool IDF: Location is not decided yet but inside of building is very hot and humid, need to select cool placeIDFs: Insufficient or no fire suppression

AT bldg basement IDF needs appropriate air-conditioning

Eastlake bldg 0S1, 1S1 & 2S1 IDF need appropriate air-conditioning

No fire suppression in main IDF of Westlake bldg, or in all other IDF's in Westlake & AT bldg

2 Recommend appropriate ventilation or air-conditioning for IDF in AT bldg basement

Recommend appropriate ventilation or air-conditioning of IDFs for Eastlake 0S1, 1S1 & 2S1

Recommend gas based fire suppression (FM200) Main IDF of Westlake because this is a distribution point for entire building

Recommend fire extinguishers in remaining IDF's


Telecommunications vaults are accessible through manholes. Documentation on the vaults being developed with the current network upgrade project.

Documentation on Therapy Pool IDF connections and Linden Hall IDF connections has yet to be completed

Documentation on Therapy Pool IDF connections and Linden Hall IDF connections has yet to be completed

3 Recommend that, as part of completing the network upgrade project, documentation on Therapy Pool IDF connections and Linden Hall IDF connections be completed.

WAN / LAN

Network upgrade project is in progressThis project includes new fiber cabling from MDF to IDF of 10 buildings and UTP cabling inside of each building.

Linden hall 1st floor and AT building will be newly wired

ESH is creating documentation such as floor plans with data drops and inventory of

None 4 None


0N1 Exam Room: Needs 1 data dropPharmacy (0N1-2): Needs 3-4 more data dropsDental (Eastlake): Needs 2 additional data drops in office, and 2 additional drops in exam/work area1N3: Very busy area (Rm 148): Up to 15-20 staff at a time: Need 4 additional data drops1S1 Nurse Station: Needs 2 more data drops (X3)1S1 Back Conference Room: Needs 2-4 data drops, or 1 extra AP for wireless (X3)

Dental (Westlake): Needs 2 additional data drops in office, and 2 additional drops in exam/work area

Westlake E-Ward (similar needs for the other 3 similar Wards D,HMH,B):Up-front nurse workstation: Needs 1-2 d/pRN3 nurse office: Needs 1 more d/pBack Lounge: Needs 1 d/pMed Room: Needs 1 d/pE-228 Conf Room (labeled Group Therapy): Confirm that 2 new data pulls are occurring with remodel

Westlake Lab: Needs 4-6 more d/p (to bring it to a total of 12) -- Westlake Lab has numerous standalone lab equipment and systems:

AT Treatment Mall: Will be much more fully wired in current network update project

Needs 1 more data drop for multifunction printer

No specific cabling plans for wireless

0N1 Exam Room: Needs 1 data dropPharmacy (0N1-2): Needs 3-4 more data dropsDental (Eastlake & Westlake): Each Needs 2 additional data drops in office, and 2 additional drops in exam/work area1S1 Nurse Station: Needs 2 more data drops (X3)1S1 Back Conference Room: Needs 2-4 data drops, or 1 extra AP for wireless

Westlake E-Ward (similar needs for the other 3 similar Wards D,HMH,B):Up-front nurse workstation: Needs 1-2 d/pRN3 nurse office: Needs 1 more d/pBack Lounge: Needs 1 d/pMed Room: Needs 1 d/pE-228 Conf Room (labeled Group Therapy): Confirm that 2 new data pulls are occurring with remodel

Westlake Lab: Needs 4-6 more d/p (to bring it to a total of 12)

AT: current wiring plan does not include cabling for wireless

2 Recommend addition of data drops as follows:0N1 Exam Room: Needs 1 data dropPharmacy (0N1-2): Needs 3-4 more data dropsDental (Eastlake & Westlake): Each Needs 2 additional data drops in office, and 2 additional drops in exam/work area1N3: 4 more data drops1S1 Nurse Station: Needs 2 more data drops (X3)1S1 Back Conference Room: Needs 2-4 data drops, or 1 extra AP for wireless

Recommend POE Wireless Cable drops to APs as follows:FSU : 5 APs per floor, total 15 APs for FSU area (3 floors)APU : Basement area (0Nx) need 7 APs. The first and second floor need 4 APs per floor. So total 15 APs will be requiredAT building : 4 APs for basement Treatment MallWestlake : Estimation is 4 APs (Minimum) for each unit, which means 4 X 6 wards (HMH, B, D, E, F, G) = 24 APs total

Recommend for Westlake E-Ward (similar needs for the other 3 similar wards D,B, and HMH) Up-front nurse workstation: Needs 1-2 d/pRN3 nurse office: Needs 1 more d/pBack Lounge: Needs 1 d/pMed Room: Needs 1 d/pE-228 Conf Room (labeled Group Therapy): Confirm that 2 new data pulls are occurring with remodelWestlake Lab: Needs 4-6 more d/p (to bring it to a total of 12)

Network









Fiber cables between MDF and IDFs : all of the IDFs will have at least 6 pairs of Multimode or Single mode fiber cables

Backbone switch is Dell 6024 (24 ports fiber connection) X 1, need bigger capacity and function-rich switch

Workgroup switches will be either Dell 5448 or Dell 5424 depends on required number of connection, switch type selection (Dell 5448 or Dell 5424) is in progress with network upgrade

j

Dell 6024 is small size network fiber backbone switch. There is no UTP port nor separate power supply which is vital for system availability.

2 Recommend Dell backbone switch that is equivalent to Cisco Catalyst 45xx grade Backbone switch (X 2 for redundancy)

Need recommendation to replace planned switches with appropriate models of POE switches to support wireless:FSU : Total 8 switches (24 ports model)AT building : 1 switch (24 ports model)Westlake : 8 switches (24 ports model)APU : Total 8 switches (48 ports model)


No statistics are existing N/A N/A N/A


No redundant Backbone switchNo redundant fiber connection to Workgroup switches

Single Point of Failure: If the switch which has connection to Backbone fails, entire stacked switches lose network connection

0 Recommend redundant Backbone switches (Cisco Catalyst 45xx grade) and backup connection to Workgroup switches (Utilize available fiber cables)

As noted above, need recommendation to replace planned switches with appropriate models of POE switches to support wireless


Backbone and workgroup switches : enough empty ports

Workgroup switches : Appropriately sized None 4 None


WAN is 10Mbps Ethernet from CenturyTel - but no usage statistics available;Under most scenarios, this should be enough bandwidth to support future EMR system load

Current 10 mb WAN usage statistics not tracked 3 Initiate regular tracking of WAN usage statistics;Obtain from DSHS ISSD


No redundancy No WAN redundancy 2 Recommend 1 T1 backup connection


Pending ISSD implementation None N/A Plans for QoS at DSHS level


DSHS ISSD team manages WANNo local management system

None 4 When wireless network is implemented, wireless network management system will be needed : see L1At DSHS level: Recommendations on network monitoring will be presented later for all DSHS project sites served by ISSD



WAN / LAN


Per DSHS / ISSD standards None 4 None



secure VPN service is available through ISSD/DIS

None 4 None

Cabling / Pathways


No wireless currently in place Westlake bldg pharmacy area has limited wireless network

n/a n/a n/a









2


Eastlake bldg FSU ; 5 APs per floorEastlake bldg APU: also a wireless candidate -- has more space for supplemental stationary workstationsSuperintendent Houses : Long range 900 mhz wireless (involving antennae) may be only viable approach

Currently, there is a limited wireless implementation in Westlake, but would likely need to be replaced (currently runs Medimar);Highest candidate areas for wireless:Westlake - B, D, E Wards, and HMHWestlake - F Ward (future treatment mall) -- future design, layout is up in the air, but wireless coverage for approximately 70'X70' area will be appropriateAT Building - Wireless appropriate particularly on Treatment Mall / Work Center floorAT building (basement) Treatment Mall : Would need 4 Aps (fairly large and open)

Needs significant wireless implementation for (in order of priority): FSU, APU, AT Bldg, Westlake

1 Recommend Wireless Solution in the following areas, with count of APs indicated:FSU : 5 APs per floor, total 15 APs for FSU area (3 floors)APU : Basement area (0Nx) need 7 APs. The first and second floor need 4 APs per floor. So total 15 APs will be requiredAT building : 4 APs for basement Treatment MallWestlake : Estimation is 4 APs (Minimum) for each unit, which means 4 X 6 units (HMH, B, D, E, F, G) = 24 APs total

Superintendents Houses: Long Range Wireless solution - Low Priority - TBD

User Devices


Additional workstation needs identified:For the entire campus: Need to initiate for formal 3-year refresh cycle for workstations

Pharmacy (up to 15 staff): Needs 3 more w/s (note: each current workstation in Pharmacy has two display screens: one for Pyxis, and one for Citrix/Worx running in Olympia;APU: Nurse Station between 1N1-1N2 needs 3-4 new w/s (X3)1N3 Nurse Station: needs 2-3 new w/s (not on 2N3 or 3N3)-- No additional needs in med rooms/pill lines (medimart on cart / wired) --Dental (Eastlake): needs 2 w/s in office, 1-2 w/s in dental work areaFSU 1S1 Back Conference Room needs 3-4 new w/sFSU 2S, 3S Nurse Station: needs 1-2 w/s eachFSU hallway conference rooms: need 1 w/s each (3 total)

Pool: Needs 2 new w/s in office

Dental (Westlake): needs 2 w/s in office, 1-2 w/s in dental work area

Westlake: no charting done in rooms

Westlake E-Ward (similar needs for the other 3 similar Wards D,HMH,B):E: Up-front nurse workstation: needs 1-2 w/sE: RN3 nurse office: needs one more w/s

E: Exam Room - needs 1 w/sE: Conf Room (Grp Therapy - E228): - needs 2 w/s

Westlake Lab: Needs 4-6 more w/s

For the entire campus: Need to initiate for formal 3-year refresh cycle for workstations

Pharmacy: Needs 3 more w/sAPU: Nurse Station between 1N1-1N2 needs 3-4 new w/s1N3 Nurse Station: needs 2-3 new w/sDental (Eastlake): needs 2 w/s in office, 1-2 w/s in dental work areaFSU 1S1 Back Conference Room needs 3-4 new w/sFSU 2S, 3S Nurse Station: needs 1-2 w/s eachPool: Needs 2 new w/s in office





2 Recommend:For the entire campus: Need to initiate for formal 3-year refresh cycle for workstations

Pharmacy: Needs 3 more w/sAPU: Nurse Station between 1N1-1N2 needs 3-4 new w/s1N3 Nurse Station: needs 2-3 new w/sDental (Eastlake): needs 2 w/s in office, 1-2 w/s in dental work areaFSU 1S1 Back Conference Room needs 3-4 new w/sFSU 2S, 3S Nurse Station: needs 1-2 w/s eachFSU hallway conference rooms: need 1 w/s each (3 total)Pool: Needs 2 new w/s in office

Recommend the following for Westlake:






ESH is not on 3 year lease for workstations and there are variety of workstations with

Pentium D req not met 1 Significant recommendation to be on 3 year lease and standardize workstations in order to ensure the workstations can support the future


1 GB req not met 1


None 4


No Direct X capability 1


None 4


Not all NICs have 100 mbps 1


Optical mouse req not met 1


None 4


None 4


None 4

User devices









None - can be enabled 4


ActiveX controls (which cannot be installed by end users) can be installed by IT support

4 IT support (not end users) can install Active X controls





User Devices

Very limited, if any, mobile device usage by ward staff;

Few laptops in use, various models/speeds - all WinXPcapable. Some Palm Tungsten E model PDA's, PalmOS standard. No upgrade standard - upgrades are performed as available.

Assuming wireless solution, laptop/notebooks are most needed in the Eastlake wards

Very limited, if any, mobile device usage by ward staff;Assuming wireless solution, laptop/notebooks are most needed in the Westlake Wards and in the AT areaFor AT: It is safe to assume that most of the users with laptops will be coming from other buildings for which laptops/mobile devices have been provisionedWestlake F-Ward : future workcenter: most conducive to wireless / laptops;

Need additional laptops for use in Eastlake wards, Westlake Wards, and in AT Treatment Mall

Recommend additional laptops for use in Eastlake wards, Westlake Wards, and in AT Treatment Mall:FSU: 1S1, 2S1, 3S1, 1S2, 2S2, 3S2: 2-3 laptops each: 12-18 TotalAPU: 1N1,1N2, 1N3: 2-3 laptops each: 6-9 TotalAPU: 2N1,2N2: 2-3 laptops each: 4-6 TotalAPU: 3N1, 3N2: 2-3 laptops each: 4-6 TotalWestlake: HMH,B,D,E Wards: 2-3 laptops each: 8-12 TotalWestlake F-Ward: 4 laptopsSum of Staff Laptops: 38-55 (assume that laptops taken to AT building come from this total)

Recommended notebooks/tablets/PDA's:Eastlake, AT Providers: 16-20 Total notebooks/tablets/or PDAsWestlake Providers: 8-10 Total notebooks/tablets/or PDAs

Printers


Medical Records: Currently has 12 w/s with 12 local printersDental (Eastlake) needs one small networked mf printerEach central nurse station on APU, FSU could use a mid-sized mf printer (6 total)FSU - 0-level (basement) nurse offices: need one mf ptr

Dental (Westlake) needs one small networked mf printerEach Ward in need of 1 mid-sized mf printing device (4 total)Need one mid-sized networked mf printer in AT Treatment Mall

Medical records needs to replace small local printers with one large networked multifunction printer

Per observations, each APU, FSU nurse station, and each Westlake Ward in need of a mid-sized networked multifunction printer

FSU - 0-level (basement) nurse offices: one networked mf printer

2 Recommend large multifunction printer for Medical Records + recommend providing mf printers as indicated at left:

Add one mid-sized multifunction , networked printer in:Each floor of FSU (3)FSU - 0-level (basement) nurse offices: (1)Each floor of APU (3)Each Westlake Ward (4)Dental (East and West) (2)AT Treatment Mall (1)


No centralized print serverEach printer has own small print server

No centralized print server 0 Recommend print server implementation (X 2 for redundancy)







Printers are in secured office areas Printers are in secured office areas None 4 None

Scanners

Some limited scanning capability. Small workstation scanners in limited locations for office level purposes. One scan enabled copier in Administration for admin purposes. Wards and Wards equipped with Pyxis scanstation/computer service for scanning of medication orders back to the pharmacy.

Scanner

Printers












Limited scanning: 2 ea HP desktop scanners, 1 ea Canon scan enabled copy machine, 11 ea ward Pyxis scanstation devices in Pharmacy.

Limited multifunction devices 2 No additional recommendation: Standard EMR scanning needs will be met by multifunction printers recommended in section O.


Limited multifunction devices 2 No additional recommendation: Standard EMR scanning needs will be met by multifunction printers recommended in section O.


1 Lab system

All Lab services are provided by Westlake Lab.Westlake Lab has numerous standalone lab systems and equipment (self-contained

n/a - Gap depends on the eventual EMR system solution and the viability of interfacing these multiple standalone systems to the EMR system

n/a n/a - Recommendation depends on the eventual EMR system solution and the viability of interfacing these multiple standalone systems to the EMR system

2 Pharmacy system

Pharmacy: Mediware WORx pharmacy software system implemented in pharmacy with Pyxis medstation dispensing devices at ward locations. Mediware MediMAR software

Pharmacy Pyxis servers are not in secure location 3 Pharmacy Pyxis servers need to be moved to more secure location (such as to main server room)

3 Radiology system

Performed by external provider:Northwest Mobile XRAY

None 4 None


Numerous interactions between Inland Northwest Health Services (INHS). INHS uses Meditech and ESH has considered implementing Meditech to make an information exchange between INHS easier.

None 4 No infrastructural recommendations at this time; Information exchanges among existing systems and regional healthcare providers need to be further studied once the future EMR solution is determined. Data conversion for those databases that are being replaced would also be necessary.


For the future EMR, information can be exchanged via DSHS's network with an appropriate interface and does not expect to

i ith t k b d idth

None 4 None


None 4 None


None 4 None


None 4 None

Ancillary Systems

External Systems



Copy of dshs_Echo_Glen.xls Page 1 of 2


Site Name Echo Glen Children's Center

Site Location & Date of Site Visit North Bend, WA -- 6/19/08

Primary Site Contacts (Technical and Medical) Technical: Rocco Volker - IT, John Verburg, Stacia - Registered Nurse


Lori Jean Parker - Business Manager, Terry Ocsow - Electrician

# Category Details

1


In-Scope: Infirmary, Clinic, Dental, Housing Units, Recreation Building

Out of Scope: Plants, School Buildings, Commissary, Shops, Plants

2



3

Additional Introductory Information Echo Glen Children's Center serves both male and female juvenile offenders with ages ranging from 10 to 21 years old. There are 13 Housing Units with 11 of them are currently active. Housing Units are being remodeled to provide more security. As part of the remodel, a dedicated network closet and more data drops are being added to each housing unit.

Primary users of the future EMR system would be Physicians, Nurses, Dentist, Psychologist, Psychiatrist, Case Manager, Housing Unit Staff Members and Housing Unit Supervisor. It is noted that Echo Glen Children's Center requires fa air amount of access to high resolution images for EKG, X-Ray and Ultrasound.

Staff members currently use Automated Client Tracking (ACT) system extensively for Case Notes, Treatment Report/Target Behavior, Behavioral Assessment and Incident report.




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# Category Details

4



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[0 - Not Met,

4 - No Gap]



Physical Space


Housing Units: Housing units are being remodeled to provide more security. As part of the remodel, a dedicated network closet and more data drops are added to each housing unit.

Recreation Building: Network equipments for Recreation Building are located in a storage room.

MDF: Demark point is exposed without any protection. It is located right behind the network rack in MDF and could lead to an accidental damage.

Network equipments in Rec Building are not secured and it could lead to security risks, equipment vandalism and/or accidental damage of the equipment.

Demark point is not protected from dust or accidental damage.

3 Install a cabinet to protect and organize all the network equipment in Rec Building.

Install a small enclosure to protect the demark point from dust and physical damage.


There is a large generator which can support the entire facility including the main network closet. However, it is noted that network equipment tends to stop working when the generator kicks in although UPSs are utilized.

None 4 No Infrastructural Recommendation - Further investigate the root cause of network equipment malfunctions.


Electrical power is supplied by Puget Sound Energy. No power capacity issue.

None 4 None


Multiple UPSs for Router, Switch and Server in MDF. Also, there is a UPS for an IDF in Gym. However, there is no UPS for each IDF in residential unit.

No UPS in Residential Units 2 Recommend a small UPS for each residential unit. Total of 13 UPSs are recommended.


N/A None N/A No Recommendation - It is typically not required to have a dual power feed from different parts of the grid for non-hosting sites.


There is no dedicated air-conditioner or ventilation in MDF or IDFs. Since each IDF typically has only one switch and it is/will be located in a shallow closet, there is no significant need to have an air-conditioner.

No separate cooling in MDF 2 Install a small air-conditioner in MDF to maintain appropriate temperature/humidity level.


N/A None N/A No Recommendation - Redundant cooling system is not required for a non-hosting site for the future EMR system


Site: Echo Glen Children's Center



Requirements




Cabling /








1


Conduits leaving MDF have enough rooms for additional cables if needed.

None 4 None


There is a fire detector, but there is no fire suppression or fire extinguisher nearby MDF.

No sufficient fire suppression for MDF 1 Acquire gas fire suppression for MDF (FM200)


Cabling / Pathways





Servers

1





3





ServersN/A - Local File and Print Server only None N/A No Recommendation - No current servers will be used in

future EMR

1


Conduits are accessible and serviceable either through a tunnel system or manholes.

None 4 None

Cabling / Pathways


There is a Rack-mounted patch panel None 4 None


There is a tunnel system below administration building and 3 inch conduits between buildings. Contents of conduits are well documented and have enough room for additional cables if needed.

None 4 None

WAN / LAN


Clinical Area: There are sufficient number of data drops to support the future needs. Also, we are recommending to implement wireless for clinical area which can alleviate any additional needs for data drops. (See Section L)

Housing Units: Housing units are being remodeled and will have enough data drops once the remodeling is completed.

Additional cabling required in Health Center to implement wireless.

3 Add additional cabling with POE for 2 new wireless APs as we recommend implementing wireless for Health Center (See Section L for more detail)


HP Procurve switch is utilized as the backbone switch and Dell PowerConnect 2724 for IDFs.

Multiple strands of Fiber cables run from MDF to a jumper block in Housing Unit 11 and Housing Unit 4. From the jumper blocks, fiber is distributed to each housing unit.

None 4 None


No LAN performance issues None 4 None



Cabling / Pathways










No LAN redundancy (Non redundant switch) No redundant switch N/A Per latest discussion, additional redundant backbone switch will not be implemented -- No recommendation



None 4 None


Fractional T-1. CenturyTel doesn't have availability to provide 10mbps service to this location.

JRA has been actively upgrading to 10-Mbps Ethernet where fiber is available since Online education/training system and online surveillance camera system will be installed at all JRA sites.

Although the number of users accessing medical records is small, more bandwidth could be required with the future EMR system.

There is a video conferencing capability with ISDN line; however, it hasn't been utilized since the current bandwidth cannot support video conferencing.

Higher bandwidth could be required 1 We support the JRA's direction as the current bandwidth is not likely adequate to support the future EMR system. Assuming fiber will be available in the area where the facility is located, we recommend to upgrade to 10-Mbps Ethernet if it makes economical sense. For now, we recommend to increase WAN bandwidth with an additional T-1.


No redundancy with WAN No redundancy with WAN 0 No Recommendation - redundancy and carrier diversity not practical in this location







Network





WAN / LAN







Cabling / Pathways


N/A - No wireless now None N/A N/A

2Sufficient Wireless access points should be available for uninterrupted access for mobile devices

No wireless now No wireless now 0 Recommend implementing wireless in Health Center to alleviate current space issues and increase efficiency.

Recommend 2 wireless access points to provide coverage for the entire Health Center.

User Devices


None 4 None


There are times when approximately 10 care staff members are working in Health Center. The care staff is expected to need more access to workstations with the future EMR system and the lack of access to workstations will likely cause inefficiency.

There is a workstation in each office, but not all exam rooms have a workstation:Med Room: No workstationEKG Exam Room - No workstationExam Room 1 - No workstationExam Room 2 / Physician's Office - Uses a laptopProcedure Room / Exam Room 3 - 1 workstation

Dental Clinic: There is one workstation the dental clinic, but there is no workstation right by each dental chair. There are 3 dental chairs (1 in a closed office, 2 in open area).

Residential Units: There are enough workstations in each residential unit as staff members already use ACT system extensively to complete required documentation using a workstation.

Short of workstations in general 2 Add 1 workstation in Med RoomAdd 1 wall-mounted workstation in EKG Exam RoomAdd 1 wall-mounted workstation in Exam Room 1Add 3 workstations in Dental Clinic (1 for each dental chair)

(See Section N for our recommendations on additional mobile devices)


Specs for leased equipment are expected to be sufficient None expected 4 Recommend to confirm that new workstations meet this specification.














User devices








DSHS standard None expected 4 Recommend to confirm that new workstations meet this specification.


















User Devices

Currently, 3 laptops are utilized in Health Center since there are not enough workstations.

Nurses visit housing units to perform med post and they require access to medical administration records; however, workstations in each housing unit is typically occupied by the staff members who work in the housing unit.

Infirmary: Since care is provided in each patient's room, computer access is necessary in each room, but it is not safe to leave a workstation in a patient's room unattended. Thus, a mobile device is required.

A few more laptops are needed for nurses who perform med post to manage medication administration records. Also, a few computers on wheels would be necessary in Infirmary to access necessary medical information while seeing a patient.

2 Add 5 more laptops. Since Nurses visit housing units to perform med post, they need an access to medication administration records.

Add 2 computers on wheels in Infirmary


Printers


There are 2 networked printers and 1 copier in Health Center. Note: 1 printer in Dental Office is currently not networked, but it is planned to be on network shortly.

Each residential unit has at least 1 networked printer.

None 4 None



None 4 None





None 4 None









Scanners

There is no Scanner at this facility No Scanner 0 Replace the copier in the Clinic with a full size multi-function device which has scanning, printing and copying capabilities.

Recommended procuring a device which has a high processing speed, has full sheet scanning capability and be TWAIN compliant


N/A None N/A None


N/A None N/A None


1 Lab system N/A - No Lab system is utilized. Lab Service is contracted to Quest Diagnostics and users can log into Quest's website to see lab results.

None N/A None

2 Pharmacy system N/A - No Pharmacy/Medication Administration system is utilized. Uses Cost Less Pharmacy to purchase meds.

None N/A None

3 Radiology system

N/A - No Radiology system is utilized. Patients are sent to Washington Imaging Services mostly for orthopedic or ultrasound service.

None N/A None


Scanner

Printers

Ancillary Systems











N/A


N/A


N/A


N/A


NoneNone

External Systems

N/A - All medical information is kept on paper. However, this site utilizes Automated Client Tracking (ACT) system extensively for Case Notes, Treatment Report/Target Behavior, Behavioral Assessment and Incident report by the end of this year. This information needs to be interfaced or migrated to the future EMR system.


Copy of dshs_Fircrest.xls Page 1 of 1


Site Name Fircrest Residential Habilitation Center

Site Location & Date of Site Visit Shoreline, WA - 6/17/2008

Primary Site Contacts (Technical and Medical) David A. Lingwood - IT, Frankie Jackson - Nursing Manager


Mike Scott - Facilities Director, Marcy Johnson - Nurse, Joyce Stiell - Pharmacist, Burny - Plant Manager

# Category Details

1


In-Scope: PAT-N Cottages, PAT-A Cottages, Adult Training Program, Admin Bldg, 200 Bldg, Dietary, Activity BuildingOut of Scope: Warehouse, Plants, Shops, Commissary, Chapel, State Health Lab (owned by Department of Health)

2


m/f - Multifunction Devices; PAT - Program Area, dp - data port, w/s - workstationICF/MR - Intermediate Care Facility/Mental Retardation, NF - Nursing Facility, ACM - Attendant Counselor Manager, RN - Registered Nurse, NP - Nurse Practitioner, PA - Physician's Assistant, HPA - Habilitation Program Administrator, LPN - Licensed Practical Nurse

3

Additional Introductory Information Fircrest serves approximately 200 clients with developmental disabilities. Residential Units are categorized into PAT-A (ICF/MR) and PAT-N (NF). This facility is Intermediate Care Facility which provides access to 24-hour medical care, as well as various habilitation programs to clients.

There are 16 active residential units with more capacity to accommodate clients in the 200 Building. Majority of clients stay in residential units, but clients are brought into Infirmary to receive acute care with a length of stay ranging from 10 to 90 days. Majority of clinical documentation happens in Infirmary. In Clinic, physicians, especially contracted physicians, tend to dictate and Dictation Transcription Service is provided on site.

This facility emphasized the needs for solid trainings for staff members, especially ACMs, to effectively adopt EMR.

4






Copy of dshs_Fircrest.xls Page 1


[0 - Not Met,

4 - No Gap]


Observations:Main Server Room (MDF) and Switch Closets

(IDFs)

Observations:PAT-N Cottages, PAT-A Cottages, ATP, Admin

Bldg, 200 Bldg, DietaryGap Score


Physical Space


The main server room/MDF for the campus is on the ground floor of the 200 Bldg; It houses all local servers and the main backbone switch.It will be referred to as MDF-200.

There is a secondary MDF/main switch room for the 500 building. It provides MDF-level services for approximately 7 IDF's in building 500, and will be referred to as MDF-500.

The main server room (MDF-200) is fairly large, and has plenty of room for any additional equipment (approx. half the room is currently used for storage)

MDF-200 and MDF-500 have secure, lockable doors.

For MDF-500, the room is shared with vacuum/pressure machinery used by dental.

IDF's are summarized under section I.

All PAT-A residential units are duplex and typically workspaces for AC Manager, Health Coordinator and HPA are set up in the 2nd floor. For PAT-A residential units, Health Coordinator, HPA and LPN cover multiple residential units.

All PAT-N residential units shape like Y and typically there are permanent workspaces for AC Manager, Health Coordinator and LPN since clients in PAT-N require more attention.For the first floor of PAT-A residential units, computers cannot be utilized without protection due to risk of client damage.

Currently, the 1st floor of the 200 Building is utilized to house a client with violent behavior. 2nd and 3rd floor of the 200 Building are currently not utilized; however, they could be used in the future to accommodate an increase in the number of respites (clients with short term stay).

For MDF-200, there are no gaps with regard to space

For MDF-500, the room is shared with vacuum/pressure machinery used by dental. -- MDF-500 switch equipment could be made more secure with a protective enclosure.

3 Recommend a protective enclosure for the switch equipment in MDF-500, to mitigate any risks associated with vacuum/pressure equipment in the same room.

Recommend a kiosk for a computer on the 1st floor of PAT-A.


There are weaknesses with the generator switch gear; and the Primary generator cannot power all circuits in 200, 500 buildings

3 Recommend capital improvement project for improving failing generator switch gear and for electric feed system (see B-2 below). Part of this project should also be an upgrade to the generator, so that it can power more of the full campus (and not just emergency circuits);Estimated cost for resolving issues with switch gear, feeder lines, and increasing primary generator capacity is $1.5 - $2.0 million


Gaps with 3 electric feeder lines N2, N3, N4 3 See above


One large UPS needed for MDF in building 200;One small UPS needed for IDF's when hubs are upgraded to manageable switches (see further details below)

4 Per gaps identified, recommend:One large UPS needed for MDF in building 200;One small UPS needed for IDF's when hubs are upgraded to manageable switches (Approximately 25-30; see further details below)


n/a n/a n/a - requirement only for hosting sites


None 4 None



Requirements





C bli /



Agency/Administration: DSHS/DDD/RHC

Site: Fircrest Residential Habilitation Center



There are multiple generators on the Fircrest campus. Emergency circuits for bldg 200, 500, and all circuits for the PAT-A cottages are powered by a 550 KW generator (D348 Caterpillar) located in the steam plant buildingThis primary generator is tested once per month, and load tested annually -- it is known to have switch gear problems (old, outdated, difficult to maintain, scarce parts -- failures multiple times per year)There are additional generators for the Y buildings (150-200KW: emergency power only) and for the Activities Bldg (150 KW: full service for Activities only)Additional portable generators also available

Provider is Seattle City Light: No issues with supply from SCL, but there are issues with electric feeder / distribution for 3 feeder lines (N2, N3, N4)

4 small UPS in MDF-200;1 small UPS in MDF-500;IDF's: Very few IDF switches/hubs are supported by UPS --No IDF with Netgear hubs have UPS

Single power feed from Seattle City Light

Dedicated air conditioner for Main Server Room MDF-200

None





(IDFs)




1


Additional conduit requirements for building 200 may require additional conduit installations

3 Depending on solution requirements and changes in the usage of building 200, prepare for possible addition of approx. 8 new data drops with new conduit pipe


No adequate fire suppression for main server room

2 Add FM200 gas-based fire suppression to MDF. Add fire extinguishers to all residence unit IDFs where upgraded switches will be placed, and to all other IDF's in 200 bldg and 500 bldg (total of approx 25-30).

Servers

1


None (with regard to system servers) 4 None (with regard to system servers)


n/a: requirement only for hosting sites n/a n/a

3





ServersNone 4 None

1


Additional conduit requirements for building 200 may require additional conduit installations

3 Depending on solution requirements and changes in the usage of building 200, prepare for possible addition of conduit pipe and cable

Cabling / Pathways

Per ISSD standards and requirements

Some existing conduits accessible and able to accommodate additional cabling, and some are not: Building 200 conduits are the smallest and most full; Building 500 conduits are in excellent shape (good size, not full); PAT-A IMR building conduits can be added relatively easily (in existing wood housing that has been created); Y-building conduit addition is more difficult -- conduit must be attached to the wall near the ceiling (there is no space above the ceiling)Wireless solution in cottages should minimize additional strain on any smaller (1" or less) conduits for which usage is nearing capacity

Some conduits leaving the main server room (MDF-200) are relatively small and full;Conduits in MDF-500 in good shape;


Cabling / Pathways


Cabling / Pathways





MDF (200 & 500): Fire detection, but no adequate automated fire suppressionIDF's: No adequate fire suppression

Note: The entire campus has a very well documented local Disaster Recovery Plan

Multiple small UPS's in MDF

Multiple servers in main server room -- used only for local systems and for file/print services

N/A

N/A





(IDFs)





MDF-500 switch needs additional ports; 1 Upgrade MDF-200 and MDF-500 switches to 48-port switches;

Recommend adding small manageable workgroup switch for each cottage


None 4 None

WAN / LAN


Additional data ports are required to provide a dedicated connection to networkable devices such as workstation and printer/multi-function device.

2 Pharmacy:Add 1 more data drop in supervisor's officeAdd 1 more data drop in each workspace (total of 3)Add 1 data drop for the color printer (recommended to upgrade with a newer model)Add 1 data drop for the copier (recommended to upgrade with a newer model)

Clinic:Add 1 data drop for the copier (recommended to upgrade with a newer model)

Infirmary: Add 2 additional data drops (with POE) for the 2 new wireless APs as we recommend to implement wireless for Infirmary (See Section L for more detail)

Residential Units: Add 2 additional data drops (with POE) for the 2 new wireless APs as we recommend to implement wireless for each residential unit (See Section L for more detail)

200 Building 1st Floor: Add 1 data drop to a room which house a client with violent behavior as the room currently houses a client and could be used as an office in the future.


For future expansion to support EMR systems, both the 200 MDF backbone switch and the bldg 500 switch have limited capability and expandability

Netgear hubs in IDFs have no expansion capability and cannot effectively support Wireless

2 Upgrade main backbone switch to CISCO Catalyst 45xx - class (48 port)Upgrade switch in bldg 500 MDF to CISCO Catalyst 45xx - class (48 port)Replace Netgear hubs in IDFs with manageable 12-port switches that can support PoE. (approx. 20-25)


n/a n/a Once switching equipment is upgraded to manageable switches, request selected tools from DSHS ISSD


n/a n/a n/a

Network


IDF Summary:IDF's are in secured locations;Most IDF's use small Netgear Hubs (not managed switches), with 4, 5, or 8 ports;Larger IDF's (such as in building 500, ATP building, Madrona shed) use 24-port switches (Either Dell 3424 or SMC EZ1024 DT);Patch Panels;

The 500 building has 8-9 IDF's in the building, most use netgear hubs (in addition to the 500-MDF main switch room on the ground floor) -- There is one larger IDF (just off the conference room on 3rd floor) that has an EZ1024DT 24-port hub (only 2 unused ports, but not all appear to be in use)Very few, if any, of the IDF's have UPS -- (Only plant switch room and Madrona shed have UPS)

Madrona shed is a locked, standalone structure (left over from a building demolition -- serves the Y cottages Aspen, Birch, Cherry, Elm, and the Rec Activities building)

Well-documented: Documentation available through Plant/Facilities; Photos of manhole contents are on file

There is dedicated fiber between the primary IDF's (or MDF) and each cottage (typically at 100Base)

The main server room in the bldg 200 MDF contains the main backbone switch, which is a Dell PowerConnect 3424 (24-ports and ports very full -- 1-2 free)

The bldg 500 MDF main switch room contains a 24-port Dell PowerConnect switch (only about 6 free ports)

Netgear hubs in IDFs have no expansion capability and cannot effectively support Wireless

No statistics available

Pharmacy: There is only one data port in each workspace/office while two workstations are placed in each workspace/office. In order to provide a network access, a hub is utilized in each area to split the LAN connection into two. Also, none of the printers are currently on network.

Clinic: There are enough data drops; however, a copier placed nearby Medical History (Chart) room is not networked.

Infirmary: There are data drops in Nurse Station and Report Room (209B); however, none of the patient rooms or Med Station have data drops.

Residential Units: Each PAT-A residential unit has 2 data ports (one on each side) on the first floor and multiple data ports on the second floor. PAT-N residential units have data drops in offices, but there are no data drops in Med Station or Day Room.

No redundancy





(IDFs)





Insufficient switch configuration to support higher volume, more port usage, or Wireless

2 As noted above:Upgrade main backbone switch to CISCO Catalyst 45xx - class (48 port)Upgrade switch in bldg 500 MDF to CISCO Catalyst 45xx - class (48 port)Replace Netgear hubs in IDFs with manageable 12-port switches that can support PoE. (approx. 20-25)


Fractional T-1 will not be sufficient with additional EMR system load

1 Recommend WAN upgrade to at least 2 X T-1 bandwidth, and if not significant cost difference, to 10 mb fiber;Recommend retaining existing fractional T-1 for redundancy and backup


n/a - requirement for hosting site n/a n/a


n/a n/a n/a


n/a - switch upgrade will be to manageable switch models

n/a n/a


Will need Cat 5e for wireless access locations 3 Recommend installation of cat 5e for wireless AP locations

WAN / LAN


None 4 None


None 4 None


None 4 None

Cabling / Pathways


No wireless in place n/a n/a

2


No wireless access at this time 0 Recommend 2 wireless access points in Infirmary

Recommend basic Wireless Access in all cottages: 2 AP in each cottage for approx. 16 cottages; Initial cost estimate for cottages, infirmary : $100K $120K equipment, and $20K - $25K labor (reference Lakeland Village study)

User Devices

Current PC workstation is being upgraded, and older (unrefreshed) inventory may be insufficient to support future EMR system at the time of system implementation

2 Recommend budgeting for acceleration to a formal 3-year refresh cycle for new model workstations (approx. 75 PCs per year)




MDF: Single Dell Powerconnect 3424 is the main backbone switch;IDF's: Small, unmanaged Netgear hubs (except for a small number larger IDFs that have either Dell 3424 or SMC EZ1024 DT

Bldg 200 Training Room: 16-port Netgear switch

Currently, WAN is fractional T-1 from Qwest: WAN utilization levels not measured;With over 200 patient clients and over 100 future EMR users, it is unlikely that even one T-1 will suffice

No redundancy

Await implementation by DSHS ISSD

Not all switches can be managed with remote software

CAT5 and 100 mb throughout campus

Per ISSD standards

McAfee 8.5 in place

VPN access possible

No wireless in place

Residential Units: Having wireless helps the staff members by providing flexibility to document while being with or keeping distance from the clients.

Infirmary: Since it is not safe to keep a workstation in a patient's room, wireless network is necessary to bring a computer on wheels into each room.

Activities Building: very limited system access needed; offices have workstations; No wireless justified;

ATP (older 40's building): very light data entry (mostly tracking of work completed); Some data may be collected by HPA's, but could be collected offline on laptop -- wireless connection not justified; Offices wired with workstations

Workstations are obtained from surplus, and are mostly 4-6 years old: Current PC inventory is dominated by a variety of Dell GX series:Newest models from surplus are Dell 260's; Newest models recently acquired are Dell 755's





(IDFs)





There are not enough workstations for attendant counselors since they are expected to need more access to workstations with the future EMR system.

Also, there are not enough workstations in Clinic or Infirmary to accommodate the future needs.

2 PAT-A Residential Units: Recommend having two workstations that are protected by an enclosure for each PAT-A residential unit (20 total).

PAT-N Residential Units: No additional workstations are necessary. However, we recommend to have more laptops/tablet PCs in each PAT-N residential unit. (See section N for more detail)

Clinic:Add 1 wall-mounted workstation for room 206AAdd 1 wall-mounted workstation for room 209AAdd 1 wall-mounted workstation for room 210AAdd 1 workstation in Chart/Medical History Room

Infirmary:Add 2 Computers on Wheels (2 nurses per shift)Add 1 Laptop/Tablet PC to check Medication Administration Record

Note: 2nd and 3rd floor of 200 Building are not currently utilized, but those places could be used to accommodate respites in the future. Add workstations as needed.


1


1


1


1


1


1


1


1


1


1


1


1


1


1

User devices

Residential Units: Each residential unit typically has a medical station and work spaces with workstations and a network printer for Attendant Counselor Manager (ACM), Habilitation Program Administrator (HPA) and Health Coordinator. However, attendant counselors/direct care staff currently do not have any access to computers since they complete necessary documentation on paper forms.

Clinic: There are 2 workstations in Nurse Station to handle client appointments and 1 workstation in each office; however, none of the exam rooms currently have a workstation.

Infirmary: There is 1 workstation in Nurse Station and 1 workstation in Report Room (209B). There is no workstation in Med room as medication administration record is kept on paper currently. Since care is provided in each patient's room, computer access is necessary in each room, but it is not safe to leave a workstation in a patient's room as clients could damage the workstation.

OK

None

Some workstations use older CRT screens

OK

OK

Current PC workstation inventory could be insufficient to support future EMR system

Can be enabled on new workstations proposed


Less than half (half of 220) of the current workstations satisfy this req

Less than half of the current workstations satisfy this req

Recommend budgeting for acceleration to a formal 3-year refresh cycle for new model workstations (approx. 75 PCs per year)

OK



XP SP2

None





(IDFs)




User Devices


2 Total of around 35 laptops/tablet PCs are recommended for this facility

Recommend 1 laptop/tablet PC for Health Coordinator who covers multiple residential unitsRecommend 1 laptop/tablet PC for each physician who performs roundsRecommend 1 laptop/tablet PC for each LPN who performs who performs med postRecommend 3 laptop/tablet PC (1 for LPN and 2 for ACs) per PAT-N Residential UnitRecommend 1 laptop/tablet PC for Med Station in Infirmary

Printers


Several printers in clinical area need to be upgraded

2 Pharmacy: Upgrade the color printer to one with higher process speed with networking capabilityUpgrade the copier to a multi-function device which has scanning, printing and copying capability

Clinic:Upgrade the copier to a multi-function device which has scanning, printing and copying capability

Infirmary:Upgrade the printer in Nurse Station to one with higher process speed with networking capability


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 No Recommendation: Redundant print server is typically not required for non-hosting site.


None 4 None

Scanners


None 4 None: Recommended mf devices will have appropriate scanning functions


None 4 None: Recommended mf devices will have appropriate scanning functions


Scanner

Printers




Printers are windows compatible

Print server in place in bldg 200

All printers are located in a secure location where an unauthorized personnel cannot easily access.

Currently, a laptop is assigned to HPAs as they move to different residential units. Physicians, Health Coordinators and LPNs also visit multiple residential units, especially for PAT-A units, to perform rounds or med post.

For PAT-N Residential Units, clients are less mobile and LPN and Attendant Counselors could be benefitted by carrying a laptop/tablet PC instead of a workstation.

There are printers throughout the facility, but some of them are too small or too old to handle printing volume that could be required for the future EMR system. There is at least one networked printer in each residential unit.

Networked printers have TCP/IP networking capability


No scanner is utilized in clinical area (See recommendation in Section O-1 to upgrade existing copiers with a multi-function device which as scanning capability)

Printers have static IP address

No redundancy in print server





(IDFs)





1 Lab system None - upgrade to 2 X T-1 or 10 mb WAN connection will satisfy interface req's

4 None

2 Pharmacy system None - upgrade to 2 X T-1 or 10 mb WAN connection will satisfy interface req's

4 None

3 Radiology system None - upgrade to 2 X T-1 or 10 mb WAN connection will satisfy interface req's

4 None



None - upgrade to 2 X T-1 or 10 mb WAN connection will satisfy interface req's

4 None



4 None



4 None


n/a n/a n/a


Ancillary Systems

External Systems


Billing information is sent to Office of Financial Recovery.

For the future EMR, information can be exchanged via DSHS's network with an appropriate interface, but expect to see issues with the current network bandwidth.

Northwest Hospital (lab results are currently faxed)

External provider: Mobile Xray

A number of functional interfaces will need to be developed to link Fircrest's database systems to other DSHS systems

WORx (Olympia-based); No Pyxis; Link to Wholesale provider (Cardinal Health)

Copy of dshs_Frances_Haddon_Morgan_Ctr.xls 1


Site Name Frances Haddon Morgan Center

Site Location & Date of Site Visit Bremerton, WA -- 5/9/08

Primary Site Contacts (Technical and Medical) Technical: Bert Thibodeaux - IT


Carol Kirk - Superintendent

# Category Details

1


In-Scope: Offices, Living Room area, KitchenOut of Scope: Maintenance, Resident Rooms

2



3

Additional Introductory Information Frances Haddon Morgan Center serves over 50 clients with developmental disorders. Clients are relatively younger population, average age is around 30 years old.

This facility has started implementing Therap, a web-based EMR system specialized to meet the needs of developmental disabilities community.

4






Copy of dshs_Frances_Haddon_Morgan_Ctr.xls Page 1


[0 - Not Met,

4 - No Gap]



The main office building is built in 1942 and other residents building in 1983 to 1985. Very old structure and significantly confined space.No attics in residences and mechanical rooms which have electrical panels and boilers are used as Network closet. The mechanical rooms are dusty and networking equipment (hub, media converter, wires) are on a wall without any protection. Although the mechanical rooms are locked, Janitors also use this room to store cleaning equipment. There are no dedicated cooling and the rooms are not well ventilated. Especially, networking equipment in the mechanical room for 3420/3422 is very close to boiler pipes that produce heat.

Not completely controlled access to networking equipment, which could expose a security risk and destruction of networking devices.

Mechanical rooms are not ideal places to keep networking equipment as the environment is not clean and temperature is not maintained in adequate level for all time.

Expand to have a network closet for each cottage.

At minimum, install an enclosure with a key to increase security and protect from the other equipment co-located in the room. Also, move the network devices to well ventilated location and keep distance from boilers and electrical panels.

NOTE: Possible capital construction project, depending on design

Cottages are not designed to be used as Office or Workplace and there are significant limitations to spaces. Larger closets are used as offices and smaller closets are used as med stations. Computers cannot be placed without an elaborated protection due to security reasons and it is extremely hard to place more workstations.

There are situations when 6 or more people are waiting for one computer to enter care information and there is a need to have more workstations in cottages.

It is recommended to implement wireless for cottages and distribute tablet PCs to care staff members.(See Section L for more detailed recommendation for wireless)

Current space for Main LAN room is very limited. Back-up computers and other computer peripherals are also stored in this LAN room and it seems cluttered with 4 servers and rack mounted network devices. Also, it is planned to add Systems Management server to manage workstations.

No more space to accommodate additional servers or networking devices that might be required for the future EMR system.

No Recommendation: The future EMR system is not likely to be hosted at this location and the number of servers and devices are not expected to increase unless staff level is expected to increase dramatically in the future. Also, Therap is a web-based application and no servers are hosted locally.

1 Back up & redundancy should be in placeOne generator exists by Plant which can provide electricity to the entire facility.

None 4 None


Electric power supply capacity is exceeded. Breaker goes out several times a year.

Power Capacity exceeded 1 Increase electric power supply capacity by at least 50% to resolve current issues and accommodate future needs.

NOTE: Increasing power capacity by at least 50% is a capital construction project; although this has been requested via capital project priorities, this sort of project and budget follow a different planning and budget cycle as compared to IT project; schedule and budget allotment coordination would be essential


Main LAN room has UPS for servers and switchesNetwork closets (Mechanical Room) in cottage 3420/3422, cottage 3423/3425 and cottage 3424/3426 do not have UPS

No UPS for Network closets in cottages

2 Add a small UPS for devices in cottage 3420/3422, cottage 3423/3425 and cottage 3424/3426



1

Physical Space


Agency/Adminstration: DSHS / DDD / RHC

Site: Frances Haddon Morgan Center



Data Center /

Requirements

A, The physical location(s) should have enough floor space capacity to house all the site's







- printers, scanners







Requirements


Main LAN room is equipped with an air conditioner, but network closets in cottage 3420/3422, cottage 3423/3425, cottage 3424/3426 and cottage 3428/3430 do not have dedicated cooling system.

No separate cooling in Network closets

2 Improve cooling in network closets, or move network equipment to well ventilated area to maintain temperature and humidity to be in adequate level for all time(Also see Section A)





Server Room

Cabling /





Requirements

1


Conduits coming into Main LAN room has adequate spaces

None 4 None


Main LAN room is equipped with a sprinkler and a fire extinguisher

Need non-water fire suppression

2 Acquire gas fire suppression (FM200) for Main LAN room


Cabling / Pathways





Requirements

Servers

1



3



Servers

1


Conduits between buildings are accessible and well documented. However, a conduit coming into cottage 3420/3422 is pretty full and could only accommodate a few more cables.

A conduit coming into cottage 3420/3422 is close to full

3 No Recommendation: There is no need to run more cables at this point. Even if more cables are required to be ran to the cottage, it will not take up significant space and an alternate conduit path is not necessary.

Cabling / Pathways


There is a Rack-mounted patch panel in Main LAN room

None 4 None


Telecommunications vaults are accessible, and their contents are well-documented. It can be accessed from basement of the Plant's main boiler room.

None 4 None

WAN / LAN


There are a few areas where additional data drops are recommended to accommodate future needs in the main building. There are only a few data drops in cottages and hubs are utilized extensively to provide data access.

Additional data drops are needed in the new buildings and cottages.

3 Add 1 data drop in Transcribing Room/Medical Record Room to network the shared printer (recommendation to replace the printer with a multifunction device is in Section Q)Add 1 data drop in cottage 3422 to network the shared printerAdd 1 data drop in cottage 3430 to network the shared printerAdd 5 data drops in Training RoomAdd 1 data drop in Exam Room (nursing office in wing 800)Add 2 data drops in nursing station (nursing office in wing 800)

N/A - Therap is a web-based application which is hosted in remote location. Also, servers hosted locally are File, Print and Utility Servers only and they are not expected to be used as the EMR system servers

No Recommendation: No current servers will be used for the future EMR solution

N/ANone



J. The LAN (Local Area Network) and WAN

Cabling / Pathways








Requirements


Fiber Optic backbone. Rooms within the main building are connected by Copper. Fiber Optic cable runs to each cottage and from each cottage, Fiber is converted to Copper by a Media Converter and wired in a star configuration with the hub/switch at the center. Currently, around 5 computers are connected for each hub/switch.

Hubs are utilized in network closets for cottage 3420/3422, cottage 3423/3425 and cottage 3424/3426.

Hubs are utilized instead of Switches

3 Replace Hubs with Switches in Network closets for cottage 3420/3422, cottage 3423/3425 and cottage 3424/3426.


There are several performance issues in the past and asked ISSD to monitor the network.

Network speed can be very slow at times

2 No Recommendation: Updated network devices and Increased WAN bandwidth should improve the performance. Investigate the other areas to troubleshoot the performance issues if the problem persists after the upgrade.


Two switches are stacked and there is no redundancy as the second switch also goes out when the main switch goes out.

It is being requested to upgrade the current switches with two 48 ports switches.

No redundant switch 0 Once two 48 port switches are received, it is recommended to use one as a back-up switch with dedicated fiber connection for redundancy.


The main switch is full, but only a few ports are utilized in the second switch and ports are available (about 20 empty ports) for additional workstations and/or other EMR devices. In addition, it is being requested to upgrade the current switches with two 48 ports switches.

None 4 None


Experiencing performance issues, especially when critical updates are pushed out. Also, performance issues are observed with e-mail with larger attachments, and time period when majority of care staff is accessing Therap.

Fraction of T1 (about half of T1) is being shared with Children's Administration and other departments co-residing within the main building.

Maximum acceptable WAN utilization level is often exceeded

1 Significant recommendation to increase WAN bandwidth: Add at least one additional T-1 and keep the existing fractional T-1 for backup, so that the site has adequate normal and backup bandwidth


One partial T1 is provided by DSHS (ISSD) No redundancy with WAN 1 While medical care can be provided by community health providers, FHMC's ability to have 24/7 access to medical record is critical. Recommend additional T1 or fractional T1 as a backup WAN connection


QoS is currently not Implemented at DSHS No QoS implemented at DSHS 0 Recommend to implement (at the DSHS level) a bandwidth management strategy including Quality of Service (QoS)


No network monitoring system is available at site. However, ISSD monitors WAN and statistics are available. Also, ISSD can send network monitoring equipment to monitor the network to determine the problem area.

None 4 None


All CAT 5 or CAT 5E None 4 None

Network





Requirements

WAN / LAN


As per DSHS (ISSD) standards None 4 None


As per DSHS (ISSD) standards

Utilizes MacAfee 8.5 and MacAfee's ePO product for virus protection. Uses Microsoft's WSUS product to push out Microsoft security patches and fixes to all workstations.

None 4 None


VPN is currently not being used by care staff in this facility, but secure VPN service is available through ISSD/DIS

None 4 None

Cabling / Pathways


N/A - No wireless now None N/A No Recommendation: Follow ISSD's wireless security standard

2


Workspace in cottages are limited and there are no space or enough data ports to place additional workstations. Workstations needs to be placed in secure area or physically secure by recessing into walls/counters which make placement of workstations in cottages a lot harder.

Having wireless in conjunction with tablet PCs/PDAs can eliminate the needs to add more workstations or data drops in cottages. All cottages are relatively open space and not hardened in most part.

Wireless is not implemented currently

N/A Implement wireless in cottages with total of 13 wireless access points:For cottage 3420/3422 (4600 sqft), 3 wireless access points are recommendedFor cottage 3423/3425 (4600 sqft), 3 wireless access points are recommendedFor cottage 3424/3426 (4600 sqft), 3 wireless access points are recommendedFor cottage 3428/3430 and Activities are (10000 sqft), 4 wireless access points are recommended

Upgrade cables from CAT5 to CAT5e

(See Section N for more detailed recommendations on Tablet PCs and PDAs)

User Devices

FHMC is not on lease for workstations and there are variety of workstations ranging from Dell GX110 to Dell GX620 PCs.

Google ToolBar is installed as a standard software

0 Significant recommendation to standardize and upgrade all 40 workstations by being on a lease. (Recommendations on Tablet PCs and PDAs are in Section N)

Older version of Google ToolBar is known to have security holes. It is recommended to verify if there are no security issues with the latest version. Since FHMC handles very sensitive information, it would be safer to remove Google ToolBar from all workstations if there is no compelling reasons to keep it.


In general, there are sufficient number of workstations in the main building. However, there are only a few workstations in cottages and currently experiencing overload. There are times when 6 care staff members trying to share 1 computer to enter care information and the lack of workstations is causing inefficiency. The care staff is expected to need more access to workstations with the future EMR system,

Needs additional workstations/laptops, as indicated at right, under recommendations

1 Add 1 workstation in Medical Record RoomAdd 5 workstations in Training Room

(Also see recommendation on N section for adding Tablet PCs ad PDAs)


Dell GX620 PCs satisfy some of the workstation requirements, but Dell GX110 PCs don't meet majority of requirements

1 Recommend to confirm that new workstations meet this specification.














Requirements











Majority of workstations are equipped with optical mouse with scroll wheel

None expected 4 Recommend to confirm that new workstations meet this specification.


Workstations have Windows XP SP3 None expected 4 Recommend to confirm that new workstations meet this specification.


Internet Explorer 6 is installed as a standard software. Planning to move to Internet Explorer 7

None expected 4 Recommend to confirm that new workstations meet this specification, and that workstations have Google Toolbar for Therap


Adobe Acrobat Reader is installed as a standard software



Internet Explorer 6 and 7 has 128-bit encryption enabled by default




Internet Explorer 6 is configured to accept signed ActiveX controls



No thin client emulation software is utilized currently o thin client emulation software I stalled to workstations

0 Include a thin client emulation software as a standard software


Java is installed as a standard software None expected 4 Recommend to confirm that new workstations meet this specification.

User devices





Requirements

User Devices

Total of 6 tablet PCs are utilized (Lenovo X60 and Lenovo X61)

Mobility is essential - workspace in cottages are limited and there are no space or enough data ports to place workstations. Workstations needs to be placed in secure area or secure them with chassis which make placement of workstations in cottages a lot harder. For those care staff who needs to visit cottages need tablet PCs.

In addition, direct care staff who escorts residents to work place, school, etc needs to document behavioral observations on the spot. Depending on the future EMR solution, but something like touch screen PDA to complete a simple behavioral notes could be ideal

There are needs for additional tablet PCs and PDAs

1 Add up to 30 Tablet PCs, docking stations, extra batteries for care staff who needs to travel back and forth between cottages and the main building.Add 30 PDAs and extra batteries for direct care staffStandardize and formalize a process to provide laptops or tablet PCs ad PDAs for care staff who requires to have more mobility.

Printers


There are about 25 printers through out the facility. There is a printer in each individual office and some are in cottages. However, only some of those printers are networked.

Shared printers are not networked

2 network all shared printers in cottages, medical record room and nursing station.



None 4 None


About half of the printers have TCP/IP networking capability. Non TCP/IP networking capable printers are used in individual offices.

None 4 None


No remote thin emulation software is utilized currently No emulation software 0 Install







4 No Recommendation: Redundant print server is typically not required for non-hosting site.



Scanners

There is only one small scanner used in Admin area. Not enough Scanners 0 Replace shared Printers in cottages with Multi-function devices. Total of 4 replacements for all cottages.Replace a shared Printer in Medical Record Room/Transcribing RoomReplace a shared Printer in nursing station (nursing office in wing 800)

Recommended to procure a device which has a high processing speed, has full sheet scanning capability and be TWAIN compliant


N/A None N/A None


N/A None N/A None


1 Lab system Lab service is contracted out and no Lab system is utilized on site

WAN performance issue is expected

2 Receive at least a new full T1, in addition to existing fractional T-1(Same recommendation as J 6)

Printers


Ancillary Systems

Scanner









Requirements

2 Pharmacy system Pharmacy service is contracted out and no Pharmacy system is utilized on site

WAN performance issue is expected


3 Radiology system Radiology service is contracted out and no Radiology system is utilized on site

Current WAN bandwidth is not adequate to incorporate radiology images




2


2


2


2

External Systems


Systems

No billing services are handled on site. billing information is set to Office of Financial Recovery.

For the future EMR, information can be exchanged via DSHS's network with an appropriate interface, but expect to see issues with network bandwidth.

Some of the external entities to communicate are Community Consultants, University of Washington, Harbor View Medical Center and Harrison Hospital

Receive at least a new full T1, in addition to existing fractional T-1(Same recommendation as J 6)

Not sufficient WA bandwidth

Copy of dshs_Green_Hill_School.xls Page 1 of 1


Site Name Green Hill School

Site Location & Date of Site Visit 375 SW 11th St. Chehalis, 5/22/2008

Primary Site Contacts (Technical and Medical) Technical : John Verburg, Medical : Corny Scheel


Marie Vanderberg (Business Administration)

# Category Details

1


In Scope :MM - Temporary Medical Building & New Medical BuildingA - Visitor's Center (MDF)F - Personnel Building & Z - Steam Plant (Main IDF & Fiber cable distribution point)W - Willow Building (IMU) & New IMUB - Birch, H - Hawthorn, M - Maple, S - S


MDF : Main Distribution FacilityIDF : Intermediate Distribution Facility

3

Additional Introductory Information Green Hill School is medium security JRA facilityNew medical building and IMU construction will be constructed this yearBasic medical treatment4 doctors and 5 full time medical staffs for about 210 teens

4






Copy of dshs_Green_Hill_School.xls Page 1


[0 - Not Met,

4 - No Gap]


New Medical building, new IMU building, MDF, Server room and

IDFsLiving Units (B, H, M & S building) Gaps Score


Physical Space


Current medical building is temporary. New medical building construction will start and finish this year. Temporary fiber connection from B building;New IMU building construction will start and finish this year too;Basic medical treatment;Short term (few hours) inpatient rooms in the medical building because students go back to their units after medical treatment;IMU unit : Cell side care;MDF : Separate and secure room. Spacious;F building IDF (Relay point between MDF to living unit IDFs and Backbone switch location) : Will provide fiber connection to new medical building & new IMU building. Spacious and in good shapeZ building IDF (Relay point between MDF to living unit IDFs) : Maintenance building. Big iron cabinet outside of building. Locked but the cabinet itself is exposed;Server room : V building. Spacious and secure

Living units are cell shaped, low security buildingsNo medical rooms inside of buildingsPill distribution to cells from cart

IDFs : Janitor room (Common), iron cabinet

Z building IDF is not appropriate

2 Recommend a new Z building IDF. F building IDF could be a model for new Z building IDF, which is wooden structure separate room beside of original building with air-conditioning and secure door.

Although location is not ideal and space is limited, living unit IDFs (B, H, M, S buildings) are difficult to move


Power : PUDGenerator can support entire campus for 30 daysGenerator test : monthly

MDF, IDFs and server room : UPSs exist

None 4 None


Power capacity is sufficient for additional requirements

None 4 None


MDF : UPS existsIDF : No UPS

IDFs : No UPS No UPS in IDFs 2 Recommend UPS in IDFs ( Total 6 UPS)


Site: Green Hill School


Requirements













MDF : Air-conditionerServer room : Air-conditionerF building IDF : Air-conditionerZ building IDF : No air-conditioner, very hot in summer

No air-conditioner but moderate temperature even in summer

Z building IDF needs air-conditioner

2 Recommend a new Z building IDF room : Refer to A above

Because living unit IDFs are inside of building and house one switch respectively, having no air-conditioning will be fine



1


Fiber cable conduits are in good shape with enough room for expansion

UTP cable conduits are in good shape with enough room for expansion

None 4 None


MDF : FM200IDFs : No fire suppression

IDFs : No fire suppression No fire suppression in F and Z building

2 Recommend fire extinguishers in IDF

Servers


1


N/A N/A N/A N/A N/A


N/A N/A N/A N/A N/A

3


N/A N/A N/A N/A N/A


N/A N/A N/A N/A N/A



None 4 Currently meet DSHS/ISSD security standards (audited periodically)





Cabling / Pathways











1



Cabling / Pathways


MDF : Rack mounted patch panel, cabling is in decent shapeIDFs : Wall mounted patch panel

IDFs : wall mounted patch panel None 4 None


AccessibleWeak documentation of current fiber cabling and network

Current documentation is not sufficient for high quality maintenance

2 Recommend more detail documentation

WAN / LAN


New medical building : At least 2 data drops at every room of the new building

New IMU building : Pods areas are wireless candidates but no data cable was included in construction plan

Living units : No medical room, current medical process doesn't require network access. No more data drops will be required because living units are wireless candidate

No UTP data cabling for wireless network AP in IMU building pods area

2 Recommend UTP data cabling for wireless network AP in IMU building pods area




Cabling / Pathways








Fiber cable between Z and F IDFs : enough pairs of available fiber cables - 24 pair spare cables

Fiber cable from Z building IDF to living unit IDFs : 1 fiber cable, no scalability nor redundancy

Backbone switch : HP Procurve 4108 gl X 1, another same model switch was in standby for hardware failure. Very scalable

Workgroup switch : Dell 2724

Living units : wireless can provide scalability

No redundant fiber connection to living units

2 Recommend 1 more fiber cable to each living unit from Z building IDF : 4 more fiber cables


No statistics but can assumed very low - Backbone switch has not been fully utilized



Physical redundant Backbone switch, no active-standby automatic backup architecture

No issue No active, real time Backbone switch redundancy

3 Recommend activate a redundant Backbone switch to make real time redundancy




WAN is 768Kbps fractional T1 from Qwest

Very high bandwidth rate all day

Fiber cable from POP is available for MPLS Ethernet WAN (10Mbps)

WAN utilization rate is too high 0


No redundancy, no carrier diversity Single Point of Failure 0


Pending ISSD implementation None N/A None


On request from ISSD None N/A None


Confirmed minimum of CAT5 None N/A None

WAN / LAN



None 4 None


MacAfee None 4 None

Recommend T1 (primary) + 512Kbps (backup) WAN architecture

Depending on EMR system, 10Mbps bandwidth may be required

Network










Cabling / Pathways


2


User Devices


Current PCs in medical building will be moved to new medical building

2 additional workstations requirement identified John will provide workstations as based on request


2 Acquire 2 more workstations for nurses


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None

Living units : 2 APs for each buildingTotal : 8 APs

New IMU : John will give us new IMU building floor plan

New medical building : No compelling reason for wireless

New IMU building : Need wireless network around pods area

M building has 1 wireless AP for staff but old standard

Living units : Need wireless network in hallway

Partial wireless 0

All buildings: New Dell 755's being rolled out over three year period


User devices









None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None

User Devices

Doctors and mental health coordinator need tablet PC (1 full time doctor, 1 mental health coordinator, 2 psychologist and 1 psychiatrist)Nurses need PDA (4 nurses at peak time)

Tablet PC : 5PDA : 4

0 Acquire tablet PCs and PDAs as indicated under Gaps:Tablet PC : 5PDA : 4

Printers


Current status : 2 laser jet printers and 1 fax

2 new multifunction devices are required for new medical building

Multifunction devices : 2 2 Acquire multifunction devices as indicated under Gaps: 2 new multifunction devices


None 4 None


None 5 None


None 6 None


None 7 None


None 8 None



Printers









1 print server No redundancy 0 Recommend backup print server


Secure place for printers 2 Place all printers in a secure location and implement controls for secure printing. Also, it is recommended to modify print server configuration to increase security.

Scanners






1 Lab system Utilize outside Lab test provider : PacLabResult by fax

N/A N/A None - access to external systems will be enhanced with T1 + 512 Kbps connection

2 Pharmacy system Small pharmacy for delivery. Outside provider - CostLess


3 Radiology system Outside provider N/A N/A None - access to external systems will be enhanced with T1 + 512 Kbps connection










External Systems




Ancillary Systems

Scanner


Copy of dshs_Lakeland_Village.xls 1


Site Name Lakeland Village

Site Location & Date of Site Visit Medical Lake, WA - 6/3/2008

Primary Site Contacts (Technical and Medical) Technical: Paul Landsverk; Medical: Randy Claybaugh


Superintendent: Kathy Montague; Plant/Facilities: Randy Petersen; Adult Programs: Bob; Technical Support: Rob Harder

# Category Details

1


In Scope: Administration Building, PAT Offices, Hab Center, Health Center (Clinic), Rosewood, Food Services, School Building, Generator in Chiller Building, and all 21 residence cottages (located in the South Campus and the North Campus)Out of Scope: Motor Pool, Day Care (Rainbow Bldg), Miller building, maintenance buildings

2


m/f - Multifunction Devices; PAT - Program Area, dp - data port, w/s - workstationICF/MR - Intermediate Care Facility/Mental Retardation, NF - Nursing FacilityHAB: Habilitation CenterRHC: Rehabilitation CenterAC/ACM: Attendant Counselor/Manager (one per cottage)




Copy of dshs_Lakeland_Village.xls 2

# Category Details

3

Additional Introductory Information Lakeland Village serves around 240 clients with developmental disabilities and there are around 60 NF beds and 180 IMR/MR beds. There are 21 Residential Cottages with 19 of them are currently being active and they are categorized in PAT-1 (IMR), PAT-2 (IMR) and PAT-4 (NF) based on needs.

Most of the current medical record documentation is done in the cottages, but clients are taken into Health Center to receive clinical and dental care. HAB Center provide various habilitation programs in 13 different class rooms.

Approximately 250 desktops and 20 notebooks, nearly all of which come from DSHS surplus;Nurse Count: 65 total (including part-time and contractors) -- peak nurse count at any time of day is approx. 22-25. -- Nurses are based at (and do their charting) at the cottages. Each cottage has one ACM (Attendant Counselor/Manager), 3 direct care staff, and up to 1 nurse at any time.Lakeland Village technical staff have recently conducted a wireless study and have received bids for a wireless solution from Cisco.

4


Clarifications to the description of fiber extensions to each cottage have been documented


Copy of dshs_Lakeland_Village.xls Page 1


[0 - Not Met,

4 - No Gap]



(IDFs)

Observations:HAB Center, PAT Offices, Health Center, School Bldg, Food Services, South Campus Cottages,

North Campus Cottages

Gap Score(0 - 4) Potential Recommendation

Physical Space


The main server room (MDF) is fairly large, and has plenty of room for any additional equipment (approx. half the room is used for storage)

MDF has secure door

The main server room (MDF) has a window to the outside (not well secured at time of review)

During IDF review, we observed two locations with some water leakage onto floor:1) In general area of the Hab Ctr South IDF (in basement)2) In general area of Rosewood Generator (in basement) -- appears to be related to a clogged drain just outside a door

There are 21 Residential Cottages with 19 of them are currently being active and they are categorized in PAT-1 (IMR), PAT-2 (IMR) and PAT-4 (NF) based on needs. Each cottage has a medical station and Attendant Counselor Manager's (ACM) office space. Currently, only a few cottages have a Med Nurse's office, but Wildrose, Cascade and Sunrise (82, 83, 84, 85) are being renovated to have an office space for a med nurse. In general, there are limitations to spaces as cottages are not designed to be used as Workplace. Some cottages (mostly in North Campus) utilize office divider panels and shelves to create a work space since there are not enough closed offices. It is difficult and not preferred to place more workstations in cottages as clients' spaces will be invaded by placing more workstations.

Having wireless in conjunction with tablet PCs/ laptops can eliminate the needs to add more workstations or data drops in cottages. (See L section for the recommendation on Wireless)

Window in MDF room needs to be more secure

Water leakage into basement areas should be resolved

3 Recommend making the window in the MDF room more secure, with iron bars

Recommend resolution of water leakage in basement (near Hab Ctr south IDF and near Rosewood generator), by unclogging drains and sealing appropriate areas


None 4 None


Occasionally electrical brown-outs on South Campus still need to be addressed

3 Pursue transformer re-work (similar to North campus project) for South Campus


None 4 None




Air conditioner not yet operational 3 Confirm that air conditioner is operational (in near term)



Dedicated air conditioner, but not operational on day of review (still being hooked up)Warm (76-77 degrees) on day of inspection

None

The server room and rest of the campus is backed up by a 560 KW generator (located in the chiller building)This primary generator is test once per week, and load tested monthlyThere is a second generator (125 KW) in the basement of the Rosewood buildingAdditional portable generators also available

Provider is Avista: No issues with supply from Avista, but there are issues with electric distribution to the North and South campusElectric transformers are being re-worked to avoid brown-outs on the North Campus (project to be done by Dec. '08)

3 UPS in MDF;IDF's: each IDF has a small UPS

Single power feed from Avista (power can be re-routed once within the campus)

Cabling /

Requirements







Agency/Administration: DSHS/DDD

Site: Lakeland Village







(IDFs)



Gap Score(0 - 4) Potential RecommendationRequirements

1


None 4 None


No adequate fire suppression for main server room 1 Add FM200 fire suppression to MDF and fire extinguishers to all cottages with IDF switches (minimum of 13 , up to 21)

Conduits leaving the main server room are OK, and can accommodate additional cable

MDF: Fire detection, but no adequate automated fire suppressionIDF's: No adequate fire suppression

Cabling / Pathways






(IDFs)




Servers

1


None 4 None



3





Servers

1


Rosewood IDF needs additional new conduit (at least 2") for serving Pharmacy

3 Install additional conduit from Rosewood IDF to PharmacyThis is not a long distance (< 100'), and the conduit with cable can be routed under the floor (does not need to go through the concrete floor above the IDF)

Recommendation to add dedicated fiber to each cottage (up to 12 new fiber runs) will require new fiber to be pulled from main server room to existing IDF's, and then new pathway/conduits for fiber extensions from existing IDF's to each cottage that does not currently have fiber.

Cabling / Pathways


Rosewood IDF switch needs additional ports;

Only some cottages have their own workgroup switch;Cottages that serve 2 additional cottages have very limited conduit space for expansion;IDF switches are not stabilized/mountedWorking locks on all IDF switch cabinets on not in place

1 Upgrade Rosewood IDF switch to 48-port;

Consider adding small manageable workgroup switch for each cottage, with dedicated fiber to each cottage (up to 12 additional fiber extensions)Recommend mounting of switches in cabinet (up to 21 switches)Recommend working locks on all IDF switch cabinets (up to 21 cabinets)IDF cabinet in Willow 76-77 needs to be raised closer to the ceiling (it is low, very near washer and water)


None 4 None

WAN / LAN

Existing conduits accessible and able to accommodate additional cabling, with the following exception:The Rosewood IDF has very full (1") conduit serving the PharmacySeveral of the cottage IDFs have fairly full conduits, but these are in the cottage IDFs that are serving 3 cottages from one switch;Our recommendation to have dedicated fiber to each cottage should remove the constraints on cottage IDFs that are currently serving 3 cottages

IDF Summary:Hab Center South (basement) IDF: Dell 3024, ports half full, warm roomHab Center North: Dell 3048 (fairly full ports), racked, cool/dry locationRosewood IDF (basement): Dell 3024, very full ports Cottage IDF's - all: are located in unsecured utility rooms, inside cabinets near ceiling (not all of which are locked)Cottage IDF's - all: switches (primarily Dell 2016) are not mounted; port availability is OK on all switchesFor cottage IDF's serving 3 cottages (Laurel, Evergreen, Willow 77-78, Sunrise 82-83, Wildrose, Bigfoot): These IDF's have fairly full conduits (because they are serving 2 additional cottages)For cottage IDF's that serve only their own cottage (Ponderosa, Douglas, Tamarack, Shamrock): conduits OKFor cottages with no IDF (and which are served by IDF's in other cottages): These cottages have no switches

Documentation available through Facility Services Administrator

Cabling / Pathways

Multiple UPS in MDF

N/A - No current servers will be used for the future EMR













(IDFs)





Additional data drops are required to support the additional workstations and to network printers, as indicated at right under recommendations

2 Total of 15 more data drops are recommended

Health Center -Dental Clinic Registration Desk - Add 1 more data drop (for printer/mf)Dental X-ray (the office close to the entrance) - Add 1 data drop (for workstation)Dental Recovery Room - Add 1 data drop (for workstation)Doctor's Office - Add 1 more data drop (for printer/mf)Lab - Add 1 more data drop (for printer/mf)Treatment Room which is connected to Exam Room (H23) - Add 1 data drop (for printer/mf)Exam Room 1 (H28) - Add 1 data drop (for workstation)Exam Room 2 (H27) - Add 1 data drop (for workstation)Conference Room (H34) - Add 2 data drops (for workstation and printer/mf)

PAT Offices -COX Conference Room: Add 1 data drop (for workstation)

HAB Center - Office located in PAT 4 Class Room area: Add 2 more data drops (for workstation and printer/mf)Physical Therapy: Add 2 more data drops (for workstation and printer/mf)

(See Section M for additional workstations recommended and Section O for additional printer/multi-function devices which need to be networked)


MDF needs an additional 48-port switchMDF needs a larger, more robust backbone switchOnly one fiber cable supporting 3 stacked 3048 switches in MDF

2 Upgrade main backbone switch to CISCO Catalyst 6000 series (48 port)Add additional 48 port switch to augment the 3 Dell 3048 switches in the MDFAttach each of the 3048 switches (4) in the MDF to main backbone switch with dedicated fiber (3 additional fiber)Consider implementation of dedicated fiber to each cottage (12 additional)


Recommend to conduct a periodic LAN network utilization once managed switches are introduced


Recommend redundant Backbone switch (CISCO catalyst 6000 series) and backup connection to Workgroup switches


Upgrade main backbone switch to CISCO Catalyst 6000 series (48 port)Add additional 48 port switch to augment the 3 Dell 3048 switches in the MDF

Consider adding small manageable workgroup switch for each cottage


Single T-1 barely enough for current usage;Will not be sufficient with additional EMR system load

1 Recommend WAN upgrade to 10 mb fiber;Recommend retaining existing T-1 for redundancy and backup


n/a - requirement for hosting site n/a n/a


n/a n/a n/a


n/a - switch upgrade will be to manageable switch models

n/a n/a


None 4 None

LAN utilization level hasn't been monitored on a regular basis

No redundant backbone switch

Current backbone switch and unmanaged workgroup switches in cottages will be out of date and insufficient for future EMR system implementation

In general, there are enough data drops for workstations, but there are a few areas where additional data drops are recommended in order to support network printing capabilities and point of care documentation, as indicated at right under recommendations

Also, to support the wireless implementations for cottages, it will need 2 additional data drops (with POE) for the 2 new wireless APs for each cottage

Currently, WAN is single T-1 (CenturyTel): Periodically above acceptable util level of 60% with current app usage;10 mb fiber connection is proposed

No redundancy

Await implementation by DSHS ISSD

CAT5 and 100 mb throughout campus

Not all switches can be managed with remote software

No redundancy

MDF: Single Cisco Catalyst 2950 is the main backbone switch;IDF's: Small, unmanaged Dell 2016/2216 switches

In the MDF (main server room), there are 3 stacked Dell 3048 switches that serve the admin and PAT buildings: These switches are served by just one fiber cable from the backbone switch in the same room

No statistics available

Network





(IDFs)




WAN / LAN


None 4 None


None 4 None


None 4 None

Cabling / Pathways


No wireless in place n/a n/a

2


No wireless access at this time 0 Recommend Wireless Access in all cottages and in selected areas of Admin and PAT office areas;Recommend 2 AP in each cottage (concur with proposed study) for 21 cottages; Initial cost estimate for cottage, admin, PAT office, and clinic wireless solution: $123K equipment, and $24K laborAlso recommend 4 AP in the School Building (one at each corner of square hallway)

User Devices

Current PC workstation inventory is insufficient to support future EMR system

1 Recommend budgeting for, and initiating, a formal 3-year refresh cycle for new model workstations (approx. 90 per year)


Insufficient number of workstations in Health Center;

As noted above, the current PC workstation inventory is not sufficiently up-to-date (with respect to technical specifications) to support future EMR system

2 Total of 8 more workstations are recommended

Health Center - Dental X-ray (the office close to the entrance): Add 1 workstationDental Recovery Room: Add 1 workstation (computer on wheels)Exam Room 1 (H28): Add 1 workstation (computer on wheels)Exam Room 2 (H27): Add 1 workstation (computer on wheels)Conference Room (H34): Add 1 workstation

PAT Offices -COX Conference Room: Add 1 workstation

HAB Center -Office located in PAT 4 Class Room area: Add 1 workstationPhysical Therapy: Add 1 workstation


1


1


1

5Workstations should have DirectX 9.0 Capable, 256MB of RAM, Support for Pixel Shader 2.0 as a Video card capability

1


1


1


1


1


1


1


1

Recommend budgeting for, and initiating, a formal 3-year refresh cycle for newer model workstations (approx. 90 per year)

Current PC workstation inventory is insufficient to support future EMR system

XP SP2

OK

OK


None

Most workstations use older CRT screens (very few flat panels

OK

None

In general, there are enough workstations through out the campus; however, additional workstations could be used in Health Center to support the workflow with the future EMR system.

Few, if any, workstations satisfy this req

Few, if any, workstations satisfy this req

No wireless in place

Cottages are wireless candidates, as is the School Building

Workstations are obtained from surplus, and are mostly 4-6 years old: Current PC inventory is dominated by Dell GX series:Dell GX 260: 80Dell GX 270: 73Dell GX 280: 11Dell GX 745: 43Misc others: approx 50

OK

Per ISSD standards

McAfee 8.5 in place

VPN access possible

User devices








(IDFs)





1


1


1








(IDFs)




User Devices

The care staff is expected to require more access to workstations with the future EMR system and additional laptops are required

2 We recommend adding 3 laptops per cottage to accommodate the future needs and the mobility required by care staff members (especially a med nurse who visits multiple cottages). For a maximum of 21 cottages, a total of 63 laptops recommended.

Since there are already 3 workstations in each cottage, there will be sufficient number of computers for the care staff to document without disturbing their workflow.

Standardize and formalize a process to provide laptops/tablet PCs for care staff who requires a mobile device.

Printers


Not enough networked printers through out the campus. 2 Replace the existing networked printer in PAT 1 with a multi-function deviceReplace the existing networked printer in PAT 2 with a multi-function deviceNetwork the existing multi-function device in PAT 4

Replace a printer in each cottage with a small networked multi-function device. One multi-function device for each cottage and total of 21 multi-function devices are recommended.

Replace the existing printer in the office located in PAT 4 Class Room area (HAB Center) with a multi-function device.

Replace the existing printer in Physical Therapy with a networked multi-function device.


No print server in place 0 Recommend addition of print server in server room to manage additional printers


None 4 None


None 4 None


None 4 None


None 4 None


N/A N/A N/A


Scanners


1


n/a


1 Lab system None - upgrade to 10 mb WAN connection will satisfy interface req's

4 None, assuming 10 mb WAN connection is implemented

2 Pharmacy system None - upgrade to 10 mb WAN connection will satisfy interface req's


3 Radiology system None - upgrade to 10 mb WAN connection will satisfy interface req's


Recommendation to add more multi-function devices are in Section O-1

Recommended to procure a device which has a high processing speed, has full sheet scanning capability and be TWAIN compliant

More scanners/multi-function devices are neededOnly a few scanners are utilized through out the campus.

PAML lab system

WORx

VPN / Stentor system

N/A - No print server in place

All networked printers have TCP/IP networking capability

All modern networked printers are compatible

Printers are windows compatible

Printers have static IP address

Currently there are approximately 20 laptops/notebooks -- various models

Although each office has at least one local printer that is attached to a workstation, only about 11 networked printers are utilized in Lakeland Village (around 4 of them are used in Pharmacy and the remaining is spread over IT room, PAT offices and HAB Center).

With the future EMR system, network printing becomes more important to support the clinical workflow. For example, a lab requisition automatically prints out in a lab when a physician makes an order from an exam room. This is possible only if network printing is available in the Lab.

Also, each cottage would need one multi-function device

No print server in place

Printers




Ancillary Systems

Scanner







(IDFs)






None - upgrade to 10 mb WAN connection will satisfy interface req's











Billing information is sent to Office of Financial Recovery.

For the future EMR, information can be exchanged via DSHS's network with an appropriate interface, but expect to see issues with the current network bandwidth (T-1). A request to increase the bandwidth to 10 mb is submitted.

Will need to interface with Meditech/Stentor imaging in the future

External Systems


Copy of dshs_Maple_Lane_School.xls Page 1 of 2


Site Name Maple Lane School

Site Location & Date of Site Visit Rochester, WA -- 5/19/2008

Primary Site Contacts (Technical and Medical) Technical: John Verburg; Medical: Jason


Network Administration: Doug; Plant Mgr: Gary Avery; Business Manager: Georgina Carleton; Capital Facilities: Randy Sparks

# Category Details

1


In Scope:Admin Building, Multi-Services (M-S) Building, which includes the Main Health Clinic (sometimes called Health & Essentials)Living Units: Baker (Intake Unit), Chelan (IMU), Cascade, Columbia, Laurel, Birch, Olympic, Rainier, PacificGeneration Unit

Out of Scope: Spruce, Commissary, Gym, Pool, School, Voc Tech (part of school district), Security Shack, External maintenance buildings, Steam Plant, and two school rooms in Laurel (part of the Rochester School District)

2


M-S: Multi-ServiceMDF: Main Distribution FacilityIDF: Intermediate Distribution FacilityDR: Disaster Recovery

3

Additional Introductory Information Maple Lane School is a medium/maximum security facility that provides serious and middle offenders an academic program as well as on-campus work experience. Maple Lane School has an inpatient chemical dependency treatment program and specializes in the treatment of sex offenders.

The Main Health Clinic (contained in the Multi-Services building) is scheduled for gutting and complete remodeling over the next 2-3 years, and is planned to be operational by 2011. Our report assumes that this remodel will go forward




Copy of dshs_Maple_Lane_School.xls Page 2 of 2

# Category Details

4



Copy of dshs_Maple_Lane_School.xls Page 1


[0 - Not Met,

4 - No Gap]


Admin Building and Multi-Services (M-S), Main Health Clinic (also

called Health & Essentials);Generation Unit

Intake (Baker) and Chelan (IMU) Living Units

All Other Living Units: Cascade/Columbia, Laurel/Birch,

Olympic/Rainier/PacificGaps Score


Physical Space


Sufficient space in main MDF in Admin Building, and in IDF for Multi-Services Bldg;Limited space for additional workstations, devices in current Multi-Services Bldg --

However, this building is planned to be gutted and totally remodeled and operational by approx. 2011 -- (Design in '09, Construct '10, Startup in '11)

Needs outlined in this report assume going forward with the new Health Clinic in the remodeled Multi-Services Bldg

Laurel - currently closed, but will be repopulated. Two school rooms inside Laurel are part of the Rochester School District and are out of scope for this project


Decent electric power service from PSE; Backup generator (800KW) on campus -- Kohler 800, with ALCAD Standby Batteries

None 4 None


Usage is nowhere near capacity


UPS in MDF No UPS in IDFs No UPS in IDFs No UPS in IDFs 2 Acquire small UPS devices for IDF closets


None n/a n/a Not viable for dual power feed


A/C for main MDF; None


No redundant cooling n/a - not viable





Site: Maple Lane School



Requirements



None4










1


Conduits accessible and in decent shape

None 4 None


Need FMC gas fire suppression in both the main MDF in the Admin bldg and the IDF in the M-S bldg;

DR plan depends on quick replacement of equipment

Water sprinklers, or no fire suppression at all, in IDF's

Water sprinklers, or no fire suppression at all, in IDF's

Need FMC gas fire suppression in both the main MDF in the Admin bldg and the IDF in the M-S bldg

1 Acquire FMC gas fire suppression -- at least for MDF and IDF in M-S building, and fire extinguishers for each IDF

Servers

n/a - no servers (other than file/print servers) will be used for EMR solution

1


n/a n/a n/a n/a n/a n/a



3








None 4 None

1





None 4 None

Cabling / Pathways


Admin Building: accessible rack mounted patch panelMDF data cable is ceiling-mounted

Main Health Clinic (Multi-Services Bldg): accessible rack mounted patch

accessible rack mounted patch panels accessible rack mounted patch panel None 4 None


Accessible; Underground fiber run locations and routes documented;

None 4 None

Cabling / Pathways

Cabling / Pathways

















WAN / LAN


Per discussion with John: Assume (but confirm) that adequate number of data drops are included in New Clinic building plans;

Admin Bldg: Offices with workstations have adequate data drops

Baker intake has data drops in exam room and dental room (but no workstations);

Chelan: All offices with workstations are wired with data drops; Nurses who visit Chelan can use dockable laptops, notebooks, or tablets (but these will be docked in the Main Clinic)

Laurel Control Room needs, at a minimum, 2 data pulls for existing jacks, and probably 2 entirely new data dropsBirch Control Booth: 3 of 3 data ports used for 2 workstations and a networked printerBirch Front and Back Offices: Each has one data port and one workstationPrice Point for cost of Data Pull in Birch: $400;

Most other access needs in other

Fairly minimal, since there appear to be more workstations than data drops, and that most new data drops needed would come with the new Main Clinic;

3 Fairly minimal: JRA needs to ensure, with the plans for the new Main Clinic, that there are adequate number of data ports for increased number of workstations (see workstation section below), and enough data ports to support nurse docking stations;

Laurel Control Room: Need 2 data pulls and 2 new data drops;

For data drops for new multifunction printers: Given that there are several available data drops per building and that smaller networked printers will be removed, there should be adequate data drops for multifunction devices


LAN architecture and cabling is scalable; recently upgraded; straight-run fiber from MDF to each building;LAN is all multi-mode

One re-cabling need: There is a loose data cable in the IDF room of the M-S bldg, serving the Clinic, this needs to be recabled and stabilized

Scalable; modern switches (Dell 2724) Scalable; modern switches (Dell 2724);

Laurel: cabling need -- needs rewiring of data cable in front program manager office: (currently is taped to floor, and crosses the floor in walking area

M-S bldg IDF room -- re-cabling need: There is a loose data cable in the IDF room of the M-S bldg, serving the Clinic, the needs to be recabled and stabilized

Laurel: cabling need -- needs rewiring of data cable in front program manager office

3 Recommend Re-cabling of cable gaps identified at left in M-S bldg and Laurel


No issues; primarily 1 GB Ethernet


No redundancy: Several single points of failure that represent a risk in the event of a line break: notably between the Admin Bldg and the M-S bldg, and between the M-S bldg and the Olympic/Rainier/Pacific residence units

No redundancy No redundancy Single points of failure on key segments of LAN cabling: between Admin and M-S bldgs, and between M-S bldg and the Rainier/Olympic/Pacific bldgs

2 Potentially recommend that a complete ring or loop of data cable pathway be achieved by installing a data cable connection between Rainier and Laurel. May require retrenching and cable laying under the Maple Lane entry road. Cost estimate: TBD


MDF: Main Backbone Device: HP Procurve 4108 gigabit , with dual power supplies, and 2 spare backup units;Cisco 2600 router

IDF Switches (including M-S bldg): Currently sized OK, up to date, Dell 2724 switch; M-S bldg will see the largest expansion

IDF's:Baker: IDF serves both Baker and ChelanDell 2724 switch -- approx 6 ports availableIDF is cool, clean, good condition, good space, very secureIDF has water fire suppression

IDF's:Cascade: External entry from outside; Dell 2724; ports half full; no fire suppression, no special air, but temp OK (concrete walls)Columbia: Same as CascadeLaurel: Switch is behind a desk -- unsecured and unprotected, in the manned Control RoomBirch: Dell 2724 (only 6 of 24 ports used) - Not in a secured closet - Needs a secured cabinet; Temp OK (on bldg A/C)Olympic: Dell 2724 -- only 3 ports used; Not Racked -- sitting loose on its side -- needs to be cleaned up and mountedRainier: Assume similar to OlympicPacific: Assume similar to Olympic

Assuming Main Clinic remodel proceeds, the M-S IDF's Dell 2724 will not suffice for future loads and additional workstations

3 Upgrade Dell 2724 in M-S IDF to a 48 port device, for M-S Main Clinic expansion

Network












WAN is currently fractional T-1 (768 KB): WAN usage: Often saturated, not sufficient for current use

Insufficient WAN bandwidth to cover current or future needs

1 Recommend installation of 10 mb fiber from Qwest. Cost estimate approx $78K (exclusive of ongoing service costs, which are no more than service costs of two T1 lines)


None n/a - no viable alternatives n/a n/a


Pending ISSD implementation None n/a n/a


On request from ISSD None n/a n/a


Confirmed minimum of CAT5E None n/a n/a

WAN / LAN





None 4 None


MacAfee MacAfee MacAfee None 4 None


VPN access possible VPN access possible VPN access possible None 4 None

Cabling / Pathways


No Wireless in Place No compelling need for wireless, due to fact that it is not viable to be charting in open spaces, and difficulty of wireless inside offices which are mostly concrete/steel

No compelling need for wireless, due to fact that it is not viable to be charting in open spaces (security), and difficulty of implementing wireless inside offices which are mostly concrete/steel

None n/a No wireless solution recommended

2


No Wireless in Place; No strong, compelling reasons for wireless implementation at this site

No compelling need for wireless No compelling need for wireless None n/a No wireless solution recommended

User Devices

Note: there is a proposed policy change that would prohibit access to system by external contractors

Recommend that the restriction on access to system by outside contractors not be imposed














Additional workstation needs identified:Main Clinic (assuming remodel and expansion):

Treatment Rooms: Add 2 w/sPsych Offices: Add 3 w/sConference Room: Add 1 w/sMed Room: Add 1 w/sNurse Station: Add 2 w/sDental: Add 1 w/s

Admin Building: no additional needs

Baker Intake:Exam Room: Needs one workstation (has a data port)Dental Exam Room: Needs one workstation (has a data port)

Columbia:Columbia is currently the busiest building -- Up to 11 staff contending for 7 PC's;Short on space for placement of additional PC's -- Could supplement workstations with 2-3 additional "pluggable" laptops (Note: staff cannot chart notes in open spaces -- they need to return to offices)

Laurel Control Room needs one more workstation

Summary of additional workstation needs:

New Main Clinic: 10Baker Intake: 2Laurel Control Room: 1

Total: 13

All other additional workstation needs would be covered by supplemental laptops/notebooks (see below in Section N)

3 Acquire additional workstations as indicated at left under "gaps"


none 4 none


none 4 none


none 4 none


none 4 none


none 4 none


none 4 none


none 4 none


none 4 none


none 4 none


none 4 none


none 4 Recommend to confirm that new workstations meet this specification.








User Devices

Currently only 3-4 laptops used by professionals;For all scenarios (even without remodel): Need 1-2 additional laptops for mobile pill cart

Nurses visiting residences could make use of dockable laptops or notebooks

Nurses visiting residences could make use of dockable laptops or notebooks;Columbia: Could supplement workstations with 2-3 additional "pluggable" laptops

Laptops needed in areas described at left

1 For all nurses who serve residential units: acquire dockable laptops or tablets that can be taken to and from the residence units, along with the necessary docking stations (Count = approximately 5);Acquire 1-2 additional laptops for mobile pill carts;Columbia: Acquire 2-3 additional laptops to supplement existing desktops;

Total (all areas): 8-10

User devices














Printers


For new Health Clinic: Add at least 2 multifunction networked printers

For each building: one additional medium- to high-end multifunction printers (networked)

For each building: one additional medium- to high-end multifunction printers (networked)

Networkable, Multi-function devices needed in all residences and in Main Clinic

1 Recommend acquisition of 2 high-end (for Clinic) and 9 medium (not small) multifunction devices for print, scan, fax -- all networkable -- to replace a number of small networked printers








Place all printers in a secure location and implement controls for secure printing. Also, it is recommended to modify print server configuration to increase security.

Scanners


No real scanning capabilities now No real scanning capabilities now No real scanning capabilities now Need scanning capability 0 Will be supplied by multifunction devices recommended


No real scanning capabilities now No real scanning capabilities now No real scanning capabilities now


1 Lab system

No lab work done onsite n/a None - access to external systems will be enhanced with 10 mb WAN connection

2 Pharmacy system Wholesale meds acquired from CostLess

n/a None - access to external systems will be enhanced with 10 mb WAN connection

3 Radiology system All radiology done offsite in Centralia hospital


Scanner

Printers





Ancillary Systems












No significant needs now -- future need for access to Provider 1 system








External Systems


Copy of dshs_Naselle_Youth_Camp.xls Page 1 of 1


Site Name Naselle Youth Camp

Site Location & Date of Site Visit 11 Youth Camp Lane Naselle, 5/23/2008

Primary Site Contacts (Technical and Medical) Technical : John Verburg, Medical : Troy Wasmundt


Dan Vaughn (Vice Superintendent)

# Category Details

1


In Scope :Medical BuildingVisitor Center (MDF)Cougar, Harbor, Mariner, Moolock Building (Living Unit)

Out of Scope (no medical or counseling care; no future EMR system equipment) :Administration BuildingEagle Lodge BuildingKitchen BuildingCommissary BuildingChapel Building



3Additional Introductory Information Naselle Youth Camp is low security JRA facility

Basic medical treatment1 doctors and 3 full time medical staffs

4






Copy of dshs_Naselle_Youth_Camp.xls Page 1


[0 - Not Met,

4 - No Gap]

Category Investment Category Medical building and MDF Living Unit (Cougar, Harbor,

Mariner, Moolock building) Gaps Score(0 - 4) Potential Recommendation

Physical Space Facility Modifications

Medical building : A small building with two exam rooms, 1 doctor office, 1 secretary office, 1 nurse office, 1 shared space. No space issue because students go back to the living units after basic medical treatment. Medical building IDF : Storage room. No secure cabinet, network devices are exposed.

MDF : Wooden door and window to outside without bars - not secure. Spacious

No medical room is required, only pill distribution by nurses and emergency callDoctor stays at the medical building and patients come to doctors after sick call

IDFs : Janitor room or storage room. Not secure cabinet, network devices are exposed

MDF and IDFs are not secure 2 Recommend secure bars on windows of MDF room and secure cabinet for IDF

Power company : PUDRenovated power system last year


No central generator, individual small generator for each buildingGenerators are old, have made a lot of problem whenever power outage happened

MDF : UPSMedical building IDF : No UPS

IDFs : No UPS Generators can't guarantee power backup

No UPS

1 Recommend a central, appropriate sized generator which can cover entire campus during power outage(750KW) - Capital project

Recommend UPS in IDFs




IDF : No UPS IDFs : No UPS No UPS in IDFs 0 Recommend UPS in IDFs


N/A (non-hosting site) N/A (non-hosting site) N/A (non-hosting site) N/A N/A

1 Cooling should have dedicated controlsMDF : Air-conditionerMedical building IDF : No air-conditioner, hot in summer

IDFs : No UPS but temperature is OK, 1 switch

Medical building IDF is too hot in summer

2 Recommend air-conditioner in medical building IDF


N/A N/A N/A N/A N/A



Site: Naselle Youth Camp



Requirements








Mariner, Moolock building) Gaps Score(0 - 4) Potential RecommendationRequirements

1


Conduits from MDF are in decent shape

Conduits from medical building IDF are OK

Conduits from IDF are OK None 4 None


MDF : No fire suppression

IDF : No fire suppression

IDFs : Sprinkler No fire suppression in MDF and medical building IDF

1 Recommend gas based FM200 fire suppression in MDFRecommend a fire extinguisher in IDF

Servers


1


N/A N/A N/A N/A N/A


N/A N/A N/A N/A N/A

3


N/A N/A N/A N/A N/A


N/A N/A N/A N/A N/A



None 4 None

1



Cabling / Pathways


MDF : Rack mounted patch panel

IDF : Wall mounted patch panel

IDFs : Wall mount patch panel None 4 None







Cabling / Pathways

Cabling / Pathways







AccessibleWeak documentation of current fiber cabling and network

Current documentation is not sufficient for high quality maintenance

2 Recommend more detail documentation

WAN / LAN


Medical building : 3 data ports are availableDoctor's office, 2 exam room, secretary office, dental clinic don't have network connectivity

Wireless candidate

Mariner building : Telemedicine room needs 1 data drop

Insufficient data drops in medical building and Mariner building

2 Recommend 2 data drops in doctor's office, 1 data drops in each exam room (2 data drops) and one data drop in secretary roomRecommend 3 data drops in dental clinic

Recommend 1 data drop in telemedicine room of Mariner building

Total : 9 data drops in medical building and Mariner building


Backbone switch : HP Procurve 4108 gl X 1, enough empty slots and ports

Workgroup switches : Dell 2724, enough empty ports

1 Fiber cable from MDF to the medical


1 fiber cable from MDF to the IDFs

1 fiber cable is not scalable 2 Recommend additional fiber cables (at least 1 fiber cables to each IDF)


No statistics but Backbone switch has enough capacity to support the network

None 4 None


Backbone switch : HP procurve 4101 glNo redundancy but redundancy is not required

None 4 None


Backbone switch : HP Procurve 4108 gl X 1, enough empty slots and ports



None 4 None


WAN is 768Kbps fractional T1 from Wahkiakum west telecom

Very high utilization rate all day

High utilization rate 2 Recommend bandwidth upgrade to T1 + fractional T1 (512Kbps) for performance and redundancy


No redundancy No redundancy 0 Recommend bandwidth upgrade to T1 + fractional T1 (512Kbps) for performance and redundancy







WAN / LAN



None 4 None



Network






MacAfee None 4 None



Cabling / Pathways


2


User Devices


Medical building : doctor, secretary, exam room and detail clinic need workstations

Insufficient workstations in medical building

2 Acquire 5 workstations for medical staff


None 4 None


None 4 None


None 4 None


None 4 None

Medical building : No compelling reason for wireless

3 year purchase cycle, up to date spec


User devices

Living units need wireless because nurses distribute pills at the patient room

No wireless in living units 0 1 AP per each living unitTotal 4 APs







None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None

User Devices

Need 3 PDAs for nurses No mobile devices 0 Acquire 3 PDAs for nurses

Printers


One small printer in medical building Insufficient printing capacity for medical staff

1 Acquire 1 multifunction device for medical staff


None 4 None


None 4 None


None 4 None


None 4 None



Printers







None 4 None


1 print server No redundancy 0 Recommend backup print server


Secure place for printers 2 Place all printers in a secure location and implement controls for secure printing. Also, it is recommended to modify print server configuration to increase security.

Scanners






1 Lab system Utilize outside Lab test provider N/A N/A None - access to external systems will be enhanced with T1

+ 512 Kbps connection

2 Pharmacy system No pharmacy. Outside provider - CostLess


3 Radiology system Outside provider N/A N/A None - access to external systems will be enhanced with T1 + 512 Kbps connection



N/A N/A N/A N/A None - access to external systems will be enhanced with T1 + 512 Kbps connection








Ancillary Systems

External Systems



Scanner


Copy of dshs_Oakridge_Comm_Fac.xls Page 1 of 1


Site Name Oakridge Community Facility

Site Location & Date of Site Visit Lakewood, WA -- 5/8/08

Primary Site Contacts (Technical and Medical) Technical: John Verburg - IT


Jerry Lind - Administrator

# Category Details

1



Out of Scope: Maintenance, Resident Rooms



3

Additional Introductory Information Oakridge Community Facility conducts rehabilitative and transition programs for juvenile offenders in a home like environment.

Primary users of the future EMR system would be counselors, case managers and secretaries. There are no on-site medical staff like nurses or doctors since medical care is provided by regional health providers.

4






Copy of dshs_Oakridge_Comm_Fac.xls Page 1


[0 - Not Met,

4 - No Gap]



Physical Space


General site overview:12 bed facility;15 total staff

Network closet has sufficient space and is clean and maintained well.

There are sufficient work spaces in the building for workers to access medical records without disturbing their workflows.

Telecommunication equipment and demarcation point are located in Electrical / Utility Room

No protection to telecommunication equipments and demark point

2 Install cable encasement / protective enclosure to increase security and protect from the other equipment co-located in the room

1 Back up & redundancy should be in placeN/A - Electrical power is supplied by Puget Sound Energy

None N/A None


No gap - Electrical power is supplied by Puget Sound Energy

None N/A None


One small UPS for a server and a switchA larger UPS is for a router provided from ISSD

None 4 None




No separate cooling in Network closet, but constant 24 hour air-flow is provided by ventilated ceiling in the room and the temperature can be maintained within acceptable range

No separate cooling in Network closet

2 Install a small air conditioner







Site: Oakridge Community Facility



Requirements




Cabling /





1


Cables are wired through ceiling None 4 None


Water fire suppression only in the telephone room, not in main switch room

No gas-based fire suppression in main switch room

2 Install a fire extinguisher in the telephone room and the main switch room


Cabling / Pathways





Servers

1





3






future EMR

1


There is only one building and there is no conduit None 4 None

Cabling / Pathways





WAN / LAN


There are data drops in all rooms which required to have access to a future medical records system; however, there are a few areas where additional data drops are recommended to accommodate future needs.


3 Consider adding 1 data drop in Duty Room, 1 data drop in Dental area and 1 data drop in Office area close to the entrance


It is appropriate for the site None 4 None


No performance issues;10/100/1000 Ethernet

None 4 None




Cabling / Pathways









No LAN redundancy (Non redundant switch) No redundant switch N/A No Recommendation - Since medical care is provided by community health providers and most or all medical records are kept by the community providers, high redundancy is not absolutely critical.


The Cisco switch has ports available for additional workstations and/or other EMR devices

None 4 None


Fractional T-1 received from DSHS; No performance issues. Since the number of users accessing medical record is small, utilization level is estimated to be well below the limit.

None 4 None


One partial T-1 is provided by DSHS (ISSD) No redundancy with WAN 1 No Recommendation: Since medical care is provided by community health providers and most or all medical records are kept by the community providers, 24/7 access to medical record is not absolutely critical. Another fractional T1 could be considered as a backup WAN connection if needed.




Can be provided on ad hoc basis by DSHS (confirming capabilities with Tina)

None 0 None


All CAT 5 None 4 None

Network





WAN / LANDSHS security standards in place


None 4 None


None 4 None



Cabling / Pathways



2


N/A - No wireless now No wireless 0 Recommend implementing wireless for this facility. Having wireless helps the staff members by providing the flexibility to document while being with or keeping distance from the clients.


User Devices

All workstations are on 3 year-lease cycle, and most or all of the current workstations will be upgraded by 2011


In general, there are is a sufficient number of workstations, but staff members are expected to require more access to workstations once they started using an EMR system.




Specs for leased equipment are expected to be sufficient



























User devices




















User Devices

Currently, only one staff member requires to have a laptop and he is receiving one soon.

None 4 Standardize and formalize a process to provide laptops or tablet PCs for medical professionals who requires to have more mobility, as necessary

Printers


There are sufficient number of printers to support workflow with the future EMR system. There are 4 networked printers and a few local printers.

None 4 None



None 4 None


At least, 4 printers have TCP/IP networking capability None 4 None


Utilizes Citrix None 4 None









There is a printer set up close to an entrance (open area) and printed material is not in secure environment

Access to print material not completely secure

3 Place a printer in a secure location and implement controls for secure printing. Also, it is recommended to modify print server configuration to increase security.

Scanners

There is no Scanner at this site. No Scanner 0 Replace a Pinter in Duty Room with a Multi-function device. Recommended to procure a device which has a high processing speed, has full sheet scanning capability and be TWAIN compliant


N/A None N/A None


N/A None N/A None


1 Lab system N/A - No Lab system is utilized None N/A None2 Pharmacy system N/A - No Pharmacy system is utilized None N/A None3 Radiology system N/A - No Radiology system is utilized None N/A None



N/A


N/A


N/A


N/A

External Systems



Printers

Ancillary Systems

Scanner



NoneNone


N/A - All medical information is kept on paper. For the future EMR system, information can be exchanged via DSHS's network with an appropriate interface and doesn't expect to see issues with network bandwidth if staff or patient volume does not increase dramatically.

Requirements for data exchange with MultiCare (who keep many of the residents health information)


Copy of dshs_Parke_Creek_Comm_Fac.xls Page 1 of 1


Site Name Parke Creek Community Facility

Site Location & Date of Site Visit Ellensburg, WA -- 6/11/08



Karen Lane - Supervisor

# Category Details

1



Out of Scope: School Building, Maintenance, Resident Rooms



3

Additional Introductory Information Parke Creek Community Facility conducts rehabilitative and transition programs for juvenile offenders in a home like environment. Specifically, this facility serves as a Drug and Alcohol treatment center. It has a faster turn over rate of residents (40 to 50 days) compare to the other JRA community homes.


Staff members use Automated Client Tracking (ACT) extensively for Case Notes, Treatment Report/Target Behavior, Behavioral Assessment and incident reports.

4






Copy of dshs_Parke_Creek_Comm_Fac.xls Page 1


[0 - Not Met,

4 - No Gap]



Physical Space


A mechanical room is used as Network closet and the room is cluttered with electrical panels and boilers. In addition, equipments for surveillance cameras will also be added in this room. This room is securely locked all the time.

Current Duty office (Kiosk) is very small and only 1 person can barely fit in the room.

Mechanical room is not an ideal location to place network equipment.

Duty office is too small for additional devices required

2 Recommend placing a cabinet in the closet for the network equipment to be housed.

Recommend expansion of the duty office to place an additional workstation and a desktop multi-function device.


Electrical power is supplied by Kittitas County PUD

There is no generator and it could go out of power for days since the facility is located in a remote place.

No generator 2 Recommend installing a generator since the facility is located in a remote place and could have extended power outages.


No power capacity issue. However, there are not enough electrical outlets in the network closet and a lot of power strips are being utilized.

It could create a fire or safety hazard by relying on too many power strips and extension cords.

3 Recommend rewiring the network closet, and adding more electrical outlets to accommodate the devices in the room.





1 Cooling should have dedicated controlsThere is no dedicated air-conditioner or ventilation. However, a heat pump for a boiler blows cool air into the room which helps to keep the temperature from rising too high.

No separate cooling in Network closet 0 No Recommendation - Temperature is properly maintained.



1


Cables are wired through ceiling. The cables then go to each room via a small hole and run along the walls without conduits. Also, data jacks are not utilized and cables are directly connected to the switch from the network closet.

Cables are exposed 1 Recommend rewiring and adding data jacks by a certified licensed technician to minimize risk of fire hazards or injury.


There is a small fire extinguisher in the room. Also, there is a larger fire extinguisher just outside of the network closet.

None 4 None




Site: Parke Creek Community Facility



Requirements






Cabling / Pathways





Servers

1





3






future EMR

1



Cabling / Pathways




2 Install a rack-mounted patch panel to increase maintainability of the network. The rack can also be used to organize cables and network equipments.

Also see recommendation in Section A



WAN / LAN


There are data drops in all rooms to support the current needs; however, there are a few areas where additional data drops are recommended to accommodate future needs.



3 Main Building:Add 2 data drops for wireless access pointsAdd 6 data drops to Duty Room (Surveillance Camera uses a few data ports)Add 4 data drops to Conference Room/Group RoomAdd 2 data drops to Secretary's OfficeAdd 2 data drops to Admin OfficeAdd 4 data drops to Staff Office (Main Office)Add 2 data drops to 1-1 roomAdd 2 data drops to CD roomAdd 2 data drops to Kitchen

Note: There are already a few data drops in each room; however, the numbers shown here are total number of data drops recommended (instead of the additional data drops recommended) in each room since rewiring by a licensed technician is recommended (See recommendation on D1)




Cabling / Pathways











None 4 None







None 4 None


Fraction of T-1 (512 K). Due to geographic reasons, fibre optic cables cannot be run to the facility.

JRA has been actively upgrading to 10-Mbps Ethernet where fibre is available since Online education/training system and online surveillance camera system will be installed to all JRA sites.

Although the number of users accessing medical record is small, more bandwidth could be required with the future EMR system.

Higher bandwidth could be required 1 We support the JRA's direction as the current bandwidth is not likely adequate to support the future EMR system. Assuming fibre will be available in the area where the facility is located, we recommend upgrading to 10-Mbps Ethernet if it makes economical sense. Recommend WAN bandwidth upgrade with an additional T-1.









WAN / LAN







Cabling / Pathways



2


No wireless now No wireless now 0 Recommend implementing wireless for this facility. Having wireless helps the staff members by providing the flexibility to document while being with or keeping distance from the clients. IT personnel responsible for this facility are aware that wireless is needed and are planning to install wireless access points within a few months.


Network







User Devices


None 4 None


In general, there are a sufficient number of workstations, but staff members are expected to require more access to workstations once they start using an EMR system.































User Devices

Currently, 2 laptops are utilized at this facility. Counselors are benefited by having a laptop.


Standardize and formalize a process to provide laptops or tablet PCs for staff members who require more mobility, as necessary

Printers


There are 3 networked printers and 1 local printer; however, printers are overloaded and 1 more printer is requested.

Printers overloaded 2 No Recommendation - See recommendation on Section Q



None 4 None





None 4 None





User devices

Printers












Scanners

There is no Scanner at this facility No Scanner 0 Replace a network printer in the Staff Office with a full size multi-function device.

Add a desk-top multi-function device for the Duty office.

Recommended procuring a device which has a high processing speed, has full sheet scanning capability and is TWAIN compliant


N/A None N/A None


N/A None N/A None


1 Lab system N/A - No Lab system is utilized None N/A None2 Pharmacy system N/A - No Pharmacy system is utilized None N/A None

3 Radiology system N/A - No Radiology system is utilized None N/A None



N/A


N/A


N/A


N/A

External Systems



Ancillary Systems

Scanner


N/A - All medical information is kept on paper. However, this site utilizes Automated Client Tracking (ACT) system extensively for Case Notes, Treatment Report/Target Behavior, Behavioral Assessment and Incident Reports. This information needs to be interfaced or migrated to the future EMR system.

For the future EMR system, information can be exchanged via DSHS's network with an appropriate interface. No expected issues with network bandwidth if staff or patient volume do not increase dramatically.

NoneNone


Copy of dshs_Rainier_School.xls Page 1 of 1


Site Name Rainier School

Site Location & Date of Site Visit Buckley, WA -- 5/21/08

Primary Site Contacts (Technical and Medical) Technical: Todd S. - IT, Medical: Dr. Christian Dahl - Med. Director


Neil Crowley - Superintendent; Allan McGlaughlin - Asst Superintendent; Phil - PAT-A manager

# Category Details

1


In-Scope: Rainier Center Bldg (Medical Center), PAT-A, -C, and -E Headquarters, and the 28 residences comprising PAT-A, PAT-C, and PAT-EOut of Scope: ATP (Adult Training Program -- has basic network access available, but no regular care or charting conducted)

2


m/f - Multifunction Devices; PAT - Program Area, dp - data port, w/s - workstationPSE - Puget Sound Energy

3

Additional Introductory Information Rainier school has a relatively stable population of 400 client patients, spread across 3 major Patient program areas (PATs);

Most care is provided in the 28 living units. There is a clinic at each headquaters building, as well as a main medical center. The inpatient unit is not in use currently. Two of the residences are set up as nursing facilities, the rest are like residences. Charting is done everywhere the residents are, and every half hour updates are required regarding restraint, behavior, food, etc.

4






Copy of dshs_Rainier_School.xls Page 1

Date of Visit: 5/21/2008

[0 - Not Met,

4 - No Gap]


Rainier Center Bldg & IDFs, MDF & Server room and Power

PAT-A (incl. 2010-A, 2010-B), PAT-C and PAT-E Gaps Score


Physical Space


MDF (Admin building) : small space, unsecured window to outside, unsecured door

Server room : spacious, inside of IT room

Rainier Center bldg north IDF : empty big room, secure door, rack has room for additional IT devices

Rainier Center bldg south IDF : not appropriate place (Pump room), switches are exposed without secure cabinet

Campus is broken into 3 Program Areas (PAT-A, PAT-C, PAT-E) based on needs. Each PAT has a medical station which supports residents from the cottages assigned to each PAT. There are 28 Residential Cottages, all duplexes. 3 styles. 2 styles are residential, 1 is designed for more intensive nursing.

PAT-A IDF : not appropriate location (Janitor room), switches are exposed without secure cabinet

PAT-C IDF : not appropriate location (Attic space), very hot in summer, switches are exposed without secure cabinet

Rainier Center bldg south, PAT-A and PAT-C IDFs are not secure

1 Recommend an iron cabinet for each of 4 IDFs : 4 iron cabinets


Two generators : installed last year, very new and enough capacity to cover entire campus

MDF : UPS exists

PAT-E IDF : no UPS

IDFs : no UPS Workgroup switches in IDFs will reboot when power outage happens - Max 1 minute service outage

2 Recommend UPS at all IDFs (5 rack mounted UPSs - small)


Power capacity and input from power supplier (PSE) is sufficientHowever, for current power systems: - feeder systems from main power distribution to each building inside of the campus are very old, stretched to limit. Need to proposed the power system upgrade

Power system inside of campus can't satisfy additional power requirements

2 Upgrade power system from main power distribution to each building -- Large Capital Project


MDF & Server room : UPS

IDFs : no UPS

IDFs : no UPS Workgroup switches in IDFs will reboot when power outage happens - maximum few minutes service outage could happen

2 UPS at all IDFs : rack mount type small UPS X 5 Same as #1 above


Does not apply because this site is not a hosting candidate

N/A N/A N/A N/A

Agency/Administration: DSHS/DDD/RHC

Site: Rainier School



Requirements












MDF : air-conditionerServer room : air-conditionerIDFs : no air-conditioner

IDFs : no air-conditionerPAT-C : attic space, very hot in summer

No air-conditioner in IDFs 1 Recommend venting or simple air-conditioner in 5 IDFs


N/A N/A N/A N/A N/A

1


Fiber cable conduits are pipes on ceiling of pathways between buildings. Some part of these pipes are exposed to street, high risk of being cut down by trucks

Conduits OK Exposed fiber cable pipes 2 Recommend more secure measure to protect fiber cables : Raise the cable pipes & restrict traffic


No fire suppression No fire suppression At a minimum, MDF needs fire suppression

0 Recommend FM200 X 1 for MDF room

Servers

Not a hosting site : N/A N/A N/A N/A N/A

1


N/A N/A N/A N/A N/A


N/A N/A N/A N/A N/A

3


N/A N/A N/A N/A N/A


N/A N/A N/A N/A N/A

Servers

1


Conduits have room for additional cabling Conduits have room for additional cabling None 4 None





Cabling / Pathways

Cabling / Pathways










Cabling / Pathways


Patch panels exist Patch panels exist None 4 None


Documentation has not been well-managed Documentation has not been well-managed Documentation needs improvement 1 Recommend detailed, up-to-date documentation of current IT architecture - cabling, network architecture, inventories

WAN / LAN


Rainier Center Bldg: Outer room of medical records needs 2 - 4 data drops. Data drops needed in X-ray, Eye exam room, lab (Needs 2: one for w/s, one for printer). Health Center med room (306) needs 1 data and 1 voice. Nurses station needs 2 more data drops for workstations, and printer needs 1 data drop. Meeting room needs 2-4 data drops.

2010A&B: No data drops in Activity/Dining Area - continuous monitoring of residents occurs here - entries made every 1/2 hour (Restraint, Behavior, Food). Would require 2-3 data drops to support wireless APs in each (A&B); 2010A: would need data and voice drop in Nurses Station; Managers desk is in the Living Room -- has 2 data ports, both used (w/s and printer); Med Rooms would both need data. 2010B: Manager uses office and has 2 data ports, both used (w/s and printer); Nurses station currently holds charts and has a phone, no data - would need at least 2 data ports, space limited so more would be difficult. Much better suited for wireless given mobility of residents and monitoring needs.

As indicated under Observations, needs are:Rainer med recs: 2-4Rainer X-ray, Eye Exam, Lab: 4Rainer Health Center Med Room: 1Rainer Nurses Station: 3Rainer Meeting Room: 2-4PAT-A 2010A&B for wireless APs: 4-6PAT-A 2010A&B for nurses stations: 4PAT-A 2010A&B for med rooms: 2

2 Recommend additional data drops in Rainier Ctr Medical building and PAT headquarters, as described in Observations and summarized below. (See L2 for recommendations for wireless in the residences.)Install the following number of data drops:Rainer med recs: 2-4Rainer X-ray, Eye Exam, Lab: 4Rainer Health Center Med Room: 1Rainer Nurses Station: 3Rainer Meeting Room: 2-4PAT-A 2010A&B for wireless APs: 4-6PAT-A 2010A&B for nurses stations: 4PAT-A 2010A&B for med rooms: 2

PAT-A Hdq: Nursing Station - 4 nurses on day shift who overlap with 2 on swing shift for a couple of hours. Only 2 data ports, need 3-4 add'l. ports. Clinic Area - needs 2 data. Exam Room - needs 1 data port. OT - 8 staff, 6 data ports - probably OK as is. Secretary Area - ok. Meeting Room - house reviews are done here, so data ports needed in order to bring up records - suggest 4 - 6 ports (min 4).PAT-E Hdq: Nurses Station - 5 LPNs, 2 RNs, 3 staff on day shift all share 2 workstations. Needs 3-4 add'l ports. Clinic Area needs 2 data. PAT-C Hdq: Nurses Office - Needs 3 additional data drops

As indicated under Observations, needs are: PAT-A Hdq: Nursing Station: 3-4 add'l. data ports. PAT-A Clinic Area - 2 data ports. PAT-A Exam Room - 1 data port. PAT-A Meeting Room - 4-6 data portsPAT-E Hdq: Nurses Station - 3-4 add'l ports. PAT-E Clinic Area - 2 data ports. PAT-C Hdq: Nurses Office - 3 additional data ports

2 Install the following number of data ports:PAT-A Hdq: Nursing Station: 3-4 add'l. data ports. PAT-A Clinic Area - 2 data ports. PAT-A Exam Room - 1 data port. PAT-A Meeting Room - 4-6 data portsPAT-E Hdq: Nurses Station - 3-4 add'l ports. PAT-E Clinic Area - 2 data ports. PAT-C Hdq: Nurses Office - 3 additional data ports

For the recommended wireless APs in residences and in 2010A&B: Recommend one data drop for each AP:In 28 living units : 2 APs per unit, total 56 APs in living units, with power line installation (1 line for each AP)Also recommend wireless coverage for:2010A: 2-3 AP's2010B: 2-3 AP's

Total of 60-62 new data drops to support wireless










Backbone switch doesn't satisfy the availability and scalability requirements

No standardized workgroup switches

1 Recommend Backbone switch upgrade : Cisco Catalyst 45xx grade X 2 (Considering redundant Backbone switch)

Recommend to standardize the workgroup switches : Cisco Catalyst 29xx or 35xx grade X 11


N/A N/A Even though statistics are not existing, recommend Backbone switch upgrade : J3


Single Point of Failure n/a Redundant Backbone switches are generally not being recommended


Backbone switch : no room for expansionWorkgroup switches : fair enough empty ports

Workgroup switches : fair enough empty ports Backbone switch doesn't satisfy the availability and scalability requirements

2 See J2


WAN is 1 T1 + 1 Fractional T1 (512Kbps)High utilization and slow response timeFiber cable for 10Mbps service is available : will cost about $40,000 for pulling cable and $1,200 for monthly charge

WAN is busy, reached to the limit of bandwidth

2 Recommend 10Mbps upgrade : cost is described in E37


Partial redundancy : two WAN connection No carrier diversity 2 Carrier diversity is not viable optionRecommend 10Mbps main WAN + 1 T1 backup in future


No QoS No QoS 0 DIS will implement QoS



None 4 When wireless network is implemented, wireless network management system will be needed : see L1



WAN / LAN




DIS VPN 4 None

4 None


No statistics exist

DSHS ISSD security standard None

Fiber cables between MDF and IDFs : all of the IDFs has available fiber cables for additional network connections such as redundant connection from Backbone switches to workgroup switches

Switches are not standardized (Cisco & Dell), which makes maintenance more complex

All of the IDFs have stacked workgroup switches

Backbone switches are not capable of supporting high availability and scalability : Cisco 3550G X 2

PAT houses : UTP to Fiber (Converters at each end of UTP cable) from the nearest IDF and small hub (5 ports)

Network








Cabling / Pathways


No wireless currently No wireless currently N/A N/A

2


No wireless currently PAT-A, PAT-C and PAT-E living units are wireless candidates2010A&B are also wireless candidates

Justification for Wireless: First of all, the current mini hubs which serve each living unit have a maximum of 2 available ports. Given that medical staff needs more data access capabilities with a new EMR system – via PC or Notebook -- these hubs would need to be replaced with larger models with additional cabling. However, if a wireless network is implemented (as opposed to standard data cabling), the current mini hubs do not need to be upgraded and additional cabling could be minimized. At the same time, staff can take advantage of mobility benefits as well.

No wireless currently in primary wireless candidate areas:PAT-A, PAT-C, PAT-E living units2010A2010B

0 Recommend wireless coverage in 28 living units : 2 APs per unit, total 56 APs in living units, with power line installation (1 line for each AP)Also recommend wireless coverage for:2010A: 2-3 AP's2010B: 2-3 AP's

Regarding the estimate for 2 APs per living unit: The living units are small sized wooden structure building with walls through which wireless signals pass easily. We have observed there is living room style open space and individual rooms through corridor. One AP for open space and one more AP at the corner of corridor would cover entire building.

2010 A&B is little bit bigger than the rest of the living unit and has a slightly different layout. It could be covered by 2 APs but adding 1 more AP would provide better coverage… Recommendation is therefore 2-3 AP’s each for A & B.

User Devices


Rainier Center Bldg: Medical Records includes Transcription and Scheduling. 7 people work in the area. There is an outer room which needs 2-4 workstations. Both exam rooms (228 and 231) need workstations. The lab needs a workstation. At the Health Center, where the critical care beds are, a rolling cart with laptop would be best if the area is reopened. It is currently not being utilized. Also would need 2 computers in the Nurses Station. The med cart in Room 306 needs a laptop - recommended for all med carts. The dining room is used as a day area and the staff need to be able to document observations. A kiosk would probably work best to keep the workstation secure.

PAT E Headquarters: 20 employees share 2 workstations over 2 shifts. Need approximately 10 laptops. The clinic needs a desktop computer as does the PT area and the IHP room.PAT A Headquarters: 1 workstation needed for Clinic; 1 workstation needed for Exam Room. Assume similar needs for laptops as PAT E.2010B: Nurses station needs 2 workstations. 6 laptops for staff use in the activity area. Need laptop on med cart.2010A: Nurses station needs 1 more workstation. Need laptop on med cart.Bldg 1050 (representative of many residence buildings): Need 1-2 workstations/laptops. Need laptop for med cart. Laptops for staff may be difficult due to security issues, but other options are limited given the mobility of the residents and the lack of dedicated office space. Kiosks may be an option, but would limit access.Cascade: Need laptop for med cart.Naches: 2 computers, both on B side, need 2 more on A. Med room has no power, no data, no phone.;PAT C HQ: Needs two workstations

As indicated in observations, needs are:

0 Additional desktop computers: 17-19, for the following locations:

Rainer Center outer room : 2-4 workstations. Rainier Center exam rooms (228 and 231) : 2.Rainier Ctr Lab: 1. Rainier Nurses Station: 2Rainier Ctr dining room : 1PAT-E HQ, PT, IHP room: 3.PAT A Headquarters Clinic, Exam Room: 2

2010B: Nurses station: 2 2010A: Nurses station needs 1 more workstation. PAT C HQ: 2

Summary recommendation for lockable, securable laptops: 1 for each med cart and 1 for each nurse manager at the residences (56 - 60), and 30 - 40 for additional medical staff who frequently visit living units










Substandard PC spec cannot support EMR system

2 Recommend establishing an upgraded, standard specification for all PC workstations at the facility.

For the approximately 400 workstations (at a minimum, for all medical care and counseling staff) currently at the facility (and for the approx 20 new workstations recommended):Commence a regular 3-year refresh, replace process:(i.e.: Year 1: Acquire approx. 140 new workstations, Year 2: Acquire approx. 140 more new workstations; Year 3: Acquire approx. 140 more new workstations, etc.)

All new workstations should meet the specifications documented at left under requirements














User Devices

Not currently in use Not currently in use 4 Summary of mobile device needs:

Laptops: 1 for each med cart and 1 for each house manager at the residences (56 - 60 total), and 30 - 40 for additional medical staff who frequently visit living units (such as from PAT-E HQ and for PAT-A-2010A&B)

Need laptop on med carts for 2010A&B (2)

The med cart in Rainier Ctr Room 306 needs a laptop

Recommend a 3 year lease cycle to keep laptop equipment specs current.

Current PC spec is variable and does not meet requirement. Most PCs cannot support Microsoft Windows Vista. Average PC purchase cycle is 5 years due to limited budget


User devices







Printers


Multifunction printing device needed in lab (mid sized)

Medical records needs one more large multifunction printer

XRAY needs one mid-sized multi function printer

Rainier pharmacy: needs one mid-sized multi function printer

PAT-A: Need multifunction devices in OT and the Nurses Station and Clinic Area. The copier in the secretary's area needs to be upgraded to a multifunction device.PAT-E: Need multifunction devices in Supervisor's office and IHP room. No room in the nurses station for a large machine, but can access the one in the supervisors office.PAT-C HQ: Needs one multifunction printer in nurses office areaAt the residences we went to, the managers used local printers; they have to go to headquarters to make copies or fax anything.

See Observations. 0 Upgrade existing printers to multifunction devices throughout campus, including residences (approx. 41 total):

Distribution / Locations:

Large: Medical Records (1)Mid-Sized: Lab (1), XRAY (1), Pharmacy (1), PAT-A HQ (4), PAT-E HQ (2), PAT-C HQ (1)Small-Sized: Each Residence (28), 2010A (1), 2010B (1)








Scanners




Scanner

Printers










1 Lab system

Quest Diagnostics Quest Diagnostics Current Bandwidth is not sufficient to accommodate interfaces required

1 As recommended in J6, Upgrade WAN bandwidth to 10mb

2 Pharmacy system Direct from wholesaler Direct from wholesaler Current Bandwidth is not sufficient to accommodate interfaces required


3 Radiology system Northwest Mobile Northwest Mobile Current Bandwidth is not sufficient to accommodate interfaces required




Current Bandwidth is not sufficient to accommodate interfaces required






This site is a pioneer in definition and use of Medicare Part D; Heavy users of Medicare Part D processing






External Systems



Ancillary Systems

Copy of dshs_Ridgeview_Comm_Fac.xls Page 1 of 2


Site Name Ridgeview Community Facility

Site Location & Date of Site Visit Yakima, WA -- 6/12/08



LeeAnn Delk - Administrator

# Category Details

1



Out of Scope: Maintenance, Resident Rooms



3

Additional Introductory Information Ridgeview Community Facility conducts rehabilitative and transition programs for juvenile offenders in a home like environment. This facility is in process of transitioning from a male to female facility.

Primary users of the future EMR system would be counselors, case managers and secretaries. There are no on-site medical staff like nurses or doctors since medical care is provided by regional health providers such as Yakima Valley Memorial Hospital and Providence Yakima Medical Center.

Staff members use Automated Client Tracking (ACT) extensively for Case Notes, Treatment Report/Target Behavior, Behavioral Assessment and incident reporting.




Copy of dshs_Ridgeview_Comm_Fac.xls Page 2 of 2

# Category Details

4



Copy of dshs_Ridgeview_Comm_Fac.xls Page 1


[0 - Not Met,

4 - No Gap]



Physical Space


Two new offices were recently added and construction is in progress to remodel bathrooms. Kitchen area will also be remodeled in the near future.

A storage space attached to a recreation room is used as Network closet. The room is somewhat cluttered and network equipment is placed on the floor. Since the room gets very hot, the door is typically kept open.

The room is not secured and it could lead to security risks, equipment vandalism and/or accidental damage of the equipment

2 Recommend moving everything out of the room to create space to add a rack, a patch panel, a ventilation and a fire extinguisher. Also, add dedicated power supply to the network closet.


Electrical power is supplied by Pacific Power.

There is no generator. When there is a power outage, it is typically for a few hours.

No generator 2 No Recommendation - Since no medical care is provided on site, it is not absolutely critical to have emergency power generation capability.


No power capacity issue. None 4 None






There is no dedicated air-conditioner or ventilation. The network closet gets very hot 0 Install a ventilation to maintain appropriate temperature/humidity level.




1


There is a crawl space and cables are wired under the floor. Although cables are not exposed, no conduits are used and data jacks are not utilized in some rooms. Cables are directly connected to the switch from the network closet since a patch panel is not utilized.

Conduits are not used for data cables 1 Recommend to ask an ISSD certified licensed technician to re-wire and install data jacks to minimize risk of fire hazards or injury.


There is no fire suppression in the network closet. Insufficient fire suppression in the network closet

2 Installation of FM200 gas fire suppression is not required for this facility. Recommend to have a fire extinguisher.




Site: Ridgeview Community Facility



Requirements






Cabling / Pathways





Servers

1





3






future EMR

1



Cabling / Pathways




2 Install a rack-mounted patch panel to increase maintainability of the network. The rack can also be used to organize cables and network equipment.



WAN / LAN


There are data drops in all rooms to support the current needs; however, there are a few areas where additional data drops are recommended to accommodate future needs.



3 Main Building:Add 2 data drops for wireless access pointsAdd 2 data drops to Counselor's OfficeAdd 4 data drops to Supervisor's OfficeAdd 2 data drops to Secretary's OfficeAdd 2 data drops to Admin OfficeAdd 2 data drops to Office for Drug and Alcohol Treatment (Room 6)Add 2 data drops to Kitchen

Note: There are already a few data drops in each room; however, the numbers shown here are total number of data drops recommended (instead of additional data drops recommended) in each room since rewiring by a licensed technician is recommended (See recommendation on D1)




None 4 None




Cabling / Pathways













The switch has only a few more available ports as some ports are also used by the surveillance camera system.

The switch does not have ports available for additional workstations and/or other EMR devices.

1 Upgrade the current switch to a model with 48 ports


Fraction of T-1 (512 K). Fibre optic cables were not available in the area until recently, but it is now possible to run fibre optic cables to the facility.



Higher bandwidth could be required 1 Recommend increasing the bandwidth with an additional T-1 or to 10 mbps if it makes economical sense.









WAN / LAN







Cabling / Pathways



2


No wireless now No wireless now 0 Recommend implementing wireless for this facility. Having wireless helps the staff members by providing the flexibility to document while being with or keeping distance from the clients.


User Devices


None 4 None


In general, there are a sufficient number of workstations, but staff members are expected to require more access to workstations once they started using an EMR system.




Network




































User devices





User Devices

Laptops are currently not utilized. Counselors are benefited by having a laptop and there could be 3 counselors at one time.



Printers


There are 2 networked printers and 1 desktop multi-function device (HP Color LaserJet 2840). There are adequate number of printers.

None 4 None



None 4 None





None 4 None









Scanners

There is an old scanner in storage and one small multi-function device which could be used as a scanner.

Insufficient number of scanners 1 Replace a copier in Supervisor's office with a full size multi-function device.

Recommended procuring a device which has a high processing speed, has full sheet scanning capability and is TWAIN compliant


N/A None N/A None


N/A None N/A None






N/A


N/A


N/A


N/A

External Systems




Ancillary Systems

Scanner

Printers



N/A - All medical information is kept on paper. However, this site utilizes Automated Client Tracking (ACT) system extensively for Case Notes, Treatment Report/Target Behavior, Behavioral Assessment and Incident Report. This information needs to be interfaced or migrated to the future EMR system.

For the future EMR system, information can be exchanged via DSHS's network with an appropriate interface. No issues with network bandwidth as long as staff or patient volumes do not increase dramatically.

NoneNone


Copy of dshs_Secure_Comm_Tran_Fac_King.xls Page 1 of 1


Site Name Special Commitment Transition Facility - King County

Site Location & Date of Site Visit Seattle, WA 6/20/08

Primary Site Contacts (Technical and Medical) Technical : Heather Sacha


SCTF Manager: Tabitha Yockey

# Category Details

1


Site is out of scope, given that there is no medical care provided

2


SCTF - Special Commitment Transition FacilitySCC - Special Commitment CenterUPS - uninterruptible power supply

3Additional Introductory Information Residents seek medical care with outside providers, who maintain the medical records. They are responsible for

scheduling their own appointments, so no access to the EMR system is required.

4






Copy of dshs_Secure_Comm_Tran_Fac_King.xls Page 1


Agency/Administration: DSHS/SCTF

Site: Speicial Commitment Transition Facility - King County[0 - Not Met,4 - No Gap]



Physical Space


The SCTF facility is physically an extension of the SCC complex ---- the residents are in the final stage of transition to the outside community.

Access to a future EMR system would be very minimal from the SCTFSpace for the main network closet at the SCTF program building is acceptable, but too warm

No physical space modifications would be necessary for a future EMR system

None 4 None

Power provided by Seattle City Light


Not Applicable N/A N/A N/A






N/A N/A N/A N/A

SCTF Main Network Closet: Entry from outside

1 Cooling should have dedicated controlsSCTF Main Network Closet: HVAC was not present, and room was very warm. (Central Air only)

Ineffective cooling in SCTF Main Network Closet

2 Install additional cooling for SCTF main network closet


No redundancy, but not considered a critical site

None 4 None

Requirements












1


Conduits have ample space None 4 None


Water fire suppression present Sprinkler can destroy electronic devices 2 Recommend fire extinguisher in IDF

Servers

Only applies to hosting sites; SCTF is not a candidate given its small size and the variable power supply.

Only applies to hosting sites; N/A N/A

1



3



Servers

Only applies to hosting sites; SCTF is not a candidate


N/A N/A

1



Cabling / Pathways


Accessible None 4 None



Cabling / Pathways

Cabling / Pathways












WAN / LAN


Nurses only come down in case of emergency; DOC is not primary responder -- 911 Paramedic services is called for Seattle-based medical assistance from the outside, . No charting typically done here. Residents are responsible for their own healthcare.

Sufficient data ports in office area, and data drop in conference area that could be used by laptops (should any practitioners need access to EMR system from SCTF)

None N/A None


SCTF Main Network Closet Dell Powerconnect, racked; Patch Panel;Cisco 48 port switch - plenty of open portsWorking UPS;1 T-1

None N/A None


None N/A None


None N/A None


None N/A None


None N/A None - Resolution of WAN issues would be taken care of by implementing recommendations for SCC


None N/A None


None N/A None


None N/A None


None N/A None

WAN / LAN


None N/A None


Network







None N/A None


None N/A None

Cabling / Pathways


No need for wireless N/A N/A None

2



User Devices


No charting done here. Residents are responsible for their own healthcare.

Adequate number of workstations at main desk and staff area in back (all wired, with at least workstations)

If ever the need should change and access was required to the future EMR system (on a very occasional basis), there are a sufficient number of workstations in the building.

None 4 None


4 None


4 None


4 None


4 None


4 None


4 None


4 None

3-year cycle purchase program.



User devices






4 None


4 None


4 None


4 None


4 None


4 None


4 None

User Devices

N/A - None needed for SCTF staff N/A N/A

Printers


No medical information is printed or kept here. No charting done here. Residents are responsible for their own healthcare.

N/A N/A None


N/A N/A None


N/A N/A None


N/A N/A None


N/A N/A None


N/A N/A None


N/A N/A None


No medical information printed N/A N/A None

ScannersNo medical information scanned


N/A N/A N/A None

Compliant

Scanner


Printers









N/A N/A N/A None





WAN/LAN

Lab system N/A N/A N/A None

Pharmacy system N/A N/A N/A None

Radiology system N/A N/A N/A None

WAN/LAN


N/A N/A N/A None


N/A N/A N/A None


N/A N/A N/A None


N/A N/A N/A None

External Systems



Ancillary Systems

Copy of dshs_Secure_Comm_Tran_Fac_Pierce.xls Page 1 of 1


Site Name Secure Community Transition Facility - Pierce County

Site Location & Date of Site Visit McNeil Island, WA 5/14/08

Primary Site Contacts (Technical and Medical) Technical : Heather Sacha


SCTF Manager: Cheryl Jones

# Category Details

1


Single SCTF main program (administrative) building

2


SCTF - Secure Community Transition FacilitySCC - Special Commitment Center

3

Additional Introductory Information Residents seek medical care with outside providers, who maintain the medical records. They are responsible for scheduling their own appointments, so no access to the EMR system is required.

4






Copy of dshs_Secure_Comm_Tran_Fac_Pierce.xls Page 1


Agency/Administration: DSHS/SCTF

Site: Secure Community Transition Facility - Pierce County[0 - Not Met,4 - No Gap]



Physical Space


The SCTF facility is physically an extension of the SCC complex ---- the residents are in the final stage of transition to the outside community.

Access to a future EMR system would be very minimal from the SCTF, and access would be only from the main program building (not from the residences)

Space for the main network closet at the SCTF program building is acceptable

No physical space modifications would be necessary for a future EMR system

None 4 None

Power provided by SCC, which in turn comes from Tacoma Power


Same as SCC: Power supply from Tacoma Power is unclean - fluctuates greatly. Old marine cable was kept active as backup, but shorted out under the Sound, and blew all UPS and Security System. Generator backup takes 9 1/2 minutes to come up to full power.

Same as SCC: Delay in switch to generator power is too long to meet 99.99% up time requirement for EMR system.

1 Same as SCC: Suggest battery backups to bridge gap between loss of electrical from Tacoma Power and Generator power. Capacitors are required in order to stop the fluctuations in the power supply.


Same as SCC: Power usage often exceeds power capacity for entire SCC / SCTF facility.

Same as SCC: Power usage often exceeds power capacity for entire SCC / SCTF facility.

1 Same as SCC: Power Supply for all of McNeil Island needs to be addressed before implementation of an EMR system


Same as SCC: UPS Present, but can't always handle the power fluctuations.

Same as SCC: UPS Present, but can't always handle the power fluctuations.

1 Same as SCC: Additional Capacitors are required on McNeil Island in order to minimize the fluctuations in the power supply.


Same as SCC: Power supply from Tacoma Power is unclean - fluctuates greatly. Old marine cable was kept active as backup, but shorted out under the Sound, and blew all UPS and Security System. Generator backup takes 9 1/2 minutes to come up to full power.

Same as SCC: Delay in switch to generator power is too long to meet 99.99% up time requirement for EMR system.

0 Same as SCC: Suggest battery backups to bridge gap between loss of electrical from Tacoma Power and Generator power.

SCTF Main Network Closet: Entry from outside

1 Cooling should have dedicated controlsSCTF Main Network Closet: HVAC was not present, and room was very warm. (Central Air only)

Ineffective cooling in SCTF Main Network Closet

2 Install additional cooling for SCTF main network closet


No redundancy, but not considered a critical site

N/A N/A







Requirements






1




Fire extinguisher present None 4 None

Servers

Only applies to hosting sites; SCTF is not a candidate given its small size and the variable power supply.

Only applies to hosting sites; McNeil Island is not a candidate given the variable power supply.

N/A N/A

1



3



Servers



N/A N/A

1



Cabling / Pathways





WAN / LAN









Cabling / Pathways

Cabling / Pathways






Nurses only come down in case of emergency, but DOC is primary responder. No charting typically done here. Residents are responsible for their own healthcare.

Sufficient data ports in office area, and data drop in conference area that could be used by laptops (should any practitioners need access to EMR system from SCTF)

No additional data drops needed for EMR system

N/A None


All supported through SCC LAN network

SCTF Main Network Closet (entry from outside)

Dell Powerconnect, racked; Patch Panel;Fire alarm, but no fire suppression;Acceptable cabling;Working UPS;Direct fiber run from SCC's main MDF

No additional gaps beyond the gaps noted for SCC

N/A None


All supported through SCC LAN network No additional gaps beyond the gaps noted for SCC

N/A None



N/A None



N/A None


All supported through SCC WAN connection


N/A None - Resolution of WAN issues would be taken care of by implementing recommendations for SCC




N/A None




N/A None




N/A None



N/A None

WAN / LAN



N/A None



N/A None



N/A None

Cabling / Pathways

Network









2



User Devices


Nurses only come down in case of emergency, but DOC is primary responder. No charting done here. Residents are responsible for their own healthcare.

Adequate number of workstations at main desk and staff area in back (all wired, with at least workstations)

In case nurses or medical professionals need basic access to the future EMR system (on a very occasional basis), there are a sufficient number of workstations in the Program Building

None 4 None


4 None


4 None


4 None


4 None


4 None


4 None


4 None


4 None


4 None


4 None


4 None


4 None


4 None


User devices

Same as SCC: 3-year cycle purchase program.The latest PC spec : Intel Core-Duo, 4MB cache, 19'' display, 1 GB RAM, 2400 ATI graphic card

Same as SCC: Compliant






4 None

User Devices

N/A - None needed for SCTF staff N/A N/A

Printers


No medical information is printed here. Nurses only come down in case of emergency, but DOC is primary responder. No charting done here. Residents are responsible for their own healthcare.

N/A N/A None


N/A N/A None


N/A N/A None


N/A N/A None


N/A N/A None


N/A N/A None


N/A N/A None


No medical information printed N/A N/A None

ScannersNo medical information scanned


N/A N/A N/A None


N/A N/A N/A None



Scanner

Printers







WAN/LAN

Lab system N/A N/A N/A None

Pharmacy system N/A N/A N/A None

Radiology system N/A N/A N/A None

WAN/LAN


N/A N/A N/A None


N/A N/A N/A None


N/A N/A N/A None


N/A N/A N/A None

External Systems



Ancillary Systems

Copy of dshs_Special_Comm_Center.xls Page 1 of 1


Site Name Special Commitment Center (DSHS)

Site Location & Date of Site Visit McNeil Island, WA - 5/14/2008

Primary Site Contacts (Technical and Medical) Technical: Heather Sacha; Medical: Linda Bryant


Facilities: Eric Beirne

# Category Details

1


In Scope:King Hall, Multi-Purpose Bldg, Medical Center, Residence Buildings: Cedar (North, West, South), Alder, Birch, Elm (E), Ginko (G), Fir, Dogwood, Redwoood (two identical H-shaped buildings), VT Building (IDF only)

2


MP - MultiPurpose Bldgmf - multifunctionPAM: Program Area

3

Additional Introductory Information The SCC provides specialized mental health treatment programs for civilly committed sex offenders who have completed their prison sentences.The resident population is approximately 285, and is planned to grow approx. 1.5 residents per month, until 2011.There are approximately 460 staff. The SCC faces many of the electrical and undersea cabling challenges that the DOC's McNeil Island CC does.

4






Copy of dshs_Special_Comm_Center.xls Page 1


Agency/Administration: DSHS/SCC

Site: Special Commitment Center - McNeil Island[0 - Not Met,4 - No Gap]

Investment Category

Pill line, Medical Records,and Medical Building, MDF & Server

roomProgram Areas 1 & 2, IDF's Gap Score

(0 - 4)Potential Recommendation

Facility Modification

s

Protective "security" hoods may need to be added to workstations in high traffic areas to comply with HIPAA requirements

MDF : Sufficient space for additional IT devicesServer room : Sufficient space for additional IT devicesMedical building IDF : Sufficient space for additional IT devices

Protective "security" hoods may need to be added to workstations in high traffic areas to comply with HIPAA requirements. Bolted down kiosk required in Cedar South.

Physical security is not in place for all workstations and printers

3 Add physical security hoods to workstations in highest traffic areas:

1 for kiosk for Cedar South, 4 hoods in Redwood (2 per unit), 1 hood for Injection Station (total of 6)


Power supply from Tacoma Power is unclean - fluctuates greatly. Old marine cable was kept active as backup, but shorted out under the Sound, and blew all UPS and Security System. Generator backup takes 9 1/2 minutes to come up to full power.


Delay in switch to generator power is too long to meet 99.99% up time requirement for EMR system.

0 Suggest battery backups to bridge gap between loss of electrical from Tacoma Power and Generator power. Capacitors are required in order to stop the fluctuations in the power supply.


Power usage often exceeds power capacity for entire facility.



0 Power Supply needs to be addressed before implementation of an EMR system


Present, but can't handle the power fluctuationsMDF, Server room : UPS exist

Medical building IDFs : UPSs exist but some of them are inoperable due to main power accident

Non-functioning UPS 1 Capacitors are required in order to stop the fluctuations in the power supply.New UPS for IDFs



Delay in switch to generator power is too long to meet 99.99% up time requirement for EMR system.

0 Suggest battery backups to bridge gap between loss of electrical from Tacoma Power and Generator power.


MDF : Good HVAC system with dedicated controlsServer room : Air conditionerMedical Building IDFs : Air conditioner

Redwood IDFs : no air conditioner but temperature is not exceedingly highRest of building IDFs : air conditioner

None 4 None


Non hosting site Non hosting site N/A N/A N/A




s




s

Cabling /

Requirements




Investment Category




1


None 4 None


MDF : Fire alarm, no fire suppression Medical building IDFs : Sprinkler Lack of sufficient fire suppression 2 Considering the importance of data availability in medical service-related buildings, recommend gas based fire suppression in MDF and fire extinguisher in IDFs

Servers

N/A

1


N/A N/A


N/A N/A

3


N/A N/A


N/A N/A

ServersN/A N/A N/A

1


None 4 None

Cabling / Pathways


None 4 None


None 4 None

WAN / LAN






Cabling / Pathways

Cabling / Pathways


General cabling infrastructure is very well managed. Cables are labeled and tied.

Documentation is well organized and accurate.

MDF & IDFs : patch panel exist

Conduits are well managed and have sufficient room for additional cabling

MDF & IDFs : Conduits are well installed and have room for additional cabling

Only applies to hosting sites; SCC is not a candidate given the variable power supply.

Only applies to hosting sites; SCC is not a candidate given the variable power supply.



Investment Category




Records: Includes Mental Health, Intake, Legal documents. Project underway to scan the records. Rest of Medical record is maintained on the units. Running out of space as files need to be retained for life of individuals, up to 70 years. Conduit exists, but additional wire needed for 1 - 2 data drops.Pill Line: multipurpose room. 4 lines per day, serving 70-80 residents. Needs 1 -2 data drops for Pyxis machine.Medical Clinic: Most rooms have some data, but a few more drops are necessary, especially in Dental area, and Main Nurses Station.

PAM AREA 1 (Alder, Birch, Cedar): Cedar South: 1st Floor: 2 Treatment Rooms (C304/C307) each have 1 data port, 1 voice. Main Control Desk has 2 v/2 dp, 1 on each side, as does the office behind the control desk; each area could use an additional data drop to accommodate usage. Isolation Room used for 1-on-1 intensive watch - need ability to chart behavior Would be risky to have unsecured laptop/tablet/PDA. Kiosk is possible, as there is already one there for patient access. Current access is through floor for both floors. 2nd Floor: Medically Fragile patients (Inpatient/Hospice). Nurse Station is in center, and rooms surround it and extend down each hall way. Rooms and hallway are not wired. Candidate for wireless.

Cedar North: Good candidate for wireless access points, rooms are not wired, Pills and sick call are occasionally door to door, but normally the patients come to the central station for pills

Additional data ports required, see observations

Recommend adding approximately 15 new data ports in the following areas: Pill Line (2); Records (2); Cedar South (2): Alder (1 for printer, 2 for w/s); Medical (1 in Nurses Station, 1 where medical records are now, 4-5 in dental for w/s and xray machines).

Alder: same footprint as 1st floor Cedar, with same needs in main areas However, patients come out into main area near officers desk to receive pills; sick call??.

IMU: 6 rooms, no computer access--candidate for wireless.Intake area: has 2 data ports, 1 workstation and 1 m/f device. ok.Birch: women's quarters, only 4 rooms, data at nurses station.PAM AREA 2 (Elm, Dogwood, Fir, Ginko): 2 sets of 48 stacked and 1 extra 24 rooms. Each are the same, all have data and voice, need workstations.

Redwood: Observation desk has plenty of data, needs additional workstation, may need to build both in and readjust in order to be HIPAA compliant.


Current Backbone switch model is not scalable

2 Recommend upgrading the Backbone switch to Cisco Catalyst 65xx grade


None 4 None


None 4 None


Insufficient Backbone switch capacity 2 SCC needs Backbone switch upgrade to Cisco Catalyst 45xx grade


Insufficient WAN bandwidth 0 WAN bandwidth upgrade is recommendedConsidering the risk of existing fiber cable (MICC B block to SCC MDF), use of the new underwater fiber cable installation is recommended for WAN upgrade, to 10 mb bandwidth.

1There are sufficient data drops in

appropriate locations to support the EMR system.

Backbone switches don't have enough available Gigabit ports for additional workgroup switchAll of the Workgroup switches have available ports for additional workstations

2

Backbone switch is two Dell PowerConnect 5212s. Each Backbone switch serves different group of workgroup switches. Number of fiber cables between MDF and IDFs are sufficient and can be utilized for future redundant Backbone switch to workgroup switch connection.

WAN utilization is very high (>80% for current applications)

Current WAN T1 X 1 from MICC Microwave tower (Qwest). One fiber cable from MICC B block building to SCC MDFCurrent fiber cable from MICC is buried without any protection (No pipe or conduit), which increased the risk of WAN outage. Due to this risk, SCC cannot add more T1 lines on Microwave network which is connected by the high-risk fiber cable. Instead existing submarine fiber cables from Steilacoom could be utilized. This new WAN connection needs new pathway from presence of submarine fiber cable to SCC MDF

Does not exceed the standard

No redundancy but the upgraded Backbone switch will have high availability



Investment Category





Single WAN connection could be single point of failure

0 After submarine cable is connected to SCC MDF, current existing microwave T1 line could be utilized as a backup even though it doesn't provide carrier diversity. Carrier diversity is not viable option due to location of site


No QoS 0 DIS will implement QoS for agencies


None 4 None


None 4 None

WAN / LAN




Cabling / Pathways


N/A No wireless No wireless 0 New wireless would be compliant

2


Dental area may be candidate for wireless, as no data exists currently.

Cedar is candidate for wireless, on both floors, as is Alder.IMU is wireless candidate

No wireless anywhere on campus 0 Necessary Access Point Installation:

Dental : 1 AP (Access Point) in main clinicCedar : 2 AP each in Cedar North, Cedar South, Cedar West, and Central Cedar monitoring area (8 total for Cedar)NOTE: Cedar North, West, and South are each approx 75' X 20' in dimensionAlder : 2 pods, 1 AP for each pod plus 1 AP for center hall, total 3 APs for Alder IMU : 2 pods, 1 AP for each pod plus 1 AP for center hall, total 3 APs for IMU (All AP installations high difficulty, due to secure, hardened buildings)

User Devices


Summary of Additional Workstation Needs:

Records: new position requires 1 new PC; Medical: 1 in nurses station, 1 in med records, 1 in each of 4 exam rooms, M355 1 if pill line is opened,; Dental Office 1 if not wireless, 1 in treatment room, 0 in lab (has a workstation), 1 in Pharmacy

Summary of Additional Workstation Needs:

Cedar: 1 in each of 2 treatment rooms, 1 at Main Control Desk, and 1 in Office behind Desk, 1 in Cedar South; Alder: same setup as Cedar, so duplicate needs; Birch: 1 workstation at desk; PAM Area 2: 1 w/s in each of 2 offices in each building (8 total); Redwood: 1 at Observation desk in both North and South.

See Observations at left 2 See Observations at left. Also would require a number of laptops / tablets / PDAs for areas where wireless would be installed (1 per staff per shift) -- see below in section N






1 Network level security should be implemented;

Establish more formal process for medical director to submit IT work orders, for setup of nursing staff with private mailboxes on area/clinic printers (to remove old staff and add new, on a regular basis)

DSHS ISSD team monitor network

No QoS is implemented

No redundancy, refer to J6

CAT5 cabling through entire campus

3-year cycle purchase program.The latest PC spec : Intel Core-Duo, 4MB cache, 19'' display, 1 GB RAM, 2400 ATI graphic card

None

DSHS ISSD team sets security standard. Current network doesn't provide any level of network security such as Network Access Control.

There needs to be a more formal process for medical director to submit IT work orders (with regular contract nursing staff changes)

No network level security;

Ineffective IT work order process for new accounts

4 None



Investment Category





5












User Devices

Minimal use of laptops currently;

Assume newly purchased laptops/tablets/PDAs would comply with specs

Minimal use of laptops currently;

Assume newly purchased laptops/tablets/PDAs would comply with specs

Additional mobile devices (laptops / tablets / PDAs needed in multiple areas

0 Newly purchased or leased laptops / tablets / PDAs should comply

Estimated count of recommended laptops, notebooks, tablets, or PDAs:Need 1 laptop, tablet, or PDA per provider - (3) Laptops / Tablets / PDAs for staff working in wireless areas (except for dental) - (approx. 8 - 12)Dental - (1)

Total - (12-16)

Printers


Multifunction device needed in Pharmacy Alder and Birch need m/f devices See observations 3 Replace existing printers with multifunction devices as their lease or life expire.

Suggested locations of replaced mf printers (2-3):Medical Clinic (back area) - (1)MP bldg: Medical Records area (1-2)

Suggested locations of new mf printers (3):Alder - near nursing officesBirch - small - near control stationCedar - wireless ptr preferred, near Central station for North, South, West

Estimated total new multifunction devices: 5-6






1 Print server, static IP address on printers, windows compliant None 4 None

Compliant None 4 None



Investment Category







No redundant print server but this site is not hosting site

None 4 None


s

Printer output could be viewed inappropriately if extra measures not taken

Susceptible to unauthorized viewing 2 Configure printers with security code on printers that are in high traffic areas.

ScannersScanning capabilities need to be turned on for existing and new multifunction devices.

Scanning capabilities need to be turned on for existing and new multifunction devices.

Scanning capabilities need to be turned on for existing and new multifunction devices.


2 See gap and observations: Scanning need would be supported by multifunction devices


2 See gap and observations: Scanning need would be supported by multifunction devices

WAN/LAN

Lab system

web based system through Quest DiagnosticsFunctional need: Will need ability to upload information from Quest Diagnostics to EMR system.

No infrastructural gap 4 None - sufficient WAN bandwidth to support interface, if 10 mb fiber link is implemented

Pharmacy system

Pharmacy function is relocating to DOC. Will need to interface with CIPS;Functional need: Interface will be required between existing Pharmacy system and new EMR system if CIPS is still in use

No infrastructural gap 4 None - sufficient WAN bandwidth to support interface, if 10 mb fiber link is implemented

Radiology system

X-ray machines are not digitized, but may have the capability to be upgraded. Dental x-rays also require ability to be digitized.NOTE: Radiology equipment may require upgrades to interface with EMR system

Equipment will require upgrades to interface with EMR system

2 None at this time: depends on solution

Sufficient WAN bandwidth if 10 mb fiber is implemented

WAN/LAN




none 4 none




none 4 none




none 4 none




none 4 none





Copy of dshs_Twin_Rivers_Comm_Fac.xls Page 1 of 1


Site Name Twin Rivers Community Facility

Site Location & Date of Site Visit 605 Mcmurray St, Richland, WA 99354. 06/05/2008

Primary Site Contacts (Technical and Medical) Technical : John Verburg, Medical : Randy Kimbler (Supervisor)


# Category Details

1Site Buildings deemed to be in scope (containing EMR system equipment or sites of medical / counseling care) and those deemed out of scope

In Scope :Twin Rivers Community Facility BuildingNo other building exists



3Additional Introductory Information Twin Rivers Community Facility is 12 beds, Juvenile Rehabilitation Administration facility

There is no medical staff

4






Copy of dshs_Twin_Rivers_Comm_Fac.xls Page 1

Date of site visit: 6/5/2008

[0 - Not Met,

4 - No Gap]

Category Investment Category Main building Gaps Score


Physical Space


There is just one building. Staff offices and student living units share this building.

No medical staff reside in the community home. All medical services are provided by outside private healthcare provider with Medi coupon

Medical records are kept at outside healthcare providers

7 staff out of total of 20 need to access medical records, but medical record may not be as critical as other state agency sites such as state hospitals

MDF space : Inside of a boiler room. Space is OK because there is just 1 switch. No secure cabinet. The network switch was exposed without any secure protection.

MDF is not secure 2 Recommend a secure cabinet for MDF

Power company : Richland PUDPower quality is very stable because the building is inside of the city


No generator is required because no medical service is provided at this facility. No critical reason to access medical record 24/7

None 4 None



Agency/Administration: DSHS / JRA

Site: Twin Rivers Community Facility


Requirements









UPS at MDF None 4 None


N/A (non-hosting site) N/A (non-hosting site) N/A N/A


MDF : No air-conditioner but temperature was fine on day visited, even though it was inside of a boiler room

None 4 None


N/A N/A N/A N/A

1


There are no conduits. Cables are directly connected from the switch to workstations without patch panel.Cables are exposed inside of office space without appropriate conduits

Inappropriate cabling standard without conduits or patch panel

0 Recommend new cabling project for appropriate network infrastructure standard(Cabling project will be a total of 15 data drops with appropriate conduits inside of one relatively small building)


MDF : No fire suppression None -- because this site doesn't require 24/7 high availability, and only one small workgroup switch serves the entire building

4 None

Servers





Cabling / Pathways








1


N/A N/A N/A N/A


N/A N/A N/A N/A

3


N/A N/A N/A N/A


N/A N/A N/A N/A

ServersCurrently meet DSHS/ISSD security standards

None 4 None

1





Cabling / Pathways






No vault (One building)No documentation

Inappropriate cabling standard without conduits or patch panelNo documentation

0 Recommend new cabling project for appropriate network infrastructure standard(Cabling project will be a total of 15 data drops with appropriate conduits inside of one relatively small building)Detailed network documentation should be maintained after new cabling project




Cabling / Pathways






WAN / LAN


Office spaces don't have enough data drops:

Supervisor room has 2 computers and they are connected through a mini hub on the floor, instead of a connection from a data drop, because there is just one network cable from a switch

Insufficient data drops in office space


This number of drops is a generous number of drops for future usage, and is based on an expected need for up to 10 data drops, X 1.5 for contingency)


Backbone switch: Dell 2724 switch None 4 None, Considering site's availability requirement, this switch is sufficient




Not required None 4 None




Network






WAN is 10Mbps Ethernet None 4 None


Not required None 4 None






CAT5 None 4 None

WAN / LAN



None 4 None


MacAfee None 4 None



Cabling / Pathways


No wireless network No wireless network 0 Recommend wireless network for main building

2


2 APs will support entire building No wireless network 0 Recommend Wireless network in the main building2 Access Points will support whole building







User Devices


Sufficient number of workstations:

2 computers in a supervisor room, 1 in secretary room, 1 in staff area;A counselor may require a computer, but JRA IT team will provide it on an as-requested basis

None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None

DSHS JRA standardDell 745 will be deployed


User devices





User Devices

2 Notebooks will help staffs keeping medical records

No mobile devices 0 Recommend 2 Notebooks

Printers


Lease program1 Color laser printer2 laser printers

None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


None 4 None


1 print server None 4 None


Scanners


No compelling reason for medical record scanning

None 4 None




Scanner

Printers








No compelling reason for medical record scanning

None 4 None


1 Lab system Outside provider N/A N/A None - 10 mb WAN service will be sufficient for interface to

any EMR solution

2 Pharmacy system No pharmacy. Outside provider N/A N/A None - 10 mb WAN service will be sufficient for interface to any EMR solution

3 Radiology system Outside provider N/A N/A None - 10 mb WAN service will be sufficient for interface to

any EMR solution



N/A None None - 10 mb WAN service will be sufficient for interface to any EMR solution







External Systems



Ancillary Systems

Copy of dshs_WA_Pen.xls Page 1 of 2


Site Name Washington Corrections Center - Women (WCCW)

Site Location & Date of Site Visit Purdy, WA -- 4/28/2008

Primary Site Contacts (Technical and Medical) Technical: Jack Michel, Bruce Ensign; Medical: Eric Hernandez


Christina Abby (HCM2)

# Category Details

1


In Scope: Current Medical Clinic Building, New Medical Clinic Building;Building M (location of pill dispensing)Z BuildingMain Server room / MDF (Outside fence)Special Needs Building;Residence Bldgs (inspected, but no need for EMR system access; emergency care only - counselors have normal desktop access to network)

Out of Scope: Maintenance shops and out-buildings needing no access to future EMR system


MDF: Main Distribution FacilityIDF: Intermediate Distribution Facility

3

Additional Introductory Information New medical building already in budget: will be at least 2.5 X size of current medical building;New building plans already include data cable wiring, with at least 2-4 data ports per room;However, no wireless is planned for the new building;Z building and special needs building are security hardened w/ concrete -- Special Needs building is approx 1/2 size of Z buildingStaff currently uses OBTS system;Medical Staff: 8 nurses, 3 doctors




Copy of dshs_WA_Pen.xls Page 2 of 2

# Category Details

4



Copy of dshs_WA_Pen.xls Page 1


[0 - Not Met,

4 - No Gap]



Physical Space


Sufficient space in MDF and IDFs for any conceivable addition of EMR-related to equipmentMDF Room is at least 20' X 20', not even half full; APC UPS systemCISCO 2821 router taking inbound fibre from State Ring

This report assumes that construction of new medical clinic proceeds as planned and will have sufficient space for workstations and printers/scanners in nurse stations, exam rooms, ICUs and other clinical area.

None 4 No action required, but over the long term DIS and DOC need to confirm full support of medical clinic construction and completion


Electrical power: Single primary feed (single core switch); Backup and redundancy via UPS and generator. The generator is tested every month to make sure it functions when needed.

None, other than no dual power feed

4 No Recommendation - Dual power feed is not necessary as it is cost prohibitive and is not consistent with agency's practice




Every IDF has a small UPS for a workgroup switch and a large UPS in MDF for servers and network devices.Observed that UPS is working properly (actually being used on 4/28)

Per DOC, there is a UPS in every closet. -- (As the UPS's fail, DOC is replacing them with surge protectors.)

None 4 None




HVAC is present and sufficiently sized None 4 None







Requirements


Site: Washington Correction Center for Women (Purdy)








1


Most conduits are accessible and serviceable; single-mode and multi-mode fibres are running between buildings;No cabling for wireless currently planned for new medical clinic

Some IDFs are difficult to access because of physical security

Additional cabling will be necessary to support wireless in new medical clinic

2 Add appropriate cabling (ceiling) to support wireless in new medical clinic and in Z Building (4 + 4 access points) and in Special Needs Bldg (2 + 2 access points)


No measures are in place to protect from natural disasters and fire

None in place 0 Install fire suppression system in MDF


Cabling / Pathways






Servers

1





3




Basic sever monitoring software exists and it should be acceptable for non-hosting location

None 4 No Recommendation - Only file and print servers are on site and advanced monitoring capability should only be applicable at hosting site


N/A

1



Cabling / Pathways


Rack mounted patch panels are observed in every IDF room.

None 4 None


No issues or problems None 4 None

WAN / LAN

This site has and uses VLAN's based on function, e.g., servers and printers, users, etc.


In general, there are sufficient number of data drops at locations where Medical Record is accessed; however, there is a need to have a data drop at pill dispensing location in Building M

Need new data drop at pill dispensing location in Building M

3 Recommend to have a data drop within the pill dispensing room (bldg M)





Pathways








LAN architecture is scalable and no issues are found.100Mb Ethernet throughout the site and an additional equipment upgrade is pending. Also, it is planned to provide 10GE (Gigabit Ethernet) between buildings.

None 4 None




No redundant core switchMulti-mode and single-mode fibres are utilized to provide redundant connection between buildings

No redundant core switch n/a While it was initially recommended to install an additional switch in MDF for added redundancy, this is counter to DOC design standards;No Recommendation


LAN devices will be upgraded and the upgraded LAN devices can support expected increase of workstations and other EMR devices

None 4 None


10 mb connection between site and State WAN None 4 None


DOC does not have redundant WAN backup circuits due to budget constraints.


n/a Recommend to have multiple WAN carriers and separate physical connections for higher availability


QoS is currently not Implemented at DOC No QoS implemented at DOC n/a Recommend to implement a bandwidth management strategy including Quality of Service (QOS)



None 4 None



Network





WAN / LAN







Cabling / Pathways




n/a Recommend to set a standard for a wireless solution (New DOC HQ standards will provide wireless security standard)

2



n/a Significant recommendation to implement a wireless solution for new medical clinic, Z building, and Special Needs Building

User Devices



None 4 None


In general, there are enough workstations to support the workflow with the future EMR system; however, we observed lack of workstations in Z building receiving and accepting area.

Gap in number of workstations in building Z- receiving/accepting area.Additional med workers will need workstation.

3 Recommend to add 3 more workstations in Z building receiving and accepting area. Wiring is already in place; adding wireless is not necessary.

For new building: If a 1:1 workstation to med worker ratio is maintained, and if the new building results in approx 30 additional med workers, approx 30 additional workstations will be required


None 4


None 4


None 4

5


None 4


None 4


None 4


None 4




User devices




























User Devices

About 20 laptops currently in use

A handful of personal PDA's used to hold drug reference and diagnostic info

Needs for portable devices with the future EMR system are identified and more laptops or tablet PCs are required (5 ~ 10)

3 Formalize the process to provide an additional laptops or tablet PCs for medical professionals who could provide care in new wireless areas.Purchase 5 ~ 10 laptop or tablet PC

Printers


Heavy usage of printers and faxes is observed and printing/faxing capacity is currently exceeded

Even if printing demand goes down with future EMR system, current printers may not be enough

2 Consider adding a multi-function device at each nurse station and general clinical area to support the future workflow with EMR

Two to four additional multi-function devices are recommended in the new building



None 4 None












0 No Recommendation - Redundant print server is not required for non-hosting site


Generally printers are in secured office areas, but there are some printers which could potentially be accessed patients

Printers are not in secured area 3 Make sure to place a printer in a secure location, so that unauthorized personnel can't easily access the printer. Also, it is recommended to modify print server configuration to increase security.

Scanners


Only one scanner (Sharp MX550) is found.MX550 is a modern multi-function device which has high processing speed

None 2 Recommendation to add more multi-function devices is included in Section O-1



None 4 None


A lot of interactions with St. Joseph Medical CenterSt. Joseph Medical Center utilizes Elysium EMR and an ability to exchange medical record with the system is necessary



1 Lab system

Laboratory tests and services are mostly done through Quest Diagnostics. However, some basic lab tests such as urine dip are done within the facility. Users can log into Quest's website to see lab results





Scanner

Printers








2 Pharmacy system

DOC has a centralized pharmacy solution from Correctional Pharmacy Software (CIPS) - It is a pharmacy software system specifically for prison or jail pharmacy. DOC wants to be able to see patients' basic medical information (lab results, progress notes, diagnosis, formularies and clinical outcome) to be accessible through CIPS once a new EMR system is implemented. DOC is also planning to have a central pharmacy which can serve all DOC sites. Pharmacy located in WCCW is also expected to be much smaller once the central pharmacy is created. Users are currently not experiencing performance issues.



3 Radiology system


Once new building is completed, radiology service will be provided within the facility and will have own digital imaging system.





Information can be exchanged via State's network No WAN Bandwidth Gap expected














External Systems


Ancillary Systems

Copy of dshs_Western_State Hosp.xls Page 1 of 2


Site Name Western State Hospital

Site Location & Dates of Site Visits Lakewood, WA - May 6-7, May 12, and June 16, 2008

Primary Site Contacts (Technical and Medical) Technical: John Wallace, Paul Davis, Mike Davis, Chris Feltis; Medical: Multiple


Plant / Electrical: Dave Hess

# Category Details

1


In Scope: All buildings and wards attached to the Main Administration Bldg, including Wards C7,C8,C9 and Wards C15 thru C19, Wards C1,C2,C3, and Wards C4,C5,C6 In Scope: South Hall wards S1 thru S5, and S6 thru S10In Scope: Other West Campus bldgs: Main Pharmacy, Patient Financial Services, Kitchen/Dining, W1/W2 (PALS), Gym/Activities Bldg 10, Auditorium (Bldg 6), Green House, TPR Bldg (only as a DR site)In Scope: East Campus: CFS (including Ward E2), Main Clinic, Dental, Wards E1, E3 thru E8

Out of Scope: Maintenance Area bldgs (office, shops, power house, laundry), North Hall, Chapel, Historic Cottages on Fort Street and Cottage Row, Tacoma Work Release

2


CFS: Forensic ServicesCSTC: Child Study Treatment CenterESH: Eastern State HospitalSCC: Secure Community Center (McNeil)COAS: Adult Services CenterUPS: uninteruptible power supplyTPR: Tacoma Pre-Release




Copy of dshs_Western_State Hosp.xls Page 2 of 2

# Category Details

3

Additional Introductory Information Largest DSHS site;Approximately 1500 potential EMR system users;Summary level inventory of user devices: 27 Laptops 24 Pocket PCs 1134 PCs PC Inventory: No current standards. Some PCs are as old as 10 years. Some are newly leased since just last year.

Currently, WSH medical staff are significant users of Veterans Administration VistA and Intersystems Cache;

Many of the buildings at WSH are historical and some are jail-hardened (such as in CFS)

Major systems currently in place: Intersystems Caché, Veterans Administration VistA.; Ancillaries: Lab, Pharmacy, Radiology, Dental, Physical Therapy, Infection Control, Inventory Control, Dietary, and Patient Funds.

4

Final Revisions Made (July, 2008) Redundant backbone switches are being recommended only in the largest, most critical locations where it is necessary to support planned changes -- WSH is such a site, and is having redundant backbone switches recommendedRedundant print servers are not being recommended.FM200 gas-based fire suppression systems are being recommended only in MDF's or highly critical IDF's where physically viable; Otherwise, fire extinguishers are being recommended.For IDF's where A/C installation is not practical, venting (for air circulation with building air) is being recommended.Additional cooling in the basement (telephone room) of Bldg 18 has been recommended.Improved network connectivity for Bldg 6 and Bldg 10 has been recommended.Added print security features for all networked printers has been suggested.An estimate for additional FTE in desktop / laptop support has been recommended.


Copy of dshs_Western_State Hosp.xls Page 1

Date of Site Visits: 5/6, 5/7 2008,5/12/2008, 6/16/2008

[0 - Not Met,

4 - No Gap]


Admin Bldg, Main Computer Room, C Wards: C1-C3, C4-C6, C7-C9, C15-

C19

South HallS1-S5, S6-S10

Other West Campus Bldgs:Pharmacy, Billing, TPR, W1-W2, Gym East Campus E-Wards: E1, E3-E8 East Campus: CFS:

Buildings A-F, + E2East Campus: Main Clinic, Dental,

PT, Pharm Gaps Score(0 - 4) Potential Recommendation

Physical Space


Main Computer Room (2nd floor of Bldg 18):Located in a side room off a computer dept. office:Substandard computer room: A/C not dedicated to computer room.

No raised floor, glass window to outside, separated from main backbone switch (which is downstairs), not very much room to expandMain computer room contains servers for misc applications, conduits are OK, decent racksThere are three rack mounted UPS’s as well as two small UPS’s.

In Summary, this server room is likely not a candidate hosting location for an agency wide solution

Physical space of nursing station in of each of the S1-S10 wards is very limited:The site visit included physical inspection of Wards S2, S5, S6, S7 and S9; Staff confirmed that S1 thru S5 had identical structure, and that S6 thru S10 were very similar to each other. All of the nurse stations had the front desk area which was not fully utilized due to security issues, and small nurse office area which was shared by all nurses, and even doctors. On the day of the site visit, each of nurse offices was busy, and staff confirmed that it was normally that busyThe back office space for nurses office is very small and busy. In best case, 1 ~ 2 more workstation could be installed.Doctors, social workers share this space & workstations when necessary.

Pharmacy: Main Pharmacy serves WSH, CSTC, ESH, Fircrest, Rainier, Lakeland Village, Yakima Valley

Patient Financial Services (related to billing) - Building 34: OK on workstations and data drops

W1-W2: one side not currently used, but could be activated: this study will assume activation of both sides

TPR building has been abandoned for over 5 years; does not meet code; uninhabitable (30K-40K sq feet of space) - not ADA compliant, very substandard wiring

Gym (building 10): proposed campus DR site

E-5, E-6 are the layed out the same;E-7, E-8 are the same layout, but different patient types

In general, the CFS wards (highest security at WSH) would never have charts or laptops in open areas with patients

10 Wards, 300 beds total; several remote offices;Community program includes approx 70 patients

12-16 PhDs, + 5 General Practitioners;Approx 450 staff would provide medical input to future EMR system

6-8 appts offsite per day

Some similarities to SCC environment -- will review when at McNeil

10 Wards with 300 Beds and 450 staff: Nearly all will need some level of access to future EMR system

COAS Treatment Mall - Bldg 29:

Age 55 and older;

Main Computer Room: Glass window to outside presents a security issue;Main Computer Room: Limited room for expansion, if considered as a hosting siteMain Computer Room: Patch cables could be more secureSouth Hall S1-S10: Limited workspace and security issues force crowding in back offices

3 Main Computer Room: Recommend additional security (such as iron bars) for glass window to outside

Main Computer Room: Recommend minor securing of patch cabling (currently on wall) with mount near ceiling

South Hall: Recommend considering additional security at front desks of nurse stations (such as the plexiglass used in CFS), to at least enable future mobile laptop usage

1 Back up & redundancy should be in place For Main Computer Room (2nd floor of Bldg 18): Generator at Plant

None 4 None


Verbally reported to be generally OK, but no usage statistics available

One electric power issue noted in East Campus Pharmacy: One long power cable stretched and barely serving need

One minor gap for electric noted - East campus pharmacy

4 Recommend to confirm acceptable electric power usage levels via measurement;

Additional electric power access - East Campus Pharmacy

Confirmed on 6/16 that East Campus Pharmacy electric issue has been resolved.


Main Computer Room (2nd floor of Bldg 18): There are three rack mounted UPS’s as well as two small UPS’s.

None 4 None


None n/a - this has been deemed to be an unrealistic requirement for non-hosting sites

n/a N/A - No cost viable option to remediate;This has been deemed to be an unrealistic requirement for non-hosting sites


Main Computer Room (2nd floor of Bldg 18): cooling shared with another room -- controls not fully dedicated;For the bldg 18 basement telephone room (housing the main backbone switch), it is warm (77-78 degrees)

Main Computer Room: inadequate cooling; needs to be remediated;

Telephone Room (which houses the backbone switch) in the basement of Building 18 also has ineffective cooling.

2 Install dedicated cooling to main computer room;

Install dedicated cooling to telephone room in basement of Building 18


Main Computer Room (2nd floor of Bldg 18): no redundant cooling

None none none none none none n/a Redundant cooling to main computer room is being recommended only for future EMR hosting sites


Requirements







Agency/Administration: DSHS / HRSA

Site: Western State Hospital






C19




PT, Pharm Gaps Score(0 - 4) Potential RecommendationRequirements

1


Conduits are generally in poor shape; conduit spaces are full, and many cables are not in formal conduits

In the first several IDF areas we inspected on Day 1 of the site visit (Specifically, IDFs and data closets in the Admin bldg and in the buildings attached to it (in buildings labeled bldgs 9,17,18,19, 20 (C4) on the map), the conduits in the IDF's were not in good shape - many conduits were nearly full or full (Conduits observed in these building averaged > 80% full, and many were > 90% full)

Conduits in building 21 (Ward S2) were observed to be full

Numerous gaps in nearly all areas:

For IDFs in the Admin bldg and in the buildings attached to it (in buildings labeled bldgs 9,17,18,19, 20 (C4) on the map), the conduits were not in good shape - many conduits were full.

Given that we recommend additional workstations, printers, and wireless access points, this conduit status cannot accommodate additional cabling.

1 Significant improvements will be necessary: At a minimum, conduits need to:

1) Accommodate additional data cables that will be required for the additional workstations, networked printers, and wireless access points that are recommended in this report2) Accommodate additional fiber cables that are recommended to each switch, to avoid stacking issues; We are recommending a Deloitte-observed industry best practice here, which is to recommend a dedicated fiber connection to each Workgroup switch. Stacked switches with a single connection (Single fiber connection from Backbone switch to a group of stacked switches) pose “Single point of Failure”. If the switch which has the connection to Backbone fails, all stacked switches lose network connectionIdeally, the resolution would be a complete redesign and replacement of the entire conduit system supporting the telecommunications network --

Further discussion on 6/16 focused on implementing a reasonable level of redundancy which will involve the addition of a redundant backbone switch and redundant standby fiber to each pair of workgroup switches. (“Medium Scenario”)


Water fire suppression only -- Because of the water fire suppression systems in and above the server room, flooding and water damage to equipment is a possibility and potential problem.

Ineffective and possibly damaging fire suppression in main server room

1 For main computer room: Recommend FM-200 (gas) fire suppression

Additional Note: For buildings selected as campus DR sites, we believe that new wiring solely in support of a WSH campus DR plan (that we have not been involve in) is out of scope of the MRTG project

Servers

Servers are sized for WSH use only; would likely be used only in a WSH-only solution

1


None n/a n/a None, since we do not believe that this is a candidate hosting site


WSH server utilization OK; based on chosen application solution, it is unclear how much more, it at all, the current servers would be used

n/a n/a None, since we do not believe that this is a candidate hosting site

3


None n/a n/a None, since we do not believe that this is a candidate hosting site


None evident n/a n/a None, since we do not believe that this is a candidate hosting site

Serversn/a n/a None, since we do not believe that this is a candidate

hosting site





Cabling / Pathways





C19





The main backbone switch is located downstairs in the telephone room (below the main computer room). The primary inbound fiber to the campus enters the building under the telephone room, under a plywood plank. The space under the plywood plank (sort of a mini-vault) is in good shape: clean, dryDistance from bldgs to main switch room, # of switches:

Bldg. 09 850 ft, 7 switches, (C7-C9, C15-C-19)Bldg. 18 r011 350 ft, 3 switches (Main Admin)Bldg. 18 R201 300 ft, 2 switches (Main Admin)Bldg. 18 R211 400 ft, 3 switches (Main Admin)Bldg. 19 R027 200 ft, 3 switches (Main Admin)Bldg. 19 R209 300 ft, 1 switches (C1-C3)Bldg. 20 R011 400 ft, 3 switches (C4-C6)

Distance from bldgs to main switch room, # of switches

Bldg. 21 r202 1100 ft, 8 switches (S1-S10)

Distance from bldgs to main switch room, # of switches:Bldg. 13 850 ft , 2 switches (Main Pharmacy)

Bldg. 16 300 ft , 2 switches (Dietary)

Bldg. 10 2350 ft , 1 switch, (Gym)

Bldg. 11 1450 ft, 1 switch, (Commissary)

Bldg. 17 R027 1100 ft , 3 switches (Wards, Admin)

Bldg. 17 R132 1200 ft, 1 switch (Wards, Admin)

Bldg. 17 r332 1000 ft, 2 switches (Wards, Admin)

Bldg. 25 1600 ft 1 switch (legal services)

Bldg. 27 2000 ft 2 switches (W1, W2)Bldg. 24 1450 ft 3 switches (patient financial services)

Distance from bldgs to main switch room, # of switchesBldg. 29 Basement 1600 ft 2 East

Bldg. 29 R162 1900 ft 1 East

Distance from bldgs to main switch room, # of switchesBldg. 28 R102 1500 ft 5 switches, CFS

Bldg. 28 R101 1500 ft 4 switches, CFS

Distance from bldgs to main switch room, # of switches

Bldg. 29 Basement 1600 ft 2 East

Bldg. 29 R162 1900 ft 1 East

Bldg. 50 CSTC 2550 ft 3

Bldg. 52 CSTC 2550 ft 1

Stacking of switches in critical, high volume areas is not preferred; additional dedicated cable to switches is necessary

1 Will recommend additional fiber to most or all medical services buildings and wards to remove switch "stacking", i.e. to have dedicated one cable per switch (see additional details below)


1


IDF switch closets should be accessible and switches should be appropriately configured

Conduits not easily serviceable, and not in good shape to accommodate updated cabling -- Examples:IDF for bldg 9 (in C17) : conduits full, no conduit pipe, very crowded, warm room: 79-82 degrees, 2 UPS, loose wiring, cabling along hallway ceilingIDF for C-2: 1 SMC switch with 22/24 ports used, warm = 78 degrees, conduits OK, water fire suppressionIDF in Bldg 18 (room 18G-011): No dedicated fiber cable per switch: one inbound fiber serving 3 stacked switches: this is very common throughout campusBldg 19 IDF: One fiber for 3 stacked switches, conduits full, central air, small PAC UPSE-3 IDF switch (servicing E1,2,3,4): Five stacked switches served by one fiber; conduits fairly full; no fire suppression

The conduits from the S2 IDF room to workstations and other devices are full

S2 IDF covers the entire building (Bldg 21 South Hall): Conduits were observed to be full. There are 2 groups of switches. Each group has 4 stacked switches with 1 fiber connection to the MDF. (Therefore, a total of 8 switches supported by 2 fiber connections)

Main Pharmacy switch room: Clean, neat, cool (outside air and vents); switch room recently re-built and cleaned up;2 stacked SMC switches; conduits are full (sawed hole in ceiling) ; OK on switch ports; W1/PALS switch closet: (serves all of PALS = (W1+W2)):Two stacked SMC 6624 switches; no formal conduit (hole sawed in ceiling)Contains VDSL box to gymCentral air, but temp OK on day visited; water fire suppressionSmall Smart UPS; Ports OK; Gym (bldg 10): VDSL, no fiber; one 2524 HP Procurve switch, only 9/16 ports used -- however, the switch is stacked with the VDSLNot secured properly - in unsecured box in janitors' closet;UPS, but no fire suppression, no ventilation; Gym: Not acceptable as a DR site

E-3 IDF switch closet: conduits full, 5 stacked switches for one inbound fiber, no fire suppression

E-7 Data Closet: One switch only; no fiber -- UTP copper serving end devices only;

Bldg 29 (East Campus E-Wards) has two IDFs, One is the basement IDF which has 2 switches, and the other one is E3 which has 5 switches. Each IDF has two data closets with UTP stacking cable respectively (E3 : E1 and E2, basement : E5 and E7).

Recommendation :Recommend direct fiber cable connection to E1, E2, E5 and E7 IDF

E2 Switch Closet: One of the better closets: good conduits, good power, water fire suppression, smoke detector, UPS;However, 2 stacked (new) HP2524 switchesNo separate air, but good temperatureE1 Switch Closet is the same

The E2 IDF is connected to the E1 IDF via CAT5 -- this connection should be fiber

Bldg F (CFS) data closet: DR location for several systems;5 stacked SMC switches; ports basically full;Warm room temp: 77-79 degreesSaid to be a DR location for several systems

No issues or problems observed with conduits, switch closets in this core area of the East Campus

Many of the telco conduits are difficult to access and service. The steam tunnel network serves only part of the campus. To achieve even minimum required networking upgrade, the conduits would need to be improved, expanded, and upgradedIDF closets have numerous issues related to reliability of switches, resulting from stacking of multiple switches being served by a single fiber connection (For example, we believe that it is a weakness and reliability issue not to have direct fiber cable connections to the E1, E2, E5 and E7 IDFs)

1 Minimum recommendation: Add sufficient fiber connections between main administration building and each building IDF switch room to eliminate stacking of switches (i.e., dedicated fiber to each switch). This would involve at least 20 additional fiber lines (avg. 700 yards) to the East Campus and at least 16 additional fiber lines (average 400 yards) to the West Campus -- counts still being confirmedIdeally, the resolution would be a complete redesign and replacement of the entire conduit system (impact lessened if wireless pursued) supporting the telco network, along with associated cable management -- Implement a reasonable level of redundancy which will involve the addition of a redundant backbone switch and redundant standby fiber to each pair of workgroup switches. (“Medium Scenario” above)Potential problems with current network: First of all, current cabling is not sufficient to support the availability level we recommend – There is little or no redundancy and there are single points of failure due to stacked switches. Labels are not very well managed and cables are not organized. Secondly, the IDF environments are generally poor. Thirdly, network devices are not standardized which would pose potential security and management problems in the future because these mixed brands can not support standardized Network Security such as Network Access Control, Secure VLAN architecture.

Cabling / Pathways

1

There should be straightforward access to network drops (such as via rack-mounted patch panels);

IDF Rooms should have appropriate environmentals and UPS

All of workgroup switches in IDFs are stacked

Patch panels in place

All of workgroup switches in IDFs are stacked

All of the IDF rooms have patch panels

IDF's supported by electric generator at plant; All switches in IDF rooms have UPS

None of the IDF rooms in South Hall have dedicated air-conditioning

None of the IDF rooms of South Hall has fire suppression


Cooling in IDF rooms varies: mostly central air or no air; few, if any dedicated cooling devices;

Gym IDF: fairly warm roomGym: no fire suppression

East Campus Electric Distribution Room (Bldg 29):Contains some switching equipmentCool; water fire suppression


Cooling in IDF rooms varies: mostly central air or no air; few, if any dedicated cooling devices



E3 switch room: no fire suppression



Air ventilation to IDF rooms needs to be improved;

Appropriate fire suppression for critical IDF rooms is lacking

3 Apply basic cooling remediation to IDF closets with temperature / air issues:Add appropriate venting and/or fans to all IDF rooms, to at least mix IDF air with room air.

For IDF rooms: Recommend fire extinguishers for fire suppression:



Cabling / Pathways





C19






No documentation available on contents of vaults;

Steam tunnel which is used as a pathway for fiber cabling between MDF and IDF in some other buildings is in fine shape - photos taken. Cables are well protected and free from any physical damage (Steam tunnel does not serve all buildings)

No documentation available on contents of telecommunications vaults

2 Recommend development of documentation for contents of telecommunications vaults

WAN / LAN

Logical network is one VLAN; no network access control;

As noted in section L, we recommend the implementation of a combined mobile device / wireless solution to supplement existing stationary workstation devices for several reasons, including: improved mobility for health care and counseling professionals, space limitations which prevent adding additional stationary workstations in congested areas, lessening the impact (vs. wired solutions) on the existing conduit system, and offering upward growth and scalability options.

1

There are sufficient data drops in appropriate locations, to support the necessary workstations, networked printers, and access points for a future EMR system

C-2: (has same basic layout as C-1 and C-3):Plenty of data drops at nurse station -- but no workstations due to security (patients take or destroy);C-9 CAS Treatment Mall: generally well-wired, but no workstations can be behind counters, due to theft/security/HIPAA;C-9 Treatment Mall: No data drop in Group Therapy Room 353;C4-C6: additional data access method inside of back office should be installed (either wireless or data drops)

S1-S10: additional data access method inside of back office should be installed (either wireless or data drops)

W1 is very lightly wired, and is short at least 6 data drops and six workstations (need 2 drops at nurses station, exam room, lounge, exercise rm);Patient Financial Services: stable work group; 1:1 user to wkstation ratioSatellite Pharmacy: sufficient data drops;Main Pharmacy: sufficient data drops;Gym (bldg 10) needs data drop in first aid room; possibly one needed in group roomDietary: Sufficient data drops

East Campus Pharmacy: substandard LAN cable wiring; need 1-2 additional data dropsE7 nursing station: (data jack punched thru wall - minor maintenance work order only -- not a gap);E5, E6 nurse stations: new addtl data drop & wkstation needed;

TRC area : not enough data drops in staff room (add 2-4):

Specifically, TRC (one of the areas in East campus) has a staff room with some data drops, but this room needs 2-4 more data dropsWireless connections may be more viable for this room.

CFS conference rooms, med rooms, treatment rooms, exam rooms in good shape w/r to data drops, except for exam rooms (1-2 per ward) which are without data drops

Group therapy rooms have data ports, but not a good idea to place workstations there due to security issues

Main Lab - East Campus: OK for data drops

Main COAS Clinic exam rooms: No data, no workstations in at least five exam rooms (wired desktops would be OK);

Main Dental: No data, no workstations in xray or in 4 dental exam rooms;

PhysTher: Need another data drop in back area

The need for additional data drops to support standard workstations in various buildings is relatively modest:W1, W2: 12East Pharm: 2E-Wards: 14Main COAS Clinic: 5, Dental: 2, PT: 1C9 treatment: 1, C4-C6: 3, S1-S10: 10,Gym (bldg 10): 1, TRC: 4 (hardened area)CFS Exam Rooms: 6Total: 65 (13 medium difficulty, 52 high difficulty drops, due to building conditions or hardening)Drops for misc new multi-func prtrs: 30 (assume all high difficulty)

2 Add data drops as indicated at left under gaps


Demand on LAN architecture has already exceeded its practical limits; The main backbone switch is not adequately sized for necessary local network upgrades that will be recommended elsewhere in this report

General data wiring cleanup needed throughout

Demand on LAN architecture has already exceeded its practical limits

Demand on LAN architecture has already exceeded its practical limits; Main Pharmacy: substandard wiring (data drops from poles, some wires in wet, dirty floor areas in the back portion of the Main Pharmacy area) .W1, W2: Insufficient number of data drops: As noted above, there is a need for six additional data drops in W1




LAN infrastructure has significant shortcomings, with respect to Backbone switch & Workgroup performance, capacity & capability, available switch ports, and the ability to accommodate additional cabling for additional workstations, networked printers, and wireless access

2 At a minimum, recommend switch upgrade and cleanup, for all switches serving EMR system access locations (2 Backbone switches and approx 72 Workgroup switches);

Note: current Workgroup switches cannot support PoE (Power over Ethernet), which would be needed for the wireless solution

Per discussions on June 16, upgraded Backbone switch type should be at least Cisco Catalyst 45xx-class (X 2) and Workgroup switch types should be at least Cisco 2960-class, 48-port devices, with upgrades to a single vendor switch type preferred. The approx. 72 24-port switches would need to be replaced by at least 55-60 48-port switches, given planned growth and additional devices and wireless access points.


No statistics available TBD n/a Further analysis of LAN utilization is warranted: LAN NMS tools such as Solarwins or Orion are recommended.

Note that we don’t recommend the network switch upgrade for utilization enhancement/reduction only. We consider availability, security and performance all together.


Network





C19






No redundancy No redundancy No redundancy No redundancy No redundancy No redundancy LAN infrastructure has no redundancy

0 Redundancy should be introduced if complete network redesign and replacement is pursued


LAN switches have no more than 24 ports and many switches don't have enough available ports for additional workstations or printers.






older switches with 24 port max presents a limitation

2 Network switch upgrade for all switches serving EMR system access locations (approx 60 switches):

Note: We don’t recommend the network switch upgrade for utilization enhancement/reduction only. We consider availability, security and performance all together. Also, network switch devices are not standardized, which would pose potential security and management problem in future because these mixed brands can not support standardized Network Security such as NAC (Network Access Control), Secure VLAN architecture.

Also, current switches cannot support PoE (Power over Ethernet), which would be preferred for the wireless solution



Main WAN connection from Main Admin Bldg to Statewide SGN (via DSHS network) is 10 mb; currently believed to be sufficient, especially since many applications are running locally

TBD - further study need to determine if 10 mb can support future EMR load (analysis in progress)

n/a TBD - further study need to determine if 10 mb can support future EMR load (analysis in progress) . Final decision on whether 10 mb WAN connection is sufficient is dependent on the final system solution, and the "chatty-ness" of the selected EMR application system.


No redundant carrier n/a not economically viable


No QoS is implemented n/a Plans for QoS at DSHS level


Network tools and monitoring capabilities are limited - can ping switches to see if they are up.

n/a More options for network monitoring will be possible if all switches are the same brand.Along with network switch upgrade, we recommend local implementation of network monitoring systems available through ISSD, such as Solarwins or Orion


CAT5 or higher except for building 6 and building 10 VDSL connection

Bldg 6 (Auditorium) and Bldg 10 (Gym) are connected to the infrastructure with inadequate VDSL lines (They are not CAT5 and not 100mb)

Bldg 6 (Auditorium) and Bldg 10 (Gym) are connected to the infrastructure with inadequate VDSL lines (They are not CAT5 and not 100mb)

3 Upgrade network connectivity for Bldg 6 (Auditorium) and Bldg 10 (Gym) with fiber connectivity [with dedicated fiber to each building, with new trenching], and provide either CAT5 cabling in those buildings and/or effective wireless access

WAN / LAN


Need to confirm with Tina (DSHS security policy)

tbd



tbd



tbd

Cabling / Pathways

All of the nursing station areas in C1-C6 potentially need wireless networkDoctors and social workers record patient behavior at patient locationWireless network with mobile device can solve physical space and security problems at nurse station

All of the nursing station areas in S1-S10 potentially need wireless networkDoctors and social workers record patient behavior at patient locationWireless network with mobile device can solve physical space and security problems at nurse station

Note: wireless technology gives more upward scalability for growth


We recommend the implementation of a combined mobile device / wireless solution to supplement existing stationary workstation devices for several reasons, including: improved mobility for health care and counseling professionals, space limitations which prevent adding additional stationary workstations in congested areas, lessening the impact (vs. wired solutions) on the existing conduit system,

and offering upward growth and scalability options.






C19






None in Place None in Place None in Place None in Place wireless not in place 0 We recommend the implementation of a combined mobile device / wireless solution to supplement existing stationary workstation devices for several reasons, including: improved mobility for health care and counseling professionals, space limitations which prevent adding additional stationary workstations in congested areas, lessening the impact (vs. wired solutions) on the existing conduit system, and offering upward growth and scalability options.

Recommend to Implement wireless solutions in selected locations indicated in this section (L1, L2) -- implementation costs to be estimated later in project

Based on discussions of June 16, we believe that there is consensus to support and pursue wireless solutions to support Nurse Station areas of patient wards in C, S, E Wards, as well as CFS, Treatment Malls, TRC, and Gym.

2


None in Place:C-2 (and C-1 and C-3): Good candidates for wireless & 1-2 more securable laptops that could be used at the nurse station; C4-C6 also good candidates for wirelessC9 (CAS) treatment mall good candidate for wireless and laptops;For all C wards: would need approx 3-4 Access Points for nursing station areas

None in Place: S1-S10 all candidates for wireless

South Treatment Mall (ground floor) - CASVery crowded area (for nurses, social workers Good potential for wireless implementation, with additional securable laptops (5-10), particularly in the area of the nursing station and attached office (S119a)

None in PlaceMain Pharmacy: No real wireless needs

W1 is an optional candidate for wireless, and since it needs data drops, it may be easier to go wireless with securable workstations

Gym is a candidate for wirelessAuditorium is a candidate for wireless

None in Place; Lower need than in other wards

None in Place: Wireless access points needed to support future increase in laptop usage;More difficult AP installation: hardened building

None in Place:

COAS treatment mall: good candidate for Wireless Access Points & additional laptops (3-4 AP, 3-4 laptops -- up to 15 med professionals using the area -- contained 2,000 sq ft area

Wireless access not in place, but very justified, for C, S, E, CFS wards, TRC, and Treatment Malls:Estimated number of access points (estimated 4 AP per central nursing station and surrounding area):Medium difficulty (non-hardened buildings):C1-C9: 36C15: 3Treatment Malls: 8S1-S10: 40E1-E8: 32TRC: 8Gym: 6IT Tech/Admin: 8;High Difficulty (hardened building)CFS: 40-60Auditorium: 8

0 Implement wireless solutions in selected locations indicated in this section (L1, L2) -- implementation costs to be estimated later in project

Based on discussions of June 16, we believe that there is consensus to support and pursue wireless solutions to support Nurse Station areas of patient wards in C, S, E Wards, as well as CFS, Treatment Malls, TRC, and Gym. (Note: most cost effective technology for providing additional EMR system access in the Gym building (wireless vs. wired) is TBD).

User Devices

C Wards: Only a 1:2 workstation: med worker ratio, due to shortage of securable user devices and places to put them;Particularly on Treatment Malls, there is volatile, chaotic peaks in patients, workers (up to 30 staff and 160 patients)

Note for E Wards (except for E2):E-6 and E-8 are lower functioning patientsThe remaining wards (E1, E3,E4,E5,E7) have active patients walking around

CFS has implemented a more effective, permanent plexiglass solution to protect workstations from patients


C-2 Due to fairly busy workspace, they are short on workstations in the right locations: May need to supplement current workstations with 1-2 securable mobile laptops (similar for C-1 and C-3)Additional needs for securable mobile laptops in C-2: 1-2 laptops to be used in Treatment Room, Group Therapy Conference Rooms;C-1 Med Room: need a workstation in this Med Room:C4-C6: Each of the nursing stations of C4-C6 needs one more workstation

C15: Only one workstation serving up to 4-5 nurses at a time (3 nurses and several therapists); Limited room to add more workstations; Area would be better served by laptops and wireless.

South Treatment Mall: 5-10 additional securable laptops would be appropriate if wireless implementedS1: currently unused, but could be in future: needs at least 2 new workstations (for nurse station and office);

South Hall: Each of the nursing stations of South Hall needs one more workstation

Pharmacy: Good 1:1 user: workstation ratioW1: (there would be duplicate observations and needs for W2, which is currently unused but could be reactivated) : W1 is very lightly wired, and is short at least 6 data drops and six workstations, particularly in exam rooms and group rooms ;Gym (bldg 10): First Aid Room has no data, no workstation

E7 Nursing Station: 3 data drops up front, 2 data drops in back -- all used;

E8 med room: needs workstation

E5, E6 nurse stations: new addtl data drop & wkstation

E6 med room needs workstationE6 therapy room needs workstation

E2 ward med room (pill station) needs a workstation;

F (CFS) Wards Exam Rooms (1-2 per ward): No data, no workstations (candidate for wired, with laptop)

Main Lab (East Campus): OK for workstations;

Main COAS Clinic: No data, no workstations in at least five exam rooms (wired desktops would be OK);

Main Dental: No data, no workstations in xray or in 4 dental exam rooms: needs at least 1-2 addtl data drops

Phys Ther: Need one workstation in back area

Needs for additional (stationary, secured) workstations:C-ward med rooms: 6S1-S10: 10W1-W2: 12Gym: 1E Wards: 10CFS Exam Rooms: 6CFS Pill rooms: 8CFS Med Rooms: 4 Main Clinic, COAS East: 5Dental: 2PhysTher: 1C1-C6: 6

Total: 77

3 Acquire and install stationary, secure workstations as indicated under gaps


none 4 none


none 4 none


none 4 none


We recommend the implementation of a combined mobile device / wireless solution to supplement existing stationary workstation devices for several reasons, including: improved mobility for health care and counseling professionals, space limitations which prevent adding additional stationary workstations in congested areas, lessening the impact (vs. wired solutions) on the existing conduit system,

and offering upward growth and scalability options.





C19






none 4 none


none 4 none


none 4 none


none 4 none


none 4 none


none 4 none


none 4 none




ActiveX controls (which cannot be installed by end users) can be installed by IT support

4 IT support (not end users) can install Active X controls




none 4 none

Additional Notes - Tech Support Desktop Tech Support: Per Paul Davis: Only 1 Infrastructure tech staff for every 350 workstations (vs. industry norm -- for this type of environment -- of 1 for every 100-150)

Source of this industry norm information is from Deloitte best practice studies for large sites that are implementing EMR systems: Desktop Infrastructure support teams for large facilities (> 300 patients) implementing EMR systems average 0.6% infrastructure support staff per FTE accessing the EMR system. If we assume WSH has approx. 1500 FTE and 1200 workstations, this would imply approximately 9 = (1500 X .006) infrastructure staff to support 1200 workstations (or about 1 for every 133).

Staffing for user device support is too low; Additional FTEs for ongoing support will be needed, particularly with added number of devices for future EMR system

2 Recommend re-assessment and strengthening of desktop support FTE headcount.

Recommend an additional approx. 4 FTE to support the desktop, laptop, and other mobile devices in the future EMR environment. (Note: This is a recommendation that does not apply solely to EMR support needs -- an FTE increase is needed to return to a more industry-standard ratio)

User Devices

Most of the C wards, including C9 treatment mall, have few laptop users, but would have many more laptops if wireless in place, and if there were securable locations for laptops;

C4-C6: Every nurse station needs 3-4 notebooks or tablet PC (Average) for doctors and social workers

C15: Additional connectivity / access needs would be better served by adding laptops / wireless

South Treatment Mall: additional securable laptops (5-10), particularly in the area of the nursing station and attached office (S119a);

S1-S10: Every nurse station needs 3-4 notebooks or tablet PC (Average) for doctors and social workers

Main Pharmacy: No real laptop needPatient Financial Services: The compliance auditors who roam and audit charts -- possible candidates for PDA's, but once charts are electronic, do they need to roam -- followup conf call with Jenna Abdul-Qadir (compliance)

TPR: Bldg is unusable

W1: (there would be duplicate observations and needs for W2, which is currently unused but could be reactivated): W1 - not a big candidate for wireless

There is a definite large need for additional laptops within CFS; their workers go out into the community and bring in 600 felon intakes per year450 staff, all of whom need to have access to future EMR system16 psychiatrists/psychologists; 4-5 medical doctors; At least 30-40 additional laptops justified;However, no cell side care possible in F-1 (hardened, solid doors, can barely see in rooms) -- this is the intake floor for the criminally insane

Laptop need also justified due to space constraints

COAS treatment mall: good candidate for Wireless Access Points & additional laptops (3-4 AP, 3-4 laptops) -- up to 15 med professionals using the area

Estimate for securable laptops / notebooks /tablets / PDAs to be added:C1-C6: 14C15: 4 (2 for nurses, 2 for therapists)S1-S10: 30South Trtmt Mall: 10CFS: 40COAS Trmt Mall: 4E1-E8 (excl E2): 14;Total: 116

2 Acquire appropriately configured and securable laptops/notebooks/tablets/PDAs for use in various areas, as indicated under gaps

Laptops would be suitable for staff who need to be mobile but have secure places to store their laptop. Much smaller micro-notebooks or tablets would be more appropriate for those who always need to carry their device, or quickly secure the device. PDAs are often appropriate for doctors. We will make reasonable estimates of the distribution (viability of any device will also depend on devices supported by the selected system vendor)

Since there is uncertainty regarding specific devices supported by the final system solution, it is advisable to ensure sufficient budget for a larger proportion of higher end devices such as laptops.

PrintersEvery nurse station in C4-C6 has one networked printer and a fax machine

Every nurse station in S1-S10 has one networked printer and a fax machine

User devices







C19






Most C Wards, particularly C9 treatment mall, can use an additional multi-function printer;Main Med Recs: Will have two high end networked printers on order;C9 Treatment Mall has only 3 printers for 50K sf ft - could use more, particularly near C9-321 (ordering), which needs a printer

South treatment mall: multi-function printer is not networked, and is only used as a copier

Main Pharmacy: Needs one more medium sized multi-function printer;G17 Pharmacy Satellite (serving 11 wards) needs a m-f ptr

E2 definitely needs a mult func printer: Many CFS wards: Need securable med-sized all in one mf ptrs

PT: need a m-f printer;COAS Treatment mall: need new secured multi-func printers, networked

Each ward is generally short one multi-function print/scan/copy device

2 Numerous multifunction, networked printers needed throughout campus;Approximately 30 networked multifunction print/copy/scan devices should be acquired


Windows compatible Windows compatible Windows compatible Windows compatible Windows compatible Windows compatible none 4 none


TCP/IP network (Common) TCP/IP network (Common) TCP/IP network (Common) TCP/IP network (Common) TCP/IP network (Common) TCP/IP network (Common) none 4 none


Yes (Common) Yes (Common) Yes (Common) Yes (Common) Yes (Common) Yes (Common) none 4 none


Yes (Common) Yes (Common) Yes (Common) Yes (Common) Yes (Common) Yes (Common) none 4 none








Prefer use of static IP 0 Recommend use of static IP addresses for printers


none none none none none none no print redundancy n/a Consider implementation of backup print server (but this is not formally recommended for the EMR project)


Printed documents are secure because printers are inside of nurses office

Not all printers in secure areas -- potential HIPAA violation if unsecured printers are not controlled with special security

3 Implement secured printing option (process configuration on the printing device) -- No additional cost --

The process configuration setting on the print device is a setting that allows the user to allow printing of documents only when the user is at the printer, to release print output

This capability needs to be a feature on all new multifunction printers acquired for the EMR solution; and for all other multifunction printers [used to print medical record information in unsecured areas] as they are updated and replaced.

Scanners

A few stand-alone scanners (7) are deployed at WSH and are used for various business reasons. WSH is looking to deploy MFCs.

Within one office of CFS (a subset of CFS medical records that maintains psychiatric files), one employee indicated the need for heavy scanning, due to large amounts of forensic data maintained in that specific area.


No scanners at nurse stations (C1-C6) No scanners at nurse stations (S1-S10)

limited scanning capability:

Note: If a formal document management system is a functional requirement of the EMR solution, then additional infrastructural requirements (servers, storage, scanning) would result.

1 To be largely remediated with acquisition of multifunction devices (see above, under printing)

However, if a formal document management system is a functional requirement of the EMR solution, then additional infrastructural requirements (servers, storage, scanning) would result.


limited scanning capability:

Note: If a formal document management system is a functional requirement of the EMR solution, then additional infrastructural requirements (servers, storage, scanning) would result.

1 To be largely remediated with acquisition of multifunction devices (see above, under printing)

However, if a formal document management system is a functional requirement of the EMR solution, then additional infrastructural requirements (servers, storage, scanning) would result.

Scanner

Printers







C19






For all locations: access to LAN, with WAN bandwidth at 10 mb, should be sufficient

Patient Financial Services: Need DSHS network access with Office of Financial Recovery in Olympia

Need access to all ancillary systems, including dental; Staff uses cache - generally does not like its usability

Main Clinic docs plan to continue use of CPRS/Vista

1 Lab system

In house lab system - in use none 4 No additional WAN infrastructure recommendations

2 Pharmacy system In house pharmacy system - in use none 4 No additional WAN infrastructure recommendations3 Radiology system In house radiology system - in use none 4 No additional WAN infrastructure recommendations

N dditi l WAN i f t t d tiWAN Network

Bandwidth

For all locations: access to LAN, with WAN bandwidth at 10 mb, should be sufficient

Need to interface with regional service network (RSN)

none 4 No additional WAN infrastructure recommendations









External Systems



Ancillary Systems

Copy of dshs_Woodinville_Comm_Fac.xls Page 1 of 2


Site Name Woodinville Community Facility

Site Location & Date of Site Visit Woodinville, WA -- 6/18/08

Primary Site Contacts (Technical and Medical) Technical: Rocco Volker - IT, John Verburg


Yolanda Lee - Program Administrator

# Category Details

1


In-Scope: Offices, Living Room area, KitchenOut of Scope: School Building, Maintenance, Resident Rooms

2



3

Additional Introductory Information Woodinville Community Facility conducts rehabilitative and transition programs for juvenile offenders in a home like environment. This is the oldest facility among JRA Community Homes which was built in 1964. The layout of the facility is a little different compare to the other community homes and there is no kiosk (duty office) which allows staff members to oversee the floor.


Staff members use Automated Client Tracking (ACT) extensively for Case Notes, Treatment Report/Target Behavior, Behavioral Assessment and Incident Report.




Copy of dshs_Woodinville_Comm_Fac.xls Page 2 of 2

# Category Details

4



Copy of dshs_Woodinville_Comm_Fac.xls Page 1


[0 - Not Met,

4 - No Gap]



Physical Space


Bathroom is being renovated to be ADA (American Disability Act) certified. The current bathroom will be the new network closet.

Currently, a storage room is used as Network closet. Although this room is typically locked all the time, it is not completely secured as staff members other than the site network administrator can access this room which could lead to security risks, equipment vandalism and/or accidental damage of the equipment. However, the issue is already addressed as a dedicated network closet is being created as part of the renovation project.

None 4 None


Electrical power is supplied by Puget Sound Energy

There is a small generator (about 15 kw) which could support the entire building including the main network closet.

None 4 None


No power capacity issue. None 4 None





1 Cooling should have dedicated controlsThere is no dedicated air-conditioner. However, the new network closet has a fan that can provide constant air-flow to maintain temperature within acceptable range

None 4 None




Cabling /


Requirements





Site: Woodinville Community Facility








1


There is enough room for additional cables. None 4 None


There is no fire suppression or fire extinguisher near by the current network closet or the future network closet location.

No sufficient fire suppression in the network closet

2 Acquire gas fire extinguisher for the new Network Closet.

Servers

1





3






future EMR

1



Cabling / Pathways





Cabling / Pathways

Cabling / Pathways











WAN / LAN


There are data drops in all rooms to support the future needs.

In addition, an additional data drop has already been requested to be added in Kitchen.

None 4 None


It is appropriate for the site (Dell 2724 switch utilized) None 4 None







None 4 None


Fractional T-1 (768 Kbps). Due to geographic reasons, fibre optic cables cannot be ran to the facility.



Higher bandwidth could be required 1 We support the JRA's direction as the current bandwidth is not likely adequate to support the future EMR system. Assuming fibre will be available in the area where the facility is located, we recommend to upgrade to 10-Mbps Ethernet if it makes an economical sense. For now, we recommend upgrading the bandwidth by an additional T-1.









WAN / LAN







Cabling / Pathways



Network








2


No wireless now No wireless now 0 Recommend implementing wireless for this facility. Having wireless helps the staff members by providing flexibility to document while being with or keeping distance from the clients.


User Devices


None 4 None


In general, there are a sufficient number of workstations. Additional workstations have already been requested for Kitchen and Supervisor's office.

None 4 None




























User devices








User Devices

Currently, 1 laptop is utilized at this facility. Counselors are benefited by having a laptop.


Standardize and formalize a process to provide laptops or tablet PCs for staff members who require more mobility, as necessary

Printers


There are 2 networked printers and 1 copier None 4 None



None 4 None





None 4 None









Scanners

There is no Scanner at this facility No Scanner 0 Replace the copier in the Staff Office with a full size multi-function device.

Recommended procuring a device which has a high processing speed, has full sheet scanning capability and be TWAIN compliant


N/A None N/A None


N/A None N/A None






Scanner

Printers






Ancillary Systems






N/A


N/A


N/A


N/A

N/A - All medical information is kept on paper. However, this site utilizes Automated Client Tracking (ACT) system extensively for Case Notes, Treatment Report/Target Behavior, Behavioral Assessment and Incident report by the end of this year. This information needs to be interfaced or migrated to the future EMR system.


NoneNone

External Systems

Copy of dshs_Yakima_Valley_School.xls Page 1


Site Name Yakima Valley School

Site Location & Date of Site Visit 609 Speyers road, Selah WA 98942, 06/18/2008

Primary Site Contacts (Technical and Medical) Technical : Rodney Kluever, Medical : Melanie Kohler


Michael J. Reneau (Plant Manager)

# Category Details

1


In Scope :Main building and living unit duplexes (total 7)

Out of Scope (no medical or counseling care; no future EMR system equipment) :Admin building, School Annex, Storage building

2


MDF - Main Distribution Facility

3

Additional Introductory Information Residential Habilitation Facility, qualified as a Nursing home from a regulatory perspecitiveAverage 100 residents and 225 medical staffsDoctors go to patient living duplexes because patients cannot move without assistance

4








[0 - Not Met,

4 - No Gap]


Main building (Medical unit and MDF) Living unit (7 duplexes) Gaps Score


Physical Space


No space issues with doctors offices or nurses station

MDF : Shared the space with IT room, no space or rack issue

1st floor IDF : Storage room, not secure

4th floor IDF : Multipurpose room, not secure

All 7 duplexes have the small nurse desk area with one workstation which is for nurses. When a doctor comes to living unit, there is no space for a doctor can sit down to counsel patients

All IDFs (5 IDFs) are inside of secure cabinet in the basement hot water room but temperature is fine

Non secure IDFs in the main building

2 Recommend secure cabinets (X 2) for IDFs in the main building


Power : Pacific Power & Light

1 Generator(450KW) for the main building supports only emergency light and very critical devices. No workstation nor network devices are covered by this generator due to lack of capacity

4 Generators support 7 duplexes Lack of generator power in the main building

2 Recommend new generator for the main building. 700 ~ 800KW would be sufficient for workstations and network devices




UPS at MDF No UPS at IDFs No power backup in IDFs 2 Recommned 5 UPSs for living unit IDFs



Agency/Administration: DSHS - DDD

Site: Yakima Valley School



Requirements










MDF : air-conditioner IDFs : No air-conditioner but temperature is fine because they are in the basement

None 4 None


N/A N/A N/A N/A N/A

1




MDF : Sprinkler

IDFs : Sprinkler

IDFs : No fire suppression None - Gas based fire suppression is not appropriate for MDF because it shares the space with IT room.

4 None

Servers


1


N/A N/A N/A N/A N/A


N/A N/A N/A N/A N/A

3


N/A N/A N/A N/A N/A


N/A N/A N/A N/A N/A

Servers


Cabling / Pathways




Cabling /










1



Cabling / Pathways


MDF and IDFs : Rack mount patch panel

IDFs : Wall mount patch panel None 4 None


No issue No issues None 4 None

WAN / LAN


2nd floor north exam room : No data port. 2 data ports are required

2nd floor west wing area : Empty and is not networked. The area around nurse station require network data ports

Wireless network is required Insufficient data drops in 2nd floor exam room and 2nd floor west wing area

2 Recommend 2 data ports in 2nd floor north exam room

Recommend 6 data ports around the nurse station of 2nd floor west wing


Current network works very well but Token ring is out-dated technology

This network may not be easy to maintain in near future

Current network cable can support Ethernet

2 Recommend Backbone switch upgrade : Cisco Catalyst 45xx grade X 2 (Considering redundant Backbone switch) with Gigabit Etherenet module for Workgroup switches (Fiber module) and workstation (48 ports UTP module)

Recommend Workgroup switch upgrade : Cisco Catalyst 2960 grade. 48 ports model X 4 for IDFs of 1st floor and 4th floor of main building and 24 ports model X 4 for IDFs of 7 duplexes

Utilize existing fiber cables to provide redundant connection between Backbone switches and Workgroup switches


No statistics are existing N/A N/A Upgraded Backbone switches are sufficient to support EMR system



Single Point of Failure 0 Refer J2

Fiber cables between MDF and IDFs : all of the IDFs have available fiber cables (Minimum 6 strands of fiber cables) for additional network connections such as redundant connection from Backbone switches to workgroup switches

Current network is a mix of Token ring 200Mbps to 16Mbps and Ethernet through bridges

Madge Token ring Backbone switch (X 1) and Madge Token ring Workgroup switches

Network


Cabling / Pathways








Refer J2 Refer J2 0 Refer J2


Physically 1 X T1 (1.5Mbps)2 X T1 in the POP cloud for redundancy

Need to check with ISSD team about utilization

None 4 None


Partial redundancy : 2 T1 in the cloud None 4 Carrier diversity is not viable option


Pending ISSD implementation No QoS 0 DIS and ISSD will implement QoS



None 4 When wireless network is implemented, wireless network management system will be needed : L1



WAN / LAN




DIS VPN 4 None

Cabling / Pathways


2


User Devices

1 AP for one living area of each duplex (2 living area per 1 duplex)Total 14 APs for these living unit duplexes

Living units require wireless network because doctors and nurses go to these units to provide medical service at patient room or location

No compelling reason for wireless network in the main building

Wireless network requirement 0

4 NoneDSHS ISSD security standard None










There are about 90 workstations in the main building and most of them are up-to-date1st floor Physical Therapy room : 4 physical therapist, need 1 more workstation

1st floor Occupational Therapy Department : 4 desks and 1 workstation, need 1 more workstation

2nd floor exam room : No workstation, need 1 workstation

Rest of the area and rooms have sufficient workstations

1 workstation at each duplex Insufficient workstation

No regular purchase cycle nor lease program to ensure the workstation spec is up-to-date

2 Acquire 1 more workstation for 1st floor physical therapy room, 1 more workstation for 1st floor Occupational Therapy Department and 1 more workstation for 2nd floor exam room














Per ISSD standard None 4 None

No periodical workstation purchase cycle nor lease program exist

IT deparment utilizes the surplus workstation of the Department of Ecology or purchase few of workstations whenever the budget allows it

Most of PC are up-to-date but the current PC acquisition process cannot guarantee the required workstation spec when EMR system is implemented

2 Recommend periodical workstation purchase program or lease program (90 workstations, 3 year refresh cycle)

User devices







User Devices

Doctors need 1 shared tablet PC because there is 1 doctor at any given time

2 PCCs (Patient Care Coordinator) each need tablet PC

Mobile device requirement 0 Acquire 3 tablet PCs for doctors and PCCs

Printers


1st floor pharmacy : 1 printer with Jetdirect print server

PT (Physical Therapy) room : 1 multifunction device

2nd floor north nurse station : 1 multifunction device

2nd floor east area : 1 multifunction device

4th floor area : 1 multifuction device

None 4 None







1 print server (OK because this site is not hosting candidate)

None 4 None


Secure location None 4 In addition to secure location, recommend personal code on printers

Scanners


No real scanning capabilities now No real scanning capabilities now None 4 Will be supplied by multifunction devices


No real scanning capabilities now No real scanning capabilities now None 4 Will be supplied by multifunction devices

None 4 None

Networked printers and static IP

Scanner



Printers









1 Lab system Outside provider N/A N/A N/A

2 Pharmacy system In-house pharmacy, don't require high bandwidth of WAN

None 4 None

3 Radiology system Outside provider N/A N/A N/A






External Systems



Ancillary Systems

Copy of dva_Central Office_WDVA.xls Page 1 of 1


Site Name Washington State DVA Central Office

Site Location & Date of Site Visit 1101 Quince St. SE, Olympia, WA 98504. 5/28/2008

Primary Site Contacts (Technical and Medical) Technical : James Topel


# Category Details

1


In Scope:Washington State DVA Central Office


3Additional Introductory Information No medical facility

No medical staff

4






Copy of dva_Central Office_WDVA.xls Page 1


[0 - Not Met,

4 - No Gap]

Category Investment Category MDF and Server room Gaps Score


Physical Space


Room is spaciousRack has enough empty space for additional IT devicesDVA has moved most servers to the DIS data centerADL servers are still in server room

None 4 None

Power company : Puget Sound Energy

1 Back up & redundancy should be in placeGenerator for building existsUPS at server room

None 4 None




UPS at server room None 4 None


N/A N/A N/A N/A

1 Cooling should have dedicated controlsAir-conditioner at server room None 4 None


N/A N/A N/A N/A


C bli /




Agency/Administration: DVA

Site: DVA Headquarters - Focus on MDF and Main Server Room



Requirements







1




Sprinkler No gas base fire suppression 2 Recommend gas base fire suppression (FM200)

Servers

ADL system is current medical record system3 ADL (Pharmacy) servers are managed by DVA IT team in server roomDVA HQ is not a likely hosting candidate, because of size (limited expandability), limited technical support team, and not being a fully hardened, secured facility

1


N/A N/A N/A N/A


N/A N/A N/A N/A

3


N/A N/A N/A N/A


N/A N/A N/A N/A

ServersCurrently meet DVA security standards None 4 None

1



Cabling / Pathways


N/A (No medical record users) N/A N/A N/A


N/A (No medical record users) N/A N/A N/A

Cabling / Pathways

Cabling / Pathways











WAN / LAN


N/A (No EMR user) N/A N/A N/A


Backbone router is Cisco 3800Backbone switch is Cisco Catalyst 4948PIX firewallScalable network devices

None 4 None


No statistics but Backbone switch has enough capacity to support the network

None 4 None






WAN is 10Mbps Ethernet from Qwest None 4 None


No redundancy No redundancy 0 WAN redundancy needed only if the server room is used as a critical EMR system hosting site, which is not likely




DVA network monitoring system : Cisco MARS (Protego)

None N/A None


CAT5 None 4 None

WAN / LAN



Firewall in place None 4 None



Network











Cabling / Pathways


N/A N/A N/A N/A

2


N/A N/A N/A N/A

User Devices


N/A N/A N/A N/A


N/A N/A N/A


N/A N/A N/A


N/A N/A N/A

5


N/A N/A N/A


N/A N/A N/A


N/A N/A N/A


N/A N/A N/A


N/A N/A N/A


N/A N/A N/A


N/A N/A N/A


N/A N/A N/A


N/A N/A N/A


N/A N/A N/A


N/A N/A N/A

User devices



DVA standard, 3 year lease program but N/A





User Devices

N/A N/A N/A N/A

Printers


N/A N/A N/A N/A


N/A N/A N/A N/A


N/A N/A N/A N/A


N/A N/A N/A N/A


N/A N/A N/A N/A


N/A N/A N/A N/A


N/A N/A N/A N/A


N/A N/A N/A N/A

Scanners


N/A N/A N/A N/A


N/A N/A N/A N/A

Scanner

Printers










1 Lab system N/A N/A N/A N/A

2 Pharmacy system N/A N/A N/A N/A

3 Radiology system N/A N/A N/A N/A



N/A N/A N/A N/A


N/A N/A N/A N/A


N/A N/A N/A N/A


N/A N/A N/A N/A

External Systems


R. There should be viable interface methods and connections between the existing ancillary systems and the future EMR systemAncillary

Systems

Copy of dva_Spokane_Vet_Home.xls Page 1 of 1


Site Name Spokane Veterans Home

Site Location & Date of Site Visit Spokane, WA -- 6/2/08

Primary Site Contacts (Technical and Medical) Technical: James Topel - IT, Dale Cane, Bob Brisbane, Randy Graham


Medical Record Manager

# Category Details

1


In-Scope: The entire building (There is only one building)

2



3

Additional Introductory Information Spokane Veterans Home is a 100 bed nursing facility for veterans which provides medical treatment, prescribed medications and 24-hour nursing care.

This location also utilizes ADL system being hosted in DVA HQ.

4






Copy of dva_Spokane_Vet_Home.xls Page 1


[0 - Not Met,

4 - No Gap]



Physical Space


The building was built in 1984. There are no dedicated network closets and networking devices are placed in electrical rooms with electrical panels.

Nursing stations are spacious. Currently, there is a construction project to add a few more offices by kitchen for Dietitians.

1st floor electrical/network closet: - Space is very limited and no more space to accommodate additional devices - The room is dusty and can get hot especially during summer time

2nd floor electrical/network closet: - Space is limited, but acceptable

Server Room: - Sufficiently sized - Server Room is also used as a storage for computer peripherals

No more space to accommodate additional devices (switch, UPS, air conditioning, etc) that are required for the future EMR system in the network closet on the first floor.

3 Significant recommendation to move all network equipment in the network closet on the first floor to the Server Room. An effort required to move all network equipment from the network closet to the server room should be minimal as the demark point is located in the server room, and the distance between the server room and the network closet is short (several doors away).

Note: recommendations to add UPS, Air-conditioning, rack, and additional switch assume that the Server Room will be used to accommodate all the network equipment for the first floor instead of the existing network closet. The network closet on the second floor is recommended to remain where it is.


There is one generator (125 KW) for the facility that can support Server Room, both network closets and nursing stations. However, the current generator's power capacitiy is not enough to support the additional EMR devices required.

Current generator is not large enough

2 Recommend to upgrade the current generator with a model with 250 KW.


Plenty of voltage is provided and this facility has not experienced power capacity issues.

None 4 None


There is one UPS (Smart UPS 1000 XL) for the server; however, no network devices are supported by UPS

No UPS for network devices 0 Assuming all network equipment will be moved to the Server Room from the network closet on the first floor, acquire an additional UPS to support the network equipment.

Add a small UPS for the network closet on the second floor


No dual power feed No dual power feed 0 No Recommendation - Dual power feed is not necessary as it is cost prohibitive and is not consistent with agency's practice


No separate cooling in Server Room or network closets

no dedicated cooling 0 Assuming all network equipment will be moved to the Server Room from the network closet on the first floor, install an air conditioner in the Server Room to maintain appropriate temperature/humidity level.

Install a ventilation for the network closet on the second floor








Agency/Administration: Department of Veterans Affairs

Site: Spokane Veterans Home

Requirements








Cabling /





1


Conduits in good shape and have room to add more cabling

None 4 None


Water Fire Suppression (Sprinkler) in Server Room and network closets

Should have a dry / gas suppression system

2 Acquire gas fire suppression (FM200) for the Server Room

Cabling / Pathways






Servers

1


None N/A


None N/A

3


None N/A


None N/A

ServersNone N/A

1


There is only one building and cables are wired through ceiling

None 4 None

Cabling / Pathways


The network closet on the first floor is equipped with a patch panel

The network closet on the second floor does not have a patch panel and cables are directly connected from a switch to data drops.

No straightforward access to network drops in the network closet on the second floor

3 Recommend to install a patch panel in the Server Room assuming all the network equipments are moved from the network closet in the first floor

Recommend to install a patch panel in the network closet on the second floor


There is only one building and cables are wired through ceiling

None 4 None

WAN / LAN


No EMR system servers expected to be located here - ADL servers hosted at DVA-Olympia

None





Cabling / Pathways







In general, there are sufficient number of data drops in the facility, but there are a few areas where additional data drops are recommended to accommodate the future needs.

Additional data drops are needed in Med Rooms to accommodate Medication Administration system and Medication dispensing system such as Pyxis which could be utilized with the future EMR system.

3 Recommend to add total of 4 data drops:

Add 2 data drops in Med Room behind the nursing station on the first floor

Add 2 data drops in Med Room behind the nursing station on the second floor


LAN architecture is scalable and no issues are found.

10 Mbps WAN (MPLS provided by Northwest Open Access Network (NoaNet))Utilizes Cisco 2800 Series Router, Cisco Catalyst 3500 Series XL as core switch and Cisco Catalyst 2950 for the 2nd floor network closetFast Ethernet throughout the site for data

Network devices are placed on top of each other. There are two Cisco Catalyst 1900 switches and cables that are no longer used in the first floor network closet. Also, there are unused cables and patch panel in the second floor network closet

No infrastructural gap; however, the environment for the network closets can be better maintained.

3 Remove unused network devices/cables to maintain a clean and manageable environment.

Assuming all network equipment will be moved to the Server Room from the network closet on the first floor, it is recommended to acquire a rack to mount the router and the switches.


LAN utilization level is under 25% None 4 None


No LAN redundancy (Non redundant core switch) No redundant core switch N/A Per latest discussion, additional redundant backbone switch will not be implemented -- No recommendation


The core switch (Cisco Catalyst 3500 Series XL - 48 ports) has about 8 available ports and the workgroup switch (Cisco Catalyst 2950 - 24 ports) has about 6 available ports.

The current facility expansion to add dietitian offices will require some more ports. Also, it is expected to require more devices to be on network with the future EMR system.

3 Acquire a 24-port switch for the first floor.

Upgrade the current workgroup switch to a 48-port switch


WAN utilization level is under 25% (10 Mbps bandwidth)

None 4 None


There is no redundancy with WAN

T-1 was contracted through AT&T, but it is currently deactivated.

No redundancy with WAN 0 Recommend to reactivate T-1 as a backup to provide redundancy


QoS is currently not Implemented at DVA No QoS implemented at DVA 0 Recommend to implement a bandwidth management strategy including Quality of Service (QOS)


Cisco MARS (Protego) : System alarm Need more function rich network monitoring system

2 Recommend to install more robust network monitoring system



Network





WAN / LAN


None 4 None


None 4 None


VPN is currently not being used by care staff in this facility, but secure VPN service is available through DIS

None 4 None

Cabling / Pathways


No wireless now None N/A No Recommendation: Follow ISB wireless security standard

2


This is a skilled nursing facility where patient care is provided by bed side; however, none of the residents rooms are wired. Having wireless in conjunction with laptops/tablet PCs/mobile carts can increase flexibility and efficiency.

The building is relatively open space and not hardened in most part. The building is estimated to have about 40,000 sqft.

Wireless is not implemented currently

0 Implement wireless in the building with total of 14 wireless access points:

(See Section N for more detailed recommendations on laptops/tablet PCs/mobile carts)

User Devices


Sufficient number of workstations None 4 None


None 4


None 4


None 4


None 4


None 4


None 4


None 4


None 4


None 4


None 4


None 4

User devices

All workstations are on 3 year-lease cycle and most of the current workstations are upgraded by 2012

Current standard DVA workstation specs will be sufficient for the future EMR system (given ongoing 3 year replacement cycle)


Mcafee antivirus, Shavlik patch management, Cisco Intrusion Detection System, Cisco NAC is being implemented.

Meet DIS requirements (ISB Standard)



M. User workstations and workstations on






None 4


None 4


None 4





User Devices

This is a skilled nursing facility where patient care is provided by bed side; however, none of the residents rooms are wired. Having wireless in conjunction with laptops/tablet PCs/mobile carts can increase flexibility and efficiency.

Mobile devices are needed to provide a bed side care

2 Acquire 3 laptops, extra batteries and synching docking stations for Social Workers conducting group sessions.

Acquire 4 laptops, extra batteries and synching docking stations to place above a med cart to verify medications when distributing to residents, or to be shared with other professionals (including doctors) who would need to use laptops.

Acquire 6 computers on wheels (3 for each nursing station). Computers on wheels can be rolled into residents rooms when providing a care.

Formalize a process to provide laptops or tablet PCs for medical professionals who require having more mobility

Printers


There are sufficient number of networked printers through out the facility. Also, DVA is planning to replace printers with multi-function devices (Sharp MX series) as the existing printers wear out.

Multi-function devices are utilized in nursing stations and Medical Record Room.

None 4 None



None 4 None


All printers/multi-function devices have TCP/IP networking capability

None 4 None


No emulation software is utilized for printing None 4 None









Printers are in secured office areas None 4 None

Scanners


Modern Multi-function devices have high processing speed.

None 4


Scanning functionality of the multi-function devices utilized have full sheet scanning capability and are TWAIN complaint

None 4

Scanner

Printers



No Recommendation: Verify new multifunction devices are compatible with the future EMR system

(Also see section O1 of this report)








Users are able to connect Federal VA's EMR system (CPRS) through Citrix to look up patient's medical information.

DVA has implemented/in process of implementing ADL Clinical module (Windows) which supports MDS (Minimal Data Set), Care Plans, Progress Notes (with ability to incorporate images) and scheduler.

ADL Financial module (Windows) is already implemented to handle billing.

ADL Pharmacy module (currently on OpenVMS, planning to move to Windows) is already implemented to handle Medicare Part D

1 Lab system Contracted thru PAML lab No gap: Network bandwidth sufficient to support

4 None

2 Pharmacy system Pharmacy is provided by Washington Veterans Home in Retsil

No gap: Network bandwidth sufficient to support

4 None

3 Radiology system Contracted thru Inland Imaging No gap: Network bandwidth sufficient to support

4 None



Users are able to access Federal VA's EMR system through Citrix


4 None


Central Office hosts billing/claims system (ADL Financial) which handles service, pharmacy and Medicare Medicaid billing


4 None




4 None




4 None


Ancillary Systems

External Systems


Copy of dva_WA_Soldiers_Home_Colony.xls Page 1 of 2


Site Name Washington Soldiers Home (DVA)

Site Location & Date of Site Visit Orting, WA -- 5/28/2008

Primary Site Contacts (Technical and Medical) Technical: James Topel; Medical: Harriett (Nursing Supervisor)


Acting Supt.& DVA Deputy Director: Lourdes E. (Alfie) Alvarado-Ramos; DVA Director: John Lee

# Category Details

1


In Scope: Nursing Center (8W and 8E), Administration Building, Roosevelt Building, Betsy Ross Bldg, Dietary portion of Dining Hall, Garfield bldg, Power Plant, Generator

Out of Scope: Chilson (Activities) building, Chapel, Child Care, Commissary (Dry Storage Only)

2


OT/PT: Occupational Therapy / Physical TherapyADL: WDVA's pharmacy systemMDF: Main Distribution FacilityIDF: Intermediate Distribution FacilityVOIP: Voice over IP

3

Additional Introductory Information Long-established Veterans Home; Land initially set aside pre-1891;Approx. 180-190 residents; 250-270 Staff (approximately 120 are medical care-related staff)Located on 181 acres in Puyallup Valley , serves up to 183 residents needing both skilled-nursing and assisted-living care. Facility was established in 1891; this was the first of three homes built for Washington state veterans.

The Washington Soldiers Home campus makes some use of VOIP, and as a result some of the PC workstations have their data cabling connected to VOIP phones (phones serve as data hubs)




Copy of dva_WA_Soldiers_Home_Colony.xls Page 2 of 2

# Category Details

4



Copy of dva_WA_Soldiers_Home_Colony.xls Page 1


[0 - Not Met,

4 - No Gap]


MDF-Member Storage (# 7) and Power

Nursing Center (# 8W & # 8E) , Roosevelt (# 6), and all other

buildingsGaps Score


Physical Space


MDF : Spacious and can house more IT devices. There are glass windows to outside without bars. Door is wood with old, simple knob

Nursing Center 8W IDF : IDF is in wood cabinet inside of a storage room. No lock. No room for expansion

Nursing Center 8E IDF : IDF is in small cabinet inside of a storage room. Not secure. No room for expansion

Roosevelt IDF : IDF is in a janitor room. Switch and patch panel are fixed on the wall directly. No rack, Environment is very poor. No secure box for network devices;

Note: The Betsy Ross building and the Garfield building have no needs at all for EMR system access, and were deemed out of scope (Garfield is uninhabitable)

MDF room is not secure

8W & 8E IDF are not secure. No space for expansion

Roosevelt IDF is not secure

0 MDF room windows need bars to prevent intrusionIron door is recommended for MDF room

8E and 8W IDF need more secure measures to protect network devices - at least an iron cabinet with a secure lock

Roosevelt IDF needs, at a minimum, a secure iron cabinet with a security lock


Electric Power service: Puget Sound Energy is the power provider, single power loop, power outage 3 ~ 4 times a yearGenerator backup (600 KW Cummings Genset), tested once per weekClean, good condition

MDF : UPS exists

IDFs : no UPS IDFs : no UPS 2 Recommend acquisition of UPS for three IDFs


Not exceed (entire campus uses only 37% of 600 KW on full campus tests)

None 4 None


Main big battery is not operational, small individual UPSs cover IT devices including switches

IDFs : no UPS Main battery is not available

No UPS

2 Need to replace main battery in MDF

As noted above, acquire UPS for IDFs (X 3)


No dual power feed N/A - not viable in this area N/A N/A

Agency/Administration: DVA

Site: Washington Soldier's Home -- Orting



Requirements










buildingsGaps Score



MDF : air-conditioner IDFs : no air-conditioner IDF rooms don't have HVAC system 2 Recommend venting in IDF rooms


Does not apply to this site -- will not be a hosting site

N/A N/A N/A

1


For the MDF building (which houses billing, but no other medical services): Conduit for fiber is OK; UTP cable conduit leaving the Main MDF is fairly full, but with sufficient capacity for additional cable in this building

Conduits are not full None 4 None


Water Sprinkler fire suppression IDFs : no fire suppression Water base fire suppression, no fire suppression in IDF rooms

1 Recommend gas based fire suppression in MDF room;Recommend fire extinguishers in 3 IDF's

Servers

Not a hosting site, not applicable to this site

1


N/A N/A N/A N/A N/A


N/A N/A N/A N/A N/A

3


N/A N/A N/A N/A N/A


N/A N/A N/A N/A N/A

ServersN/A N/A N/A N/A N/A

1


For the MDF building (which houses billing, but no other medical services): Conduit for fiber is OK; UTP cable conduit leaving the Main MDF is fairly full, but with sufficient capacity for additional cable in this building

Conduits are not full None 4 None





Cabling / Pathways

Cabling / Pathways









buildingsGaps Score


Cabling / Pathways


Patch panel exists Patch panel exists None 4 None


No documentation;Steam tunnel contains some cabling; difficult access

No documentation No documentation for cabling or network 0 Recommend documentation of current cabling and network architecture as well as other IT equipment status

WAN / LAN


Sufficient data drops for MDF Nursing Center areas (8W and 8E): have a variety of data drop and data access needs, and there are inherent limitations because the VOIP phones serve as data port hubs. (Many data drops are single data jacks to a phone, and through the phone a single connection for a PC): One phone can support only one workstation (PC). Given the status of the current cable and data drops, it will be more feasible to provide additional data access using multiple wireless access points for the Nursing Center wings. Additional data access needs for Nursing Center 8W and 8E are summarized under gaps;

Admin office area of nursing center is adequately wired (8-10 offices are all wired, and medical records area is well wired)Roosevelt Bldg (bldg 6): Due to concrete walls, not conducive to wireless; additional cabling must be traditional data drops; Additional data drop needs outlined under gaps at right

Existing wired LAN access in Nursing Center needs to be augmented with the following wireless data access service: Need one data cable per access point:Nursing Center:Core Area between 8W & 8E: Nursing Station: Needs 1 APCore Area between 8W & 8E: Back Office: Needs 2 APNear Pill Room: Needs 1 APOn way back toward OT/PT, outside dietary: Needs 1 APWing 3&4 Nursing Station: Needs 1 APRest Therapy, Rec Therapy Area; Needs 1 AP for wireless-enabled printerOT/PT: Needs 1 APInfection Control needs 1 data pull (and minor data wiring cleanup) for additional printerBldg 8 Admin offices: No additional needs, all offices wired OK for printers and workstations

Roosevelt Bldg:Only the nursing room has sufficient data ports;In office/lounge areas: Need 4 more data drops;In Room 4110 exam room: Need 1 data drop

2 Nursing Center: Install 8 cables to support 8 AP's, in the locations listed under gaps; Nursing center is not a hardened building -- medium difficulty.; Install/pull one more data drop for Infection Control

Roosevelt Building: Install additional data drops as follows:In office/lounge areas: Need 4 more data drops;In Room 4110 exam room: Need 1 data dropUpstairs in DVA social services: Need 1 more data dropRoosevelt: High difficulty install, due to concrete


Backbone switch is Cisco Catalyst 3550 (Low level) --

Router which connects the Orting site to DVA HQ and SGN is a Cisco 2800;

Dedicated fiber to each building

Workgroup switches are Cisco Catalyst 2950

LAN is poorly wired inside Roosevelt building

Backbone switch is too low level to provide high availability and security

LAN is poorly wired inside Roosevelt building

2 Upgrade Backbone switch to Cisco Catalyst 45xx grade;

Improve LAN wiring in Roosevelt bldg when recommended additions are made

Network








buildingsGaps Score



Utilization doesn't exceed the standard None 4 None


No redundancy - one Backbone switch

There are available fiber cables between MDF and IDFs for future redundant connection from Backbone switches to Workgroup switch

No redundancy : Single point of failure n/a Redundant backbone switch preferable, but not being recommended


Not enough available ports on Backbone Switch

Enough ports are available on Workgroup switches

Backbone switch is not scalable 2 Backbone switch is recommended to be replaced


WAN is MPLS 10Mbps Ethernet from CenturyTelService level of CenturyTel is not acceptable, but no alternative service provider is available in OrtingWAN utilization < 20%;

None 4 None


No redundant WAN connection Single point of failure n/a WAN redundancy being recommended only for hosting site


No QoS No QoS 0 DIS QoS implementation is pending

9Network monitoring system (NMS) should be utilized to track availability and performance of network

Cisco MARS (Protego) in Olympia : System alarm

NMS function is limited 2 Need richer NMS functionality


CAT5 None 4 None

WAN / LAN


MacAfee antivirus, Shavlik patch management

None 4 None


Meets DIS requirements None 4 None


Secure VPN service is provided by DIS Secure VPN service is provided by DIS None 4 None

Cabling / Pathways

Nursing Center : strong wireless candidate. This wireless implementation can substitute for additional cabling requirements








buildingsGaps Score



No wireless network No wireless network N/A N/A N/A: Future wireless will meet encryption requirements

2


No wireless network No wireless network Wireless Access needed in the following areas of the Nursing Center bldgs:

Core Area between 8W & 8E: Nursing Station: Needs 1 APCore Area between 8W & 8E: Back Office: Needs 2 APNear Pill Room: Needs 1 APOn way back toward OT/PT, outside dietary: Needs 1 APWing 3&4 Nursing Station: Needs 1 APRest Therapy, Rec Therapy Area; Needs 1 AP for wireless-enable printerOT/PT: Needs 1 AP

0 Nursing Center : 8 APs recommended, in the following areas:

Nursing Center:Core Area between 8W & 8E: Nursing Station: Needs 1 AP;Core Area between 8W & 8E: Back Office: Needs 2 AP;Near Pill Room: Needs 1 AP;On way back toward OT/PT, outside dietary: Needs 1 AP;Wing 3&4 Nursing Station: Needs 1 AP;Rest Therapy, Rec Therapy Area; Needs 1 AP for wireless-enable printer;OT/PT: Needs 1 AP;

(8 APs covering approximately 5,000-6,000 sq ft -- not a hardened bldg)

User Devices


n/a Short on workstations in both the Nursing Center and in the Roosevelt building -- see details in gaps listed to right

Existing workstation counts in Nursing Center needs to be augmented with the following additional wireless-enabled workstations or laptops: Nursing Center:Core Area between 8W & 8E: Nursing Station: Needs 1 workstationCore Area between 8W & 8E: Back Office: Needs 3 workstationsNear Pill Room: Needs 1 workstationOn way back toward OT/PT, outside dietary: Needs 1 workstationWing 3&4 Nursing Station: Needs 1 more workstationRest Therapy, Rec Therapy Area: Care conference room: Needs 1 workstationRT: Clinical Services (front room): Needs 1 w/sOT/PT: Needs 1 workstationPharmacy: Needs one workstation (has data port)Bldg 8 Admin offices: MedRecs area: needs 1 more w/sRoosevelt Bldg:Only the nursing room has sufficient data ports;In office/lounge areas: Need 4 more w/s;

For Building 8 Nursing Center:Per gaps listed at left, acquire 12 wireless-enabled workstations or laptops (for use with wireless)

For Roosevelt building: Acquire 6 standard, stationary workstations, for placement in locations indicated at left under gaps





User devices

4 NoneDVA Workstation standard and software image None






buildingsGaps Score


5












User Devices

The primary mobile device need for the Nursing Center would be for rolling med carts

Currently no laptops for rolling med carts -- can be used in a dockable or wireless mode in the Nursing Center

0 Acquire 2 dockable, wireless-enabled laptops for use on rolling med carts in Nursing Center

For Building 8 Nursing Center:Per gaps listed in Section M, acquire 12 wireless-enabled workstations or laptops (for use with wireless)

Printers


n/a Acceptable multifunction printers in Admin area of Nursing Center;Need new multifunction printers in one nursing station and in Rec Therapy/PT area of Nursing Area, and in Infection Control

In Nursing Center: need two m/f printers, plus one more m/f printer for infection control

2 Acquire three mid-sized multifunction printers for Nursing Center (includes printer for infection control)





User devices

Printers


None 4 None

1 print server, static IPCompliant with standard






buildingsGaps Score





No redundancy No redundancy n/a Redundant print servers not being recommended


Scanners


For Pharmacy in Nursing Center: Need one bar code scanner

For Pharmacy in Nursing Center: Need one bar code scanner

3 Acquire 1 bar code scanner for Pharmacy


n/a: New multifunction printers will meet requirements

4 None


1 Lab system

Access Lab results thru Web portal to Lab contractor (PAC LAB, ChartConnect)


4 None at this time: integration with external systems dependent on solution selected

2 Pharmacy system

Completely on ADL Pharmacy System; Multiple ADL database instances at DVA Olympia


4 None

3 Radiology system n/a: contracted out n/a: contracted out n/a None


Potential interface with OFR in Olympia


None 4 None


None 4 None


None 4 None


None 4 None

External Systems




Ancillary Systems

Scanner


Copy of dva_WA_Veterans_Home.xls Page 1 of 2


Site Name Washington Veterans Home

Site Location & Date of Site Visit Retsil, WA -- 4/29/2008

Primary Site Contacts (Technical and Medical) Technical: Bob Murphy, Dale Cain, Randy ; Medical: Dr. Karen Anderson


Pharmacy Manager

# Category Details

1


In Scope: "New Building" (240 beds) - includes MDF and multiple IDFsBuilding 10 (older building)

Out of Scope: Building 9Plant Maintenance Buildings

2


ADL: Pharmacy System;MDF: Main Distribution FacilityIDF: Intermediate Distribution FacilityAC1: Assisted Care Wing in New BuildingNMS: Network Monitoring System




Copy of dva_WA_Veterans_Home.xls Page 2 of 2

# Category Details

3

Additional Introductory Information The Retsil site has most of its primary medical care concentrated in its new 240-bed building. This building contains all core medical services and clinics; -- Highest level of medical care requires transfer to Harrison Hospital (local);Bldg 10 (much older) provides light nursing;DVA Retsil uses ADL pharmacy system and PacLab / Chart Connect services for Lab (nearly all Lab is contracted out); Also, radiology is contracted out to AMI RadiologyDr. Anderson states that no prior EMR studies have been done, and believes that the driving force behind EMR system implementations will be regulations;3 primary care providers, <1 doctor;Approx 200 patients in new building, and approx. 100 patients in Bldg 10 and AC1, which is part of new building;Approx 10 skilled nursing nurses during day, 5 nurses at night;Use paper-based medical records and scheduling system

4



Copy of dva_WA_Veterans_Home.xls Page 1


[0 - Not Met,

4 - No Gap]



Physical Space


Most medical care is provided in the New Building - Ample space in all areas (main computer room / MDF / IDF / nursing stations in wings)

Medical care is also provided in Building 10 - Electrical room in Building 10 is very crammed, no patch panel and cables are directory connected to a switch. Also, EMR-related technologies (phone, printer and fax) at a nursing station on the first floor are not close to each other.

Electrical room in Building 10 is very crammed and does not have floor space capacity to house required infrastructure equipment

EMR-related technologies are not placed close to each other

3 No recommendation with respect to physical space for the new building

However, it is recommended to expand the electrical room or create an IDF for Building 10 to accommodate network devices, HVAC, fire suppression, etc. Also, the nursing station needs to be redesigned to place EMR-related technologies near each other - Recommend to place a multi-function device.

1 Back up & redundancy should be in place Two generators in place: 1000 KW for new Building, 400 KW for Buildings 9 &10

None 4 None


Plenty of voltage -- consuming less than 15% of max available

None 4 None


UPS (at least 10 mins) in MDF; no UPS for switches in IDF rooms

No UPS for switches in IDF rooms

3 Add small UPS for IDFs


No dual power feed No dual power feed 0 No Recommendation - Dual power feed is not necessary as it is cost prohibitive and is not consistent with agency's practice


Separate cooling in MDF - Data Aire, Inc.No separate cooling in IDF room - temp 75.2 Worst closet cooling is in Bldg 10: 79 degrees

Cooling for the electrical room in Building 10 is not sufficient

3 The electrical room in Building 10 needs to be redesigned with sufficient temperature control (also refer to section A)


Cooling supported by generator None 4 None

Agency/Administration: Department of Veterans Affairs

Site: Washington Veterans Home (Retsil)






C bli /

Requirements








1


Conduits in good shape and have room to add more cabling in MDF

The electrical room in Building 10 has limited space for an additional cabling

The electrical room in Building 10 does not accommodate more cabling

3 The electrical room in Building 10 needs to be redesigned to accommodate more cabling for future expansion(also refer to section A above)


Water Fire Suppression in both MDF and IDF Should have a dry / gas suppression system

2 Acquire gas fire suppression for MDF (FM200)

Cabling / Pathways






Servers

N/A

1



None N/A



None N/A

3



None N/A



None N/A

ServersNo EMR system servers expected to be located here - ADL servers hosted at DVA-Olympia

None N/A

3

1


Conduits in good shape and have room to add more cabling in MDF

The electrical room in Building 10 has limited space for an additional cabling

The electrical room in Building 10 cannot accommodate more cabling

3 The electrical room in Building 10 needs to be redesigned to accommodate more cablings for future expansion(also refer to section A above)

Cabling / Pathways


New building is all equipped with patch panels

The electrical room in Building 10 does not have patch panels and cables are directory connected to a switch

No straightforward access to network drops for the electrical room in Building 10

3 Recommend to install a rack-mounted patch panel(also refer to Section A)


Primary man-hole --- near the main road; repairs done in 2005, somewhat messy, but serviceable

None 4 None

WAN / LAN

No function based VLAN nor Network Access Control are implemented at this site

Recommend to implement function based VLAN and Network Access Control to reduce IS Services staff involvement and maintain or enhance Network Security.





Cabling / Pathways








No issues are found in new building

Nursing station in Building 10 has only 2 data ports with substandard wiring (network drop is on a pole next to desk being exposed)

Network wiring needs to be redone at Nursing station in Building 10

There are only 2 data ports. Usage level of workstation is expected to increase with the future EMR

3 or more data ports will be necessary to support 2 workstations and 1 network printer or multi-function device

3 Make appropriate IDF room for building 10 and implement rack mounted patch panels

Improve data drops in Bldg 10 to support workstation and printer

Add at least 3 or more data drop in the nursing station on the first floor. Consider making a similar modifications to the nursing station on the second floor if it will be utilized in the future.


Backbone switch is small size site grade, low end model

Need more robust, function rich medium size site grade Backbone switch

2 Upgrade Backbone switch


Not close to max -- well under 20% None 4 None


No LAN redundancy (Non redundant core switch) No redundant core switch N/A Per latest discussion, additional redundant backbone switch will not be implemented -- No recommendation




Not close to max -- well under 30% (10 Mbps bandwidth)

None 4 None


No redundancy for last mileExperienced 3 outages last year due to issues with WAN

No redundancy with WAN 1 Recommend to reactivate T-1 as a backup to provide redundancy as it is not economically feasible for alternate carrier


QoS is currently not Implemented at DVA No QoS implemented at DVA 0 Recommend to implement a bandwidth management strategy including Quality of Service (QOS)


Cisco MARS (Protego) : System alarm Need more function rich NMS 2 Recommend to install more robust network monitoring system


All CAT 5 or CAT 6 None 4 None

Network





WAN / LAN


Mcafee antivirus, Shavlik patch management None 4 None


Meet DIS requirements; Two ISB audits successfully passed

None 4 None



Cabling / Pathways


No wireless now None N/A None - no compelling need for wireless

2


No huge need for wireless: Since most medical care is either in the wings or in the clinic, the nurse workstation locations [or the clinic workstations] are close enough to the patients

None N/A None - no compelling need for wireless

User Devices

Per Dr Anderson, mobile tablets (which could be synched later) would be sufficient: No system access needed from patient rooms

All workstations are on 3 year-lease cycle and most of the current workstations are upgraded by 2012


Sufficient number of workstations, but sub-nurse stations (mid wing) should be allocated workstations -- having these mid wind workstations would remove any requirement for wireless

There is only one workstation at the nursing station on the first floor of Building 10.

Add workstations at mid-wing in new building

Add one more workstation at the nursing station in Building 10

3 Add 6 workstations (one per mid-wing) in new building for increased access

Add 1 workstation in Building 10 (nursing station on the first floor).


No issues None expected 4 None














User devices

























User Devices

Short on mobile tablets (which could be synched) would provide adequate mobility

Gap of approx 2-3 tablets 2 Acquire 2 to 3 tablets, extra batteries and synching docking stations

Formalize a process to provide laptops or tablet PCs for medical professionals who requires to have more mobility

Printers


Networked printers (multi-function device with printing capability) in place in new building wings (one for each nursing station). Heavy usage of a printer is observed in Medical Record Room in new building.

In general, fair amount of faxing is done to transfer information with internal/external entities.

Building 10 printer is substandard and not networked.

The printer at the nursing station in Building 10 is not networked

3 Upgrade Building 10 printer to networked printer(also refer to Section A)

Medical Record Room needs a new multi function printer (reportedly on order)



None 4 None


All printers/multi-function devices have TCP/IP networking capability

None 4 None


Utilizes Citrix None 4 None







N/A Redundant print server is typically not required for non-hosting site


Printed material not in secure environment Access to print material not completely secure

3 Place a printer/multi-function device in a secure location and implement controls for secure printing. Also, it is recommended to modify print server configuration to increase security.

Scanners


Scanners utilized in new building are modern multi-function device which has high processing speed.

Have scanners on wings, not in clinic or pharmacy (only a McKesson ordering scanning device)

Need additional scanner technology in Pharmacy;Need a scanner in the clinic

2 Add one multi-function device in the clinicReplace the existing printer in the pharmacy with a multi-function device

Building 10 scanner would need to be located to an accessible location (also refer to Section A)


Scanning functionality of the multi-function device is TWAIN complaint

None 4 None



Scanner

Printers








Users are able to connect Federal VA's EMR system (CPRS) through Citrix to look up patient's medical information.

DVA has implemented/in process of implementing ADL Clinical module (Windows) which supports MDS (Minimal Data Set), Care Plans, Progress Notes (with ability to incorporate images) and scheduler.

ADL Financial module (Windows) is already implemented to handle billing.

ADL Pharmacy module (currently on OpenVMS, planning to move to Windows) is already implemented to handle Medicare Part D

1 Lab system

Access Lab results thru Web portal to Lab contractor (PAC LAB, ChartConnect)



2 Pharmacy system

Central Pharmacy services for all DVA sites. Contracted with McKesson for Pharmaceutical services.

Completely on ADL Pharmacy System; this location supports Spokane vets, and FedEx's pharmacy orders to SpokaneMultiple ADL database instances at DVA Olympia


4 None

3 Radiology system Contracted thru AMI Radiology No gap: Network bandwidth sufficient to support




Users are able to access Federal VA's EMR system through Citrix


4 None




4 None




4 None




4 None

External Systems



Ancillary Systems

Agency DOCAdministration (All)

Data

SiteInvestment

Type Investment Category Investment Item BuildingInitial Base(Unit Price)

Best Estimate(Unit Price) Total Qty Initial Base Best Estimate

Ahtanum View CC One-Time Cabling / PathwaysPower cabling to support wireless (High) Living Unit $3,195 $4,473 1 $3,195 $4,473Power cabling to support wireless (Med) Living Unit $1,065 $1,491 3 $3,195 $4,473

Medical Unit $1,065 $1,491 2 $2,130 $2,982Multipurpose $1,065 $1,491 1 $1,065 $1,491

Cabling / Pathways Total 7 $9,585 $13,419

Facility Modifications Ductless Air Conditioner Living Unit $3,882 $5,435 1 $3,882 $5,435Ductless Air-conditioner Labor surcharge Living Unit $3,600 $3,600 1 $3,600 $3,600UPS (Sm) Living Unit $341 $443 1 $341 $443

Facility Modifications Total 3 $7,823 $9,478

Preventative Measures Fire Extinguishers Medical Unit $59 $76 1 $59 $76FM200 Fire Suppression Living Unit $37,275 $52,185 1 $37,275 $52,185

Preventative Measures Total 2 $37,334 $52,261

WAN / LAN Access Points Living Unit $1,118 $1,454 4 $4,473 $5,815Medical Unit $1,118 $1,454 2 $2,237 $2,907Multipurpose $1,118 $1,454 1 $1,118 $1,454

Data drops (High) Living Unit $4,793 $6,710 1 $4,793 $6,710Data drops (Med) Living Unit $1,598 $2,237 3 $4,793 $6,710

Medical Unit $1,598 $2,237 2 $3,195 $4,473Multipurpose $1,598 $2,237 1 $1,598 $2,237

Firewall + IDPS for Wireless Entire Facility $7,668 $9,968 1 $7,668 $9,968Rack Living Unit $749 $973 1 $749 $973Wireless controller (Sm) Living Unit $5,858 $7,615 1 $5,858 $7,615

Wireless Network Design/Implementation Cost Entire Facility $1,000 $1,000 7 $7,000 $7,000

WAN / LAN Total 24 $43,479 $55,861

One-Time Total 36 $98,221 $131,019

MRTG Cost Model_905_Vista_Final v1 7.xlsx

SiteInvestment



Ahtanum View CC On-Going User Devices Laptops Medical Unit $1,043 $1,251 3 $3,129 $3,754Workstations Medical Unit $613 $736 2 $1,227 $1,472

Office $613 $736 1 $613 $736User Devices Total 6 $4,969 $5,963

WAN / LAN Firewall + IDPS Maintenance Entire Facility $1,544 $2,008 1 $1,544 $2,008Wireless AP Maintenance Living Unit $128 $166 7 $895 $1,163Wireless Controller Maintenance (Sm) Living Unit $916 $1,191 1 $916 $1,191

WAN / LAN Total 9 $3,355 $4,361

On-Going Total 15 $8,324 $10,324


SiteInvestment



Airway Heights CC One-Time Cabling / PathwaysPower cabling to support wireless (High) D5 $3,195 $4,473 8 $25,560 $35,784Re-wiring to utilize Patch panel C1 $799 $1,118 1 $799 $1,118


Facility Modifications UPS (Sm) D2 $341 $443 1 $341 $443D5 $341 $443 1 $341 $443

Ventilation D2 $2,663 $3,728 1 $2,663 $3,728D5 $2,663 $3,728 1 $2,663 $3,728


Preventative Measures FM200 Fire Suppression C1 $37,275 $52,185 2 $74,550 $104,370Preventative Measures Total 2 $74,550 $104,370

WAN / LAN Access Points D5 $1,118 $1,454 8 $8,946 $11,630Data drops (High) C3 $4,793 $6,710 2 $9,585 $13,419

D3 $4,793 $6,710 1 $4,793 $6,710D5 $4,793 $6,710 16 $76,680 $107,352

Data drops (Med) D4 $1,598 $2,237 1 $1,598 $2,237P-8T $1,598 $2,237 1 $1,598 $2,237

Firewall + IDPS for Wireless Entire Facility $7,668 $9,968 1 $7,668 $9,968WAN Initiation (T1) C1 $15,975 $20,768 1 $15,975 $20,768Wireless controller (Sm) Entire Facility $5,858 $7,615 1 $5,858 $7,615


Workgroup Switch - 48 ports D2 $2,876 $3,738 1 $2,876 $3,738WAN / LAN Total 41 $143,575 $193,672

One-Time Total 56 $250,490 $343,285


SiteInvestment



Airway Heights CC On-Going Printer / Scanner Multi-Function Device (Med) C3 $3,233 $4,203 1 $3,233 $4,203D3 $3,233 $4,203 1 $3,233 $4,203D4 $3,233 $4,203 1 $3,233 $4,203D5 $3,233 $4,203 7 $22,633 $29,423

Printer / Scanner Total 10 $32,333 $42,033

User DevicesComputer on Wheels / Laptop Carts D5 $1,254 $1,630 5 $6,268 $8,148Laptops D5 $1,043 $1,251 15 $15,643 $18,771Workstations C3 $613 $736 3 $1,840 $2,208

D3 $613 $736 1 $613 $736D4 $613 $736 1 $613 $736D5 $613 $736 15 $9,202 $11,042

User Devices Total 40 $34,179 $41,642

WAN / LAN Firewall + IDPS Maintenance Entire Facility $1,544 $2,008 1 $1,544 $2,008Wireless AP Maintenance Entire Facility $128 $166 8 $1,022 $1,329Wireless Controller Maintenance (Sm) Entire Facility $916 $1,191 1 $916 $1,191Workgroup Switch Maintenance - 48 ports Entire Facility $351 $457 1 $351 $457

Yearly WAN Service Fee (T1) Entire Facility $10,224 $13,291 1 $10,224 $13,291WAN / LAN Total 12 $14,058 $18,275

On-Going Total 62 $80,570 $101,950


SiteInvestment



Cedar Creek CC One-Time Facility ModificationsInstallation of Strengthened Door Med Clinic $2,130 $2,982 1 $2,130 $2,982


Preventative Measures Fire Extinguishers

Med Clinic, Cascade, Timberline Bldgs $59 $76 3 $176 $228

FM200 Fire Suppression Admin $37,275 $52,185 1 $37,275 $52,185Preventative Measures Total 4 $37,451 $52,413

WAN / LAN Data drops (Med)Cascade, CD Counseling $1,598 $2,237 2 $3,195 $4,473

Data Pull Main Clinic $533 $746 1 $533 $746WAN / LAN Total 3 $3,728 $5,219

One-Time Total 8 $43,308 $60,614


SiteInvestment



Cedar Creek CC On-Going Printer / Scanner Multi-Function Device (Med) Med Clinic / CD $3,233 $4,203 2 $6,467 $8,407Printer / Scanner Total 2 $6,467 $8,407

User Devices Laptops Med Clinic / CD $1,043 $1,251 3 $3,129 $3,754Workstations Med Clinic $613 $736 8 $4,908 $5,889


On-Going Total 13 $14,503 $18,050


SiteInvestment



Clallam Bay CC One-Time Cabling / PathwaysPower cabling to support wireless (High) D unit $3,195 $4,473 3 $9,585 $13,419

IMU $3,195 $4,473 7 $22,365 $31,311Power cabling to support wireless (Med) Medical Unit $1,065 $1,491 4 $4,260 $5,964


Preventative Measures Fire Extinguishers D unit $59 $76 1 $59 $76IMU $59 $76 1 $59 $76Medical Unit $59 $76 1 $59 $76

Preventative Measures Total 3 $176 $228

User Devices PDA Medical Unit $213 $256 7 $1,491 $1,789User Devices Total 7 $1,491 $1,789

WAN / LAN Access Points D unit $1,118 $1,454 3 $3,355 $4,361IMU $1,118 $1,454 7 $7,828 $10,176Medical Unit $1,118 $1,454 4 $4,473 $5,815

Data drops (High) D unit $4,793 $6,710 3 $14,378 $20,129IMU $4,793 $6,710 7 $33,548 $46,967

Data drops (Med) Medical Unit $1,598 $2,237 4 $6,390 $8,946

Firewall + IDPS for Wireless New IT $7,668 $9,968 1 $7,668 $9,968Wireless controller (Med) New IT $8,414 $10,938 1 $8,414 $10,938

Wireless Network Design/Implementation Cost Entire Facility $500 $500 14 $7,000 $7,000

WAN / LAN Total 44 $93,052 $124,299

One-Time Total 68 $130,929 $177,011


SiteInvestment



Clallam Bay CC On-Going Printer / Scanner Multi-Function Device (Lrg) Medical Unit $7,246 $9,420 1 $7,246 $9,420Printer / Scanner Total 1 $7,246 $9,420

User DevicesComputer on Wheels / Laptop Carts Medical Unit $1,254 $1,630 6 $7,521 $9,777PDA Yearly Service Fee Medical Unit $639 $767 7 $4,473 $5,368Workstations D unit $613 $736 1 $613 $736

IMU $613 $736 1 $613 $736Medical Unit $613 $736 4 $2,454 $2,945


WAN / LAN Firewall + IDPS Maintenance New IT $1,544 $2,008 1 $1,544 $2,008Wireless AP Maintenance Entire Facility $128 $166 14 $1,789 $2,326Wireless Controller Maintenance (Med) New IT $1,321 $1,717 1 $1,321 $1,717

WAN / LAN Total 16 $4,654 $6,050

On-Going Total 36 $27,575 $35,032


SiteInvestment



Coyote Ridge CC One-Time Cabling / Pathways Data Cable Cover Old Medical Bldg $5 $7 20 $100 $140Cabling / Pathways Total 20 $100 $140

WAN / LAN Data drops (Med) New Medical Bldg. $1,598 $2,237 4 $6,390 $8,946WAN / LAN Total 4 $6,390 $8,946

One-Time Total 24 $6,490 $9,086


SiteInvestment



Coyote Ridge CC On-Going User Devices Laptops New Medical Bldg. $1,043 $1,251 6 $6,257 $7,509User Devices Total 6 $6,257 $7,509

On-Going Total 6 $6,257 $7,509


SiteInvestment



Larch CC One-Time Facility Modifications

Move switch slightly; physically enclose(Minor carpentry work) Secure Holding $1,065 $1,491 1 $1,065 $1,491

Swivel ArmsPGM Bldg Med Clinic $792 $1,030 2 $1,584 $2,059

UPS (Lrg) New Warehouse $1,385 $1,800 1 $1,385 $1,800UPS (Med) PGM Bldg $595 $774 1 $595 $774


Preventative Measures Fire Extinguishers

Secure Holding, Warehouse/IT, Program Bldg $59 $76 3 $176 $228

FM200 Fire Suppression New Warehouse $37,275 $52,185 1 $37,275 $52,185Preventative Measures Total 4 $37,451 $52,413

WAN / LAN Data drops (Med)

Secure Holding, PGM Bldg Med Clinic $1,598 $2,237 3 $4,793 $6,710

Data Port ActivationPGM Bldg Med Clinic $107 $149 3 $320 $447

Data PullPGM Bldg Med Clinic $533 $746 1 $533 $746

WAN / LAN Total 7 $5,645 $7,902

One-Time Total 16 $47,724 $66,440


SiteInvestment



Larch CC On-Going Printer / Scanner Multi-Function Device (Med)PGM Bldg Med Clinic $3,233 $4,203 1 $3,233 $4,203


User Devices Laptops PGM Bldg Med / CD $1,043 $1,251 3 $3,129 $3,754

WorkstationsPGM Bldg Med Clinic $613 $736 2 $1,227 $1,472




SiteInvestment



McNeil Island CC One-Time Cabling / Pathways Patch panel Corridor Bldg / MDF $510 $664 1 $510 $664

Patch Panel Installation Labor Corridor Bldg / MDF $1,000 $1,000 1 $1,000 $1,000Power cabling to support wireless (High)

Corridor Bldg / IMSVCS3 $3,195 $4,473 4 $12,780 $17,892F $3,195 $4,473 7 $22,365 $31,311


Facility Modifications Ductless Air Conditioner Corridor Bldg / MDF $3,882 $5,435 1 $3,882 $5,435Ductless Air-conditioner Labor surcharge Corridor Bldg / MDF $3,600 $3,600 1 $3,600 $3,600

Protective Enclosure (Lrg) Corridor Bldg / MDF $2,130 $2,769 1 $2,130 $2,769

UPS (Lrg) Corridor Bldg / MDF $1,385 $1,800 1 $1,385 $1,800Facility Modifications Total 4 $10,996 $13,604

Preventative Measures Fire Extinguishers All IDF Locations $59 $76 7 $410 $533

FM200 Fire Suppression Corridor Bldg / MDF $37,275 $52,185 1 $37,275 $52,185Preventative Measures Total 8 $37,685 $52,718

WAN / LAN Access PointsCorridor Bldg / IMSVCS3 $1,118 $1,454 4 $4,473 $5,815F $1,118 $1,454 7 $7,828 $10,176

Data drops (High) A $4,793 $6,710 2 $9,585 $13,419Corridor Bldg / IMSVCS1 $4,793 $6,710 2 $9,585 $13,419Corridor Bldg / IMSVCS3 $4,793 $6,710 17 $81,473 $114,062F $4,793 $6,710 8 $38,340 $53,676

Firewall + IDPS for Wireless Corridor Bldg / MDF $7,668 $9,968 1 $7,668 $9,968

Wireless controller (Sm) Corridor Bldg / MDF $5,858 $7,615 1 $5,858 $7,615

Wireless Network Design/Implementation Cost Multiple $1,000 $1,000 11 $11,000 $11,000

WAN / LAN Total 53 $175,809 $239,150

Exceptional Facility ModificationElectrical Distribution / Capacitor Improvements Entire Facility $500,000 $1,000,000 1 $500,000 $1,000,000

Exceptional Facility Modification Total 1 $500,000 $1,000,000

One-Time Total 79 $761,146 $1,356,338


SiteInvestment



McNeil Island CC On-Going Printer / Scanner Multi-Function Device (Med) A-F $3,233 $4,203 6 $19,400 $25,220Corridor Bldg / IMSVCS1 $3,233 $4,203 1 $3,233 $4,203Corridor Bldg / IMSVCS3 $3,233 $4,203 3 $9,700 $12,610


User DevicesComputer on Wheels / Laptop Carts Entire Facility $1,254 $1,630 3 $3,761 $4,889Laptops Entire Facility $1,043 $1,251 15 $15,643 $18,771Workstations A $613 $736 1 $613 $736

B-F $613 $736 5 $3,067 $3,681Corridor Bldg / IMSVCS1 $613 $736 2 $1,227 $1,472Corridor Bldg / IMSVCS3 $613 $736 11 $6,748 $8,097


WAN / LAN Firewall + IDPS Maintenance Corridor Bldg / MDF $1,544 $2,008 1 $1,544 $2,008Wireless AP Maintenance Multiple $128 $166 11 $1,406 $1,828Wireless Controller Maintenance (Sm) Corridor Bldg / MDF $916 $1,191 1 $916 $1,191

WAN / LAN Total 13 $3,866 $5,026

On-Going Total 60 $67,258 $84,706


SiteInvestment



Monroe CC One-Time Cabling / Pathways Add'l electrical outlets Pharmacy $213 $298 6 $1,278 $1,789Power cabling to support wireless (High) IMU/SEG $3,195 $4,473 8 $25,560 $35,784


Facility Modifications Building Expansion Medical $479 $671 1000 $479,250 $670,950Ductless Air Conditioner A/B, C/D IDF $3,882 $5,435 2 $7,764 $10,869Ductless Air-conditioner Labor surcharge A/B, C/D IDF $3,600 $3,600 1 $3,600 $3,600Expand Nursing Station SOU $570 $798 200 $113,955 $159,537Med Room Expansion IMU $570 $798 50 $28,489 $39,884Repair Walls Old Admin $570 $798 100 $56,978 $79,769Replace Air Conditioner MDF $44,150 $61,810 1 $44,150 $61,810

Facility Modifications Total 1354 $734,185 $1,026,419

Preventative Measures Fire Extinguishers IDF $59 $76 3 $176 $228Preventative Measures Total 3 $176 $228

WAN / LAN Access Points IMU/SEG $1,118 $1,454 8 $8,946 $11,630Data drops (High) WSR/TRU $4,793 $6,710 3 $14,378 $20,129Data drops (Med) IMU/SEG $1,598 $2,237 8 $12,780 $17,892

MSU $1,598 $2,237 2 $3,195 $4,473SOU/IMU $1,598 $2,237 8 $12,780 $17,892

Firewall + IDPS for Wireless MDF $7,668 $9,968 1 $7,668 $9,968Wireless controller (Sm) MDF $5,858 $7,615 1 $5,858 $7,615


WAN / LAN Total 39 $73,604 $97,598

One-Time Total 1410 $834,803 $1,161,819


SiteInvestment



Monroe CC On-Going Printer / Scanner Multi-Function Device (Lrg) IMU $7,246 $9,420 1 $7,246 $9,420SOU $7,246 $9,420 3 $21,739 $28,260

Multi-Function Device (Med) Medical $3,233 $4,203 2 $6,467 $8,407Printer / Scanner Total 6 $35,452 $46,087

User DevicesComputer on Wheels / Laptop Carts SEG $1,254 $1,630 1 $1,254 $1,630

SOU $1,254 $1,630 1 $1,254 $1,630Laptops Entire Facility $1,043 $1,251 20 $20,857 $25,028Workstations IMU $613 $736 5 $3,067 $3,681

Medical $613 $736 5 $3,067 $3,681SOU $613 $736 16 $9,815 $11,778TRU $613 $736 2 $1,227 $1,472


WAN / LAN Firewall + IDPS Maintenance MDF $1,544 $2,008 1 $1,544 $2,008Wireless Controller Maintenance (Sm) MDF $916 $1,191 1 $916 $1,191

WAN / LAN Total 2 $2,460 $3,198

Other

Additional FTEs to support wireless network and new user device technology Entire Facility $80,000 $104,000 1 $80,000 $104,000

Other Total 1 $80,000 $104,000

On-Going Total 59 $158,452 $202,184


SiteInvestment



Olympic CC One-Time Preventative Measures Fire Extinguishers Medical Unit $59 $76 1 $59 $76Preventative Measures Total 1 $59 $76

User Devices PDA Medical Unit $213 $256 2 $426 $511User Devices Total 2 $426 $511

WAN / LANWAN Initiation (Fractional T1-512K) Admin $12,780 $16,614 1 $12,780 $16,614

WAN / LAN Total 1 $12,780 $16,614

One-Time Total 4 $13,265 $17,201


SiteInvestment



Olympic CC On-Going Printer / Scanner Multi-Function Device (Lrg) Medical Unit $7,246 $9,420 1 $7,246 $9,420Printer / Scanner Total 1 $7,246 $9,420

User Devices Laptops Medical Unit $1,043 $1,251 2 $2,086 $2,503PDA Yearly Service Fee Medical Unit $639 $767 2 $1,278 $1,534Workstations Medical Unit $613 $736 1 $613 $736


WAN / LANYearly WAN Service Fee (Fractional T1-512K) Admin $6,390 $8,307 1 $6,390 $8,307

WAN / LAN Total 1 $6,390 $8,307

On-Going Total 7 $17,613 $22,500


SiteInvestment



Pine Lodge CC for Women One-Time Cabling / Pathways Add'l electrical outlets Medical $213 $298 2 $426 $596Data drops (High) Medical $4,793 $6,710 4 $19,170 $26,838Power cabling to support wireless (High) Medical $3,195 $4,473 4 $12,780 $17,892


Preventative Measures FM200 Fire Suppression MDF $37,275 $52,185 1 $37,275 $52,185Preventative Measures Total 1 $37,275 $52,185

WAN / LAN Access Points Medical $1,118 $1,454 4 $4,473 $5,815Data drops (High) see notes $4,793 $6,710 6 $28,755 $40,257

Firewall + IDPS for Wireless Entire Facility $7,668 $9,968 1 $7,668 $9,968Wireless controller (Sm) Entire Facility $5,858 $7,615 1 $5,858 $7,615


Workgroup Switch - 48 ports Medical $2,876 $3,738 1 $2,876 $3,738WAN / LAN Total 17 $53,629 $71,393

Other Generator hookup Medical $5,000 $7,000 1 $5,000 $7,000Sprinkler System Medical $16,400 $32,800 1 $16,400 $32,800

Other Total 2 $21,400 $39,800

One-Time Total 30 $144,680 $208,705


SiteInvestment



Pine Lodge CC for Women On-Going Printer / Scanner Multi-Function Device (Sm) Medical $1,240 $1,612 4 $4,959 $6,446Printer / Scanner Total 4 $4,959 $6,446

User Devices Laptops Medical $1,043 $1,251 5 $5,214 $6,257Workstations Medical $613 $736 11 $6,748 $8,097


WAN / LAN Firewall + IDPS Maintenance Entire Facility $1,544 $2,008 1 $1,544 $2,008Wireless AP Maintenance Entire Facility $128 $166 4 $511 $665Wireless Controller Maintenance (Sm) Entire Facility $916 $1,191 1 $916 $1,191Workgroup Switch Maintenance - 48 ports Medical $351 $457 1 $351 $457

WAN / LAN Total 7 $3,323 $4,320

On-Going Total 27 $20,244 $25,120


SiteInvestment



Rap/Lincoln One-Time Facility Modifications Build-out Rap House $320 $447 20 $6,390 $8,946Cabinet (Lrg) Admin Building $1,844 $2,397 1 $1,844 $2,397Electrical Outlet Rap House $213 $298 4 $852 $1,193


WAN / LAN Data Drops (Low) Rap House $533 $746 2 $1,065 $1,491WAN / LAN Total 2 $1,065 $1,491

One-Time Total 27 $10,151 $14,027


SiteInvestment



Rap/Lincoln On-Going User Devices Laptops Entire Facility $1,043 $1,251 2 $2,086 $2,503Workstations Rap House $613 $736 1 $613 $736




SiteInvestment



Seattle Community Justice Center One-Time Other No investment item Main Building $0 $0 1 $0 $0Other Total 1 $0 $0

One-Time Total 1 $0 $0


SiteInvestment



Stafford Creek CC One-Time Cabling / Pathways Data Cable Cover R $5 $7 30 $150 $210Telephone cabling R $1,598 $2,237 3 $4,793 $6,710


Facility Modifications Build-out IMU/SEG $320 $447 300 $95,850 $134,190Ductless Air Conditioner R $3,882 $5,435 1 $3,882 $5,435Ductless Air-conditioner Labor surcharge R $3,600 $3,600 1 $3,600 $3,600


Preventative Measures FM200 Fire Suppression D $37,275 $52,185 1 $37,275 $52,185Preventative Measures Total 1 $37,275 $52,185

User Devices PDA F $213 $256 1 $213 $256User Devices Total 1 $213 $256

WAN / LAN Access Points F $1,118 $1,454 7 $7,828 $10,176R $1,118 $1,454 4 $4,473 $5,815

Data drops (High) R $4,793 $6,710 2 $9,585 $13,419

Firewall + IDPS for Wireless MDF $7,668 $9,968 1 $7,668 $9,968Wireless controller (Sm) MDF $5,858 $7,615 1 $5,858 $7,615

Wireless Network Design/Implementation Cost MDF $1,000 $1,000 11 $11,000 $11,000

WAN / LAN Total 26 $46,411 $57,993

Exceptional Facility Modification Ground Water Seepage D $100,000 $150,000 1 $100,000 $150,000Exceptional Facility Modification Total 1 $100,000 $150,000

One-Time Total 364 $292,174 $410,578


SiteInvestment



Stafford Creek CC On-Going Printer / Scanner Multi-Function Device (Med) R $3,233 $4,203 5 $16,167 $21,017Printer / Scanner Total 5 $16,167 $21,017

User DevicesComputer on Wheels / Laptop Carts R $1,254 $1,630 3 $3,761 $4,889Laptops R $1,043 $1,251 25 $26,071 $31,285Workstations F $613 $736 1 $613 $736

R $613 $736 4 $2,454 $2,945User Devices Total 33 $32,899 $39,855

WAN / LAN Firewall + IDPS Maintenance MDF $1,544 $2,008 1 $1,544 $2,008Wireless AP Maintenance MDF $128 $166 11 $1,406 $1,828Wireless Controller Maintenance (Sm) MDF $916 $1,191 1 $916 $1,191

WAN / LAN Total 13 $3,866 $5,026

On-Going Total 51 $52,932 $65,897


SiteInvestment



Washington CC for Women One-Time Cabling / PathwaysPower cabling to support wireless (High) Building Z $3,195 $4,473 8 $25,560 $35,784

New Medical Clinic $3,195 $4,473 12 $38,340 $53,676Special Needs $3,195 $4,473 4 $12,780 $17,892



WAN / LAN Access Points Building Z $1,118 $1,454 8 $8,946 $11,630

New Medical Clinic $1,118 $1,454 12 $13,419 $17,445Special Needs $1,118 $1,454 4 $4,473 $5,815

Data drops (High) Building M $4,793 $6,710 1 $4,793 $6,710Building Z $4,793 $6,710 8 $38,340 $53,676Special Needs $4,793 $6,710 4 $19,170 $26,838

Data drops (Med) New Medical Clinic $1,598 $2,237 12 $19,170 $26,838

Firewall + IDPS for Wireless Entire Facility $7,668 $9,968 1 $7,668 $9,968WAN Initiation (T1) Entire Facility $15,975 $20,768 1 $15,975 $20,768Wireless controller (Lrg) Entire Facility $11,715 $15,230 1 $11,715 $15,230


WAN / LAN Total 76 $155,669 $206,916

One-Time Total 101 $269,624 $366,453


SiteInvestment



Washington CC for Women On-Going Printer / Scanner Multi-Function Device (Lrg) New Medical Clinic $7,246 $9,420 4 $28,985 $37,681Printer / Scanner Total 4 $28,985 $37,681

User Devices Laptops Entire Facility $1,043 $1,251 10 $10,428 $12,514Workstations Building Z $613 $736 3 $1,840 $2,208

New Medical Clinic $613 $736 30 $18,403 $22,084User Devices Total 43 $30,672 $36,806

WAN / LAN Firewall + IDPS Maintenance Entire Facility $1,544 $2,008 1 $1,544 $2,008Wireless AP Maintenance Entire Facility $128 $166 24 $3,067 $3,987Wireless Controller Maintenance (Lrg) Entire Facility $1,832 $2,381 1 $1,832 $2,381


On-Going Total 74 $76,324 $96,154


SiteInvestment



Washington State Penitentiary One-Time Cabling / Pathways Data Cable Cover Unit 5 $5 $7 20 $100 $140Power cabling to support wireless (High) See AP locations $3,195 $4,473 22 $70,290 $98,406


Preventative Measures Fire ExtinguishersUnits 1, 4, 5, 6, 7, 8, MSU IDFs $59 $76 9 $527 $685

FM200 Fire Suppression MDF $37,275 $52,185 1 $37,275 $52,185Preventative Measures Total 10 $37,802 $52,870

WAN / LAN Access Points IMU North $1,118 $1,454 4 $4,473 $5,815IMU South $1,118 $1,454 6 $6,710 $8,722Medical Unit $1,118 $1,454 8 $8,946 $11,630Units 1 and 4 $1,118 $1,454 4 $4,473 $5,815

Data drops (High) BAR Units $4,793 $6,710 3 $14,378 $20,129Gen. Pop. Pill Line $4,793 $6,710 2 $9,585 $13,419Medical $4,793 $6,710 6 $28,755 $40,257MSU $4,793 $6,710 1 $4,793 $6,710Old Admin $4,793 $6,710 1 $4,793 $6,710See AP locations $4,793 $6,710 22 $105,435 $147,609Units 6,7,8 $4,793 $6,710 3 $14,378 $20,129

Data Drops (Low) Unit 5 $533 $746 1 $533 $746Data drops (Med) MSU $1,598 $2,237 1 $1,598 $2,237

Data drops with locking ports Unit 5 $4,993 $6,990 2 $9,986 $13,980Data Pull D,E,F,G $533 $746 4 $2,130 $2,982

IMU North $533 $746 1 $533 $746IMU South $533 $746 1 $533 $746Medical $533 $746 2 $1,065 $1,491

Wireless controller (Med) MDF $8,414 $10,938 1 $8,414 $10,938


WAN / LAN Total 95 $242,506 $331,807

One-Time Total 147 $350,698 $483,223


SiteInvestment



Washington State Penitentiary On-Going Printer / Scanner Multi-Function Device (Lrg) Medical Bldg $7,246 $9,420 5 $36,231 $47,101

Multi-Function Device (Med) Rainier $3,233 $4,203 1 $3,233 $4,203Multi-Function Device (Sm) MSU $1,240 $1,612 2 $2,479 $3,223

Units 1/4, 6, 7, 8 $1,240 $1,612 4 $4,959 $6,446Printer / Scanner Total 12 $46,903 $60,973

User DevicesComputer on Wheels / Laptop Carts IMU $1,254 $1,630 2 $2,507 $3,259

Medical Bldg $1,254 $1,630 2 $2,507 $3,259Units 1 and 4 $1,254 $1,630 2 $2,507 $3,259

Workstations BAR $613 $736 2 $1,227 $1,472IMU $613 $736 2 $1,227 $1,472Medical Bldg $613 $736 11 $6,748 $8,097MSU $613 $736 2 $1,227 $1,472Unit 1/4 $613 $736 1 $613 $736Unit 5 $613 $736 4 $2,454 $2,945Unit 7 $613 $736 1 $613 $736


WAN / LAN Wireless AP Maintenance Entire Facility $128 $166 22 $2,812 $3,655Wireless Controller Maintenance (Med) MDF $1,321 $1,717 1 $1,321 $1,717

WAN / LAN Total 23 $4,132 $5,372

Other


Other Total 1 $80,000 $104,000

On-Going Total 65 $152,665 $197,054


SiteInvestment



WCC Shelton One-Time Cabling / PathwaysPower cabling to support wireless (High) IMU $3,195 $4,473 14 $44,730 $62,622Telephone cabling D unit $1,598 $2,237 3 $4,793 $6,710


Facility Modifications Build-out Cedar $570 $798 400 $227,910 $319,074R4 $570 $798 50 $28,489 $39,884R5 $570 $798 400 $227,910 $319,074R6 $570 $798 400 $227,910 $319,074R7 $570 $798 400 $227,910 $319,074

Ductless Air Conditioner IMU $3,882 $5,435 1 $3,882 $5,435R2 $3,882 $5,435 1 $3,882 $5,435

Ductless Air-conditioner Labor surcharge IMU $3,600 $3,600 1 $3,600 $3,600

R2 $3,600 $3,600 1 $3,600 $3,600Facility Modifications Total 1654 $955,093 $1,334,250

Preventative Measures Fire Extinguishers Cedar $59 $76 1 $59 $76IMU $59 $76 1 $59 $76R1 $59 $76 1 $59 $76R2 $59 $76 1 $59 $76R3 $59 $76 1 $59 $76R4 $59 $76 1 $59 $76R5 $59 $76 1 $59 $76R6 $59 $76 1 $59 $76R7 $59 $76 1 $59 $76


WAN / LAN Access Points IMU $1,118 $1,454 14 $15,656 $20,352Data drops (High) Cedar $4,793 $6,710 3 $14,378 $20,129

IMU $4,793 $6,710 16 $76,680 $107,352R1 $4,793 $6,710 2 $9,585 $13,419R2 $4,793 $6,710 2 $9,585 $13,419R3 $4,793 $6,710 2 $9,585 $13,419R5 $4,793 $6,710 3 $14,378 $20,129R6 $4,793 $6,710 3 $14,378 $20,129R7 $4,793 $6,710 3 $14,378 $20,129

Firewall + IDPS for Wireless IT $7,668 $9,968 1 $7,668 $9,968Wireless controller (Med) IT $8,414 $10,938 1 $8,414 $10,938


WAN / LAN Total 103 $221,182 $295,881

Exceptional Facility Modification Generator (1,500KW) Entire Facility $552,735 $773,829 1 $552,735 $773,829Exceptional Facility Modification Total 1 $552,735 $773,829

One-Time Total 1784 $1,779,059 $2,473,977


SiteInvestment



WCC Shelton On-Going Printer / Scanner Multi-Function Device (Med) Cedar $3,233 $4,203 1 $3,233 $4,203D unit $3,233 $4,203 1 $3,233 $4,203IMU $3,233 $4,203 1 $3,233 $4,203R1 $3,233 $4,203 1 $3,233 $4,203R2 $3,233 $4,203 1 $3,233 $4,203R3 $3,233 $4,203 1 $3,233 $4,203R4 $3,233 $4,203 1 $3,233 $4,203R5 $3,233 $4,203 1 $3,233 $4,203R6 $3,233 $4,203 1 $3,233 $4,203


User DevicesComputer on Wheels / Laptop Carts IMU $1,254 $1,630 2 $2,507 $3,259

R1 $1,254 $1,630 1 $1,254 $1,630R2 $1,254 $1,630 1 $1,254 $1,630R3 $1,254 $1,630 1 $1,254 $1,630

Laptops D unit $1,043 $1,251 3 $3,129 $3,754IMU $1,043 $1,251 1 $1,043 $1,251

Workstations C unit $613 $736 3 $1,840 $2,208Cedar $613 $736 3 $1,840 $2,208D unit $613 $736 4 $2,454 $2,945R5 $613 $736 3 $1,840 $2,208R7 $613 $736 3 $1,840 $2,208


WAN / LAN Firewall + IDPS Maintenance IT $1,544 $2,008 1 $1,544 $2,008Wireless AP Maintenance Entire Facility $128 $166 53 $6,773 $8,805Wireless Controller Maintenance (Med) New IT $1,321 $1,717 1 $1,321 $1,717

WAN / LAN Total 55 $9,638 $12,530

On-Going Total 89 $58,992 $75,291


SiteInvestment



WCCW Mission Creek One-Time Cabling / PathwaysAdditional Fiber without conduit Main $639 $895 100 $63,900 $89,460


Facility Modifications UPS (Med) Main $595 $774 1 $595 $774Facility Modifications Total 1 $595 $774

Preventative Measures Fire Extinguishers Main $59 $76 1 $59 $76FM200 Fire Suppression Main $37,275 $52,185 1 $37,275 $52,185


WAN / LAN Data drops (Med) Main $1,598 $2,237 6 $9,585 $13,419WAN Initiation (Fractional T1-512K) Main $12,780 $16,614 1 $12,780 $16,614

WAN / LAN Total 7 $22,365 $30,033

One-Time Total 110 $124,194 $172,528


SiteInvestment



WCCW Mission Creek On-Going User Devices Workstations Main $613 $736 5 $3,067 $3,681User Devices Total 5 $3,067 $3,681

WAN / LANYearly WAN Service Fee (Fractional T1-512K) Main $6,390 $8,307 1 $6,390 $8,307

WAN / LAN Total 1 $6,390 $8,307

On-Going Total 6 $9,457 $11,988


Agency DSHSAdministration (All)

Data

SiteInvestment



Camp Outlook (Basic Training Camp) One-Time WAN / LAN Workgroup Switch - 24 ports Main Building $1,598 $2,077 1 $1,598 $2,077WAN / LAN Total 1 $1,598 $2,077

One-Time Total 1 $1,598 $2,077


SiteInvestment



Camp Outlook (Basic Training Camp) On-Going WAN / LANWorkgroup Switch Maintenance - 24 ports Main Building $218 $284 1 $218 $284

WAN / LAN Total 1 $218 $284

On-Going Total 1 $218 $284


SiteInvestment



Canyon View Community Facility One-Time Cabling / Pathways Patch panel Main Building $510 $664 1 $510 $664

Patch Panel Installation Labor Main Building $1,000 $1,000 1 $1,000 $1,000Power cabling to support wireless (Low) Main Building $533 $746 3 $1,598 $2,237


Facility Modifications Build-out Main Building $320 $447 60 $19,170 $26,838Ductless Air Conditioner Main Building $3,882 $5,435 1 $3,882 $5,435Increase Power Capacity Main Building $4,260 $8,520 1 $4,260 $8,520


Preventative Measures Fire Extinguishers Main Building $59 $76 1 $59 $76Preventative Measures Total 1 $59 $76

WAN / LAN Access Points Main Building $1,118 $1,454 3 $3,355 $4,361Data Drops (Low) Main Building $533 $746 35 $18,638 $26,093

Firewall + IDPS for Wireless Main Building $7,668 $9,968 1 $7,668 $9,968Rack Main Building $749 $973 1 $749 $973Wireless controller (Sm) Main Building $5,858 $7,615 1 $5,858 $7,615

Wireless Network Design/Implementation Cost Main Building $1,000 $1,000 3 $3,000 $3,000

WAN / LAN Total 44 $39,266 $52,010

One-Time Total 112 $69,745 $96,779


SiteInvestment



Canyon View Community Facility On-Going Printer / Scanner Multi-Function Device (Lrg) Main Building $7,246 $9,420 1 $7,246 $9,420Multi-Function Device (Sm) Main Building $1,240 $1,612 1 $1,240 $1,612


User Devices Laptops Main Building $1,043 $1,251 3 $3,129 $3,754Workstations Main Building $613 $736 1 $613 $736


WAN / LAN Firewall + IDPS Maintenance Main Building $1,544 $2,008 1 $1,544 $2,008Wireless AP Maintenance Main Building $128 $166 3 $383 $498Wireless Controller Maintenance (Sm) Main Building $916 $1,191 1 $916 $1,191

WAN / LAN Total 5 $2,844 $3,697

On-Going Total 11 $15,071 $19,219


SiteInvestment



Child Study and Treatment Center One-Time Cabling / PathwaysAdditional Fiber without conduit Admin $213 $298 1300 $276,900 $387,660

Camano $213 $298 750 $159,750 $223,650Ketron $213 $298 750 $159,750 $223,650Orcas $213 $298 750 $159,750 $223,650

Power cabling to support wireless (Low) Camano $533 $746 4 $2,130 $2,982

Ketron $533 $746 4 $2,130 $2,982Orcas $533 $746 4 $2,130 $2,982

Cabling / Pathways Total 3562 $762,540 $1,067,556

Facility Modifications Cabinet (Sm) Camano $749 $973 1 $749 $973Ketron $749 $973 1 $749 $973Orcas $749 $973 1 $749 $973

Protective Enclosure (Sm) Camano $533 $692 2 $1,065 $1,385Ketron $533 $692 2 $1,065 $1,385Orcas $533 $692 2 $1,065 $1,385


Preventative Measures Fire Extinguishers Admin $59 $76 1 $59 $76Camano $59 $76 1 $59 $76Ketron $59 $76 1 $59 $76Orcas $59 $76 1 $59 $76


WAN / LAN Access Points Camano $1,118 $1,454 4 $4,473 $5,815Ketron $1,118 $1,454 4 $4,473 $5,815Orcas $1,118 $1,454 4 $4,473 $5,815

Data Drops (Low) Camano $533 $746 4 $2,130 $2,982Ketron $533 $746 4 $2,130 $2,982Orcas $533 $746 4 $2,130 $2,982

Firewall + IDPS for Wireless Admin $7,668 $9,968 1 $7,668 $9,968Wireless controller (Sm) Admin $5,858 $7,615 1 $5,858 $7,615


Workgroup Switch - 24 ports Ketron $1,598 $2,077 1 $1,598 $2,077Orcas $1,598 $2,077 1 $1,598 $2,077

Workgroup Switch - 48 ports Admin $2,876 $3,738 1 $2,876 $3,738Camano $2,876 $3,738 1 $2,876 $3,738

WAN / LAN Total 42 $54,281 $67,604

One-Time Total 3617 $822,496 $1,142,537


SiteInvestment



Child Study and Treatment Center On-Going Printer / Scanner Multi-Function Device (Med) Admin $3,233 $4,203 1 $3,233 $4,203Camano $3,233 $4,203 1 $3,233 $4,203Ketron $3,233 $4,203 1 $3,233 $4,203Orcas $3,233 $4,203 1 $3,233 $4,203


User Devices Laptops Admin $1,043 $1,251 5 $5,214 $6,257Camano $1,043 $1,251 5 $5,214 $6,257Ketron $1,043 $1,251 5 $5,214 $6,257Orcas $1,043 $1,251 5 $5,214 $6,257

Workstations Elementary School $613 $736 1 $613 $736Orcas $613 $736 2 $1,227 $1,472


WAN / LAN Firewall + IDPS Maintenance Admin $1,544 $2,008 1 $1,544 $2,008Wireless AP Maintenance Entire Facility $128 $166 12 $1,534 $1,994Wireless Controller Maintenance (Sm) Admin $916 $1,191 1 $916 $1,191Workgroup Switch Maintenance - 24 ports Entire Facility $218 $284 2 $437 $568Workgroup Switch Maintenance - 48 ports Entire Facility $351 $457 2 $703 $914

WAN / LAN Total 18 $5,133 $6,673

On-Going Total 45 $40,764 $50,723


SiteInvestment



Eastern State Hospital One-Time Cabling / Pathways Add'l power plugs/strips 1S, 2S, 3S, AT-C $213 $298 32 $6,816 $9,542Cabling / Pathways Total 32 $6,816 $9,542

Facility Modifications Cabinet (Sm) APU $749 $973 1 $749 $973Facility Modifications Total 1 $749 $973

Preventative Measures Fire Extinguishers Entire Facility $59 $76 24 $1,406 $1,828FM200 Fire Suppression Admin $37,275 $52,185 1 $37,275 $52,185


WAN / LAN Access Points APU $1,118 $1,454 15 $16,774 $21,806AT $1,118 $1,454 4 $4,473 $5,815FSU $1,118 $1,454 15 $16,774 $21,806

HMH, B, D, E, F, G $1,118 $1,454 24 $26,838 $34,889Backbone Switch with Modules MDF $78,810 $102,453 1 $78,810 $102,453Data drops (High) FSU $4,793 $6,710 22 $105,435 $147,609Data drops (Med) APU $1,598 $2,237 28 $44,730 $62,622

AT $1,598 $2,237 4 $6,390 $8,946Westlake $1,598 $2,237 36 $57,510 $80,514

Firewall + IDPS for Wireless Entire Facility $7,668 $9,968 1 $7,668 $9,968Long Range Point to Point Wireless

Superintendent's House $3,000 $4,200 4 $12,000 $16,800

Long Range Wireless Installation Labor

Superintendent's House $24,000 $24,000 4 $96,000 $96,000

Wireless controller (Lrg) Entire Facility $11,715 $15,230 1 $11,715 $15,230Wireless controller (Sm) Entire Facility $5,858 $7,615 1 $5,858 $7,615

Wireless Network Design/Implementation Cost Entire Facility $500 $500 58 $29,000 $29,000Workgroup Switch - 24 ports POE APU $2,876 $3,738 16 $46,008 $59,810

AT $2,876 $3,738 1 $2,876 $3,738FSU $2,876 $3,738 8 $23,004 $29,905Westlake $2,876 $3,738 8 $23,004 $29,905

WAN / LAN Total 251 $614,866 $784,432

Exceptional Facility Modification Generator (200KW) AT $82,000 $114,800 1 $82,000 $114,800Upgrade Power System Admin Building $100,000 $150,000 1 $100,000 $150,000

AT $100,000 $150,000 1 $100,000 $150,000Exceptional Facility Modification Total 3 $282,000 $414,800

One-Time Total 312 $943,111 $1,263,760


SiteInvestment



Eastern State Hospital On-Going Printer / Scanner Multi-Function Device (Lrg) Admin Building $7,246 $9,420 1 $7,246 $9,420

Multi-Function Device (Med) APU $3,233 $4,203 3 $9,700 $12,610AT $3,233 $4,203 1 $3,233 $4,203Eastlake $3,233 $4,203 1 $3,233 $4,203FSU $3,233 $4,203 4 $12,933 $16,813Westlake $3,233 $4,203 5 $16,167 $21,017


User Devices Laptops APU $1,043 $1,251 21 $21,900 $26,280Eastlake $1,043 $1,251 16 $16,686 $20,023FSU $1,043 $1,251 18 $18,771 $22,526Westlake $1,043 $1,251 26 $27,114 $32,537

Workstations APU $613 $736 6 $3,681 $4,417Eastlake $613 $736 4 $2,454 $2,945FSU $613 $736 11 $6,748 $8,097Pharmacy $613 $736 3 $1,840 $2,208Therapy Pool $613 $736 2 $1,227 $1,472


WAN / LANBackbone Switch Maintenance MDF $5,325 $6,923 1 $5,325 $6,923

Firewall + IDPS Maintenance Entire Facility $1,544 $2,008 1 $1,544 $2,008Long Range Wireless Maintenance

Superintendent's House $230 $322 4 $920 $1,288

Wireless AP Maintenance Entire Facility $128 $166 58 $7,412 $9,636Wireless Controller Maintenance (Lrg) Entire Facility $1,832 $2,381 1 $1,832 $2,381Wireless Controller Maintenance (Sm) Entire Facility $916 $1,191 1 $916 $1,191

Workgroup Switch Maintenance - 24 ports POE IDFs $351 $457 33 $11,598 $15,077Workgroup Switch Maintenance - 48 ports IDFs $351 $457 8 $2,812 $3,655

WAN / LAN Total 107 $32,359 $42,158

Other


Other Total 1 $80,000 $104,000

On-Going Total 230 $265,292 $334,930


SiteInvestment



Echo Glen Children's Center One-Time Cabling / PathwaysPower cabling to support wireless (Low) Health Center $533 $746 2 $1,065 $1,491


Facility Modifications Cabinet (Sm) Recreation Building $749 $973 1 $749 $973Ductless Air Conditioner Admin Building $3,882 $5,435 1 $3,882 $5,435Protective Enclosure (Sm) Admin Building $533 $692 1 $533 $692UPS (Sm) Entire Facility $341 $443 13 $4,430 $5,759Wall Mount for Workstation Health Center $1,516 $1,971 3 $4,549 $5,914


Preventative Measures FM200 Fire Suppression Admin Building $37,275 $52,185 1 $37,275 $52,185Preventative Measures Total 1 $37,275 $52,185

WAN / LAN Access Points Health Center $1,118 $1,454 2 $2,237 $2,907Data Drops (Low) Health Center $533 $746 2 $1,065 $1,491

Firewall + IDPS for Wireless Entire Facility $7,668 $9,968 1 $7,668 $9,968WAN Initiation (T1/10mb) Entire Facility $15,975 $20,768 1 $15,975 $20,768Wireless controller (Sm) Entire Facility $5,858 $7,615 1 $5,858 $7,615


WAN / LAN Total 9 $34,802 $44,749

One-Time Total 31 $87,284 $117,198


SiteInvestment



Echo Glen Children's Center On-Going Printer / Scanner Multi-Function Device (Lrg) Health Center $7,246 $9,420 1 $7,246 $9,420Printer / Scanner Total 1 $7,246 $9,420

User DevicesComputer on Wheels / Laptop Carts Health Center $1,254 $1,630 2 $2,507 $3,259Laptops Health Center $1,043 $1,251 5 $5,214 $6,257Workstations Health Center $613 $736 6 $3,681 $4,417


WAN / LAN Firewall + IDPS Maintenance Entire Facility $1,544 $2,008 1 $1,544 $2,008Wireless AP Maintenance Entire Facility $128 $166 2 $256 $332Wireless Controller Maintenance (Sm) Entire Facility $916 $1,191 1 $916 $1,191


On-Going Total 19 $31,588 $40,175


SiteInvestment



Fircrest One-Time Cabling / PathwaysPower cabling to support wireless (Low) Entire Facility $533 $746 32 $17,040 $23,856


Facility Modifications Cabinet (Lrg) 500 Bldg $1,844 $2,397 1 $1,844 $2,397

Protective Enclosure (Lrg)PAT-A Residential Units $2,130 $2,769 20 $42,600 $55,380

UPS (Lrg) 200 Bldg $1,385 $1,800 1 $1,385 $1,800UPS (Sm) Entire Facility $341 $443 30 $10,224 $13,291Wall Mount for Workstation Clinic $1,516 $1,971 4 $6,065 $7,885


Preventative Measures FM200 Fire Suppression 200/500 Bldg $37,275 $52,185 2 $74,550 $104,370Preventative Measures Total 2 $74,550 $104,370

WAN / LAN Access Points Entire Facility $1,118 $1,454 32 $35,784 $46,519Backbone Switch with Modules 200 Bldg $78,810 $102,453 1 $78,810 $102,453Data Drops (Low) Entire Facility $533 $746 42 $22,365 $31,311Data drops (Med) 200 Bldg $1,598 $2,237 8 $12,780 $17,892

Firewall + IDPS for Wireless Entire Facility $7,668 $9,968 1 $7,668 $9,968WAN Initiation (10mb) Entire Facility $31,950 $41,535 1 $31,950 $41,535Wireless controller (Lrg) Entire Facility $11,715 $15,230 1 $11,715 $15,230


Workgroup Switch - 24 ports Entire Facility $1,598 $2,077 25 $39,938 $51,919

Workgroup Switch - 48 ports 500 Bldg $2,876 $3,738 1 $2,876 $3,738WAN / LAN Total 144 $259,885 $336,565

Exceptional Facility ModificationElectric feeder overhaul and new generator project Entire Facility $1,704,000 $2,385,600 1 $1,704,000 $2,385,600

Exceptional Facility Modification Total 1 $1,704,000 $2,385,600

One-Time Total 235 $2,117,593 $2,931,144


SiteInvestment



Fircrest On-Going Printer / Scanner Multi-Function Device (Med) Entire Facility $3,233 $4,203 4 $12,933 $16,813Printer / Scanner Total 4 $12,933 $16,813

User DevicesComputer on Wheels / Laptop Carts Infirmary $1,254 $1,630 2 $2,507 $3,259Laptops Entire Facility $1,043 $1,251 35 $36,500 $43,800Workstations Clinic $613 $736 4 $2,454 $2,945

Entire Facility $613 $736 225 $138,024 $165,629PAT-A Residential Units $613 $736 20 $12,269 $14,723


WAN / LANBackbone Switch Maintenance 200 Bldg $5,325 $6,923 1 $5,325 $6,923

Firewall + IDPS Maintenance Entire Facility $1,544 $2,008 1 $1,544 $2,008Wireless AP Maintenance Entire Facility $128 $166 32 $4,090 $5,316Wireless Controller Maintenance (Lrg) Entire Facility $1,832 $2,381 1 $1,832 $2,381Workgroup Switch Maintenance - 24 ports Entire Facility $218 $284 25 $5,458 $7,096Workgroup Switch Maintenance - 48 ports 500 Bldg $351 $457 1 $351 $457Yearly WAN Service Fee (10mb) Entire Facility $19,170 $24,921 1 $19,170 $24,921

WAN / LAN Total 62 $37,770 $49,101

Other


Other Total 1 $80,000 $104,000

On-Going Total 353 $322,457 $400,269


SiteInvestment



Frances Haddon Morgan Center One-Time Cabling / PathwaysPower cabling to support wireless (Med) Activities $1,065 $1,491 1 $1,065 $1,491

cottage 3420/3422 $1,065 $1,491 2 $2,130 $2,982cottage 3423/3425 $1,065 $1,491 2 $2,130 $2,982cottage 3424/3426 $1,065 $1,491 2 $2,130 $2,982cottage 3428/3430 $1,065 $1,491 2 $2,130 $2,982


Facility Modifications Build-out cottage 3420/3422 $320 $447 60 $19,170 $26,838cottage 3423/3425 $320 $447 60 $19,170 $26,838cottage 3424/3426 $320 $447 60 $19,170 $26,838

UPS (Sm) cottage 3420/3422 $341 $443 1 $341 $443cottage 3423/3425 $341 $443 1 $341 $443cottage 3424/3426 $341 $443 1 $341 $443



User Devices PDA Entire Facility $213 $256 20 $4,260 $5,112User Devices Total 20 $4,260 $5,112

WAN / LAN Access Points Activities $1,118 $1,454 1 $1,118 $1,454cottage 3420/3422 $1,118 $1,454 2 $2,237 $2,907cottage 3423/3425 $1,118 $1,454 2 $2,237 $2,907cottage 3424/3426 $1,118 $1,454 2 $2,237 $2,907cottage 3428/3430 $1,118 $1,454 2 $2,237 $2,907

Data drops (Med) Activities $1,598 $2,237 1 $1,598 $2,237cottage 3420/3422 $1,598 $2,237 2 $3,195 $4,473cottage 3422 $1,598 $2,237 1 $1,598 $2,237cottage 3423/3425 $1,598 $2,237 2 $3,195 $4,473cottage 3424/3426 $1,598 $2,237 2 $3,195 $4,473cottage 3428/3430 $1,598 $2,237 2 $3,195 $4,473cottage 3430 $1,598 $2,237 1 $1,598 $2,237

Forest Ridge Lodge $1,598 $2,237 5 $7,988 $11,183Main Building $1,598 $2,237 4 $6,390 $8,946

Firewall + IDPS for Wireless Main Building $7,668 $9,968 1 $7,668 $9,968Wireless controller (Sm) Main Building $5,858 $7,615 1 $5,858 $7,615


Workgroup Switch - 24 ports cottage 3420/3422 $1,598 $2,077 1 $1,598 $2,077cottage 3423/3425 $1,598 $2,077 1 $1,598 $2,077cottage 3424/3426 $1,598 $2,077 1 $1,598 $2,077

WAN / LAN Total 43 $69,332 $90,627

Exceptional Facility Modification Increase Power Capacity Entire Facility $12,780 $17,892 1 $12,780 $17,892Exceptional Facility Modification Total 1 $12,780 $17,892

One-Time Total 257 $191,765 $261,078


SiteInvestment



Frances Haddon Morgan Center On-Going Printer / Scanner Multi-Function Device (Lrg) Main Building $7,246 $9,420 1 $7,246 $9,420

Multi-Function Device (Med) Main Building $3,233 $4,203 1 $3,233 $4,203Multi-Function Device (Sm) All Cottages $1,240 $1,612 4 $4,959 $6,446


User Devices Laptops Entire Facility $1,043 $1,251 20 $20,857 $25,028PDA Yearly Service Fee Entire Facility $639 $767 20 $12,780 $15,336Workstations Entire Facility $613 $736 46 $28,218 $33,862


WAN / LAN Firewall + IDPS Maintenance Main Building $1,544 $2,008 1 $1,544 $2,008Wireless AP Maintenance Entire Facility $128 $166 9 $1,150 $1,495Wireless Controller Maintenance (Sm) Entire Facility $916 $1,191 1 $916 $1,191Workgroup Switch Maintenance - 24 ports Main Building $218 $284 3 $655 $851

WAN / LAN Total 14 $4,265 $5,545

On-Going Total 106 $81,559 $99,841


SiteInvestment



Green Hill School One-Time Cabling / PathwaysPower cabling to support wireless (Med) B Unit $1,065 $1,491 2 $2,130 $2,982

H unit $1,065 $1,491 2 $2,130 $2,982M unit $1,065 $1,491 2 $2,130 $2,982New IMU $1,065 $1,491 4 $4,260 $5,964S unit $1,065 $1,491 2 $2,130 $2,982


Facility Modifications Build-out Z building $320 $447 60 $19,170 $26,838UPS (Sm) Entire Facility $341 $443 6 $2,045 $2,658


Preventative Measures Fire Extinguishers B building $59 $76 1 $59 $76H building $59 $76 1 $59 $76M building $59 $76 1 $59 $76S building $59 $76 1 $59 $76Z building $59 $76 1 $59 $76


WAN / LAN Access Points B Unit $1,118 $1,454 2 $2,237 $2,907H unit $1,118 $1,454 2 $2,237 $2,907M unit $1,118 $1,454 2 $2,237 $2,907New IMU $1,118 $1,454 4 $4,473 $5,815S unit $1,118 $1,454 2 $2,237 $2,907

Data drops (Med) B Unit $1,598 $2,237 2 $3,195 $4,473H unit $1,598 $2,237 2 $3,195 $4,473M unit $1,598 $2,237 2 $3,195 $4,473New IMU $1,598 $2,237 4 $6,390 $8,946S unit $1,598 $2,237 2 $3,195 $4,473

Firewall + IDPS for Wireless MDF $7,668 $9,968 1 $7,668 $9,968WAN Initiation (T1) MDF $15,975 $20,768 1 $15,975 $20,768Wireless controller (Sm) MDF $5,858 $7,615 1 $5,858 $7,615


WAN / LAN Total 39 $74,090 $94,633

One-Time Total 122 $108,377 $142,402


SiteInvestment



Green Hill School On-Going Printer / Scanner Multi-Function Device (Med) Medical Unit $3,233 $4,203 2 $6,467 $8,407Printer / Scanner Total 2 $6,467 $8,407

User Devices Laptops Medical Unit $1,043 $1,251 5 $5,214 $6,257PDA Yearly Service Fee Medical Unit $639 $767 4 $2,556 $3,067Workstations Medical Unit $613 $736 2 $1,227 $1,472


WAN / LAN Firewall + IDPS Maintenance MDF $1,544 $2,008 1 $1,544 $2,008Wireless AP Maintenance Entire Facility $128 $166 12 $1,534 $1,994Wireless Controller Maintenance (Sm) MDF $916 $1,191 1 $916 $1,191

Yearly WAN Service Fee (T1) MDF $10,224 $13,291 1 $10,224 $13,291WAN / LAN Total 15 $14,218 $18,483

Other


Other Total 1 $80,000 $104,000

On-Going Total 29 $109,682 $141,686


SiteInvestment



Lakeland Village One-Time Cabling / Pathways Additional Fiber with conduit Entire Facility $426 $596 1200 $511,200 $715,680Additional Fiber without conduit Entire Facility $213 $298 2400 $511,200 $715,680Data drops (Med) Entire Facility $1,598 $2,237 12 $19,170 $26,838Fiber Optic Patch Cord MDF $107 $138 3 $320 $415Power cabling to support wireless (Low) All Cottages $533 $746 42 $22,365 $31,311

School Building $533 $746 4 $2,130 $2,982Cabling / Pathways Total 3661 $1,066,385 $1,492,906

Facility ModificationsFixing water leakage in basement

near Hab Ctr south IDF and near Rosewood generator $1,065 $1,491 1 $1,065 $1,491

IDF Cabinet Relocation Willow 76 - 77 $1,065 $1,491 1 $1,065 $1,491Secure bars on windows MDF $746 $1,044 1 $746 $1,044


Preventative Measures Fire Extinguishers All Cottages $59 $76 19 $1,113 $1,447FM200 Fire Suppression MDF $37,275 $52,185 1 $37,275 $52,185


WAN / LAN Access Points All Cottages $1,118 $1,454 42 $46,967 $61,056School Building $1,118 $1,454 4 $4,473 $5,815

Backbone Switch with Modules MDF $78,810 $102,453 1 $78,810 $102,453Data Drops (Low) All Cottages $533 $746 42 $22,365 $31,311

HAB Center $533 $746 4 $2,130 $2,982Health Center $533 $746 10 $5,325 $7,455PAT Offices $533 $746 1 $533 $746School Building $533 $746 4 $2,130 $2,982

Firewall + IDPS for Wireless Entire Facility $7,668 $9,968 1 $7,668 $9,968Rack All Cottages $749 $973 21 $15,721 $20,438WAN Initiation (10mb) Entire Facility $21,300 $29,820 1 $21,300 $29,820Wireless controller (Lrg) Entire Facility $11,715 $15,230 1 $11,715 $15,230


Workgroup Switch - 24 ports All Cottages $1,598 $2,077 12 $19,170 $24,921

Workgroup Switch - 48 ports MDF $2,876 $3,738 1 $2,876 $3,738Rosewood $2,876 $3,738 1 $2,876 $3,738

WAN / LAN Total 192 $267,057 $345,653

Exceptional Facility Modification Transformer re-work South Campus $159,750 $223,650 1 $159,750 $223,650Exceptional Facility Modification Total 1 $159,750 $223,650

One-Time Total 3877 $1,534,455 $2,119,867


SiteInvestment



Lakeland Village On-Going Printer / Scanner Multi-Function Device (Lrg) PAT Offices $7,246 $9,420 2 $14,493 $18,840Multi-Function Device (Sm) HAB Center $1,240 $1,612 1 $1,240 $1,612

Health Center $1,240 $1,612 1 $1,240 $1,612Residential Units $1,240 $1,612 21 $26,033 $33,843


User Devices Laptops Entire Facility $1,043 $1,251 63 $65,699 $78,839Workstations Entire Facility $613 $736 265 $162,562 $195,074


WAN / LANBackbone Switch Maintenance Entire Facility $5,325 $6,923 1 $5,325 $6,923

Firewall + IDPS Maintenance Entire Facility $1,544 $2,008 1 $1,544 $2,008Wireless AP Maintenance Entire Facility $128 $166 46 $5,879 $7,642Wireless Controller Maintenance (Lrg) Entire Facility $1,832 $2,381 1 $1,832 $2,381Workgroup Switch Maintenance - 24 ports Entire Facility $218 $284 12 $2,620 $3,406Workgroup Switch Maintenance - 48 ports Entire Facility $351 $457 2 $703 $914Yearly WAN Service Fee (10mb) Entire Facility $19,170 $24,921 1 $19,170 $24,921

WAN / LAN Total 64 $37,073 $48,194

Other


Other Total 1 $80,000 $104,000

On-Going Total 418 $388,338 $482,014


SiteInvestment



Maple Lane School One-Time Facility Modifications UPS (Sm)

All residences, Admin, and M-S bldg $341 $443 12 $4,089 $5,316


Preventative Measures Fire ExtinguishersAll residences, Admin $59 $76 10 $586 $761

FM200 Fire Suppression Admin, M-S Bldg $37,275 $52,185 2 $74,550 $104,370Preventative Measures Total 12 $75,136 $105,131

WAN / LAN Data Drops (Low) Laurel $533 $746 2 $1,065 $1,491Data Pull Laurel $533 $746 2 $1,065 $1,491

Minor Recabling Maintenance M-S, Laurel $500 $650 2 $1,000 $1,300

RackOlympic, Rainier, Pacific $749 $973 3 $2,246 $2,920

WAN Initiation (10mb) Entire Facility $83,070 $116,298 1 $83,070 $116,298

Workgroup Switch - 48 ports M-S $2,876 $3,738 1 $2,876 $3,738WAN / LAN Total 11 $91,321 $127,238

One-Time Total 35 $170,547 $237,686


SiteInvestment



Maple Lane School On-Going Printer / Scanner Multi-Function Device (Lrg) New Main Clinic $7,246 $9,420 2 $14,493 $18,840

Multi-Function Device (Med)Each Residence Bldg $3,233 $4,203 9 $29,100 $37,830


User DevicesComputer on Wheels / Laptop Carts Entire Facility $1,254 $1,630 2 $2,507 $3,259Laptops Columbia $1,043 $1,251 3 $3,129 $3,754

Entire Facility $1,043 $1,251 5 $5,214 $6,257Workstations Baker $613 $736 2 $1,227 $1,472

Laurel $613 $736 1 $613 $736New Main Clinic $613 $736 10 $6,134 $7,361


WAN / LANWorkgroup Switch Maintenance - 48 ports M-S $351 $457 1 $351 $457Yearly WAN Service Fee (10mb) Entire Facility $25,560 $35,784 1 $25,560 $35,784

WAN / LAN Total 2 $25,911 $36,241

Other


Other Total 1 $80,000 $104,000

On-Going Total 37 $168,329 $219,751


SiteInvestment



Naselle Youth Camp One-Time Cabling / PathwaysPower cabling to support wireless (Low) Cougar $533 $746 1 $533 $746

Harbor $533 $746 1 $533 $746Mariner $533 $746 1 $533 $746Moolock $533 $746 1 $533 $746


Facility Modifications Cabinet (Sm) Cougar $749 $973 1 $749 $973Harbor $749 $973 1 $749 $973Mariner $749 $973 1 $749 $973Moolock $749 $973 1 $749 $973

Ductless Air Conditioner Medical Unit $3,882 $5,435 1 $3,882 $5,435Secure bars on windows Admin $746 $1,044 1 $746 $1,044


Preventative Measures Fire Extinguishers Cougar $59 $76 1 $59 $76Harbor $59 $76 1 $59 $76Mariner $59 $76 1 $59 $76Medical Unit $59 $76 1 $59 $76Moolock $59 $76 1 $59 $76


User Devices PDA Medical Unit $213 $256 3 $639 $767User Devices Total 3 $639 $767

WAN / LAN Access Points Cougar $1,118 $1,454 1 $1,118 $1,454Harbor $1,118 $1,454 1 $1,118 $1,454Mariner $1,118 $1,454 1 $1,118 $1,454Moolock $1,118 $1,454 1 $1,118 $1,454

Data Drops (Low) Cougar $533 $746 1 $533 $746Harbor $533 $746 1 $533 $746Mariner $533 $746 2 $1,065 $1,491Medical Unit $533 $746 8 $4,260 $5,964Moolock $533 $746 1 $533 $746

Firewall + IDPS for Wireless Admin $7,668 $9,968 1 $7,668 $9,968WAN Initiation (T1) Admin $15,975 $20,768 1 $15,975 $20,768Wireless controller (Sm) Admin $5,858 $7,615 1 $5,858 $7,615


WAN / LAN Total 24 $44,896 $57,857

Exceptional Facility Modification Generator (750KW) Entire Facility $236,430 $331,002 1 $236,430 $331,002Exceptional Facility Modification Total 1 $236,430 $331,002

One-Time Total 44 $329,285 $455,545


SiteInvestment



Naselle Youth Camp On-Going Printer / Scanner Multi-Function Device (Med) Medical Unit $3,233 $4,203 1 $3,233 $4,203Printer / Scanner Total 1 $3,233 $4,203

User Devices PDA Yearly Service Fee Medical Unit $639 $767 3 $1,917 $2,300Workstations Medical Unit $613 $736 5 $3,067 $3,681


WAN / LAN Firewall + IDPS Maintenance Admin $1,544 $2,008 1 $1,544 $2,008Wireless AP Maintenance Entire Facility $128 $166 4 $511 $665

Yearly WAN Service Fee (T1) Admin $10,224 $13,291 2 $20,448 $26,582WAN / LAN Total 7 $22,503 $29,254

On-Going Total 16 $30,721 $39,439


SiteInvestment



Oakridge Community Facility One-Time Cabling / PathwaysPower cabling to support wireless (Low) Main Building $533 $746 2 $1,065 $1,491


Facility Modifications Protective Enclosure (Sm) Main Building $533 $692 1 $533 $692Facility Modifications Total 1 $533 $692


WAN / LAN Access Points Main Building $1,118 $1,454 2 $2,237 $2,907Data Drops (Low) Main Building $533 $746 5 $2,663 $3,728Ductless Air Conditioner Main Building $3,882 $5,435 1 $3,882 $5,435



WAN / LAN Total 12 $24,306 $31,653

One-Time Total 17 $26,021 $33,988


SiteInvestment



Oakridge Community Facility On-Going Printer / Scanner Multi-Function Device (Lrg) Main Building $7,246 $9,420 1 $7,246 $9,420Printer / Scanner Total 1 $7,246 $9,420

User Devices Workstations Main Building $613 $736 1 $613 $736User Devices Total 1 $613 $736


WAN / LAN Total 4 $2,716 $3,530

On-Going Total 6 $10,575 $13,687


SiteInvestment



Parke Creek Community Facility One-Time Cabling / Pathways Patch panel Main Building $510 $664 1 $510 $664



Facility Modifications Build-out Main Building $320 $447 35 $11,183 $15,656Increase Power Capacity Main Building $213 $298 1 $213 $298



Firewall + IDPS for Wireless Main Building $7,668 $9,968 1 $7,668 $9,968Rack Main Building $749 $973 1 $749 $973WAN Initiation (T1) Main Building $15,975 $20,768 1 $15,975 $20,768Wireless controller (Sm) Main Building $5,858 $7,615 1 $5,858 $7,615


WAN / LAN Total 34 $48,331 $63,614

Exceptional Facility Modification Generator (50KW) Main Building $17,892 $25,049 1 $17,892 $25,049Exceptional Facility Modification Total 1 $17,892 $25,049

One-Time Total 75 $80,194 $107,771


SiteInvestment



Parke Creek Community Facility On-Going Printer / Scanner Multi-Function Device (Lrg) Main Building $7,246 $9,420 1 $7,246 $9,420Multi-Function Device (Sm) Main Building $1,240 $1,612 1 $1,240 $1,612





Yearly WAN Service Fee (T1) Main Building $10,224 $13,291 1 $10,224 $13,291WAN / LAN Total 5 $12,940 $16,822

On-Going Total 10 $24,125 $31,092


SiteInvestment



Rainier School One-Time Cabling / PathwaysPower cabling to support wireless (Low) 2010A&B $533 $746 6 $3,195 $4,473

Residence unit $533 $746 56 $29,820 $41,748Cabling / Pathways Total 62 $33,015 $46,221

Facility Modifications Cabinet (Lrg) PAT-A $1,844 $2,397 1 $1,844 $2,397PAT-C $1,844 $2,397 1 $1,844 $2,397Rainier Center $1,844 $2,397 1 $1,844 $2,397

Secure bars on windows IT $746 $1,044 1 $746 $1,044UPS (Sm) PAT-A $341 $443 1 $341 $443

PAT-C $341 $443 1 $341 $443PAT-E $341 $443 1 $341 $443Rainier Center $341 $443 2 $682 $886

Ventilation PAT-C $2,663 $3,728 1 $2,663 $3,728Facility Modifications Total 10 $10,645 $14,179

Preventative Measures Fire Extinguishers PAT-A $59 $76 1 $59 $76PAT-C $59 $76 1 $59 $76PAT-E $59 $76 1 $59 $76Rainier Center $59 $76 2 $117 $152

FM200 Fire Suppression IT $37,275 $52,185 1 $37,275 $52,185Preventative Measures Total 6 $37,568 $52,566

WAN / LAN Access Points 2010A&B $1,118 $1,454 6 $6,710 $8,722Residence unit $1,118 $1,454 56 $62,622 $81,409

Backbone Switch with Modules IT $78,810 $102,453 1 $78,810 $102,453Data Drops (Low) 2010A&B $533 $746 6 $3,195 $4,473

PAT-A $533 $746 19 $10,118 $14,165PAT-C $533 $746 3 $1,598 $2,237PAT-E $533 $746 6 $3,195 $4,473Rainier Center $533 $746 13 $6,923 $9,692Residence unit $533 $746 56 $29,820 $41,748

Firewall + IDPS for Wireless IT $7,668 $9,968 1 $7,668 $9,968WAN Initiation (10mb) IT $31,950 $41,535 1 $31,950 $41,535Wireless controller (Lrg) IT $11,715 $15,230 1 $11,715 $15,230Wireless controller (Med) IT $8,414 $10,938 1 $8,414 $10,938


Workgroup Switch - 24 ports Entire Facility $1,598 $2,077 11 $17,573 $22,844WAN / LAN Total 243 $311,308 $400,885

Exceptional Facility Modification Power feed system upgrade Entire Facility $500,000 $1,000,000 1 $500,000 $1,000,000Exceptional Facility Modification Total 1 $500,000 $1,000,000

One-Time Total 322 $892,536 $1,513,851


SiteInvestment



Rainier School On-Going Printer / Scanner Multi-Function Device (Lrg) Rainier Center $7,246 $9,420 1 $7,246 $9,420

Multi-Function Device (Med) PAT-A $3,233 $4,203 4 $12,933 $16,813PAT-C $3,233 $4,203 1 $3,233 $4,203PAT-E $3,233 $4,203 2 $6,467 $8,407Rainier Center $3,233 $4,203 2 $6,467 $8,407

Multi-Function Device (Sm) 2010A&B $1,240 $1,612 2 $2,479 $3,223Residence unit $1,240 $1,612 28 $34,710 $45,124


User Devices Laptops 2010A&B $1,043 $1,251 2 $2,086 $2,503Entire Facility $1,043 $1,251 40 $41,714 $50,057Rainier Center $1,043 $1,251 1 $1,043 $1,251Residence unit $1,043 $1,251 60 $62,571 $75,085

Workstations 2010A&B $613 $736 3 $1,840 $2,208Entire Facility $613 $736 420 $257,645 $309,174PAT-A $613 $736 2 $1,227 $1,472PAT-C $613 $736 2 $1,227 $1,472PAT-E $613 $736 3 $1,840 $2,208Rainier Center $613 $736 10 $6,134 $7,361


WAN / LANBackbone Switch Maintenance IT $5,325 $6,923 2 $10,650 $13,845

Firewall + IDPS Maintenance IT $1,544 $2,008 1 $1,544 $2,008Wireless AP Maintenance Entire Facility $128 $166 62 $7,924 $10,301Wireless Controller Maintenance (Lrg) IT $1,832 $2,381 1 $1,832 $2,381Wireless Controller Maintenance (Med) IT $1,321 $1,717 1 $1,321 $1,717Workgroup Switch Maintenance - 24 ports Entire Facility $218 $284 11 $2,402 $3,122Yearly WAN Service Fee (10mb) IT $19,170 $24,921 1 $19,170 $24,921

WAN / LAN Total 79 $44,842 $58,294

Other


Other Total 2 $160,000 $208,000

On-Going Total 664 $655,705 $814,684


SiteInvestment



Ridgeview Community Facility One-Time Cabling / Pathways Patch panel Main Building $510 $664 1 $510 $664



Facility Modifications Dedicated Power Supply Main Building $213 $298 1 $213 $298Ventilation Main Building $2,663 $3,728 1 $2,663 $3,728




Firewall + IDPS for Wireless Main Building $7,668 $9,968 1 $7,668 $9,968Rack Main Building $749 $973 1 $749 $973WAN Initiation (T1) Main Building $15,975 $20,768 1 $15,975 $20,768Wireless controller (Sm) Main Building $5,858 $7,615 1 $5,858 $7,615


Workgroup Switch - 48 ports Main Building $2,876 $3,738 1 $2,876 $3,738WAN / LAN Total 25 $45,881 $59,897

One-Time Total 32 $51,391 $67,154


SiteInvestment



Ridgeview Community Facility On-Going Printer / Scanner Multi-Function Device (Lrg) Main Building $7,246 $9,420 1 $7,246 $9,420Printer / Scanner Total 1 $7,246 $9,420



WAN / LAN Firewall + IDPS Maintenance Main Building $1,544 $2,008 1 $1,544 $2,008Wireless AP Maintenance Main Building $128 $166 2 $256 $332Wireless Controller Maintenance (Sm) Main Building $916 $1,191 1 $916 $1,191Workgroup Switch Maintenance - 48 ports Main Building $351 $457 1 $351 $457


On-Going Total 12 $25,322 $32,440


SiteInvestment



Secure Community Transition Facility - King Co One-Time Facility Modifications Ductless Air Conditioner Main Building $3,882 $5,435 1 $3,882 $5,435




SiteInvestment



Secure Community Transition Facility - Pierce Co One-Time Facility Modifications Ductless Air Conditioner Program Office $3,882 $5,435 1 $3,882 $5,435




SiteInvestment



Special Commitment Center One-Time Cabling / PathwaysPower cabling to support wireless (High)

Dental, Cedar, Alder, IMU $3,195 $4,473 15 $47,925 $67,095


Facility Modifications Ductless Air Conditioner Power House $3,882 $5,435 2 $7,764 $10,869

Protective Enclosure (Med)Cedar, Redwood, Injection Station $1,065 $1,385 6 $6,390 $8,307

UPS (Sm) IDF $341 $443 2 $682 $886Facility Modifications Total 10 $14,835 $20,062


WAN / LAN Access PointsDental, Cedar, Alder, IMU $1,118 $1,454 15 $16,774 $21,806

Backbone Switch with Modules MDF $78,810 $102,453 1 $78,810 $102,453

Data drops (High)Dental, Cedar, Alder, IMU $4,793 $6,710 15 $71,888 $100,643Pill Line, Records, Cedar, Alder, Medical $4,793 $6,710 15 $71,888 $100,643

Firewall + IDPS for Wireless MDF $7,668 $9,968 1 $7,668 $9,968WAN Initiation (10mb) MDF $31,950 $41,535 1 $31,950 $41,535Wireless controller (Med) MDF $8,414 $10,938 1 $8,414 $10,938

WAN / LAN Total 49 $287,390 $387,985

Exceptional Facility ModificationBattery backups for Generator Power House $74,000 $96,200 1 $74,000 $96,200Electrical Distribution / Capacitor Improvements Power House $500,000 $1,000,000 1 $500,000 $1,000,000

Extension of 10 mb WAN service to SCC (3 miles along road) - Additional funding MDF $500,000 $600,000 1 $500,000 $600,000

Exceptional Facility Modification Total 3 $1,074,000 $1,696,200

One-Time Total 79 $1,498,701 $2,275,712


SiteInvestment



Special Commitment Center On-Going Printer / Scanner Multi-Function Device (Med) Alder, Birch, Cedar $3,233 $4,203 3 $9,700 $12,610Medical $3,233 $4,203 5 $16,167 $21,017


User Devices Laptops Entire Facility $1,043 $1,251 16 $16,686 $20,023

Workstations

Medical, Cedar, Birch, Redwood, Alder, PAM area $613 $736 21 $12,882 $15,459


WAN / LANBackbone Switch Maintenance MDF $5,325 $6,923 1 $5,325 $6,923

Firewall + IDPS Maintenance MDF $1,544 $2,008 1 $1,544 $2,008Wireless AP Maintenance MDF $128 $166 15 $1,917 $2,492Yearly WAN Service Fee (10mb) MDF $19,170 $24,921 1 $19,170 $24,921

WAN / LAN Total 18 $27,956 $36,343

Other


Other Total 2 $160,000 $208,000

On-Going Total 65 $243,391 $313,451


SiteInvestment



Twin Rivers Community Facility One-Time Cabling / PathwaysPower cabling to support wireless (Low) Main Building $533 $746 2 $1,065 $1,491


Facility Modifications Cabinet (Lrg) Main Building $1,844 $2,397 1 $1,844 $2,397Facility Modifications Total 1 $1,844 $2,397





WAN / LAN Total 23 $26,815 $35,164

One-Time Total 27 $29,782 $39,129


SiteInvestment



Twin Rivers Community Facility On-Going WAN / LAN Firewall + IDPS Maintenance Main Building $1,544 $2,008 1 $1,544 $2,008Wireless AP Maintenance Main Building $128 $166 2 $256 $332Wireless Controller Maintenance (Sm) Main Building $916 $1,191 1 $916 $1,191

WAN / LAN Total 4 $2,716 $3,530



SiteInvestment



Western State Hospital One-Time Cabling / PathwaysAdditional fiber with trenching and conduit East campus $680,000 $816,000 1 $680,000 $816,000

West campus $1,554,900 $1,865,880 1 $1,554,900 $1,865,880Additional Fiber without trenching West campus $720,000 $864,000 1 $720,000 $864,000

Cabling / Pathways Total 3 $2,954,900 $3,545,880

Facility Modifications Ductless Air Conditioner Admin $3,882 $5,435 1 $3,882 $5,435Bldg 18 $3,882 $5,435 1 $3,882 $5,435

Secure bars on windows Admin $746 $1,044 1 $746 $1,044Ventilation Entire Facility $2,663 $3,728 27 $71,888 $100,643


Preventative Measures FM200 Fire Suppression Admin $37,275 $52,185 2 $74,550 $104,370Preventative Measures Total 2 $74,550 $104,370

WAN / LAN Access Points Admin $1,118 $1,454 47 $52,558 $68,325Auditorium $1,118 $1,454 8 $8,946 $11,630East campus $1,118 $1,454 108 $120,771 $157,002Gym $1,118 $1,454 6 $6,710 $8,722South Hall $1,118 $1,454 40 $44,730 $58,149W1 & W2 $1,118 $1,454 8 $8,946 $11,630

Backbone switch upgrade and redundant Backbone switch (Cisco Catalyst 6509) Admin $78,810 $102,453 2 $157,620 $204,906Data drops (High) East campus $4,793 $6,710 6 $28,755 $40,257

East campus $4,793 $6,710 60 $287,550 $402,570Data drops (Med) Admin $1,598 $2,237 61 $97,448 $136,427

Auditorium $1,598 $2,237 8 $12,780 $17,892East campus $1,598 $2,237 28 $44,730 $62,622East campus $1,598 $2,237 48 $76,680 $107,352Gym $1,598 $2,237 7 $11,183 $15,656Multiple Locations (printers) $1,598 $2,237 30 $47,925 $67,095South Hall $1,598 $2,237 40 $63,900 $89,460W1 & W2 $1,598 $2,237 20 $31,950 $44,730

Firewall + IDPS for Wireless Admin $7,668 $9,968 1 $7,668 $9,968WAN Initiation (10mb) Admin $31,950 $41,535 1 $31,950 $41,535Wireless controller (Lrg) Admin $11,715 $15,230 5 $58,575 $76,148

Wireless Network Design/Implementation Cost Entire Facility $500 $500 217 $108,500 $108,500Workgroup Switch - 24 ports POE Admin $2,876 $3,738 73 $209,912 $272,885

WAN / LAN Total 824 $1,519,785 $2,013,460

Exceptional Facility ModificationNetwork re-design consulting cost Entire Facility $100,000 $120,000 1 $100,000 $120,000New conduit construction for future expansion Entire Facility $500,000 $1,000,000 1 $500,000 $1,000,000

Exceptional Facility Modification Total 2 $600,000 $1,120,000

One-Time Total 861 $5,229,632 $6,896,266


SiteInvestment



Western State Hospital On-Going Printer / Scanner Multi-Function Device (Lrg) Entire Facility $7,246 $9,420 30 $217,388 $282,604

Multi-Function Device (Med) Entire Facility $3,233 $4,203 30 $97,000 $126,100Printer / Scanner Total 60 $314,388 $408,704

User Devices Laptops Admin $1,043 $1,251 18 $18,771 $22,526East campus $1,043 $1,251 58 $60,485 $72,582South Hall $1,043 $1,251 40 $41,714 $50,057

Workstations Admin $613 $736 12 $7,361 $8,834East campus $613 $736 36 $22,084 $26,501Gym $613 $736 1 $613 $736South Hall $613 $736 10 $6,134 $7,361W1 & W2 $613 $736 12 $7,361 $8,834


WAN / LANBackbone switches maintenance Admin $5,325 $6,923 2 $10,650 $13,845

Firewall + IDPS Maintenance Admin $1,544 $2,008 1 $1,544 $2,008Wireless AP Maintenance Entire Facility $128 $166 217 $27,733 $36,052Wireless Controller Maintenance (Lrg) Admin $1,832 $2,381 5 $9,159 $11,907Workgroup Switch Maintenance - 24 ports Entire Facility $351 $457 73 $25,656 $33,353Yearly WAN Service Fee (10mb) Admin $19,170 $24,921 1 $19,170 $24,921

WAN / LAN Total 299 $93,912 $122,085

Other


Other Total 4 $320,000 $416,000

On-Going Total 550 $892,824 $1,144,219


SiteInvestment



Woodinville Community Facility One-Time Cabling / PathwaysPower cabling to support wireless (Low) Main Building $533 $746 2 $1,065 $1,491




Firewall + IDPS for Wireless Main Building $7,668 $9,968 1 $7,668 $9,968WAN Initiation (T1) Main Building $15,975 $20,768 1 $15,975 $20,768Wireless controller (Sm) Main Building $5,858 $7,615 1 $5,858 $7,615


WAN / LAN Total 9 $34,802 $44,749

One-Time Total 12 $35,926 $46,316


SiteInvestment



Woodinville Community Facility On-Going Printer / Scanner Multi-Function Device (Lrg) Main Building $7,246 $9,420 1 $7,246 $9,420Printer / Scanner Total 1 $7,246 $9,420

User Devices Laptops Main Building $1,043 $1,251 3 $3,129 $3,754User Devices Total 3 $3,129 $3,754



On-Going Total 9 $23,315 $29,996


SiteInvestment



Yakima Valley School One-Time Cabling / PathwaysPower cabling to support wireless (Low) Living Unit $533 $746 14 $7,455 $10,437


Facility Modifications Cabinet (Sm) Main Building $749 $973 2 $1,497 $1,946UPS (Sm) Living Unit $341 $443 5 $1,704 $2,215


Preventative Measures Fire Extinguishers Living Unit $59 $76 5 $293 $381Main Building $59 $76 2 $117 $152

FM200 Fire Suppression Main Building $37,275 $52,185 1 $37,275 $52,185Preventative Measures Total 8 $37,685 $52,718

WAN / LAN Access Points Living Unit $1,118 $1,454 14 $15,656 $20,352Backbone Switch with Modules Main Building $78,810 $102,453 1 $78,810 $102,453Data Drops (Low) Living Unit $533 $746 14 $7,455 $10,437

Main Building $533 $746 8 $4,260 $5,964

Firewall + IDPS for Wireless Main Building $7,668 $9,968 1 $7,668 $9,968Wireless controller (Med) Main Building $8,414 $10,938 1 $8,414 $10,938

Wireless Network Design/Implementation Cost Living Unit $500 $500 14 $7,000 $7,000

Workgroup Switch - 24 ports Living Unit $1,598 $2,077 5 $7,988 $10,384


Exceptional Facility Modification Generator (750KW) Main Building $236,430 $331,002 1 $236,430 $331,002Exceptional Facility Modification Total 1 $236,430 $331,002

One-Time Total 92 $433,523 $590,767


SiteInvestment



Yakima Valley School On-Going User Devices Laptops Main Building $1,043 $1,251 3 $3,129 $3,754Workstations Main Building $613 $736 93 $57,050 $68,460


WAN / LANBackbone Switch Maintenance Main Building $5,325 $6,923 1 $5,325 $6,923

Firewall + IDPS Maintenance Main Building $1,544 $2,008 1 $1,544 $2,008Wireless AP Maintenance Living Unit $128 $166 14 $1,789 $2,326Wireless Controller Maintenance (Med) Living Unit $1,321 $1,717 1 $1,321 $1,717Workgroup Switch Maintenance - 24 ports Living Unit $218 $284 5 $1,092 $1,419Workgroup Switch Maintenance - 48 ports Main Building $351 $457 4 $1,406 $1,828

WAN / LAN Total 26 $12,476 $16,219

On-Going Total 122 $72,655 $88,434


Agency DVAAdministration (All)

Data

SiteInvestment



Central Office - WDVA One-Time Preventative Measures FM200 Fire Suppression Main Building $37,275 $52,185 1 $37,275 $52,185Preventative Measures Total 1 $37,275 $52,185

One-Time Total 1 $37,275 $52,185


SiteInvestment



Central Office - WDVA On-Going Other

Additional FTEs to support wireless network and new user device technology Main Building $80,000 $104,000 2 $160,000 $208,000

Other Total 2 $160,000 $208,000

On-Going Total 2 $160,000 $208,000


SiteInvestment



Spokane Veterans Home One-Time Cabling / Pathways Patch panel Main Building $510 $664 1 $510 $664



Facility Modifications Ductless Air Conditioner Main Building $3,882 $5,435 1 $3,882 $5,435Relocation of the network closet Main Building $1,065 $1,491 1 $1,065 $1,491UPS (Med) Main Building $595 $774 1 $595 $774UPS (Sm) Main Building $341 $443 1 $341 $443Ventilation Main Building $2,663 $3,728 1 $2,663 $3,728


Preventative Measures FM200 Fire Suppression Main Building $37,275 $52,185 1 $37,275 $52,185Preventative Measures Total 1 $37,275 $52,185


Firewall + IDPS for Wireless Main Building $7,668 $9,968 1 $7,668 $9,968Rack Main Building $749 $973 1 $749 $973Wireless controller (Med) Main Building $8,414 $10,938 1 $8,414 $10,938

Wireless Network Design/Implementation Cost Main Building $500 $500 14 $7,000 $7,000


Exceptional Facility Modification Generator (250 KW) Main Building $111,680 $142,352 1 $111,680 $142,352Exceptional Facility Modification Total 1 $111,680 $142,352

One-Time Total 74 $218,732 $285,312


SiteInvestment



Spokane Veterans Home On-Going User DevicesComputer on Wheels / Laptop Carts Main Building $1,254 $1,630 6 $7,521 $9,777Laptops Main Building $1,043 $1,251 7 $7,300 $8,760


WAN / LAN Firewall + IDPS Maintenance Main Building $1,544 $2,008 1 $1,544 $2,008Wireless AP Maintenance Main Building $128 $166 14 $1,789 $2,326Wireless Controller Maintenance (Med) Main Building $1,321 $1,717 1 $1,321 $1,717Workgroup Switch Maintenance - 24 ports Main Building $218 $284 2 $437 $568


On-Going Total 32 $30,136 $38,446


SiteInvestment



Washington Soldiers Home & Colony One-Time Cabling / PathwaysPower cabling to support wireless (Med) Nursing Center $1,065 $1,491 8 $8,520 $11,928


Facility Modifications Cabinet (Sm) Nursing Center $749 $973 2 $1,497 $1,946Roosevelt $749 $973 1 $749 $973

Ductless Air ConditionerNursing Center, Roosevelt $3,882 $5,435 3 $11,646 $16,304

Make window more secure with iron bars Admin $1,065 $1,491 1 $1,065 $1,491Secure Iron Door Admin $1,065 $1,491 1 $1,065 $1,491

UPS (Med)Nursing Center, Roosevelt $595 $774 3 $1,786 $2,322


Preventative Measures Fire ExtinguishersNursing Center, Roosevelt $59 $76 3 $176 $228


WAN / LAN Access Points Nursing Center $1,118 $1,454 8 $8,946 $11,630Backbone Switch with Modules Admin $78,810 $102,453 1 $78,810 $102,453Data drops (High) Roosevelt $4,793 $6,710 1 $4,793 $6,710Data drops (Med) Nursing Center $1,598 $2,237 9 $14,378 $20,129

Roosevelt $1,598 $2,237 5 $7,988 $11,183Documentation of cabling and network architecture Entire Facility $20,000 $25,000 1 $20,000 $25,000

Firewall + IDPS for Wireless Nursing Center $7,668 $9,968 1 $7,668 $9,968LAN Wiring cleanup and improvements Roosevelt $5,325 $7,455 1 $5,325 $7,455Wireless controller (Sm) Nursing Center $5,858 $7,615 1 $5,858 $7,615

Wireless Network Design/Implementation Cost Nursing Center $1,000 $1,000 8 $8,000 $8,000

WAN / LAN Total 36 $161,764 $210,141

Exceptional Facility Modification Main Battery in Powerhouse Admin $74,000 $96,200 1 $74,000 $96,200Exceptional Facility Modification Total 1 $74,000 $96,200

One-Time Total 60 $299,542 $395,210


SiteInvestment



Washington Soldiers Home & Colony On-Going Printer / Scanner Multi-Function Device (Lrg) Nursing Center $7,246 $9,420 3 $21,739 $28,260Printer / Scanner Total 3 $21,739 $28,260

User DevicesComputer on Wheels / Laptop Carts Nursing Center $1,254 $1,630 2 $2,507 $3,259Laptops Nursing Center $1,043 $1,251 6 $6,257 $7,509Wireless Card Nursing Center $64 $83 6 $383 $498Workstations Nursing Center $613 $736 6 $3,681 $4,417

Roosevelt $613 $736 6 $3,681 $4,417User Devices Total 26 $16,509 $20,100

WAN / LANBackbone Switch Maintenance Admin $5,325 $6,923 1 $5,325 $6,923

Firewall + IDPS Maintenance Nursing Center $1,544 $2,008 1 $1,544 $2,008Wireless AP Maintenance Nursing Center $128 $166 8 $1,022 $1,329Wireless Controller Maintenance (Sm) Nursing Center $916 $1,191 1 $916 $1,191

WAN / LAN Total 11 $8,808 $11,450

On-Going Total 40 $47,055 $59,810


SiteInvestment



Washington Veterans Home One-Time Cabling / Pathways Patch panel Building 10 $510 $664 1 $510 $664

Patch Panel Installation Labor Building 10 $1,000 $1,000 1 $1,000 $1,000Cabling / Pathways Total 2 $1,510 $1,664

Facility Modifications Build-out Building 10 $320 $447 60 $19,170 $26,838UPS (Sm) Building 10 $341 $443 1 $341 $443

New Building $341 $443 3 $1,022 $1,329Facility Modifications Total 64 $20,533 $28,610

Preventative Measures FM200 Fire Suppression New Building $37,275 $52,185 1 $37,275 $52,185Preventative Measures Total 1 $37,275 $52,185

WAN / LANBackbone Switch with Modules New Building $78,810 $102,453 1 $78,810 $102,453Data Drops (Low) Building 10 $533 $746 6 $3,195 $4,473

WAN / LAN Total 7 $82,005 $106,926

One-Time Total 74 $141,324 $189,385


SiteInvestment



Washington Veterans Home On-Going Printer / Scanner Multi-Function Device (Lrg) Building 10 $7,246 $9,420 1 $7,246 $9,420New Building $7,246 $9,420 2 $14,493 $18,840


User Devices Laptops Entire Facility $1,043 $1,251 3 $3,129 $3,754Workstations Building 10 $613 $736 1 $613 $736

New Building $613 $736 6 $3,681 $4,417User Devices Total 10 $7,423 $8,907

WAN / LANBackbone Switch Maintenance Entire Facility $5,325 $6,923 1 $5,325 $6,923

Yearly WAN Service Fee (T1) New Building $10,224 $13,291 1 $10,224 $13,291WAN / LAN Total 2 $15,549 $20,214

On-Going Total 15 $44,710 $57,381


Documents

Publications Medical Records Technology Gap (MRTG) - Wa